Health: Liver Disease

Baroness Wheeler Excerpts

Tuesday 6th May 2014 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords—

[Lord McConnell of Glenscorrodale]

I was up three times before.

[Noble Lords]

Front Bench.

[Baroness Wheeler]

My Lords, I, too, pay tribute to Elena Baltacha, who was a truly remarkable and very brave woman. One in five people in the UK is at serious risk of liver damage, but a recent government response shows that the Secretary of State has not met any external organisations to discuss liver disease since May 2010, and current Ministers have not met representatives of people living with liver disease since September 2012. Can the Minister commit urgently to remedying this situation, particularly as it is in such stark contrast to the 130-plus meetings the Government have had with the drinks industry?

[Earl Howe]

My Lords, liver disease is very much in the sights of my honourable friend the Minister for Public Health, as is evidenced by the document we published last week, Living Well for Longer, in which there is a whole section on alcohol and liver disease, and by what NHS England and Public Health England are doing to tackle them.

Mental Health: Young People

Baroness Wheeler Excerpts

Monday 7th April 2014 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, a recent survey found that more than half of young carers reported having a mental health problem, including feelings of stress, anxiety and depression, eating and sleeping problems and risk of self-harm. What are the Government doing to support these dedicated young people? What guidance will be given in the Children and Families Act and the Care Bill on how local authorities should work with mental health services to ensure that young carers get the support they so clearly need and deserve?

[Earl Howe]

The noble Baroness is absolutely right and the pressures and strains on young carers have been well recorded. It is fair to say that compared with a few years ago, not least thanks to the efforts of the previous Government but also the work that we have continued, GPs and others working with families are much more alert now to the needs of young carers and can signpost them to appropriate support. The CYP IAPT programme is designed no less for young carers than it is for others.

Tobacco: Packaging

Baroness Wheeler Excerpts

Thursday 3rd April 2014 Lords Chamber

[Baroness Wheeler (Lab)]

I thank the Minister for repeating the Statement. I also take this opportunity to place on record the Opposition’s thanks to Sir Cyril Chantler and our congratulations on his excellent review of the public health evidence. We welcome much of what the Minister said, but I am sure that we share with other noble Lords who have long campaigned on this issue our frustration at the prospect of yet another consultation—albeit on regulations—especially when Sir Cyril's review is so clear and unequivocal about the impact that standardised packaging would have.

We know that the case for the introduction of standardised packaging is, as ever, urgent. The cost to the NHS of treating diseases caused by smoking is approximately £2.7 billion a year. Two-thirds of adult smokers took up smoking as children. One in two long-term smokers dies prematurely as a result of smoking-related diseases, and more than 200,000 children take up smoking every year in the UK. As Sir Cyril says, if we can reduce that figure by even 2%, that is 4,000 fewer children taking up smoking every year. For that reason, we strongly welcome the confirmation in Sir Cyril’s review of what public health experts have been arguing for some time—namely, that standardised packaging makes cigarettes less attractive to young people and could help save lives.

Sir Cyril's remit was to consider whether standardised packaging would lead to a decrease in tobacco consumption. Does the Minister not accept his clear conclusion that,

“standardised packaging would serve to reduce the rate of children taking up smoking”,

and that it could lead to,

“an important reduction … on the uptake and prevalence of smoking and … have a positive impact on public health”?

Of course, this is something that all the previous evidence reviews showed. Indeed, Sir Cyril states:

“My overall findings are not dissimilar to those of previous reviews”.

Did not the Government’s own systematic review in 2012, which Sir Cyril describes as “extensive and authoritative”, conclude that standardised packaging is less appealing than branded packaging, that it makes the health warnings more prominent and that it refutes the utter falsehood that some brands are healthier than others?

All the royal colleges and health experts, including the Royal College of Paediatrics and Child Health, the BMA and the campaigning health charities are united on this. The majority of responses to the Government’s own consultation also favoured it. Does the Minister therefore finally accept that there is an overwhelming body of evidence in favour of standardised packaging and that there can be no excuse for further delay?

