Health: Prostate Cancer

Baroness Wall of New Barnet Excerpts

Monday 19th July 2010 Lords Chamber

[Earl Howe]

My Lords, there is quite a bit of ongoing work to devise such a test but I am advised that no reliable test exists at the moment. The PSA test is the best that we have. The noble Lord will know that the results of tests show that you have to screen about 1,400 men and treat 48 unnecessarily to save one life. It is not an easy equation.

[Baroness Wall of New Barnet]

My Lords—

[Lord Lloyd-Webber]

My Lords—

--- Later in debate ---

[Earl Howe]

My Lords, the noble Lord, Lord Winston, is probably in a better position to advise the House on advances in that area of research. I can tell the House that the National Cancer Research Network, set up by the Department of Health in 2001, has brought about a tripling of the number of cancer patients entered into clinical trials. About 12 per cent of cancer patients in England enter NCRN trials, which is the highest per capita rate of cancer-trial participation in the world. The network currently supports about 51 prostate cancer studies, so there is no shortage of research going on.

[Baroness Wall of New Barnet]

My Lords, does the noble Lord agree that the recording and quality standards around prostate cancer ought to be considered by the Care Quality Commission? Does he also agree that it is a shame that the CQC has decided not to report at the end of this year on the state of the hospitals that it has been working with across the piece? My own hospital, Barnet and Chase Farm, is predicted to be excellent, but it has been told that the Care Quality Commission will not announce those positions at all.

NHS: White Paper

Baroness Wall of New Barnet Excerpts

Monday 12th July 2010 Lords Chamber

[Earl Howe]

My Lords, I shall be brief because time is against us. I agree with the noble Lord that we must not lose the gains that we have made in specialised commissioning following the Carter reforms. He will see that the national commissioning board will retain responsibility not only for national specialised commissioning but for regional specialised commissioning. That will safeguard the quality of those services.

The noble Lord referred to GPs who do not wish to commission or who are in some way found wanting in their performance. Our experience to date—a number of consortia have been formed around the country, all of which are working encouragingly well—suggests that those GPs within the consortium who are in the lead and are the most go-ahead are best placed to bring up to standard their colleagues who are perhaps struggling. We have witnessed that in a number of instances. Those GPs who are incapable of being brought up to an adequate standard may be subject to a question over their future. In certain consortia, we have seen GPs retiring from NHS service.

[Baroness Wall of New Barnet]

My Lords—

NHS: Patient Targets

Baroness Wall of New Barnet Excerpts

Wednesday 23rd June 2010 Lords Chamber

[Earl Howe]

My Lords, the noble Lord is absolutely right. I believe that the message that he wants sent has been sent by the NHS chief executive in his letter to NHS bodies. It is certainly a message that the Government want to send. Timeliness is important. A great deal has been achieved. We do not want to squander that, but we think that clinicians should now be given the responsibility to prioritise patients and treatments for themselves, not have central performance management dictated from above.

[Baroness Wall of New Barnet]

Does the noble Earl agree that it would be appropriate for hospitals such as Barnet and Chase Farm to carry on with our internal stretch targets, which we do not declare anywhere, but which ensure that our patients are aware that it is a good hospital to go to? They are not arbitrary—trust me, they are not; they are real—and they make a big difference.

[Earl Howe]

I have always drawn—and I think that my ministerial colleagues do as well—the distinction between targets that are useful for internal management purposes and for patient decision-making and targets that are micromanaged from Whitehall. There is a distinct utility in the kind of targets that the noble Baroness is talking about because, as she knows, they are often very good proxies for outcomes.

NHS: Budget

Baroness Wall of New Barnet Excerpts

Wednesday 23rd June 2010 Lords Chamber

[Earl Howe]

My Lords, as I hope was apparent from our debate in the House the other day, the Government attach great importance to chaplaincy in the NHS. The kind of encouragement that the right reverend Prelate speaks of is something that I will consider. I need to be sure in my mind of how best to do that, but his point is well made and I will take it back to the department to see what we can do.

[Baroness Wall of New Barnet]

My Lords, will the noble Earl assure the House that in looking for economies in the health service—I am sure that there are opportunities to do that—he will safeguard the vanguard policy of the last Government, which is fortunately retained by this Government, to ensure that patients’ experience comes first and foremost? Would he also perhaps take an idea from me to look at how we deal with patients who do not attend—DNAs, as we call them—despite having had prior notice? Failure to attend is costly and inefficient for the health service.

[Earl Howe]

The noble Baroness is quite right that patients who do not attend their appointments cost the NHS a great deal. How do we deal with the issue—I am sure that the previous Government wrestled with it, too—if we are to avoid charging patients for failing to turn up? I would resist the idea of charging because I do not think that it is a road down which we should be going in secondary or primary care. However, the ways in which we can encourage patients to turn up on time should attract greater focus in our efforts towards achieving efficiency.

Queen's Speech

Baroness Wall of New Barnet Excerpts

Thursday 3rd June 2010 Lords Chamber

[Baroness Wall of New Barnet]

My Lords, through a very croaky voice—my voice box has just given up, forgive me—and after more than 30 previous speakers, I, too, welcome the noble Lord, Lord Hill, and congratulate him on his maiden speech. However, I particularly want to focus on the noble Earl, Lord Howe, and say how delighted I am that he has received the reward we all hoped he would receive by becoming a Minister on the Front Bench. It has been an absolute joy working with him over the six years that I have been here. So I say to him, “Well done”, and look forward to working with him again in the future.

