Carers
Earl Howe Excerpts(12 years, 5 months ago)
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Lord Touhig
To ask Her Majesty’s Government what is their estimate of the saving to public funds as a result of the work of unpaid carers in the United Kingdom.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the Government themselves have not estimated savings to public funds as a result of unpaid carers’ contribution to care and support, although we are aware of estimates by other organisations. There is scope for debate about how best to put a financial value on this care but there can be no doubt about its huge value to those who receive care and to the wider community.
Lord Touhig
My Lords, I am sure that the Minister would agree that we owe a great debt to the carers of this country and, indeed, the Government recognise that because they have promised that families with a disabled child and in receipt of disability living allowance will be exempt from the housing benefit cap. However, according to the regulations, when that disabled child becomes a disabled adult, the child is considered to be a separate household from the parents who they live with. No matter that the disabled adult will perhaps need the same level of care that they received as a disabled child; the parents will then be subject to the housing benefit cap. Why?
Earl Howe
My Lords, the noble Lord will have to forgive me because I will need to write to him about benefits, which do not directly fall under my remit in the Department of Health. However, I can say to him that more young carers services are extending their age group to cover young adult carers, and there needs to be a proper join-up between the two. In some situations, it is true that the young adults’ needs are unmet; they can fall down the gap and not receive adequate support. A transition between children’s services and adult services should be smoother—we acknowledge that, and we are addressing this in the draft Care and Support Bill.
Lord Wigley
My Lords, does the noble Earl accept that many unpaid carers manage to carry their enormous responsibilities only because of respite care and other assistance, sometimes from paid sources, and that if those paid sources were not available, many people now living at home might find themselves in institutional care? Will he therefore, in any government cut backs, make sure that no action is taken that undermines the position of carers?
Earl Howe
I agree with the noble Lord. Carer’s breaks are extremely important, which is why we have pledged to invest £400 million between 2011 and 2015 to improve the NHS’s support carers to enable them to take a break from their caring responsibilities. The current operating framework for the NHS requires the service to work closer than ever before with local carers organisations and councils to agree plans to pool resources and ensure that carers get the support and the break that they deserve.
Baroness Barker
My Lords, is the Minister aware that in November 2011, in a report from the Cass Business School for Carers UK called The UK Care Economy: Improving Outcomes for Carers, the authors noted that the only reliable data about carers comes from the census, which is national? Given that CCGs and health and well-being boards are about to start commissioning services locally and that their information is at best incoherent and inconsistent, what help will the Government give them in order properly to assess the numbers of carers and the level of need they are supposed to be meeting?
Earl Howe
My Lords, my noble friend makes an extremely important point. Our report, Recognised, Valued and Supported: Next Steps for the Carers Strategy, had four key priorities, one of which was to identify carers earlier. Healthcare professionals undoubtedly have a role to play in supporting those with caring responsibilities to identify themselves as carers in the first instance. We therefore made around £850,000 available in the previous financial year to the Royal College of General Practitioners, Carers UK and the Carers Trust to develop a range of initiatives to increase awareness and understanding of carers’ needs in primary care. We are building on that further.
Baroness Pitkeathley
My Lords, I remind the House that the figure usually given is £119 billion that is being saved from public funds. Since the census now shows that the number of carers has increased by 11%, no doubt that figure will go up. Since many carers give up paid work to become carers and only 600,000 of them receive the carer’s allowance, does the Minister agree that many of them will be building up poverty for themselves in the future? What guidance must be given, therefore when carers’ assessments are being made to enable them to stay in paid work for as long as possible?
Earl Howe
My Lords, the latest figure I have for carers from the census is that there are 5.4 million unpaid carers in England. The noble Baroness was right to mention the figure of £119 billion, although it is a figure we can argue about. It is probably an overestimate as regards the cost to public funds. However, she makes a very important point about employment. The Government fully recognise the importance of supporting carers to remain in work. The Department of Health has established a task and finish group with employers for carers to explore how to improve support for carers to remain in employment. Jobcentre Plus provides practical assistance for carers seeking work; in particular, it can offer practical support for all carers who are employed for less than 16 hours a week.
The Earl of Listowel
My Lords, is the Minister aware of the concern of many adult carers of children with disability at the number of changes in social workers that their child has, and how that undermines their ability to be effective advocates for these children, especially as they make the transition to adult services? Does the Minister monitor the number of changes in social workers supporting such families? How can we ensure that this important factor is improved upon?
Earl Howe
My Lords, the noble Earl makes an extremely important point about continuity of care. I am not aware that my department monitors the point that he raises, although it is one that we expect local authorities to bear closely in mind as they fulfil the criteria to be rolled out in the social care outcomes framework, which contains a strong strand relating to service user satisfaction.
Health: Cancer
Earl Howe Excerpts(12 years, 5 months ago)
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Lord Aberdare
To ask Her Majesty’s Government what steps they are taking to ensure that the Department of Health 2013 generic cancer symptoms awareness campaign will help improve early diagnosis of pancreatic cancer.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, from today, we are piloting a general cancer symptoms campaign to raise awareness and encourage people with relevant symptoms to visit their GP. The campaign will run in five cancer network areas until mid-March and will be relevant to a range of cancers, including pancreatic cancer. Data, including GP attendance, urgent referrals for suspected cancer and diagnostic test activity, will be collected and analysed to assess the impact of the campaign.
Lord Aberdare
My Lords, pancreatic cancer is the fifth most deadly cancer in the UK, accounting for some 7,900 deaths a year. UK survival rates are significantly worse than in some other countries, as are the numbers of patients being referred for operations, the only effective cure. Since earlier diagnosis is essential to improve these outcomes, what plans does the Minister have to ensure that the proposed campaign includes new tools to help GPs detect pancreatic cancer and better pathways for them to refer suspected cases for further testing and support?
Earl Howe
The noble Lord is absolutely right about the importance of earlier diagnosis. I can give two examples of work running this year to assist GPs in the assessment and earlier diagnosis of cancer patients, including those with pancreatic cancer. Rolling out from March, Macmillan Cancer Support, with funding from the department, will be piloting an electronic cancer decision support tool for GPs to use as part of their routine practice in order to help identify and assess more effectively patients with possible cancer. The initial pilot will cover a number of cancers, including pancreatic cancer. Further, the National Action Cancer Team is supporting the distribution of further desk-based versions of risk assessment tools for use in general practice, and these include a pancreatic cancer risk assessment tool.
Baroness Gardner of Parkes
My Lords, is the Minister aware that people think that there is no effective treatment for pancreatic cancer—we are always told that lung and pancreatic cancer are the two worst—but other treatments are being given in other countries? A very dear relation of mine in Australia has benefited from having radium pellets injected directly into the secondary lesions and is progressing very well indeed in the second year since her treatment. Her symptoms are much improved. Can he give an assurance that we will give people in this country hope that we will look at treatments being used in other countries that are improving pancreatic cancer outcomes and ensure that we are not left behind in this area?
Earl Howe
My Lords, I am very interested to hear about the treatment mentioned by my noble friend and I can remind her, although I am sure she needs no reminding, that one of the key roles of NICE is to keep evidence of new treatments under review. I do not doubt that as a result of my noble friend’s intervention, it will wish to look at that particular treatment. Pancreatic cancer can grow initially without any symptoms and it is possible that people might not recognise the symptoms. That is why the “Know 4 sure” campaign, which I have mentioned, highlights four key symptoms including loss of weight and pain, which can be symptoms of pancreatic cancer.