The House will know that Labour has long called for the immediate introduction of standardised packaging. However, for every step we took in government on smoking and tobacco, the tobacco industry fought us all the way and then took a new approach. As my noble friend Lady Thornton put it when we recently pressed for amendments introducing standardised packaging to be included in the Children and Families Bill,

“we are talking about whether we are prepared to allow the over-powerful and wealthy tobacco companies to gain their next market for the profits they need to make from tobacco products … They can exist only if they continue to recruit young people to tobacco addiction so that they have their next generation of smokers”.—[Official Report, 20/11/13; col. GC 404-05.]

Do the Government not accept that the failure to take action on this issue under the Children and Families Bill was yet another missed opportunity? After Labour banned tobacco advertising, manufacturers developed increasingly sophisticated marketing devices for their packaging. We know that they spend millions every year on design testing to lure in new, young smokers. The question is: why have we had to wait so long for action on standardised packaging? Does the Minister accept the impact that further delay will have? More than 70,000 children will have taken up smoking since the Minister announced the review, and today he announced yet another consultation. The Government have already had a consultation, which reported less than a year ago. What do they expect to change?

At the time of announcing Sir Cyril’s review last November, the Government promised to issue regulations if they could be persuaded by the case made by Sir Cyril. Now they say that they are persuaded that he has made a “compelling case”—so why the further consultation and inevitable delay? Is this another attempt to kick the matter into the long grass, and can we be reassured that there will not be another government U-turn on this issue? How many more children will take up smoking before the Government make a decision and act? Does the Minister not accept that it is the clear will of both Houses of this Parliament to proceed with standardised packaging without further delay?

NHS: Midwives

Baroness Wheeler Excerpts

Monday 17th March 2014 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, does the Minister accept that the Public Accounts Committee report on maternity services was pretty damning, not just in terms of midwife shortages but on the lack of overall government accountability and strategy for maternity services, the increasing clinical negligence bill and substantial regional and demographic inequalities and variations in maternity care? What are the Government doing about this and when can we expect a coherent plan in response to these issues?

[Earl Howe]

The noble Baroness is right: the PAC raised a number of very important issues, many of which we agree need close attention. I have already mentioned the work that we are doing to improve recruitment and to reduce variation in the quality of services around the country. This requires more than just government; it requires all the arm’s-length bodies with an interest to pull together and, of course, local commissioners to do their bit as well.

Mesothelioma: Research Funding

Baroness Wheeler Excerpts

Thursday 16th January 2014 Grand Committee

[Baroness Wheeler (Lab)]

My Lords, I also commend the noble Lord, Lord Alton, for securing this debate and for ensuring that we keep the focus on the Government’s pledge on a package of measures to stimulate and build high-quality research into mesothelioma. There is optimism that progress is slowly being made but we are a long way from getting the secure and guaranteed funding on the scale we all want to see and which we recognise is vitally needed to offer hope to mesothelioma sufferers and to find a cure.

Noble Lords, and supporters of the Bill across all parties in the other place during last week’s Third Reading, have stressed our moral obligation on this issue in this country and internationally, as my noble friend Lord Giddens has underlined today. I also pay tribute to the vital contribution and role of Paul Goggins. I did not know him personally but certainly was fully aware of his work and reputation in my party, and of the respect in which he was held across Parliament. Now that the Bill has passed, I also pay tribute to the work of the British Lung Foundation and the campaigners, trade unions, MPs and Peers who have been lobbying for many years for justice for victims of this terrible disease. The BLF carer support project, in conjunction with Carers UK, is also developing vital support networks for carers and their families. It deserves special mention and recognition.

