Health: Folic Acid
Earl Howe Excerpts(11 years, 4 months ago)
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Lord Rooker
To ask Her Majesty’s Government, further to the answers by Earl Howe on 18 December 2013 (HL Deb, col 1261) and 21 January (HL Deb, col 567), what was the population sample of females of child-bearing age used in the National Diet and Nutrition Survey for folate status; and on what dates the survey data were collected.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
Blood samples for folate-status analysis were collected from more than 600 females of childbearing age—15 to 49 years—as part of a UK representative sample of adults and children in the National Diet and Nutrition Survey. Blood samples were collected over four years from 2008-09 until 2011-12.
Lord Rooker (Lab)
My Lords, will the Minister accept that those figures are much smaller than recent research samples such as the 50,000 people involved in the Lancet-published research last year and the 500,000 women in England over a 12-year period in the research published last week that showed that the quantity of folic supplements taken by them was actually falling, which is the current policy? Given that the UK has the highest rate of neurological defects in the whole of Europe—80% of which pregnancies are terminated—is it not time to make a decision, talk to industry, the medics and science and join the other 70 countries protecting women from those births?
Earl Howe
My Lords, I recognise that this is an extremely important decision for the Government to make, affecting many people’s lives. I do not accept the implication behind the noble Lord’s question that the numbers involved in the analysis were somehow statistically invalid. I am assured that they represent a valid statistical base. We welcome all robust new evidence around the issue of fortification, such as the study published last week by the Wolfson Institute, and I can assure the noble Lord that we will take a decision on this matter as soon as possible.
Lord Hunt of Kings Heath (Lab)
My Lords, could the noble Earl give a little more precision as to what “as soon as possible” actually means? He referred to the study produced by the Wolfson Institute last week. Is he aware of the comments of Sir Nicholas Wald of the Wolfson Institute that it will be a public health tragedy if this country does not follow the example of the many other countries that have introduced this in a mandatory way? Is it not time that the Government simply made a decision? Indeed, they are clearly briefing to the media that they are going to make a positive decision. Why do not they just come clean and say, “We’re going to do it”, and say which date it will start from?
Earl Howe
My Lords, as I have explained on earlier occasions, it is very important that we use the latest data to reach a robust and defensible view of the risks and benefits on this issue. We will take the new National Diet and Nutrition Survey data on folate status into account when we do reach a decision. As for the position taken in other countries, while a number of countries have introduced mandatory fortification of flour with folic acid, others notably have decided against it, including Ireland and New Zealand.
Lord Patel (CB)
My Lords, the single most effective public health measure, which would prevent the birth of babies with severe spina bifida and lifelong disability, would be 400 micrograms daily of folic acid. Why would we not do that as a public health measure, when all the scientific evidence is already there?
Earl Howe
My Lords, in recommending the fortification of flour with folic acid, the Scientific Advisory Committee on Nutrition also advised that action should be taken to reduce levels of voluntary fortification, which, as the noble Lord knows, is applied to a number of breakfast cereals, for example. That is no easy matter. It would be necessary to avoid folate levels exceeding recommended limits and to put action in train to achieve that. There are other conditions and advice attached to the SACN recommendation; it is not quite as straightforward in practice as the noble Lord might suggest, although I recognise that the recommendation from SACN is there.
Baroness Gardner of Parkes (Con)
My Lords, I am very disappointed by these answers today. I thought that this matter was signed and sealed when we heard my noble friend’s answers some weeks ago. In reply to my question, he just said that I was a bit premature in asking whether it could be put in brown bread as well as white. Really, the facts have been established that in order to have an overdose you would have to eat two or more full loaves of bread, and I think that the danger of any pregnant woman doing that is pretty small.
Earl Howe
My Lords, my noble friend always raises some extremely valid points and, of course, I take them. However, I would just gently point out that SACN is concerned about overdosing, which is why it urged that action should be taken to reduce levels of voluntary fortification. Mandatory fortification of a staple food is, I would suggest, a serious matter for the nation, and these decisions have to be reached in a robust and responsible way.
Baroness Symons of Vernham Dean (Lab)
My Lords, can the Minister tell us who is actually doing the assessment on the data that are available so far? The noble Earl finds himself in a difficult position as we revisit this question almost on a monthly basis. A number of us are at a total loss to know why he cannot tell us when a decision will be taken. Will the assessment be made in his department and, if not, where is the assessment going to be made so that Ministers are given the knowledge and data to make a decision on this question, which is long overdue?
Earl Howe
My Lords, the Scientific Advisory Committee on Nutrition is the body charged by government to advise Ministers, and the decision will be taken by Ministers. But we have thought it prudent and sensible to take into account the latest data on the folate status of the population. The information that SACN drew from is more than a decade old, and we do not think that that is a sensible basis on which to take a decision one way or the other. So we must wait for that evaluation.
The Countess of Mar (CB)
My Lords, does the Minister agree that there is an equal conundrum with adding fluoride to water? Her Majesty’s Government seem to be quite happy that fluoride should be added to water, yet there is a possibility of overdose if people have fluoride tablets, fluoride toothpaste and all sorts of other things. What is the difference between that and folates?
Baroness Brinton (LD)
My Lords, given that there is a delay in the Government’s decision, what is being done to ensure that young women are informed about the importance of having some supplements? Waiting until they are pregnant is clearly too late.
Earl Howe
My Lords, government advice on taking supplements is available to women through a number of channels, including Healthy Start, NHS Choices, Start4Life, The Young Woman’s Guide to Pregnancy and the Information Service for Parents. To improve maternity services for women, NICE has published a comprehensive suite of evidence-based clinical guidelines in this area.
Drug Companies: Medical Trials
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Lord Kennedy of Southwark
To ask Her Majesty’s Government what action they intend to take in respect of drug companies that withhold the results of medical trials.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, companies are legally required through the marketing authorisation application process to provide the relevant regulatory authority with all information for evaluation of a medicine. This includes clinical trial results which are both favourable and unfavourable. The Medicines and Healthcare products Regulatory Agency has powers to take action where particulars supporting an application are incorrect or where the company has failed to inform authorities of new information that would influence the evaluation of the benefits and risks of the product.
Lord Kennedy of Southwark (Lab)
My Lords, the number 1 risk on the Government’s national risk assessment for civil emergencies, ahead of both coastal flooding and a major terrorist incident, is that of pandemic influenza. Is the noble Lord concerned that Tamiflu, which is supplied for use in a flu epidemic, may not be as effective as was once thought? Is he concerned that many large-scale trials of Tamiflu have not been publicly reported?
Earl Howe
My Lords, during the course of last year, the Government gave detailed evidence to the Science and Technology Committee on the issue of data provision in respect of clinical trials. The committee made a number of helpful recommendations on the removal of barriers to transparency. In our formal response, we set out how we would work to achieve the aims of greater transparency. In the light of that response, the Government are looking into the recommendations of the PAC report on the stockpiling of Tamiflu and access to clinical trials data, published in January. We will give our formal response to the report next month.
Baroness Brinton (LD)
My Lords, evidence shows that the chances of a complete trial being published are roughly 50%. The recent EU clinical trials draft directive will require all trials to be registered before they start, and full results to be published within a year. However, the regulation will be applicable only to trials starting from this year. How do the Government plan to ensure that pharmaceutical companies will release medical records for drugs that were launched before 2014?