Lord Turnberg
My Lords, is it not the case that the diagnosis of pancreatic cancer is extremely difficult? The organ lies deep within the abdomen and cannot be seen or felt, so by the time the patient shows symptoms, it is often too late. What we really need is research that will provide us with a biomarker which can be used for screening and early diagnosis. Can the noble Earl tell us whether research along these lines is going on within the NHS?
Earl Howe
My Lords, via the Medical Research Council we are supporting a study to assess the effectiveness of a new test called the Mcm5 protein test to see if it can help to diagnose cancer of the pancreas, bile duct and gall bladder. I am also aware of a number of other research projects that my department is funding in the field of pancreatic cancer and I would be happy to write to the noble Lord with the details.
Lord Sharkey
My Lords, where you live will dramatically affect your chances of surviving pancreatic cancer. In south-west London the one-year survival rate is 22% while in north Trent it is 11%. Do we know why this is? What are we getting right in south-west London but not in north Trent?
Earl Howe
My noble friend is absolutely right to raise the point. To support the NHS in tackling regional variations in cancer survival rates, we are providing data to providers and commissioners that allow them to benchmark their services and outcomes against one another and to identify where improvements need to be made. Surgical resection is currently the best curative intervention for pancreatic cancer, and through the National Cancer Intelligence Network we have already made available data collections on the survival rates and surgical resection rates across a range of cancers, including pancreatic cancer.
Lord Kakkar
My Lords, what proportion of patients diagnosed with pancreatic cancer is managed in specialist centres by a specialist, multidisciplinary team? What proportion of patients in those centres is entered into clinical trials? We all recognise that participation in clinical research improves clinical outcomes in these centres.
Earl Howe
My Lords, the UK now has the highest national per capita rate of cancer trial participation in the world, which is something that not everybody realises. We have improved the amount of information available to patients, clinicians and the public about clinical trials by establishing the UK Clinical Trials Gateway. I will write to the noble Lord with information about specialist centres, but he will know that surgery for pancreatic cancer is a complex business and needs to be undertaken by those who are very well versed in that particular line of clinical activity. I am sure that a high proportion will be treated in those centres but I will find out more if I can.
Lord Hunt of Kings Heath
My Lords, I refer the House to my health interest. On the question of variation, the noble Earl mentioned earlier the role of GPs. Will he accept that there is a wide variation in the performance of GPs? Can he confirm that we can expect the NHS Commissioning Board from 1 April this year to start taking action where GPs are not doing what is required?
Earl Howe
Yes, my Lords, because a major role of the Commissioning Board is to support general practice and, indeed, vice versa. In the current year, cancer networks are continuing to support GPs to diagnose cancer earlier through a range of work including continual professional development, primary care-led audits of cancers, and ensuring that GPs are prepared when patients present in response to public cancer awareness campaigns. Therefore, there is a range of work going on to ensure that GPs are better versed in this area.
Diabetes
Earl Howe Excerpts(12 years, 6 months ago)
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Lord Kennedy of Southwark
To ask Her Majesty’s Government what action they are taking to reduce the number of amputations due to diabetes.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, foot complications of diabetes are usually preventable. Early identification and prompt treatment prevent amputations. NICE guidelines recommend annual foot checks, which are included in the quality and outcomes framework for general practitioners. NHS Diabetes has established regional diabetes footcare networks. People with vulnerable feet require expert protection, while those with problems need urgent specialist care. Local national health services are responsible for commissioning podiatry services and multidisciplinary specialist footcare teams for people with diabetes according to local needs.
Lord Kennedy of Southwark
I draw the attention of the House to my declaration of interests in respect of Diabetes UK. One hundred and twenty-five amputations take place each and every week in England alone, and 80% of those are preventable. The record of the Department of Health is not good; the figures are going up, not down. If I asked this question in a year’s time, what progress does the Minister expect that his department would have made to reverse that trend?
Earl Howe
The noble Lord is absolutely right that this is a major public health issue and one that impacts very seriously on the health and well-being of individuals, so it is a priority for us. We are committed to reducing the number of avoidable amputations among people with diabetes. In fact, progress is being made: although the number of amputations is going up, the rate is falling. However, we are under no illusion that this will be a growing problem because of the growing number of people with diabetes. All our work on improving completion of the NICE nine care processes for people with diabetes and improving timely access to specialist diabetic footcare multidisciplinary teams will support that aim, and the Diabetes UK Putting Feet First campaign has real potential to improve awareness of foot complications in diabetes.
Lord McColl of Dulwich
My Lords, does the Minister agree that the real way to reduce the number of amputations is to reduce the incidence of diabetes and that the way to do that is to do something about the obesity epidemic, which is the main cause of diabetes and one of the main causes of amputation? What is he doing to try to prevent that quango, NICE, misleading the nation and politicians, as it did, into believing that the answer to the obesity epidemic was to take more exercise when, although exercise is important, the real answer is to eat fewer calories?
Earl Howe
I agree with my noble friend about the importance of targeting obesity as a serious public health risk and one which leads to diabetes in many cases. I believe that, if my noble friend were to talk to NICE about its recommendations to prevent obesity, he would find that its line is slightly modified from the one that he has criticised. We should pay tribute to NICE for the good work it has done in the specific area of diabetes. The recommendations and guidelines it has issued have been very positive. There is, of course, a quality standard for diabetes, which is also excellent.
Baroness Hollins
My Lords, people with learning disabilities and those with serious mental illness have a higher incidence of diabetes. They have a later diagnosis and are therefore more at risk of complications. Does the Minister agree that one way to reduce the number of amputations associated with diabetes would be to improve access to diabetic care for people with learning disabilities or mental illness?
Earl Howe
My Lords, yes, I certainly do. There are a number of positive ways in which we can do that. One is the NHS health check, which should, if it is performed correctly, pick up those with undiagnosed diabetes. Early identification of diabetics is key in this area, particularly for those who are at risk of ulceration. Other ways are targeting preventive services at those most at risk, including those with learning disabilities; early management of foot infection and rapid access to multidisciplinary teams; and having good diabetic foot prevention and ulcer management services in local areas.
Lord Harrison
My Lords, the point at issue is surely this: that to prevent the four out of five needless amputations that currently take place, Her Majesty’s Government need to respond to the Question of my noble friend Lord Kennedy by saying how they will ensure that there are those multidisciplinary groups with specialist knowledge of feet and the ability to make sure that there is not a postcode lottery as there is now. They should be properly monitored by the Government to ensure that a proper service is offered to diabetics at a time of decline in the amount of money going into the National Health Service.
Earl Howe
My Lords, there is no single magic bullet that will solve this problem, but undoubtedly better monitoring in general practice is one answer; the QOF incentivises that. The NHS outcomes framework will also incentivise clinical commissioning groups to ensure that those with long-term conditions—particularly diabetes—are properly looked after. The benefits of multidisciplinary teams are now proven. The evidence is there and, if we can shine a spotlight on the statistics—and there is, as the noble Lord knows, a wide variation in success rates across the country—that will be the key to driving better performance throughout the health service.
Lord Patel
My Lords, does the Minister agree that part of the problem is that while the NICE guidelines, if implemented throughout the country, would reduce the variation rate in amputations, particularly of lower limb extremities, it is not mandatory to implement those guidelines? He may be aware that several nations, including Scotland, have recently reported a reduction of 30% in the amputation rate, following strict protocols in diabetic management.