The Government have agreed that the scheme regulations will provide for a review of the operation and effectiveness of the scheme in four years’ time, which we welcome. On research funding, we must ensure that considerable progress has been made by then. The noble Lord, Lord Kakkar, again has ably underlined the need for a strategic, defined national initiative on mesothelioma research. I look forward to hearing from the Minister what actions are being taken on this. How will the current initiatives his department and the DWP are rightly pursuing be developed and built into a coherent strategy which will lead to real progress being made?

There is no doubt that the mesothelioma research programmes funded by the BLF itself, as well as jointly with the four insurance companies, and by other charities, have played an important role in kick-starting research and academic interest and laying the foundations for future developments. The meso-bank which is collecting tissue and blood samples from sufferers will provide the opportunity for fundamental and translational research. There are important projects too on palliative care and pain relief. I notice on the BLF website that it has recently awarded a further tranche of grants which will help to improve understanding of how the disease develops and progresses, and how our genes contribute to the disease.

We strongly supported the amendment in the name of the noble Lord, Lord Alton, for the 1% levy on the insurance companies, which would have provided secured and guaranteed research funding, and could have led to major advances and breakthroughs. It was sad to see this amendment again defeated in the Commons last week. As our shadow Minister, Kate Green, said, the levy,

“is very modest in the context of the overall scheme … a very modest sum for a multibillion pound insurance industry to afford, but a sum that could make an exponential difference to the scale of research that is possible into the disease”.—[Official Report, Commons, 7/1/14; col. 201.]

As we have heard, the DWP Minister of State, Mike Penning, cited the quality of research issue—on which there are clearly differing views among medical and research experts—but also rejected the amendment on the basis that it would “break the deal” with the insurance industry on the whole compensation scheme. It will be interesting to get further insight from the Minister today on why the insurance industry saw this issue in this way. I, too, look forward to the update on the ABI discussions that was promised by the Minister.

We know that the terrible reach of mesothelioma extends across all occupations and is not just an industrial disease. Indeed, it is anticipated that in the coming years more people will be diagnosed from all occupational backgrounds who have come into contact with asbestos or who contracted it via secondary exposure, such as wives who washed their partners’ overalls.

I was particularly concerned to learn of the huge problem of asbestos in schools, to which the noble Lord, Lord Wigley, referred. The risk or impact is not just on teachers but on children and ancillary and office workers. More than 70% of schools still contain significant amounts of asbestos. I am sure the Minister will agree that this frightening situation underlines the importance of making real and substantial progress on mesothelioma research, not just into treatment and cure but also into how the workplace can be protected.

Like other noble Lords, I look forward to hearing from the Minister what progress is being made on the joint DWP and Department of Health initiatives, and on the Government’s plans and timescales for developing the full-scale strategy for mesothelioma research that is so desperately needed.

NHS: Essential Services

Baroness Wheeler Excerpts

Tuesday 14th January 2014 Lords Chamber

Asked by

[Baroness Wheeler]

To ask Her Majesty’s Government, in the light of the Dr Foster Hospital Guide 2013, how NHS England is monitoring access to essential services and how it intends to address variations in access to and provision of services at clinical commissioning group level.

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

My Lords, to help reduce variations in access to health services, Professor Sir Bruce Keogh, the medical director of NHS England, is working with the medical royal colleges and others to ensure that the NHS is clear about the evidence base for common types of surgical interventions. For example, it will produce guidance for commissioners to help ensure that consistent eligibility criteria are used to access surgical services and so minimise the scope for variation at a local level.

[Baroness Wheeler (Lab)]

I thank the Minister for his response. Dr Foster’s report shows that the number of knee and hip replacements and cataract removals has fallen to its lowest level in four years, meaning that more than 12 million people now live in areas where the number of these operations has substantially declined. This is despite our elderly population continuing to rise over the same period and these common surgical procedures being vital to ensuring that older people can regain their mobility, keep active and stay living in the community. Does the Minister agree that these are essential treatments? What pressures will be placed on NHS England to ensure that CCGs actually provide them and also that they fulfil their legal obligation to issue guidance to local communities, revealing what their policies are on providing medicines, surgeries and therapeutic interventions?