Earl Howe
My noble friend raises a topical question. The industry’s trade body, the Association of the British Pharmaceutical Industry made clear, in its code of practice in 2012, that companies are obliged to publish all clinical trial results within a year of marketing authorisation and publicly register new clinical trials within 21 days of the first patient being enrolled. That, of course, is a forward-looking exhortation, but we are encouraged by the fact that the industry is taking an increasingly responsible view in this area by publishing data voluntarily, as demonstrated by companies such as GSK, AstraZeneca and Johnson & Johnson. We want to encourage more companies to do the same.
Lord Walton of Detchant (CB)
The noble Earl has made very clear the legal background to the present situation. He is fully aware that if a drug that has been fully tested and shown to be highly effective, and NICE has recommended that it should be prescribed to patients, the authorities have the legal responsibility to prescribe it. If, on the other hand, NICE has been given evidence to indicate that a particular remedy is ineffective as a result of negative clinical trials, is it equally incumbent on health authorities to recommend that that drug should not be prescribed?
Lord Mawhinney (Con)
I compliment my noble friend on the full and comprehensive Answer that he gave to the Question, and on the reassurance that it contained. Do he and his colleagues think that perhaps the issue here is not the legal framework but the issue of transparency and ease of access to information? If they think that that has some merit, would they be willing to consider having a simplified summary of the legal position on the department’s website for easy access for those who are interested?
Earl Howe
I absolutely agree with my noble friend. The Government are committed to transparency in the area of clinical trials. Transparency is important for patients, the public, researchers and the NHS, and it can be achieved through ensuring trial registration and outcome publication, as well as making data available through the appropriate channels. I think that the new EU regulation will be extremely helpful in promoting transparency, and the availability of summaries of all trials and clinical study reports will be a part of that regulation. However, I take my noble friend’s point about a simple guide for the public and I will gladly consider it.
Lord West of Spithead (Lab)
My Lords, will the Minister confirm that the work put in hand by the previous Government to ensure that we had the capacity to produce sufficient quantities of drugs to counteract various types of bird flu, once it had been identified, has now been completed and that we are in a position to be able to do that?
Lord Hunt of Kings Heath (Lab)
My Lords, I come back to the question raised by the noble Baroness, Lady Brinton. Once a medicine goes off patent it can, through generic production, remain available to members of the public for many years. The evidence seems to be that trials that give a favourable verdict are twice as likely to be published as trials giving unfavourable results. Could the noble Earl focus a little more on whether the industry can be encouraged to produce evidence around those trials in relation to current medicines as well as future ones? I also refer noble Lords to my health interest in the register.
Earl Howe
My Lords, it is important to point out that the MHRA does not have evidence that there is systematic or large-scale withholding of data. However, it has investigated cases in the past where clinical trials and safety data were not properly reported. The Government believe that the proposals included in the new EU clinical trials regulation will, as I said, contribute to greater transparency in the area of clinical trials. It must be remembered that any company infringing even the current rules can lay itself open to some very severe penalties.
Health: Meningitis B Vaccine
Earl Howe Excerpts(11 years, 4 months ago)
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Lord Turnberg
To ask Her Majesty’s Government whether they plan to introduce a vaccine for meningitis B in children.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, the Joint Committee on Vaccination and Immunisation, the independent expert committee that advises the Government on immunisation matters, has not yet made a final recommendation about the use of the meningococcal B vaccine, Bexsero. The JCVI is due to report in March 2014, having reviewed additional evidence at its meeting earlier this month. We will respond to any JCVI recommendation as quickly as possible.
Lord Turnberg (Lab)
My Lords, I am grateful to the Minister for that response. Meningococcus B causes a very nasty form of meningitis. It affects about 1,000 cases a year, mostly in children. It kills about one in 10 and causes severe and lasting disability in one in three. It is no wonder that it is a parent’s worst nightmare. Yet the safe and licensed vaccine that can prevent most cases was turned down by the JCVI after what seems to have been rather a doubtful cost-benefit analysis. Will the Minister make sure that when the JCVI comes to look at it again, as it is doing, it uses a more relevant discount value for the quantity and quality of a child’s life; and that once the Government have received the committee’s advice, they will make a rapid decision to make the vaccine available?
Earl Howe
I can give the noble Lord an assurance on the latter point. We will take a decision as rapidly as we can once we receive the JCVI advice. I appreciate that the JCVI’s interim position statement will have been disappointing to many people. I know the noble Lord recognises that it is important that decisions about the introduction of new vaccines into the national immunisation programme take account of evidence of their effectiveness, safety and cost-effectiveness compared to other healthcare interventions. We need to wait and see what the JCVI’s final advice is. I am aware that it is looking at the cost-effectiveness methodology that is used for vaccines of this type.
Lord Avebury (LD)
My Lords, do the options now being developed by Public Health England at the request of the Government include a population-based evaluation of the meningitis B vaccination, taking into account the discounted lifetime cost to the public sector of supporting children who are disabled by the disease? Will my noble friend also explain why the Department of Health assumed that the carriage effects achieved with meningitis C do not read across to this variant of the disease?
Earl Howe
I can tell my noble friend that the JCVI has been considering both those issues: first, the possible need for a population-based evaluation of the MenB vaccine to address uncertainties in its effectiveness; and, secondly, what the possible effect of the MenB vaccine on the carriage of meningitis B bacteria might be. I say again that we need to wait for the JCVI’s final statement of advice to get clarity on either of those issues.
Lord Hunt of Kings Heath (Lab)
My Lords, of course I understand that we need to await the outcome of the Joint Committee’s further deliberations. However, following up the Question asked by my noble friend, if the committee sticks to the view that a vaccine would have a huge impact on an estimated 1,000 young people every year but still considers that that is not cost-effective, surely it calls into question the methodology that it is using. Will the noble Earl say a little more about how the Government can ensure that this methodology is put under full scrutiny?
Earl Howe
Last October, in recognition of concerns about the methodology currently used for assessing cost-effectiveness of vaccines, the JCVI agreed that a working group should be formed to consider two issues: first, how the impact of vaccination programmes to prevent rare diseases of high severity should be best assessed; and, secondly, whether there were aspects of cost-effectiveness in relation specifically to children that should be addressed. It is a complex issue both economically and, indeed, ethically. We should not expect a report from that group, once it has been established, until next year at the earliest.
Lord Patel (CB)
My Lords, the vaccines that my friend, the noble Lord, Lord Turnberg—he is a friend, at least as regards medical matters—talked about are developed through a new kind of science, which does not involve the use of eggs or any other animal material, and therefore is not only more effective but produces fewer side-effects, particularly in children. The vaccine that we are talking about is for a particular type of meningitis. The new vaccine may not be considered as cost-effective as a conventional vaccine. However, if you take into account clinical side-effects, the new vaccine may be considered cost-effective, so a different kind of assessment must be carried out that is based not just on conventional cost-effectiveness.
Baroness Masham of Ilton (CB)
My Lords, how do we compare with other European countries in giving children this vaccine?