Earl Howe
My Lords, there are centres of excellence throughout the United Kingdom, from which I am sure the health service as a whole can learn. The noble Lord is absolutely right. He mentions the NICE guidelines; he is right that they are not mandatory, but they do point to best practice. By highlighting the data, we can ensure that commissioners and practitioners ask themselves the right questions about whether best practice is being followed.
NHS: South London Healthcare Trust
Earl Howe Excerpts(12 years, 6 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, I shall now repeat as a statement the Answer given by my right honourable friend the Secretary of State for Health in another place earlier today to an Urgent Question on the report of the trust special administrator to South London Healthcare NHS Trust. The statement is as follows:
“I have today published the final report of the trust special administrator to South London Healthcare NHS Trust and laid it before Parliament. I received the report yesterday and must now consider it carefully. I am under a statutory duty to take a decision by 1 February on how best to secure a sustainable future for services provided by the trust.
The trust administrator began his appointment on 16 July. He published his draft report on 29 October, and undertook a consultation on his draft recommendations between 2 November and 13 December. More than 27,000 full consultation documents and 104,000 summary documents were distributed during the trust special administrator’s consultation, sent to 2,000 locations across south-east London, including hospital sites, GP surgeries, libraries and town halls. A dedicated website was established to support the consultation, the TSA team arranged or attended more than 100 events or meetings and the consultation generated more than 8,200 responses.
I understand the concerns of honourable Members and, indeed, the people living in the areas affected by these proposals, especially the people of Lewisham. They have a right to expect the highest-quality NHS care, and I have a duty to ensure that they receive it. However, they will understand that it would not be appropriate for me to give a view now on the report’s recommendations, only one day after receiving the report. To do so would be pre-emptive, and would prejudice my duty to consider the recommendations with care and reach a decision that is in the best interests of the people of south-east London.
However, I have made it clear that any solution would need to satisfy the four tests outlined by the Prime Minister and my right honourable predecessor with respect to any major reconfigurations. The changes must have support from GP commissioners; the public, patients and local authorities must have been genuinely engaged in the process; the recommendations must be underpinned by a clear clinical evidence base; and the changes must give patients a choice of good-quality providers.
The challenges facing South London Healthcare NHS Trust are complex and long-standing, but to fail to address them is to penalise other parts of the NHS from which resources must be taken to finance the biggest deficit anywhere in the NHS. To date, it has not proved possible to ensure that South London Healthcare NHS Trust is able to secure a sustainable future for its services within its existing configuration and organisational form. In appointing a trust special administrator to the trust, the Government’s priority was to ensure that patients continue to receive high-quality, sustainable NHS services. I will consider the special administrator’s report with that objective in mind”.
My Lords, that concludes the statement.
Baroness Wheeler
I thank the Minister for repeating the Answer to the Urgent Question. We commend the work of the trust special administrator and support a number of the recommendations developed from previous reviews. However, it is difficult to understand how the Government consider this report to constitute the full strategic review of the sustainability of services across south-east London that is required. The TSA has overstepped its remit under the Health Act 2009 by including service changes to Lewisham hospital; and the parallel work by King’s Health Partners on reconfiguration under three other south-east London trusts has yet to be completed.
Can the Minister explain why the rules on making changes to hospitals have been changed to allow back-door reconfigurations in this way without proper scrutiny and consultation? What public consultation will there be on the King’s Health Partners report? Can he reassure the people of Lewisham that they will have their full consultation rights to challenge the closure of their A&E services and the other major changes being proposed?
Earl Howe
My Lords, I am grateful to the noble Baroness and I understand the concerns that she has raised.
The first question she asked me was whether I considered the trust special administrator to have overstepped his remit. The clear advice that we have received is that no part of the NHS can exist in a vacuum. The independent trust special administrator is responsible for developing recommendations to deal with the severe failings at South London Healthcare Trust based on local discussions and consultation. I hope that the statement I read out gave the House a flavour of how extensive those consultations have been. His recommendations must secure high-quality care for local people in a financially sustainable way.
However, as I have mentioned, each NHS trust is part of a complex, wider health system, and it is quite clearly the view of the administrator in this case that it is not possible to find a solution without considering the possible impact on other hospitals in the areas. That conclusion is one that my right honourable friend will have to consider very carefully, but Ministers have received clear advice that it is within the powers of the administrator to make recommendations about necessary changes to other local providers if they are a necessary and consequential part of finding a long-term solution to securing high-quality services for patients at that trust. I emphasise that I do not in any way wish to pre-empt the decision that my right honourable friend has to take within 20 working days. However, he will have to consider advice on the clinical, legal and financial aspects of the administrator’s recommendations and I have no doubt that concerns raised by the noble Baroness will be central to his consideration.
Lord Warner
My Lords, I declare an interest as the former chairman of the provider agency in the London SHA area who grappled with some of these problems in south-east London which, to the best of my knowledge, have been around for at least 20 years. I congratulate the TSA on the work that he has done in trying to resolve this. Could the Minister explain a little more about the involvement of Guy’s and St Thomas’s Hospital and King’s College Hospital? The TSA is to be congratulated on involving them much more than has been the case in the past in finding solutions in this area because the failure of those two powerful hospitals to get involved in sorting out the mess in south-east London has bedevilled earlier solutions.
Earl Howe
My Lords, I am grateful to the noble Lord, who I know well appreciates the scale of the problem with which the administrator was grappling. This trust was losing more than £1 million a week. That is not a sustainable position in the current NHS, or even when times were rosier as regards the financial settlement. It is important for me not to say anything that will pre-empt my right honourable friend’s conclusion, but I am aware, from the press release issued today by the trust special administrator, that, as the noble Lord rightly says, the wider health economy has been taken into consideration, including the role of Guy’s and King’s College Hospital, in a number of areas, including, in particular, in emergency care and in obstetrician-led maternity care. I would commend to the noble Lord a summary of the recommendations, which is on the department’s website today. I hope he will find that helpful in giving him a sense of the breadth of the administrator’s purview.
Baroness Donaghy
Is the Minister aware of the extreme anxiety among the population in Lewisham about the possible future closure of the A&E department in Lewisham? The population of 250,000 is estimated to rise to 300,000 in a very few years’ time as a result of a huge increase in the birth rate. There are very deep social needs and there is no doubt whatever that there is unanimity among the professionals and the population about the importance of maintaining that hospital. Is the Minister also concerned that one report that was produced, which was supposedly a clinical report, in fact turned out to be written by the communications department? Is he satisfied that the process has been a fair one and that there has not been a prejudgment in the consultation exercise?
Earl Howe
My Lords, all questions of process must be for my right honourable friend to consider, including that one. I emphasise the Government’s approach to reconfiguration decisions. When the Government came into office, we took a very clear decision about four tests that needed to be applied to any sustainable reconfiguration within the NHS: the changes, whatever they were, had to command support from GP commissioners—that is to say, the clinical community; the public must be engaged in the process; the recommendations must be clinically sustainable and sound; and, as the statement mentioned, they must leave patients with a clear choice of good-quality providers. Those safeguards were not there before, but they are there now and my right honourable friend will be looking at those tests when he considers not just the matter of Lewisham but the totality of the administrator’s recommendations.