[Earl Howe]

My Lords, I should first tell the noble Baroness that we cannot reconcile our own figures with those of Dr Foster. We believe that there has in fact been a significant increase in the number of cataract and knee and hip replacement operations since 2009-10 and not a drop. Regardless of that, I suggest to her that the absolute numbers of operations taking place do not tell us anything about possible rationing or the absence of it. That question can be answered only with the benefit of fuller data. The key to consistent access to these treatments is a common understanding among commissioners of the evidence base in each case. That is exactly what Sir Bruce Keogh is working towards and will provide guidance on in due course.

World Innovation Summit for Health

Baroness Wheeler Excerpts

Monday 16th December 2013 Lords Chamber

[Earl Howe]

My Lords, in broad terms, dementia falls outside the scope of mental health but it is, of course, closely allied. Many of the principles that apply to good mental health care apply equally to dementia. We are, again, doing our best, in responding to the Prime Minister’s challenge on dementia, to ensure that those who contract this dreadful condition are looked after with dignity and respect in the appropriate setting.

[Baroness Wheeler (Lab)]

My Lords, the WISH report, to which the Government are signed up, recommends key improvements to community care for mental health by 2020. Yet the recent FoI survey of 51 NHS mental health trusts by BBC News and Community Care magazine shows overall budgets shrinking by over 2%, including those for community mental health support teams, despite referrals to them rising by 13%. How is this consistent with pledging to achieve the WISH goal by 2020? What leadership and direction will the Government give to preventing this very disturbing situation from getting worse?

[Earl Howe]

My Lords, we need to hold the NHS to account by reference to the outcomes that it achieves. I do not belittle the need to spend sufficient sums of money. The National Survey of Investment in Adult Mental Health Services has indicated that reported spend on mental health services has continued to hold reasonably steady over time. I reiterate that mental health and well-being is a priority for the Government, as I hope the noble Baroness knows. We have clear indicators in the NHS outcomes framework, which will ensure that NHS England will need to focus on this area very closely.

NHS: Walk-in Centres

Baroness Wheeler Excerpts

Tuesday 10th December 2013 Lords Chamber

Asked by

[Baroness Wheeler]

To ask Her Majesty’s Government what plans they have in respect of the closures of NHS walk-in centres over the past three years, in the light of the preliminary report made by Monitor.

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

My Lords, since 2007, the local NHS has been responsible for NHS walk-in centres. It is for local commissioners to decide on the availability of these services. It is also for local commissioners to determine how walk-in centres fit into plans locally, rather than being governed by a top-down imposition of services. They make such decisions by involving patients and by using their clinical expertise to determine the pattern of local services and where walk-in centres fit in with this.

--- Later in debate ---

[Baroness Wheeler (Lab)]

I thank the Minister for his response. However, 76 NHS walk-in centres have been closed over the past three years and the Monitor report makes clear that this is often without proper consultation locally on alternative provision, leading to increased pressure on A&E and urgent care services. In Monitor’s survey, one in five patients using the centres said that they would have visited the nearest A&E department had the centre not been there. Monitor also finds in a number of cases that the closure decision has been made by CCGs, with member GP practices themselves having a financial interest in whether or not the service continues. What action will the Government take to ensure that, if future closures of walk-in centres are considered, the public will be properly consulted and patients will have access to an equivalent level of service?

[Earl Howe]

My Lords, when any service change is proposed, we expect that the four tests which the Government laid down early on in their term of office should be followed. One of those is a patient and public consultation or involvement in the decision. Another is clinical buy-in. I can give the noble Baroness the assurance that this is what local area teams of NHS England would expect to see in any proposals involving the closure of a walk-in centre.