The Earl of Listowel (CB)
My Lords, will the Minister assure the House that, if this vaccine is accepted, the infrastructure will be in place to enable it to be administered swiftly to as many children as possible? Are health professionals trained and ready to administer the vaccine, if it is decided to accept it?
Abortion
Earl Howe Excerpts(11 years, 4 months ago)
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Baroness Knight of Collingtree
To ask Her Majesty’s Government what action they intend to take in the light of recent analysis of the ratio of boys and girls in United Kingdom families suggesting that sex-selective abortion is taking place.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, it cannot be concluded from the recent analysis in the Independent newspaper that sex-selective abortions are taking place. We are absolutely clear that abortion on the grounds of gender alone is against the law and completely unacceptable.
Baroness Knight of Collingtree (Con)
My Lords, does my noble friend recall that when I last asked a Question on this matter in October, the House was informed that it was impossible to prosecute doctors known to be aborting on gender grounds because the evidence was not strong enough? However, has the Minister noted the findings of the national census of 2011, which show that between 1,400 and 4,700 fewer girls have been born recently? This, it was said, can be explained only by the fact that termination of girl babies is going on, even though my noble friend has said this morning and NHS spokesmen have warned that such operations are,
“against the law and completely unacceptable”.
When are the Government going to stop this practice, and what are the implications if they do not do so?
Earl Howe
My Lords, the analysis recently reported in the Independent newspaper was based on census data, as my noble friend pointed out, for households with usually-resident dependent children. The gender balance of dependent children in these households is affected by a number of events that occur after birth, such as the age at which dependent children leave the parental home. As there are a number of alternative explanations for these observations, it cannot be concluded from the Independent’s analysis that sex-selective abortions are taking place. The best available data on which to base gender ratio analysis continue to be births data, which were the basis on which we did our analysis last year. I can tell my noble friend that that analysis will be updated on an annual basis when new data are available.
Lord Singh of Wimbledon (CB)
My Lords, gender-selection abortions are an extreme form of gender discrimination. Sadly, it is all too prevalent in sub-continent communities. The Sikh guru, Guru Nanak, taught from day one the total equality of women; they can join in and lead any part of the Sikh service. Unfortunately, culture sometimes gets the better of religion; even in the Sikh community, that sort of discrimination can take place. Will the Minister ensure that funding given to sub-continent communities is conditional—indeed, is predicated—on promoting gender equality and respect for women because, at the moment, it often feels as if it is given to those who shout the loudest?
Earl Howe
My Lords, the provisions of the Equality Act 2010 must be adhered to by all who provide a public service. Any specific allegations about gender-selective abortions being undertaken will be reported to the police. Abortion on the grounds of gender alone is illegal, as I have said. The Abortion Act is very clear on that point.
Lord Steel of Aikwood (LD)
Have my noble friend and his department had any discussions with the General Medical Council on this matter? It needs to be made publicly clear that, as he said, whatever happens in other countries, this practice is not acceptable in this country.
The Lord Bishop of St Albans
My Lords, there is an opportunity coming up where this can be underlined. At the moment, the procedures for the approval of independent sector places for the termination of pregnancy are being revised. Will Her Majesty’s Government undertake to ensure that they spell out clearly and unequivocally that termination on grounds of gender alone is illegal and that an appeal on gender alone is insufficient to satisfy the mental health criteria of the Abortion Act?
Baroness Thornton (Lab)
The Minister has explained the issue extremely clearly. When the next tranche of research on live births comes through, will the Government undertake to dig deep into it to ensure that illegal sex-selective abortions are not taking place? Secondly, there is a statement in today’s Daily Telegraph about 36 abortion centres that are giving unreliable and misleading advice to women who wish to discuss terminations—for example, by telling them that if they have a termination they may get breast cancer. I know that the Department of Health has issued guidelines on this but I would like to know what the Government intend to do about it.
Earl Howe
On the noble Baroness’s first question, the detailed analysis that we did last year was quality-assured by the methodology team at the Office for National Statistics. I can tell her that the team will quality-assure the future analysis of data each year. On the story in the Daily Telegraph, patients should be able to expect impartial advice from the NHS. CCGs and NHS providers must account for the counselling services that they recommend. Guidance on the provision of non-judgmental counselling was included in the Government’s framework for sexual health improvement, published in March last year.
Food and Soft Drink Industry: Sugar
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Baroness Morgan of Ely
To ask Her Majesty’s Government what representations they have made to the food and drink industry about reducing levels of sugar in processed products in the United Kingdom.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, through the public health responsibility deal calorie reduction pledge, food and soft drink companies are taking a range of actions to reduce calories, including sugar, in their products. Currently 38 businesses are signed up to the pledge. We are working across the industry to encourage further sign-up.
Baroness Morgan of Ely (Lab)
My Lords, five out of eight members of the carbohydrate working group on nutrition which advises the Government have direct links to the food and drink industry. Does that explain why it has taken five years for this group to report? Can the Minister explain why we do not simply follow the position of the World Health Organisation, which is expected to report that people’s energy from added sugar should be reduced from the current recommended level of 10% to 5%?
Earl Howe
My Lords, the reason that we meet the food industry is to ask it to do more than it is doing at the moment. If that is what the noble Baroness means by the Government’s links to the food industry, then I make no apology for them. Our current emphasis is on overall calorie reduction, of which sugar can form a part. The scope for reformulation to reduce sugar levels varies widely depending on the food, and a reduction in sugar levels does not always mean that the overall calorie content is reduced. The Scientific Advisory Committee on Nutrition is currently undertaking a review of carbohydrates, as part of which it is looking at sugar. Its report will inform our future thinking.
Baroness Brinton (LD)
It is shocking that a 375-gram portion of Sharwood’s sweet and sour chicken with rice contains six teaspoons of sugar. Some of our supermarkets, notably Waitrose, are working with their suppliers to reduce the amount of sugar in processed food, but many are not. What steps are the Government taking to ensure that all supermarkets and suppliers follow those setting a good example and reduce the amount of sugar, as well as clearly labelling sugar, in their processed foods?
Earl Howe
My noble friend raises a series of important issues. I can tell her some encouraging news on this front. Sainsbury’s and Tesco, for example, have pledged to reduce the sugar content in their own-brand soft drinks. We are asking other supermarkets to follow suit. I think that the noble Baroness will be aware that Lidl made an encouraging gesture the other day in pledging not to display sweets at till exits. However, we are working across a range of areas, not just reformulation of food but pack size, introducing low-sugar or no-sugar alternatives, and looking at ways in which food is promoted.
Lord Brooke of Alverthorpe (Lab)
Will the Minister please explain why in his first Answer he referred only to the food and soft drinks industry? Why did he not refer to the alcoholic drinks industry? Is it not true that, in the 130 meetings which the Government have had with the drinks industry since 2010, no progress whatever has been made on persuading it voluntarily to show calorific effects and sugar content on the labels of its products?
Earl Howe
No, my Lords, that is not so. Ninety-two producers and retailers committed through the responsibility deal to having 80% of bottles and cans on sale in the UK displaying unit and health information and a pregnancy warning by the end of 2013. The three elements that industry has committed to display on labels are: the drink’s unit content, the Government’s guidelines for lower-risk drinking, and pregnancy warnings. I argue with the noble Lord that this is progress.