Baroness Jolly
My Lords, today it is the South London Healthcare Trust, and there is anxiety abroad that tomorrow it could well be another trust. Can the Minister tell the House how many trusts are in the “at risk” box today and what role is being played by Monitor and others in these cases?
Earl Howe
My Lords, it is important to stress to my noble friend that a trust will be put into special administration only when all other options have been exhausted. I think that the noble Lord, Lord Warner, is aware that that was the situation we faced in this instance. Where possible, NHS providers will be supported to return to sustainability in both the clinical and financial sense. Our priority is to do what is best to ensure that patients receive high-quality care and special administration is a last resort. However, as my noble friend knows, a number of trusts are facing financial challenges. The department is working with Monitor and the NHS Trust Development Authority to oversee the performance of those trusts. I would just say that while some organisations are in difficulties, currently there are absolutely no firm plans to trigger the regime for any other trusts at all.
Baroness Wall of New Barnet
My Lords, I am sure that the noble Earl recognises the experience I have had as chairman of the Barnet and Chase Farm Hospitals NHS Trust, which went through a similar exercise that took many years. First, however, I want to associate myself with the comments made by my noble friend Lord Warner, and I support the action that has been taken. I recognise what my noble friend said about the concerns of the local community, but that will always be the case. However, what is most important is to make the decision and secure the support of outlying hospitals. My own trust is working towards a partnership with the Royal Free Hospital, although we are not there yet. The move could have been considered much earlier, which would have prevented a lot of pain and heartache for many people. My advice and plea is to stick with what is being done. That did not happen for Barnet and Chase Farm. As noble Lords know, a number of holds were put on what we were doing that made things worse for the community and for the staff. They almost ensured that the services we were providing were harder to deliver.
Earl Howe
As ever, I am grateful to the noble Baroness for her perspective from the front line. I think it was with that in mind that the previous Government drew up the legislation which my right honourable friend now has to abide by, in that there is now a very tight timescale of 20 working days for him to take a decision. That is not a long time but it is indicative of the need for urgency in arriving at the right solution. The TSA has done his work and we must now judge whether the recommendations are the right ones.
World Sepsis Declaration
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Baroness Greengross
To ask Her Majesty’s Government whether they intend to support the goals of the World Sepsis Declaration; and what action they are taking to improve knowledge and skills regarding sepsis.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the Government fully recognise the importance of addressing sepsis—a potentially life-threatening condition. We support the overall thrust of the World Sepsis Declaration. We have taken a range of actions to address sepsis, focusing on those interventions directly relevant to England—for example, the training of healthcare professionals in the awareness of sepsis. I commend the Global Sepsis Alliance for its initiative in raising the profile of this serious condition.
Baroness Greengross
I thank the noble Earl for that reply. However, given the problem of even adequate recognition of the problem of sepsis, and to ensure that the desired treatment improvements are fully underpinned by quality standards, can he assure the House that the Government are able to identify where sepsis sits within the NHS Outcomes Framework and the QIPP workstreams?
Earl Howe
Yes, my Lords. The NHS Outcomes Framework is, as the noble Baroness will know, a high-level document intended to drive improvements in the service generally. A condition such as sepsis would be covered in three separate domains of the framework, depending on which aspect of the condition was being considered—for example, safety, most obviously, or quality, or indeed the patient experience. The patient safety aspects are reiterated under Section 5 of the mandate as well, and under this general direction it will be for clinicians to take responsibility for delivering the clinical outcomes.
Lord Walton of Detchant
My Lords, can the Minister tell the House what research the Government are supporting for the development of new and effective antibiotics for the treatment of sepsis? Can he also comment on a recent report from Southampton, which is based on a huge controlled trial of treatment where antibiotics were prescribed for patients with minor respiratory tract infections, and showed that such treatment was of no particular value but inevitably leads to increased bacterial resistance to current antibiotics? What is the Government reaction to that report?
Earl Howe
My Lords, on the research on antibiotics, the noble Lord alights on a real problem. There is a dearth of such research; I am aware of at least one company engaging in it but in view of the increasing prevalence of antibiotic resistance it is a real issue. As the noble Lord will know, there are extensive guidelines to ensure that there is responsible prescribing of antibiotics. I am not aware of the Southampton example which he quotes, although I shall look into it and write to him as appropriate. He may like to know that the department has been developing a five-year antimicrobial resistance strategy—an action plan. It has an integrated approach and builds on a range of initiatives, such as the 2000 UK strategy and the 2011 EU strategic action plan.
Baroness Gardner of Parkes
My Lords, I believe it was the same report from Southampton that said the public have no idea of the difference between sepsis and septicaemia, which of course is a fatal condition if not treated. In view of the success of educating the public on strokes and how effective that has been, does the Minister think that as well as educating professionals there should also be a wider publicity campaign given to the general public to make people aware of the very important differences between these conditions?
Earl Howe
My noble friend makes an important point. Public awareness is a key focus of the Global Sepsis Alliance’s declaration. On raising awareness, the NHS Choices website has extensive information about sepsis, its causes, symptoms and treatment. I do agree, however, that it is important to empower both patients and the public to ensure that everybody is on their guard against this very serious illness.
Baroness Pitkeathley
My Lords, since sepsis accounts for more deaths than bowel, bladder and breast cancer put together and for one-third of all the expenditure on critical care in the NHS, would the Minister agree that early diagnosis is the key here? I declare an interest as someone who recovered from full-body sepsis, thanks to early diagnosis.
Earl Howe
My Lords, I absolutely agree with the noble Baroness. The need to rapidly identify sepsis when it occurs is vital to ensure that unnecessary death is prevented. A crucial measure to tackle sepsis when it appears is early treatment with broad-spectrum antibiotics. My understanding is that once the bacterium has been identified, the treatment of choice is to have a more focused antibiotic, but rapid reaction is of the essence.
Baroness Jolly
My Lords, every year sepsis kills 37,000 people and costs the NHS £2.5 billion. Can my noble friend please tell the House what research programmes are in place across the NHS into care pathways and diagnosis?
Earl Howe
My Lords, the department’s National Institute for Health Research is funding a range of research on sepsis, which includes a study into the clinical and cost-effectiveness of early resuscitation protocols for emerging septic shock. Other examples include a trial of vasopressin versus noradrenaline as initial therapy; a study on how risks associated with nutropenic sepsis are conveyed to and interpreted by patients undergoing chemotherapy; and there is also a very interesting project on a point-of-care test for sepsis.
NHS: Research and Development
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Baroness Gardner of Parkes
To ask Her Majesty’s Government what proportion of funding allocated by the National Health Service for research and development at major teaching hospitals is provided to (1) the researchers themselves, and (2) administrators of funding.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the National Institute for Health Research awards funding transparently and competitively for research of high scientific quality that has relevance to the NHS and represents value for money. We therefore expect that the maximum is spent on research rather than on administrative overheads. Trusts with teaching hospitals received a total of £500 million from the NIHR in 2011-12.
Baroness Gardner of Parkes
I appreciate that funds go directly to the researchers from the body that the Minister mentioned and from the Medical Research Council. What I am concerned about is that I am told by those working, and possibly doing research, in these teaching hospitals that the bulk of the money is paid to the person doing the governance of research and development, and not a penny of that money is actually going to the researchers, who are funded in the way that the Minister has said. Ever since 2006, when that was set up, there has been a great growth of these people doing nothing but checking on the work of the real researchers.