NHS: Clinical Commissioning Groups’ Funding of Treatment

Baroness Wheeler Excerpts

Tuesday 12th November 2013 Lords Chamber

Asked by

[Baroness Wheeler]

To ask Her Majesty’s Government how many types of treatment Clinical Commissioning Groups have decided not to offer to patients since April 2013.

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

My Lords, clinical commissioning groups are now responsible for commissioning services and treatments for their local populations, with NHS England providing oversight and support. NHS England has advised that it does not routinely collect data on the number and type of treatments that CCGs have decided not to offer to patients. We have been clear: restricting access to services on the basis of cost alone is wrong and compromises patient care. Commissioning decisions should be made using clinical evidence and best practice guidance.

[Baroness Wheeler (Lab)]

I thank the Minister for his response. Is he not concerned about the recent British Medical Journal survey, which showed that since CCGs took over, one in seven have introduced new treatment restrictions, including treatment for hip and knee replacements, cataracts, and caesarean births for non-medical reasons? What steps are the Government taking to ensure regional and national monitoring and consistency of treatment policies across the NHS? Moreover, the Royal College of Surgeons is concerned that so few CCGs are meeting their legal obligation to publish guidance on how they will provide medicines, surgery and therapeutic interventions. This was meant to provide transparency in rationing decisions. What will the Government do about it?

[Earl Howe]

My Lords, the availability of some healthcare services is determined nationally; for example, under NICE technology recommendations. Some services are commissioned directly by NHS England, but in most cases decision-making on whether to fund a service or treatment is left to the local CCG or local authority. That is to enable CCGs and local authorities to commission services that best fit the needs of their local population. For such decision-making it is very important that the process is rational, transparent and fair. The right contained in the NHS constitution ensures that that happens. If a CCG decides that a treatment will not normally be funded, it needs to be able to consider whether to fund that treatment for an individual patient on an exceptional basis.

Care Bill [HL]

Baroness Wheeler Excerpts

Tuesday 29th October 2013 Lords Chamber

[Lord Ramsbotham (CB)]

My Lords, I support the noble Lord, Lord Patel, because I agree that this is an extremely worrying issue. Focusing on prisons, there is an increasing number of elderly prisoners, as has been reported, and it is quite clear that the prison medical authorities are not capable of looking after all their needs. For example, people have talked about dementia and other problems of increasing age, and it is of concern that those people are not being properly looked after.

I am also very concerned about the use of the words “probation trusts” because they are about to go. According to the Transforming Rehabilitation agenda, which the Ministry of Justice has released, they are to be replaced by directors of rehabilitation in various parts of the country and/or private companies acting as rehabilitation companies responsible for services. What we do not know from the Ministry of Justice is exactly how many people are to stay with the existing probation service, which has been given a lot of responsibilities that do not include running probation hostels, which is currently a probation responsibility. Nor have I seen any mention of this accommodation in the transforming rehabilitation agenda that has been produced. Therefore, this matter needs following up. Within a year would be a very useful timeframe, because it would allow a follow-up of what is happening in the Ministry of Justice to be conducted.

[Baroness Wheeler (Lab)]

My Lords, from what my noble friend Lord Patel has said, it is clear that the issue of safeguarding inquiries is not at all sorted. He has highlighted a substantial gap in the Bill that could have a very serious impact on some of the most vulnerable people in our communities and prisons. He rightly seeks equivalence of care and protection for adults detained in prison and those residing in approved premises such as bail hostels—care and protection that all other vulnerable adults have when it comes to safeguarding inquiries by local authorities. We take on board his deep concerns about prisons and what appears to be a lack of co-ordinated and clear responsibilities in respect of safeguarding inquiries. I ask the Minister to look further into the matter, as my noble friend suggested.