The Lord Bishop of St Albans
My Lords, while I support the need to reduce the level of sugar in processed food wherever possible, I am concerned that this alone will do little to improve the nation’s health or deal with the problem of obesity. What progress are the Department for Education and the Department of Health making on reducing the number of calories in meals served in schools, and what progress is being made on increasing the level of physical activities for the pupils in our schools?
Earl Howe
My Lords, tackling obesity calls for action by the widest possible range of partners, including the food industry but also including schools. That is what we are trying to do through the responsibility deal. Our National Child Measurement Programme, the School Food Plan, the School Games and the money that we are putting into school sports funding—£150 million a year—all contribute to the joint effort across government to influence the way in which calories are consumed by children. I have encouraging news on that front, which is that the level of child obesity is now the lowest that it has been since 1998, so we are moving in the right direction.
Lord Ribeiro (Con)
My Lords, I congratulate the noble Earl on leading on the successful amendment in this House which led to the vote going through the other place yesterday on smoking in cars. Can he further protect children by tackling the issues around obesity? What are the Government doing to encourage the soft drinks industry to take action on calorie reduction as part of the responsibility deal?
Earl Howe
My Lords, I think that the compliment should be paid to my noble friend Lord Ribeiro for the part that he played in bringing about the amendment on smoking in cars. A number of soft drinks companies have taken action to reduce calorie content in their drinks. Coca-Cola has reformulated its Sprite product. AG Barr pledged to reduce the average calorific content in its portfolio of drinks. I have mentioned Sainsbury’s and Tesco’s actions on their own brands. Premier Foods has reformulated various products and reduced sugar in those. Therefore, we are making headway and I think that the responsibility deal is proving its worth.
Lord Patel (CB)
Does the Minister think it might be advisable to ask the Government’s Scientific Advisory Committee on Nutrition to define a standard of added sugar that should not be exceeded in 100 millilitres of fluid or 100 grams of food?
NHS: Competition
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, I join other noble Lords in thanking the noble Lord, Lord Turnberg, for tabling this topic for debate. I will begin with three simple statements, to serve as mental marker posts, as it were, before I respond to the questions that have been raised.
First, amid the many changes that we made to NHS commissioning through the Health and Social Care Act, one area of the law that has not changed one iota is the law relating to competitive tendering. That law has been in place for a number of years; it has been governed by a European directive; and, as regards the rules governing NHS procurement, the Section 75 regulations change nothing at all.
Secondly, the noble Baroness, Lady Thornton, referred to “Mr Lansley’s agenda” on privatisation. There is no government agenda to privatise NHS services—quite the contrary. We made it illegal in the Health and Social Care Act for the Secretary of State, Monitor or NHS England to have a policy deliberately favouring the independent sector.
Thirdly, the noble Lord, Lord Hunt, spoke of a deliberate policy of enforced competition and marketisation. I must correct him. It is NHS commissioners alone who will decide whether, where and how competition in service provision should be introduced. There are no obligations on commissioners to create or promote markets; nor are they required to fragment services against the interests of patients.
Those three points are key to understanding what the Government are doing and what we are not doing. I will now turn to the place and value of competition in the NHS, which has long existed. As the noble Lord, Lord Turnberg, pointed out, patients have long exercised choice over where they receive services from. I was pleased to hear the noble Lord, Lord Hunt, acknowledge that third sector and independent providers play an important part in providing NHS care; for example, in hospice care for terminally ill patients, mental health services and long-term nursing care for the frail elderly.
We have seen over the past decade the independent sector treatment centre programme and the introduction of payment by results in 2003, the advent of patient choice in 2006, and the transforming community services programme of 2008. I must point out to the noble Lord, Lord Turnberg, that it was this changing landscape that introduced greater competition to the NHS; it was not the Health and Social Care Act. There is robust evidence from a variety of sources that quality-based competition can work to the benefit of patients, and I shall come on to cite that evidence in a moment.
The previous Administration put in place a set of rules to manage that competition, known as the Principles and Rules for Co-operation and Competition, and the Government committed in their response to the NHS Future Forum report to maintain these and place them on a statutory footing so that they could continue to apply to commissioners. That is exactly what we have done; there has been absolute continuity in how the rules apply. Clinical commissioning groups work within this framework to secure the best services for patients that they can, from whichever provider best offers that prospect. In essence that is the value of this framework of rules. They will be supported in this activity by guidance from NHS England and Monitor, and through the work of commissioning support units.
The noble Baroness, Lady Thornton, asked me what I would regard as a reasonable proportion of NHS activity to be put out to tender. I have no view on this, and nor should I. The decisions on tendering are entirely up to commissioners and not Ministers. The noble Baroness also indicated that seven out of 10 NHS contracts have gone to the private sector since last April. I point out that that figure is highly misleading. It was quoted in a newspaper article, but the contracts in the sample that was quoted amount to a tiny and unrepresentative sample of the scale of NHS activity. In reality, spending on healthcare from private-sector providers equates only to around 6% of total NHS expenditure. It was roughly 5% at the end of the previous Administration.
My noble friend Lady Brinton asked whether there will be guidance from Monitor to clarify the duties on commissioners, and the noble Lord, Lord Hunt, suggested that commissioners are confused about that. Monitor has now published its guidance to support commissioners in understanding and complying with the Section 75 regulations. Monitor, along with NHS England, will undertake further engagement with commissioners to support them in understanding the requirements. I acknowledge that there is a degree of misunderstanding out there, but not everywhere. NHS England’s forthcoming procurement guidance will provide further guidance on the EU requirements.
The noble Lord, Lord Hunt, raised concerns about fragmentation and barriers to integration. To the extent that fragmentation exists, I say to him that it existed as greatly under his Government. I am proud to say that this Government are taking practical steps to make integration more commonplace throughout the country. We are supporting a number of integration pioneer sites, which will trailblaze new ideas to bring care closer together. They will be leaders of change—a change we have to see in the system if we want to offer the best-quality care.
We are also supporting the system through the £3.8 billion Better Care Fund, which will encourage organisations to act earlier to prevent people reaching crisis point, to offer seven-day services, and to deliver care that is centred on people’s needs. That idea and that fund have been widely welcomed. Therefore, our focus is for commissioners to innovate and to work with partners in the sector to design integrated care pathways for patients that allow for a seamless experience of care. I assure the Committee that the competition rules do not stand in the way of that. In fact, the Section 75 regulations explicitly allow for it.
Under the regulations, the objective of a commissioner must always be to secure the needs of patients, including through services being integrated. For example, in Milton Keynes, substance misuse services used to be delivered by several providers, resulting in fragmented care. Users found services difficult to navigate, which impacted on treatment entry and retention rates. In response to this, NHS Milton Keynes CCG and Milton Keynes Council developed an outcomes-based approach to commissioning. Existing services were brought together into one fully integrated, recovery-focused service, delivered by a third sector organisation, which enabled more effective delivery of care and efficiency savings of 15% to 20%. That is a clear example of good commissioning delivering improved services for patients.
I turn to the OFT’s role and the review of mergers. Again, it is important to realise that the NHS has long had arrangements in place to review mergers on competition grounds, and that in considering mergers the competition authorities are acting under their existing powers under the Enterprise Act 2002.