Earl Howe
My Lords, every NHS trust or foundation trust has to oversee the governance of the research taking place within it. That is an inescapable part of the process. I do not think there is any confusion in anyone’s mind between support for research governance and the actual research itself, which is done by academics and clinicians working in academic and clinical departments. It is up to each trust to determine how its budget for research is allocated, but I can reassure my noble friend that the money is getting to where it needs to go.
Lord Winston
My Lords, would the Minister agree that since Sally Davies took charge of how research is done within trusts, there has been a significant improvement in insuring that more of this money actually goes to serious translational research, which is an area that the health service really needs to concentrate on? I hope that the Minister will agree that that job has been done rather effectively.
Earl Howe
I do agree with the noble Lord. Before the creation of the NIHR, research allocations to NHS hospitals were made essentially on a historical basis, with no assessment of quality or value and no ability for the funding to move in response to competition. The NIHR undoubtedly changed all that. The NHS funding for research is now awarded transparently and competitively and robust systems are in place to ensure that it is used only to support research rather than being diverted for other purposes.
Lord Patel
Does the Minister agree that the biomedical research centres established by NIHR funding are more likely to develop and deliver on the Government’s innovation strategy in health science and on the life sciences strategy?
Earl Howe
I agree with the noble Lord. The Government are providing a record £800 million over five years for NIHR biomedical research centres and units as from April of this year. The centres are based within the most outstanding NHS and university partnerships in the country; they are leaders in scientific translation; and they will play an integral part in the life sciences strategy which the Government published last year.
Lord Ribeiro
My Lords, may I declare an interest as a surgeon and say that surgical research attracts less than 2% of the total funding that goes into research? There may be those in this House who feel that surgeons just cut and do not actually do an awful lot of laboratory work, but the truth is that research is an integral part of surgery. We are there to bring translational research from the lab to the patient and to produce results, particularly in the field of cancer. I would therefore be grateful if my noble friend could assure me that there will be much greater emphasis on providing support for surgery?
Earl Howe
I agree with my noble friend about the importance of surgical research. The NIHR funds extensive research in surgery across a wide range of funding streams. The most recent estimate of its spend on directly funded research relating to surgery was £7.3 million, but that is a rather historic figure which goes back to 2009-10. In February this year, the NIHR issued a call for research on the evaluation of technology-driven implanted or implantable medical devices and decisions will be made on that next March. Twenty million pounds has been invested in the NIHR Surgical Reconstruction and Microbiology Research Centre, which is an initiative between my department, the Ministry of Defence, the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham. I hope that my noble friend will agree that that is a positive development.
Lord Davies of Coity
My Lords, the Minister said very clearly in his Answer to the first Question that it was a matter of “value for money”. Is there not a danger that the Government will cost the exercise at the expense of the care that should be had by patients in this country?
Earl Howe
No, my Lords. The very point that I made to the noble Lord, Lord Winston, was that by the creation of the National Institute for Health Research, we were avoiding the very thing which used to happen in the past. Now, we can be quite certain that research money from the NIHR will be used to support research and not be diverted into other places.
Lord Stoneham of Droxford
My Lords, we welcome the greater emphasis that the Government are giving to NHS research and the commitment to the National Institute for Health Research. However, there is an acute shortage of clinical academics who are both medics and front-line researchers. What steps are the Government taking to rectify this situation so that we can get better links between research and patient outcomes?
Earl Howe
I share the concern of my noble friend, although he will be pleased, I am sure, to know that through its integrated academic training programme, the NIHR has taken a lead in reversing the decline that we have seen in recent years in clinical academic careers. Around 250 NIHR academic clinical fellowships and 100 NIHR clinical lectureships are now available annually for medics, which is good news. I also think that intercalated degrees play a very important part in developing the next generation of clinical academics, as does the INSPIRE programme from the Academy of Medical Sciences.
Baroness Masham of Ilton
My Lords, does the Minister agree that some exciting research is being done, such as that which treated a paralysed dachshund with stem cells and enabled it to walk?
Health: Hearing Loss
Earl Howe Excerpts(12 years, 6 months ago)
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Baroness Wilkins
To ask Her Majesty’s Government what plans they have to introduce a screening programme for hearing loss for those over the age of 65.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the United Kingdom National Screening Committee, UKNSC, advises Ministers and the National Health Service in all four United Kingdom countries about all aspects of screening policy. The UKNSC reviewed the evidence for screening for adult hearing loss in 2009 and recommended that there was currently insufficient evidence to warrant a screening programme. In line with its three-yearly review policy, the UKNSC is currently reviewing the evidence for screening for adult hearing loss.
Baroness Wilkins
I thank the Minister for that reply. He will be aware of the huge level of undiagnosed hearing loss in the UK and the impact this can have on other conditions. It is estimated that at least 4 million people who need a hearing aid do not have one. Not only does unaddressed hearing loss increase social isolation and depression, but there is increasing evidence that there is a link to dementia. People with mild hearing loss have nearly double the chance of developing dementia. Given that there is an average 10-year delay between someone identifying that they have a problem and seeking help, will the Government take early action to ensure that hearing loss is addressed early by introducing a screening programme?
Earl Howe
My Lords, the noble Baroness’s comments relating to the features that can often accompany hearing loss, such as depression and other forms of mental illness, are absolutely to the point and I recognise all that she said in that area. The national screening committee had a number of reasons for feeling that a universal screening programme would not be appropriate. First, it was not clear to it what the test should be. Secondly, it was unclear about what agreed time or schedule there should be for doing the testing. Thirdly, it felt that if there were a realistic proposal for screening, there should be randomised trials of screening beforehand. However, it is reviewing its decision of three years ago and we will have to await the results of that.
Baroness Bakewell
My Lords, the Minister referred to the screening authority, which recommends screening for many different ailments. Is he aware that screening notification, which goes out to all eligible citizens, stops at the age of 70 whereas it is necessary to be screened for many of these ailments after 70? Indeed, when you are over 70 you need reminding more often than when you are younger.
Baroness Howe of Idlicote
My Lords, as someone who has had hearing problems since the birth of our children—a hearing loss which is now being considerably worsened by my own ageing process—I know how important it is to persevere with actually using hearing aids, once the right ones have been agreed with a specialist. I very much hope that the national screening committee will agree to my noble friend’s suggestion that there should be a definite age, with a follow-up to the screening. What plans does it have to help those who have hearing aids assessed for them to persevere with the use of those aids, since that is absolutely vital to their well-being in the future?
Earl Howe
The noble Baroness is quite right. Clinicians have found very often that patients who receive hearing aids decide, for one reason or another, not to use them. That is of course very serious; it is a waste of resources but, perhaps more importantly, it is potentially damaging to or indeed dangerous for the patient. Compliance is undoubtedly an issue. In the end, however, nobody can be forced to wear hearing aids but, once again, we believe that there is a role for audiology specialists and general practitioners in encouraging the proper use of hearing aids.
Lord Trefgarne
My Lords, is my noble friend aware that of all the soldiers who went south to the Falkland Islands in 1982, approximately one-third came back with permanent hearing damage? Will he ensure that the arrangements he has described will fully take into account the needs of that group of people?
Lord Collins of Highbury
My Lords, I note what the Minister said in terms of the previous review but we now have an increase in retirement age and people are working longer. Hearing loss is not simply a personal health issue; it also becomes a bigger public health issue and a health and safety issue. Can the Minister therefore better understand the importance of national screening?