My noble friend raises some key issues on whose responsibility it is to carry out a safeguarding inquiry for adults living in the community in approved premises. Given all the uncertainty about future service delivery as a result of the Government’s major reorganisation and break-up of the probation service, if that responsibility is currently with the local probation trust, this amendment, which calls on the Secretary of State to report to Parliament within one year of this clause of the Bill coming into force, becomes even more necessary. To require the new community rehabilitation companies or their successor bodies to account for how they have discharged their responsibilities for safeguarding adults residing in approved premises is an acceptable way forward.

I look forward to hearing from the Government about how they intend to deal with the matter in the light of the serious concerns expressed by my noble friend today and in previous discussions on the Bill, and in light of the huge confusion that will result from the proposed changes to the probation service. I very much hope that the Minister will be able to support my noble friend’s endeavours to fill what is potentially a serious gap in the Bill, and to ensure future adequate protection of these vulnerable adults.

[Earl Howe]

My Lords, I will begin by making absolutely clear that we agree that all prisons and approved premises should have arrangements for safeguarding the adults in their care. They should have a comprehensive policy that is understood by all staff and which ensures that vulnerable adults are identified and given appropriate support. I hope that we also agree that we cannot relieve prisons and probation providers of their duty of care by imposing a duty on a local authority to make safeguarding inquiries into suspected abuse or neglect in a prison or approved premises.

We need clear guidance for prisons, probation providers and local authorities to ensure that the procedures within prisons and approved premises are informed by best practice and local expertise. My officials will work with the Ministry of Justice and the National Offender Management Service, together with the Association of Directors of Adult Social Services and other stakeholders, such as the Prison Reform Trust, to develop instructions and guidance for prisons, probation providers and their local authorities. Those instructions and guidance will be in place by the time the Bill is implemented and will give improved clarity about the Prison Service and probation providers’ roles and responsibilities in safeguarding adults in their care, including the need to have a whole-institution approach to safeguarding, and cover their relationship with the local safeguarding adults board.

The Ministry of Justice encourages prison and probation staff to be involved with local safeguarding adults boards. The guidance on how safeguarding should be carried out in conjunction with local authority partners can draw attention to the duty in Clause 6 that local authorities and their partners must co-operate in the exercise of their respective functions relating to adults with needs for care and support. The guidance will be consistent with the broader advice and guidance on safeguarding adults in the community to ensure that good practice on safeguarding policies and inquiries is routinely shared.

In addition, the guidance will set out clearly the need for locally agreed relationships with local safeguarding boards, including clear local protocols around the circumstances for involvement of local SABs. The guidance will also make clear how prison and probation staff can benefit from the expertise of social services and local authority safeguarding teams.

For approved premises, the probation provider has a clear responsibility in relation to safeguarding but there is nothing to prevent it seeking advice from either the safeguarding adults board or the local authority safeguarding team. This already happens in many areas. Since a local authority’s duties in relation to safeguarding would not extend to safeguarding adults who are at risk of abuse or neglect by reason of their detention or their offence, a joint approach would be much more effective where there is a particularly difficult safeguarding challenge in an approved premises.

Her Majesty’s Inspectorates of Prisons and Probation and the Prisons and Probation Ombudsman will take account of the guidance and local agreements and make recommendations for improved practice, if relevant, when inspecting services and investigating complaints within the prison and probation services.

I wish to be clear in answering the noble Lord, Lord Patel of Bradford, who said that the document No Secrets said that local authorities have responsibility for safeguarding in approved premises. Local authorities do not have a statutory duty at the moment. It is the duty to conduct inquiries that will not apply—not that local authorities cannot conduct an inquiry if invited to by the probation trust or provider. Guidance and probation instructions will provide further detail on how local authorities and probation trusts, as they currently are, can work together at a local level. The guidance will go to all probation providers who run approved premises. Probation services will be contracted out in due course, so these will be approved premises provided by the probation service and by voluntary or private providers. The guidance will make it clear that the provider running the accommodation has a duty of care and a safeguarding responsibility.

I hope that, with those assurances and clarifications, the noble Lord will feel able to withdraw his amendment.