The noble Lord, Lord Turnberg, criticised Part 3 of the Health and Social Care Act. Repealing Part 3 of that Act would not remove the powers of the competition authorities. In fact, the 2012 Act was important in clarifying those powers in order to address the legal uncertainty for NHS bodies as to whether mergers between them would be considered by the OFT or the CCP. Without this clarification, providers would have been at risk of double jeopardy, with both bodies potentially seeking to undertake a review.
The noble Lord, Lord Turnberg, cited several examples of challenges being issued on competition grounds which he attributes to the existence of Part 3 of the Act. I do not want to comment on the detail of those cases—it would be wrong of me to do so—but I would point out that challenges of that kind would have been quite capable of being brought even if the Government had never introduced the Health and Social Care Bill.
Lord Hunt of Kings Heath
My Lords, I understand where the noble Earl is coming from in relation to the Enterprise Act. However, is it not a fact that essentially what happened was that the 2012 Act was a signal to the market that a market was being put in place? Why have a 300-page Act and why have the Section 75 competition regulations? In essence, the Government opened the door in this regard and that is why these challenges are now taking place. They did not take place before the 2012 Act.
Earl Howe
The market, however, did exist, which was the point that I made. The market was out there well before the 2012 Act and well before this Government came to office. It was incumbent on us to clarify and simplify the rules that the previous Government put in place. We did that through Part 3 of the Act. It was not a signal to anybody to marketise the NHS. Indeed, as I said, we explicitly provided for it to be illegal for Ministers or Monitor to prefer the independent sector over public sector providers. That is explicit in the Act, so the noble Lord cannot accuse the Government of enabling legislation to promote marketisation.
Baroness Thornton
My noble friend’s question was actually about the signal. If, as the noble Earl has told us, all these things existed before the Act, why did we have to have Part 3 of the Act? Why was it necessary? The only reason that it seems to have been necessary—we think that the evidence now shows that to be the case—is that it increased marketisation in the NHS.
Earl Howe
Let me be clear. Repealing Part 3 of the Health and Social Care Act, which is what the noble Baroness appears to be suggesting is desirable, would not stop competition law applying. It would not remove the powers that the OFT has, which were introduced by the previous Government. It would just mean that a health expert regulator—Monitor—would not be the body considering the application of competition law to the NHS. I do not believe that that is in the best interests of patients. That provision was widely welcomed by those who understood these matters.
I was asked about the case involving Blackpool and Spire. It would not be appropriate for me to comment on an ongoing investigation by the independent regulator but I stress that, in considering this case, Monitor is doing nothing that the Co-operation and Competition Panel could not have done under the principles and rules for co-operation and competition. As regards the Greater Manchester proposals which the noble Lord, Lord Hunt, raised, I can inform him that Monitor has closed that case and NHS England is pursuing its procurement of these services.
The noble Baroness, Lady Thornton, asked about Bournemouth and Poole. I want to be clear that there is nothing to stop two providers coming together if it is in the best interest of patients. The OFT has already cleared two out of three mergers. However, while in some places mergers have improved things for patients, there is evidence that some mergers can be costly and may not deliver the benefits that were intended. It is therefore right that these are examined. The competition authorities have listened to concerns raised in the system. That is why, in October last year, they set out their commitment to work together with Monitor to ensure that the interests of patients are always at the heart of the merger review process; that the process works quickly and predictably; and, importantly, that any costs can be minimised.
Monitor will take a more active role in supporting merging parties and advising the OFT. This means that some mergers may not need to go to the competition authorities at all, and that those which do can be dealt with more quickly. For example, the proposed merger involving Torbay and Southern Devon Health and Care NHS Trust—an integration pioneer—and the South Devon Healthcare NHS Foundation Trust is one of the first cases in which, with the help of Monitor, the trusts have been able to self-assess and conclude that they do not need to notify the merger to the OFT, as it would be unlikely to raise concerns from a competition perspective.
The noble Lord, Lord Turnberg, challenged me on the evidence for the value of competition. There is robust evidence, as I have already mentioned. A report of January 2012 by the Office of Health Economics states that,
“evidence both from the UK and internationally suggests that quality based competition with prices fixed by a regulator can be beneficial, producing higher quality care at the same cost on average and, importantly, not leading to increased inequity in access to care”.
Researchers at the London School of Economics have found that hospitals in areas where patients have more choice of provider have shorter lengths of stay in hospital and lower death rates than in less competitive markets. Research by York University found an increase in quality at a hospital stimulated local rivals to respond, as well as to increase the quality of their services. The research found improvements in relation to mortality rates, stroke readmission and patient satisfaction.
There are various other answers that I would like to give, but I have been advised that I am well over time, for which I apologise. I simply conclude by saying that this has been, as ever, a stimulating debate on a topic to which I am sure we will return in coming months. I hope that my comments today have at least partially clarified the legal position and wholly clarified our intentions regarding the place of competition in the NHS. I hope, too, that they have provided some measure of reassurance to noble Lords that the system is acting upon the concerns that it hears.
NHS: Black and Minority Ethnic Nursing Directors
Earl Howe Excerpts(11 years, 4 months ago)
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Lord Crisp
To ask Her Majesty’s Government how many Executive Directors of Nursing in the National Health Service are of black or minority ethnic background.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
Data from September 2012 estimate that there are 195 nursing directors. Of these, five, representing 3%, identified themselves as being from a black or minority ethnic background. The Government recognise that there needs to be better progress in promoting talented BME nurses to senior and influential positions. Last month, NHS England launched a coaching and mentoring scheme, and it is currently working on a strategy alongside the Chief Nursing Officer’s Black and Minority Ethnic Advisory Group.
Lord Crisp (CB)
My Lords, I thank the noble Earl for that detailed response, and I am pleased to know that NHS England is taking some steps on this. This is a hidden problem, with fewer than 3% of nursing directors coming from black and minority ethnic backgrounds. This underrepresentation, which is mirrored elsewhere in the NHS, is particularly important because it affects morale, and staff morale in turn, as noble Lords will know, inevitably affects patient care and outcomes. In other words, this is a health issue and not just an equal opportunities one. Will the Minister say a bit more about his plans to deal with this problem and, crucially, whether he will arrange for progress to be monitored and reported on publicly by the Care Quality Commission, the Equality and Human Rights Commission or some other independent body?
Earl Howe
My Lords, I fully agree with the noble Lord about the importance of this issue. A strong focus on equality and diversity is essential to create services and workplaces that are equitable and where everyone feels that they count. The position at present is highly unsatisfactory. The Chief Nursing Officer has personally assured me that this is a priority for her, and she is working closely with BME nurse leaders to address how to support BME nurses to prepare themselves for promotion. Forty-six million pounds has been invested at the NHS Leadership Academy in schemes on leadership development being led by the Chief Nursing Officer. At last year’s BME nursing conference, she made a public commitment to renew efforts to develop BME nurses more effectively, and that will include monitoring.
Lord Mawhinney (Con)
My Lords, what figure, set by the Government or Public Health England, would constitute a success for the strategy that my noble friend has just outlined?