Earl Howe
My Lords, the Government fully recognise that hearing loss is not just a health issue. For example, it can lead to isolation and loss of independence; it can impact on education and employment; and it can impact in the various ways mentioned by the noble Baroness, Lady Wilkins, in her earlier question. We believe that health outcomes for people with hearing loss should be among the best in the world. To achieve that it is necessary to think and act differently. Therefore, we are developing a cross-government strategy to maximise the current effort to prevent hearing loss and to support those suffering from it. In particular, that will focus on identifying the potential better to join up services provided by the different agencies.
Lord McColl of Dulwich
We have a generation of deaf people in this country produced by loud noise and music. What about preventing it in the first place?
Baroness Tyler of Enfield
My Lords, given the prevalence of hearing loss among our ageing population, will the Minister say what is being done to ensure that hearing loss is being effectively managed in residential care homes for the elderly? What steps are the Government taking to work with the regulator to ensure that providers are being held accountable for responding to the needs of people with hearing loss?
Earl Howe
My noble friend raises a very important point about care homes. There have been considerable improvements in services for people with hearing loss over recent years. The waiting times for assessment and treatment for hearing problems in adults have been considerably reduced. The health and social care reforms provide opportunities to improve services further. For example, two-thirds of PCT clusters have chosen adult community hearing assessment services as a priority area in which to extend patient choice of provider. We expect that work to continue when CCGs take over.
Health: Active Lifestyles
Earl Howe Excerpts(12 years, 6 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, I congratulate my noble friend on securing this debate, which though brief has been of a very high quality. I found myself agreeing with noble Lords from all sides of the House in many of the things that they were saying so powerfully. We are all aware of the distinguished contribution that my noble friend has made to English sport and helping to raise the profile of women’s participation. That wisdom and experience were amply demonstrated in her opening speech. The timing of the debate, as a number of noble Lords have said, is very appropriate following our extraordinary summer of sport.
Many of us would agree with the noble Baroness, Lady Massey, that we should be moving more as part of a healthy lifestyle—indeed, many noble Lords have spoken eloquently about the benefits of regular exercise—and commentators have started to argue that as a nation we are suffering from a physical activity deficit. Regular physical activity helps to prevent and manage over 20 chronic conditions. The noble Baroness, Lady Massey, was right to remind us of that as did the noble Baroness, Lady Billingham. Conditions include coronary heart disease, stroke, type 2 diabetes, cancer, obesity, mental health problems and muscular-skeletal conditions. The strength of the relationship between physical activity and health outcomes persists across the life course and highlights the potential health gains that could be achieved if individuals can be supported to become more active. Inactivity, on the other hand, is associated with coronary heart disease, breast and colon cancer, and diabetes. It is been estimated to lead to 9% of early deaths globally. It is a silent killer. Less well understood are the risks of sedentary behaviour—sitting for long periods and excessive screen time—which would appear to be independent of how much exercise we do.
My noble friend Lord Addington asked whether the Government were intent on making exercise and sport part of a lifestyle. In July of last year the chief medical officers of the four home countries published Start Active, Stay Active, setting out new guidelines for physical activity. For adults, the new recommendation for at least 150 minutes of physical activity spread across the week replaces the old “five times thirty minutes” message. Importantly, the guidelines address the whole life course from early years to older people and include advice on avoiding sedentary behaviour. Providing expert-led advice to individuals in this way to inform their own lifestyle choices lies at the heart of this Government’s approach to health promotion, one that provides information and enables choice without nannying or hectoring.
As I will set out in a moment, much is being done to encourage people to play sport and exercise more. However, the sad fact is that most of us are insufficiently active. In England, six out of 10 men and seven out of 10 women do less than the CMO guidelines. For children, the guidelines recommend at least 60 minutes of activity daily, but again participation levels are low, with less than a third of youngsters getting enough exercise. In the face of these statistics, we have established a national ambition for physical activity for a year on year increase in the number of adults doing 150 minutes of exercise per week and a similar reduction in those who are “inactive”. This represents what could be achieved if all sectors work together, supported by the new delivery system for public health. The ambition is reflected in the public health outcomes framework indicator for physical activity.
The London Olympic and Paralympics Games this summer have provided us with a once in a lifetime opportunity to address the “activity deficit”. Much has been put in place in the run up to the games to deliver a sport and physical activity legacy. For example, Sport England is investing £150 million into grassroots sport through the “Places, People, Play” programme. Following on from the Games we are determined to raise the proportion of young people playing sport at least once a week through the youth and community sport strategy. Indeed, increasing access to and participation in sport is one of the key themes of the Government’s ongoing legacy plans.
The focus of this debate is about raising awareness of the importance of an active lifestyle. During the summer, the Department of Health ran a highly successful Games4Life campaign, which built on the success of the 2011 really big summer adventure campaign and targeted children, their families and adults. The central theme of Games4Life was for families to get up off the couch and join in the summer of sport. A quarter of a million people received personalised activity plans as a result of the campaign and 88,000 signed up to receive Games4Life follow up e-mails. Alongside Change4Life, NHS Choices offers a great deal of extra information for those who want to learn more about activity. A cornerstone of Change4Life is partnership. The public health responsibility deal physical activity network also takes a partnership approach to engage a range of organisations in the promotion of physical activity to employees, consumers and communities.
My noble friend Lord Addington spoke powerfully about the need to encourage the young into sport. Change4Life recognises that healthy behaviours are forged in the young and we make no apologies for placing children and young people at the centre of our plans for driving up sports participation. The School Games represent a major legacy commitment, creating the opportunity for every school and every child to play competitive sport all year round. Over 15,000 schools have registered to be part of the games, with a reach of around 4 million pupils. We are also working with the Youth Sport Trust to deliver Change4Life sports clubs in schools. These are targeted towards children and young people who are at risk of dropping out of sport and have already seen a 166% increase in participation by those youngsters. All this should of course be seen in the context of our support for PE and school sport and the wider youth sport strategy.
My noble friend prompts me to mention that central to our ambition and commitment to have a lasting legacy from the Olympics is our determination to put competitive sport firmly on the agenda in all schools. Competitive team and individual sports will be at the heart of the programme of study. In addition, through the School Games, we will make sure that a range of competitive sporting opportunities are in place for all schools that sign up to be a part of the Olympic aspiration to “inspire a generation”. My own department remains committed to this agenda for all youngsters, irrespective of ability.
The noble Baroness, Lady Massey, indicated that changes to the school curriculum might remove opportunities for young people. We are aware that some pupils would prefer to take part in non-competitive activities such as dance. We are supportive of that wish. However, our aim is that all pupils, regardless of ability, should have the opportunity to experience both individual and team-based competitive sports. The Change4Life sports clubs in schools are targeted at the least active children, and the independent evaluation has shown that they are particularly effective at engaging girls, which is very positive.
Incidentally, the noble Baroness, Lady Billingham, mentioned my right honourable friend Mr Gove’s policies, in particular what she described as his decision to scrap two hours of compulsory PE. This issue has been subject to frequent misunderstanding. The previous Government’s targets for physical education were wholly aspirational and could not be enforced. The law specifically prevents the Secretary of State for Education dictating to schools how much time they should devote to PE or, indeed, to any other national curriculum subject. That is for schools to decide. PE will remain a compulsory subject at all four key stages following the review of the national curriculum. I believe that is positive.