More importantly, I look forward to him coming to my hospital. I declare an interest as chair of Barnet and Chase Farm NHS Hospitals Trust, which is a two district general hospital trust serving the community in north London. On his appointment, the Secretary of State, Andrew Lansley, picked out my trust as the first one he should visit. From his interest, particularly in our A&E, and the questions he raised with us about the rest of the trust, it was obvious that he had gained a real insight into the services across our two hospitals. We greatly welcomed the opportunity to see him and to have his support.

Shaping the future of healthcare that is safe, of high quality and responsive is a vital component for any government reform in the NHS. In fact, it is enshrined in the NHS constitution that patients must receive the best care possible when they come into contact with our services. Patients, in consultation with their GPs—much of this has been referred to already today—have a choice about where they can receive their care or treatment, and we in Barnet and Chase Farm welcome that. I agree almost totally with the comments of my noble friend Lord Warner about the independent sector because the fact that people have the opportunity to use it makes our services better. I strongly believe that when a choice is offered, people will make sure that they are the ones who are chosen. We certainly do that in my hospital. The decisions patients make are the driving force behind my trust working hard to become the provider of choice, whatever the competition. If the Government are going to work on that principle, all I ask of the noble Earl is that we have a level playing field. That is very important.

We are committed to ensuring that every patient is treated with dignity, compassion and respect while receiving high-quality clinical care. Every time I follow the noble Baroness, Lady Knight, in a debate, I wish that I had said to her the last time, “Please come to my hospital” because the things she tells the House—which I am sure are true—are so heartbreaking. She will remember that we spoke in the House about the red trays. I shared with her our experience of the equipment we use in Barnet and Chase Farm which ensures that people who cannot feed themselves are drawn to the notice of everyone and receive support from either the nursing staff or volunteers; that because their red tray indicates, “I cannot do this by myself”, someone goes along and helps them to do it. We now have red jokes which I am sure the noble Baroness, Lady Knight, will be delighted to know. Although we gave patients food, sometimes the water was too far away, and so we remedied that as well. I extend an invitation to the noble Baroness today and I shall make sure that I follow it up.

In my trust, we believe that greater ease of access to healthcare will improve patient outcomes. There is no mention in the gracious Speech of whether the coalition Government will continue with the four-hour A&E access target, from which our patients benefit and which they value. In my trust, in order to achieve the four-hour A&E target we had to go back to the drawing board and redesign the patient pathway so that patients are seen as quickly as possible but by the right clinician. This, too, is much better for patients and, thank goodness, the 12-hour trolley waits are a thing of the past—certainly in my trust. It is interesting that whenever patients talk to friends or relatives when they have come out of hospital, they comment on the quality of their treatment—about their operation being successful, we hope—mostly very favourably, but one thing they are quick to talk about, in the pub or wherever they go, is how long it took to be seen. No matter how good the quality of care was, if they were kept longer than they thought was appropriate, if it was longer than four hours—and four hours is not appropriate any more—they still remember that bit: “It was great but I had to wait”. The focus of some kind of incentive for people to work on that is really important.

We in Barnet and Chase Farm regard the fact that we have achieved “green” on the “traffic-light” indicator for our access targets for so long—together with being “green” for just as long in our quality targets—as a key factor in patients choosing to come to our hospitals. Seeing those quality targets being met, they know that our hospitals are places where they will get both the treatment that they need and the performance that they are entitled to. Perhaps the noble Earl will tell us when responding that the value that patients place on this system is important also to the new Government. I put all the caveats around how we make sure that that happens.

One speaker today has talked about removing the Care Quality Commission. I would plead with the Government not to do that. It is a great improvement on the Healthcare Commission; it is much more proactive; and it makes our trust feel that we will be challenged and that we will be superb in the way we go about our work. Let us combine timely access with high-quality clinical care and sound financial management, which is equally important.

I make this plea for targets not because they are about being achieved at any cost—they are not—but because they are about treating patients well. People who benefit from really good access along with absolute professional care get seen more quickly. In my trust, the introduction of MRSA reduction targets—there has been much discussion of them today—has led to a reduction in MRSA bacteraemia cases every single year. The noble Baroness, Lady Knight, mentioned very high figures. Last year, we had 16 cases in our trust, which we thought was awful. This current year, we have had four cases, with no more than seven predicted by the end of the year. That is a result of the care that we make sure is given to patients. All the nightmare stories that one hears will happen again if people do not take care of their patients. This is another example of how appropriately set targets can provide better care and improved outcomes. It is good for patients. We again urge the coalition Government to hold us all to account in this way.

During this time of change, might I be so bold as to say that we must take care in making any decisions about changing or removing targets? They can and do benefit patients as long as we always have the patient and the quality of the service at the front of our minds, which is absolutely essential.

I conclude by sharing with your Lordships a case study made by the Department of Health on delivering same-sex accommodation, which was a flagship policy of the previous Labour Government. We hope that the new coalition Government will hold on to this policy and push all hospitals into delivering this environment which is so valued and appreciated by patients of both sexes. That is what dignity and care are about.