Earl Howe
We have to be a little careful about doing anything that appears to look like positive discrimination or setting quotas, because we stray into areas of dubious legality if we do that. Having said that, as I have indicated, the priority of the Chief Nursing Officer is extremely clear and substantial resources have been put behind this. I pay tribute to the work that the noble Lord, Lord Crisp, did when he was NHS Chief Executive. We have picked up a lot of the ideas that he promoted at that time. I would be very disappointed if there were not progress within a few years but one has to set a realistic time horizon.
Lord Hunt of Kings Heath
My Lords, I refer noble Lords to my health interests. One answer to the question raised by the noble Lord, Lord Mawhinney, would be to point out that 18% of the NHS workforce in England is from a BME background and 14% of the population of England is from a BME background. As 2.6% of nursing directors comes from a BME background, that shows that there is a very long way to go. Is the Minister confident that NHS England is acting in accordance with the Equality Act? If he is not confident, what is he going to do about it?
Earl Howe
My Lords, just to correct the noble Lord, the latest figure I have from 2012 is that total ethnic minority groups in nursing, midwifery and health visiting comprise 19.7% of the nursing workforce. That underscores the basic point that he made. One cannot aspire to 19.7% of those ethnic nurses becoming nurse leaders because there is only a limited number of leadership posts. However, we are clear that this should be a priority for the NHS.
The answer to the noble Lord’s second question is that the Equality and Diversity Council has published some refreshed guidelines. One of its goals is to have a representative and supportive workforce throughout the NHS. It is putting that in train by asking NHS organisations to monitor their equality performance jointly with their patients, communities and staff.
Baroness Brinton (LD)
My Lords, ten years ago, the noble Lord, Lord Crisp, described the NHS as being snow-capped—that is, all white at the top. Since his departure as Chief Executive of the NHS in 2005, there are now fewer leaders from visibly different backgrounds and, as we have heard, pitifully few executive directors of nursing. What are the Government doing to ensure that this matter is kept at the top of the agenda and to assure us that we will hear about the success of the programme as it continues?
Earl Howe
My Lords, I have already mentioned some of the initiatives that are in train. However, I can tell my noble friend that, within the NHS Leadership Academy, there are two programmes specifically for nurses and midwives that map to foundation, mid and executive level leadership development. There is the front-line leadership programme which is for staff who have leadership responsibilities—for example, ward sisters and nurses working in primary care. We expect 6,000 nurses and midwives to participate in that programme in the first year. There is also the senior operational leaders programme which provides senior nursing clinicians with an opportunity to enhance their leadership skills.
Baroness Manzoor (LD)
My Lords, a web audit found that only 80 NHS trusts publish annual staff data broken down by ethnicity. Will the Minister reassure the House that all NHS trusts meet their legal obligations under the Race Relations Act and that all workforce issues faced by black and minority ethnic staff are identified?
NHS: Seven-day Working
Earl Howe Excerpts(11 years, 4 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, I congratulate my noble friend Lord Ribeiro on securing a debate on this important issue. I know that as a former consultant surgeon and former president of the Royal College of Surgeons this is a subject in which he takes a great deal of interest. I also take this opportunity to pay tribute to the work done on seven-day services by NHS England, the NHS Services Seven Days a Week forum, the Academy of Royal Medical Colleges and the Royal College of Surgeons, among others.
The historical five-day service model offered in many NHS hospitals no longer meets justifiable patient and public expectations of a safe, efficient, effective and responsive service. I very much echo the comments of the noble Lord, Lord Parekh, in that context. Over the past 10 years, a growing body of national and international evidence has emerged that links poor outcomes, including a higher risk of death, to patients admitted to hospital at the weekend, around the world. It is impractical and inefficient to continue to operate a five-day approach when our illnesses and conditions do not limit themselves to office hours. Patients are entitled to receive the same standard of care regardless of the day of the week.
As the largest and most comprehensive health service in the world, the NHS is well positioned to solve the issue of poorer outcomes and reduced levels of service provision at the weekend. That is why NHS England has set out a vision for the NHS which is of a service more closely organised around the lives of the public it serves. To develop this vision, NHS England established the NHS Services Seven Days a Week forum in February last year to consider how NHS services can be improved to provide a more responsive and patient-centred service across the seven-day week.
The forum’s work has been met with nothing but positive feedback and support from the public and patients, the Academy of Medical Royal Colleges and the British Medical Association, among other organisations. The immediate focus for improvement activity will be addressing the need for high-quality urgent and emergency care services, seven days a week. NHS England is also looking to make similar improvements across primary and community health services and social care, and the forum will report in autumn this year, setting out proposals for the creation of a fully integrated service. NHS England’s ambition is for seven-day services to be fully implemented in England by the end of 2016-17.
I recognise that we cannot talk about the idea of seven-day services without giving full consideration to questions of staffing and finance; many noble Lords have raised those issues. NHS providers and their commissioners already face difficult choices when deciding where to invest their resources in order to maximise the outcomes for patients and value for taxpayers. Early indications are that seven-day services have the potential to be part of the solution. However, more information is needed. NHS England is therefore conducting research which will provide a helpful indication of the likely costs providers and commissioners face when considering how to redesign their services to provide comprehensive seven-day care. In addition, to answer my noble friend Lady Brinton, NHS England intends to commission financial and system modelling and analysis of the implications of its strategy for achieving seven-day service provision in the NHS.
My noble friend Lord Ribeiro rightly highlighted the workforce implications of having a consistent, high-quality service seven days a week. The department, alongside NHS England, Health Education England, NHS Employers and a number of strategic partners, is considering that very issue. Its analysis is considering issues such as junior doctors feeling unsupported during weekend working and the resulting need to ensure that education contracts include appropriate seven-day senior supervision; and numbers of diagnostic and scientific staff, with NHS England intending to undertake a thorough assessment of the different roles needed in diagnostic and scientific services to support an extended service.
Of course, many commissioners and providers will need support to address the challenges presented by seven-day services. To that end, NHS Improving Quality has just introduced a new, large-scale transformation change programme, set up in collaboration with all healthcare commissioners and providers, to support the spread of seven-day services over a three-year period.
I realise that the move towards seven-day care will not be easy, but there are encouraging examples of pioneering NHS organisations that have moved to make healthcare services more accessible seven days a week to avoid compromising safety and patient experience. For example, Sheffield Teaching Hospitals NHS Foundation Trust has adopted seven-day service provision, improving patient flow of frail and older people through the emergency pathway. Bed occupancy for emergency care for older patients has now reduced by more than 60 beds. Other examples in my brief include Salisbury District Hospital and the Lancashire Intermediate Support Team, both of which have produced impressive results.
We know that across the country, more hospitals, primary and community care organisations and social care services are working together to break the link between poorer outcomes for patients and the reduced level of service provision at the weekend. We also know that patients and the public want us to act now to make seven-day services a reality in all parts of our NHS.
A number of noble Lords, including my noble friend Lord Ribeiro and the noble Lords, Lord Parekh and Lord Hunt of Kings Heath, raised the issue of cost. Interestingly, there is already evidence that seven-day services can be implemented in a way that does not increase the overall cost of healthcare. The average cost of implementation at trusts pioneering the service was 1.5% to 2% of their total income. Costs vary according to local service models, but research shows that they can be reduced by reconfiguring services and by trusts working collaboratively. Seven-day services at the front end—that is to say, A&E departments—could also pay for themselves by reducing admissions and lengths of stay.