The Government’s youth sport strategy is intended to encourage everyone, but particularly young people, to take up sport and develop a sporting habit for life. This will deliver at least 6,000 partnerships between schools and local sports clubs, an additional £160 million on new and upgraded sports facilities and £250 million for communities, including our work with county sports partnerships and local authorities.
I have spoken a great deal about sport, but my noble friend Lady Byford has reminded me to mention that the Department for Transport and my own department are working across government to give a strong boost to walking and cycling for travel purposes. Most recently, the Chancellor’s Autumn Statement included an additional £42 million investment in the sustainable transport fund for cycling infrastructure, including cycling safety.
Healthcare professionals are in a unique position to encourage their patients to exercise as part of a healthy lifestyle. As early as 2006, NICE advised that brief advice in primary care was a cost-effective way of promoting physical activity. “Let’s Get Moving” is one way for GPs to build on this guidance.
My noble friend Lady Byford invited me to say a little about the Government’s investment of £30 million to develop the new National Centre of Excellence for Sport and Exercise Medicine. The national centre will build on research into sport science and current expertise to translate this knowledge into benefits for patients and to enable more people to be more active. The primary role of the centre is to provide the best possible evidence base for sport and exercise health for our elite athletes, but also for the general population, particularly those with chronic, long-term conditions, which can be improved by exercise, safely supervised. The £30 million funding that we have made available will allow researchers to work alongside clinicians to quickly translate research into clinical practice. I hope that that will be music to the ears of my noble friend Lord Addington as well.
I am receiving strong messages that my time is nearly up. I have, however, one minute left and I would like to turn to some of the excellent questions posed by my noble friend Lady Heyhoe Flint. In response to her comments on Start Active, Stay Active, I think it is fair to say that there remains a disappointing lack of awareness of the UK physical activity guidelines among health professionals. We are committed to the dissemination of the messages contained in Start Active, Stay Active, both to the public and to doctors. For example, this summer’s Games4Life campaign included summaries of the guidelines in personal activity plans provided to families. My noble friends referred to specific funding streams to help disabled people take up sport. These are only part of the bigger, long-term approach being taken by Sport England in its youth and community sports strategy. Forty national governing bodies of sport have presented plans to make sport a practical choice for disabled people as part of the wider whole-sport plan investment programme, which is funded and overseen by Sport England.
I turn to the teaching of PE and swimming in primary schools. Initial teacher training should prepare newly qualified primary teachers to teach the full range of curriculum subjects to the required standard. This would include the national curriculum for PE, which currently requires all pupils to be capable of swimming 25 metres unaided by the end of key stage 2. Ofsted will inspect swimming, as well as PE and sport, if it is one of the lessons encountered during the inspection.
With the leave of the House, I will continue for another minute or so, as there is theoretically time in hand. With regard to the Government’s plans for 4,000 secondary schools to host a link with a community sports club, which I have already mentioned, I can confirm that progress in this huge undertaking has been very promising. There are currently 380 satellite clubs already up and running, and this will increase to 700 by March 2013. We are monitoring delivery very closely to ensure that we maintain progress throughout the lifetime of the strategy.
My noble friend asked what would replace the Cabinet sub-committee on public health. Public health issues will now be brought into the broader domestic policy committees rather than sitting with a separate sub-committee. This will allow public health issues to be discussed and decisions to be taken by a wider group of senior Ministers across government.
The noble Baroness, Lady Massey, asked me about women in sport. Sport England continues to fund the Women’s Sport and Fitness Foundation, which campaigns to make physical activity an everyday part of life for every woman and girl.
The noble Baroness, Lady Billingham, rightly drew attention to the public health problem of obesity. She will, I am sure, recall that our call to action on obesity in England, published in October last year, sets out how obesity will be tackled in the new public health and NHS system. Clear ambitions are set out in that strategy, which bear on much of the debate this evening.
I have tried to demonstrate how we are using the London Games as a springboard to raise everyone’s awareness of the importance of exercise for health—in short, how we can turn a winning summer into an active future.
NHS: Clinical Networks
Earl Howe Excerpts(12 years, 7 months ago)
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Baroness Thornton
To ask Her Majesty’s Government how they will address any shortfall in the funding of clinical networks.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, national funding for clinical networks has been maintained at £33.6 million since 2009. Forty-two million pounds has been allocated by the NHS Commissioning Board to support strategic clinical networks and clinical senates in 2013-14. It is for local health communities and the board to determine the number and size of networks, based on patient flows and clinical relationships, and to deploy their resources appropriately.
Baroness Thornton
I thank the Minister for that Answer. His boss, the Secretary of State, is on the record as saying that clinical networks funding is increasing and will continue, yet on Monday a freedom of information survey revealed severe cuts to budgets and staff in clinical networks, so I wonder who is right. Cancer networks are cut by 26% and stroke and cardiac by 12% in the same period—2009-13—with the loss of hundreds of experienced and motivated staff. Do the figures that the Minister has given to me also cover clinical senates? Will those cuts be restored? What incentives are the Government putting in place to ensure that local health organisations contribute to the additional funding of cancer networks? Indeed, how will the local diabetes networks be supported in the new commissioning regime? We know that these networks work.
Earl Howe
My Lords, I agree with the noble Baroness’s last comment. These networks are extremely valuable. I confirm that the figure I gave her in my Answer of £42 million covers clinical senates as well. It is perfectly correct that the share of the pot which cancer networks will be able to avail of is likely to be smaller next year than it is this year. However, I can categorically confirm that, as I said in my Answer, national funding has not been cut to date and is going up next year very considerably. Furthermore, we should recognise that the Commissioning Board’s announcement amounts to a ringing endorsement of the value of networks in improving patient outcomes. Not only will funding be increased but for the first time there will be nationally supported networks for mental health, dementia and neurological conditions as well as maternity and children’s services. I say to the noble Baroness that recruitment to the networks is proceeding very smoothly and encouragingly.
Lord Sharkey
My Lords, I declare an interest as a lay member of a cancer network lung cancer group. I know the Minister is aware that our survival scores for lung cancer need improvement and that early diagnosis is the key to that improvement. In the light of that, what steps are being taken to make absolutely certain that any reduction in the number, staff or funding of cancer networks does not damage the efforts to improve early diagnosis?
Earl Howe
My Lords, I am grateful to my noble friend. As regards cancer, it is important to look at what the Government are doing across the piece. As the noble Lord may recall, the cancer strategy that we published a while ago is backed by more than £450 million of investment. This is specifically to target earlier diagnosis of cancer; to give GPs increased access to diagnostic tests; to allow for the increased testing and treatment costs in secondary care; to support campaigns; and so on. That is a large sum of money and it is committed.
Lord Kakkar
Does the Minister envisage a role for the to-be-designated academic health science networks in delivering clinical networks in the future? I declare my interest as chair for quality, University College London Partners academic health science partnership.
Earl Howe
My Lords, yes. National guidance is being produced by the NHS Commissioning Board, setting out the different areas of focus for academic health science networks, health and well-being boards, local education and training bodies and clinical senates. The defined geographies of the 12 network support teams have been developed precisely to gain close alignment and therefore promote close relationships and co-operation with the other structures in the new system—including academic health science networks.
Baroness Masham of Ilton
My Lords, how are clinical network members recruited? Are they advertised?