Seven-day services would not work under a one size fits all model—a point made by my noble friend Lord Ribeiro. Local solutions need to be found and pioneering NHS providers and commissioners are already working to develop them.
In answer to the noble Baroness, Lady Masham, on the issue of safety at weekends, we expect all NHS services to be able to meet patients’ needs as they arise. To do this, trusts should adopt the clinical standards developed by the seven-day services forum to drive up clinical outcomes and improve patient experience at weekends.
My noble friend Lady Manzoor referred to the CQC. The CQC and the Chief Inspector of Hospitals are considering how implementation of the clinical standards could best be assessed by the CQC and how this might be reflected in its forthcoming ratings and the judgments it makes when it inspects.
As I said, workforce is a major issue. The noble Baroness, Lady Masham, was right to raise that point. There are over 12,200 more clinical staff in the NHS than there were before the election, thanks to the money we have invested in the service and to the reforms we have carried out. Nevertheless, there is an issue about motivating staff to work at weekends, as the noble Baroness rightly said. We understand that contractual levers and incentives are required to drive change. NHS England and a number of key strategic partners are already looking into this. However, in many cases seven-day services have reportedly already had a positive impact on individuals’ work-life balance, offering greater certainty in planning ahead and flexibility in time off. In addition, the medical royal colleges are all in support of seven-day services. Building seven-day service provision into recruitment, job planning and appraisal processes will help create a sense of common purpose to underpin organisational delivery.
A number of noble Lords, including my noble friends Lord Ribeiro and Lady Barker, referred to the role of GPs. To address that important role in the mix of services the NHS provides, we recently announced the setting up of a £50 million fund to support innovative GP practices in improving services, and in particular access for their patients, including seven-day week access and evening opening hours and the testing of a variety of services including Skype, e-mail and phone consultations.
However, as the noble Lord, Lord Hunt of Kings Heath, emphasised—as did my noble friend Lady Barker—community services and social care are absolutely integral to this as well, particularly when it comes to the care of the frail elderly. Social care and the NHS are priorities for the Government and we know that there is interdependency between the two systems. However, providing more resources is not enough on its own. We have provided more resources from the Department of Health but we need to do more. NHS England is currently working with the Local Government Association to create a health and social care system that is truly seamless so that people receive the right care at the right time and in the right place. The Seven Days a Week forum will report on that work in the autumn, setting out proposals for a fully integrated service.
The Better Care Fund is a key enabler for change, as my noble friend Lady Manzoor pointed out. As part of the process for accessing funding, clinical commissioning groups and local authorities will have to demonstrate, as part of agreed local plans, that they are addressing a number of national conditions, including seven-day services in health and social care.
The noble Lord, Lord Warner, asked whether the Government would expect A&E departments to have weekend consultant cover. We recognise that the consultant contract is a key enabler of seven-day services. In October last year the Government mandated NHS Employers to enter into formal negotiations with the BMA to deliver joint proposals for consultant contract reform, including changes that will support seven-day services.
My noble friend Lord Bridgeman focused on the working time directive. He may know that we asked the president of the Royal College of Surgeons, Professor Norman Williams, to chair an independent task force to look at the implementation of the working time directive, and the impact of the directive on the delivery of patient care and the training of the next generation of doctors. The independent review will provide its report during March 2014. Professor Williams is working with stakeholders from the Royal College of Surgeons, NHS organisations, the BMA, National Voices and others, and we ourselves are working with the task force to ensure that it has appropriate legal and analytical support.
There is a compelling case for healthcare services to be accessible seven days a week. To echo the noble Lord, Lord Parekh, if we were starting the NHS from scratch I very much doubt whether we would design a part-time system. We would surely create a seven-day service to better meet patients’ needs. Seven-day service provision is about equitable access, care and treatment, regardless of the day of the week. It is a cause for some pride that the NHS will be the global pioneer in providing equality of access to consistent, high-quality healthcare seven days a week.
Lord Hunt of Kings Heath
My Lords, before the noble Earl sits down, I was remiss in not declaring my interests at the start as chair of a foundation trust, president of GS1 and a consultant trainer with Cumberlege Connections. I know that we all know that, but I have to do it every time.
NHS Property Services Ltd
Earl Howe Excerpts(11 years, 5 months ago)
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Lord Warner
To ask Her Majesty’s Government what assessment they have made of the performance of NHS Property Services Ltd in disposing of surplus properties and operating within their working capital.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, NHS Property Services is on target to dispose of 97 properties by 31 March 2014 and a further 100 properties by 31 March 2015. The department has provided the company with a £350 million flexible working capital loan facility, of which £271 million had been drawn down as at 27 January 2014. This working capital support is in line with the department’s expectations for a start-up company of this size and complexity.
Lord Warner (Lab)
I thank the Minister for his Answer, but what action has been taken to improve the performance of this company in controlling its costs? What action has been taken to reduce its running costs, given the large number of staff that it inherited, and what action has been taken to improve the professional competence of those staff and to collect bad debts, which have been a rising problem for this organisation?
Earl Howe
My Lords, on administration costs, the company is already reviewing the way in which its strategic asset management and facilities management functions are structured. It is probably inevitable that the consolidation of 161 PCT and strategic health authority estates into one will throw up duplication, overlap and operational policies that conflict. These all need to be rationalised and a commercial ethos introduced. It is vital that the skills are imported into the organisation to match that challenge.
Lord Mawson (CB)
My Lords, for the past six years, we in St Paul’s Way in Tower Hamlets have been pursuing the Government’s policy of integration in health services, bringing together a school, housing, health and community services centre on one street. I was asked to lead this project following a murder and considerable racial violence on this housing estate. The overall transformation project has been very successful, and I must declare an interest. However, the primary care premises elements have stalled and we are going backwards in terms of dental outreach facility. Can the Minister explain how NHS England engages with NHS Property Services, the CCG, local GPs and local partners to deliver in an effective and timely manner the kind of innovative and integrated premises we all agree are essential?
Earl Howe
My Lords, I pay tribute to the work that the noble Lord does. However, it is important to understand that the decision as to whether a property in the NHS Property Services portfolio is surplus to requirements and should therefore be sold resides with the commissioners; that is, NHS England and clinical commissioning groups. It is up to the commissioners how they wish to utilise the estate.
Lord Brabazon of Tara (Con)
Is my noble friend aware of the situation of Putney Hospital, which closed about 15 years ago and has only recently been sold to Wandsworth Borough Council, but is still undeveloped?
Lord Hunt of Kings Heath (Lab)
My Lords, I refer noble Lords to my interests in the register; I should have done that yesterday on another health Question, for which I apologise to the House. Can the Minister confirm that the chairman of this organisation resigned early, that capital money was raided to cover a revenue shortfall and that, only months after the organisation formally started, an investigation has been mounted by the National Audit Office? Given that the shares in this company are owned by Ministers, will Ministers take responsibility and can the noble Earl confirm that this was forecast in the NHS risk register, which the Government have not yet published?
Earl Howe
My Lords, the noble Lord has painted rather a black picture of the company, which we believe has got off to an extremely good start, contrary to his impression. The company’s former chair asked to step down six months earlier than planned because the company had completed the transition phase early, and it was agreed that a chair with a different skill set was needed to oversee the rationalisation of the company.
As regards the company’s cash needs, we made £350 million available to the company as a working capital loan. That was planned some six months ago and was needed in large part due to the slow payment of invoices by the company’s customers, many of whom were themselves new organisations set up as part of the reforms, so it is not altogether surprising that cash flow initially was slow, but the situation is improving.
Lord Colwyn (Con)
My Lords, can my noble friend tell us what efficiencies and successes NHS Property Services has actually made?
Earl Howe
My Lords, it has been a good start for the company. It has generated £22 million from sales of surplus assets and savings of £2 million a year on the running costs of those disposed properties. The company is also harnessing economies of scale—for example, savings to date of £1.2 million by standardising the procurement of electricity across the whole estate. The company is now exploring how to make savings across other utilities and services, such as legal services.
Lord Turnberg (Lab)
My Lords, following the response to my noble friend Lord Hunt’s question, can the noble Earl tell us why the National Audit Office has decided to conduct an investigation so soon after the establishment of this organisation?
Earl Howe
My Lords, the National Audit Office is indeed looking at the company—only to assure us and itself that the company is properly organised and structured. We welcome that, as does the company. There was no sinister purpose or concern underlying that process; it is perfectly normal and natural.
Baroness Manzoor (LD)
My Lords, can the Minister confirm best value for money on all properties sold and that there has been proper consultation with local organisations on all NHS estates?
Earl Howe
My Lords, I can assure my noble friend of that. The company ensures best value by marketing through an arm’s-length open market process, which ensures that the market value is achieved in a sale. Where necessary, the sale price is supported by a district valuer or other third-party independent valuation.
Baroness O'Cathain (Con)
My Lords, I ask my noble friend: when people are appointing chairmen to such organisations, could they look at their skill sets in advance rather than getting rid of them because of their lack of skill sets?
Earl Howe
My Lords, it is important to understand that the chairman who has stepped down had a very good set of skill sets, but it is not the skill set that we now need to take the company forward. The task at the beginning was to consolidate a very complex portfolio of properties, and that was done very successfully. The task now is different: it is to manage those properties effectively and to get maximum value for the taxpayer for the properties that are sold.
NHS: Cancer Treatment
Earl Howe Excerpts(11 years, 5 months ago)
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Baroness Pitkeathley
To ask Her Majesty’s Government what action they propose to take to ensure that older people receive equal access to NHS cancer treatment.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
In December, the national clinical director for cancer at NHS England launched a call for action on the treatment for older people. NHS England is now setting up an advisory group to identify where improvements in cancer services for older people can be made. It is also supporting an initiative to ensure that patients are better informed about the options available to them and that they are fully involved in decisions about their treatment.
Baroness Pitkeathley (Lab)
I thank the Minister for that welcome Answer, but is he aware of the recently published Macmillan Cancer Support report, which shows that up to as 10,000 cancer patients die needlessly each year because of blatant ageism among doctors? For example, recommendations for chemotherapy diminish by as much as half if you are over 70. Since we are an ageing population and half of all new cancer diagnoses are in people over 70, does the Minister agree that it is of the utmost importance that we ensure that people are treated as individuals regardless of their age? How will he ensure that this view is held also among GPs and hospital consultants?
Earl Howe
My Lords, I completely agree. The noble Baroness is right that a series of reports has shown that the NHS has too often failed to provide the best possible services to older people. We cannot save lives without tackling inequalities. The NHS has a statutory duty to reduce health inequalities and to improve the health of those with the poorest outcomes. A ban on age discrimination in the NHS services was introduced in 2012, meaning that NHS services need to do everything they can to ensure that they do not discriminate against older people. We will hold the NHS to account for that through the mandate and the NHS outcomes framework.
Lord Turnberg (Lab)
To what extent are these shocking figures due to lack of funding for cancer services? In that light, what is the Government’s plan for the cancer drugs fund?
Earl Howe
My Lords, the noble Lord may recall that the Government pledged an additional £750 million to support the cancer strategy. We are doing that, and a range of actions are proceeding there. On the cancer drugs fund, we initially pledged a total of £600 million for the first three years of the fund and we recently pledged another £400 million, making £1 billion in all. I am pleased to say that the cancer drugs fund has so far helped more than 38,000 patients.
Lord Walton of Detchant (CB)
My Lords, some two weeks ago, the Minister agreed that, when NICE recommends that a particular form of treatment should be given to patients with cancer, rare cancers and other rare diseases, it is incumbent on clinical commissioning groups to see that those drugs are prescribed. Does the Minister agree that clinical criteria must be employed in reaching decisions as to which patients are to receive those drugs and that age alone must never be a barrier to the prescription of drugs in patients with cancers of that type?
Earl Howe
My Lords, I agree. The noble Lord may recall that in December 2012 we worked on a project with Macmillan Cancer Support and Age UK to improve uptake of treatment in older people. That established some key principles for the delivery of age-friendly cancer services. In December 2013, NHS England published an analysis of chemotherapy uptake in older people, and that report reaffirmed those principles and set out some new recommendations around improving the uptake of chemotherapy.
Baroness Gardner of Parkes (Con)
My Lords, in the previous reply the Minister said he had looked at figures for chemotherapy for older people. Has he looked at the figures for radiotherapy for cancer patients of an age, in particular for intensity-modulated radiotherapy, which is not reaching its target but is considered a great improvement on the previous type of radiotherapy being used for cancer cases?
Earl Howe
My Lords, the Government invested £23 million aimed at increasing the capacity of radiotherapy centres in England to deliver intensity-modulated radiotherapy. The latest analysis shows that the median average of IMRT activity in England is at 29%, with the vast majority of centres delivering at 24% or above. That 24% was the magic figure recommended a few years ago by the national radiotherapy implementation group. We continue to monitor progress and local action plans closely.
Baroness Masham of Ilton (CB)
My Lords, I declare an interest as vice-chair of the all-party cancer group. Does the Minister agree that many older people develop cancer and, therefore, to stop treatment would ensure that many Members of your Lordships’ House would not get treatment? Will he therefore take this really very seriously?
Earl Howe
My Lords, I am with the noble Baroness all the way in wishing to see your Lordships live a healthy and long life but, as regards the population generally, I hope that I have made clear the Government’s determination to see that all citizens of this country receive treatment according to their ability to benefit from it.
Lord Hunt of Kings Heath (Lab)
My Lords, I am sure we are all with the noble Baroness in those sentiments. Can I refer the noble Earl back to the research that my noble friend referred to? The report seems to show that survival rates for cancer patients over the age of 75 are very poor in this country compared with other European countries. The noble Earl has said that he will ensure that action is taken through the mandate to NHS England. Should he not give instructions to clinical commissioning groups to start commissioning cancer services with no age discrimination?
Earl Howe
My Lords, commissioning is an important ingredient in this, but there is a range of actions that we can take and have taken. We know that low levels of awareness and late diagnosis are particular problems for older patients, so it is welcome news that Public Health England is to run a national campaign to raise awareness of breast cancer in women over the age of 70. We are also raising the screening age for breast cancer to include women aged 71 to 73, and the extension of the NHS bowel cancer screening programme to men and women aged 74 is now complete.