The Countess of Mar
My Lords, the people with CFSME were greatly heartened in 2008 when the Chief Medical Officer ring-fenced £8 million to set up clinical networks on their behalf. They have become disillusioned as the funding of these networks has gradually been cut. There is also no provision for children in the clinical networks. What priority is given to CFSME?
Earl Howe
My Lords, strategic clinical networks are only one category of network in the new system. There is nothing to stop professional groups coming together to share best practice and support professional development. In addition, clinical commissioning groups may well wish to establish networks to support local priorities and ways of working; and providers may use a network model to enable the joint delivery of a service, such as pathology. The noble Baroness, Lady Thornton, rightly referred to the extent to which local providers and commissioners already support strategic clinical networks. So there is a variety of ways of doing this.
Lord Patel
Does the Minister recognise that reducing funding for cancer networks will lead to a reduction in staff and therefore a reduction in the effectiveness of cancer networks?
Earl Howe
My Lords, Professor Sir Mike Richards, the national cancer director, said the other day:
“Although cancer networks will have a smaller proportion of the budget in the future, there are still backroom efficiencies that can be made to make things work more effectively. Increasing the footprint of each network will make them more cost-efficient”.
I have spoken to him personally and he is confident that the available budget can still be used to ensure that there is at least equal cost-effectiveness of networks.
Nursing Quality and Compassion: The Future of Nursing Education
Earl Howe Excerpts(12 years, 7 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the noble Baroness, Lady Emerton, has been a tireless champion of the values and standards that underpin good nursing. This debate, on which I congratulate her, is therefore no surprise. Listening to her excellent speech reminds us once again of her long-standing expertise and wisdom in the field of nurse education and the regulation of the nursing profession.
My noble friend Lord Willis published his very comprehensive and helpful report into the future of nurse education in November. The report was the result of deliberations by his independent commission, which was established by the Royal College of Nursing under his consummate chairmanship. On publication, the report was handed to the chair of the RCN for her consideration. It was not a report to the Government and we will therefore not be formally responding to it. However, I recognise that its 29 wide-ranging recommendations are important and, as this debate has shown, need to be given due weight and consideration by leaders of the nursing profession.
As part of government changes, a new Secretary of State for Health was appointed this year. He has clearly stated that he has four priorities for his term in office: to improve the general quality of care, including nursing care; to rise to the challenge of caring for people with dementia; to improve the management of long-term conditions; and to reduce avoidable deaths from the major diseases. These priorities, importantly, impact on nursing care and nurse education and come as national nursing leaders have also changed significantly during the year. As part of the Health and Social Care Act, which passed through your Lordships’ House earlier this year, the NHS Commissioning Board was established, alongside the separate creation of Health Education England, both of which have prominent nurse leaders.
The noble Baroness, Lady Emerton, asked for some assurance that these bodies will take full account of the Willis report. Jane Cummings has been appointed chief nursing officer for England on the NHS Commissioning Board and Lisa Bayliss-Pratt is director of nursing for Health Education England. Both have significant leadership roles in the education and training of nurses, and I can tell the noble Baroness that they are looking at the Willis report in detail. Health Education England takes over the Secretary of State’s duties for ensuring an education and training system fit for purpose, and the chief nursing officer for England and the director of nursing for Health Education England will collaborate very closely in that regard.
My noble friend Lady Cumberlege asked what would make the report really live. It has a high degree of resonance across the profession already, with nurse leaders in the vanguard who will help ensure that it does not gather dust. Earlier this month, Compassion in Practice, a vision and strategy for nurses, midwives and care staff in the NHS, public health and social care, was published jointly by the chief nursing officer and the director of nursing in the Department of Health and lead nurse for Public Health England, Viv Bennett. Compassion in Practice articulates the values and behaviours expected of nurses, midwives and care staff. These values and behaviours are expressed as the “six Cs” of care, compassion, competence, communication, courage and commitment, each of which resonates with findings and recommendations of the Willis report.
This is not a vision without action. One area for specific action will be to ensure that the NHS, public health and social care services have the right staff with the right skills in the right place. This means that staff will be recruited for their values and behaviours as well as their capability to be lifelong learners. This point was made by a number of noble Lords. Importantly, the Willis report recognises how demanding and rewarding the practice of nursing is. It states very clearly that it found no evidence that revealed any major shortcomings in nursing education that could be held directly responsible for poor practice or the perceived decline in standards of care.
My noble friend and his commission are unequivocally supportive of degree-level registration for new nurses. This commitment by the Nursing and Midwifery Council will be fully implemented by September 2013. I am aware that the noble Baroness, Lady Emerton, too, is fully supportive of that. When it comes to achieving this change to nurse education, my noble friend Lord Willis rightly emphasised that educating nurses is a partnership between the NHS and universities. The noble Lord, Lord Hunt, was right to emphasise that. Student nurses cannot qualify and register if they have not satisfied both the university and, in practice settings, their NHS mentors, who formally assess them for their practical skills and knowledge as well as for their values, behaviours and ability to give care with compassion.
The compulsory state regulation of currently unregulated health and social care support workers in England is a topic that has arisen throughout the debate. It is a live issue in the nursing profession. We recognise the need to drive up standards among health and social care support workers, and have commissioned Skills for Health and Skills for Care to develop a code of conduct and national minimum training standards by January 2013. In addition, the Professional Standards Authority will have powers to accredit voluntary registers from this month. The Skills for Health and Skills for Care work will, for the first time, set clear national expectations about standards for these workers.
Health and social care assistants already work in environments that are subject to regulation by the Care Quality Commission. The Independent Safeguarding Authority can take action to bar them from working in regulated activity. Further, the work they do should be delegated to them and managed by staff—usually nurses—who are themselves subject to professional regulation and should not be asked to undertake a task for which they are not trained. The care given by health and social care support workers is at the heart of NHS-funded services. We plan to keep this under review in the light of the findings and recommendations in particular of the Francis inquiry, which is due to be published in the new year, to ensure that the system and process remain fit for purpose. I will repeat what I said yesterday at the Dispatch Box. The Government’s mind is open but we need to ensure that there is a good, evidence-based case before proceeding with mandatory regulation.
The noble Baroness, Lady Emerton, asked whether there had been a more recent cost analysis than the 2009 data of registering healthcare support workers. The answer is, not to my knowledge. Clearly, the cost of regulating 1.8 million health and social care support workers would be significant, but the basis of our decision not to regulate was not cost. Those who advocate regulation of support workers sometimes speak as if regulation were a panacea. I do not believe it is in any way a substitute for performance management. The duties of a support worker are always delegated from a responsible registrant, usually a nurse, as I have mentioned, and that fact could not, and should not, change.
If the concern is that we are somehow exposing patients to unacceptable risk by not regulating, then again, I do not think the assumption underlying that suggestion—that regulation would be the answer—is valid. It implies that support workers are inherently dangerous, which I do not accept at all. If a support worker were to be seen as a danger then, as I have mentioned, the Independent Safeguarding Authority has a vetting and barring scheme which can prevent unsuitable support workers being employed.
My noble friend Lord Willis asked about research as part of a nursing degree. I absolutely agree with what he said in that regard. It is already, in fact. Nurses, as undergraduate nurses, will be able to critically appraise research. Some will wish to become researchers and there are nationally funded clinical academic training schemes to support this.
A number of noble Lords, including the noble Lords, Lord Hunt and Lord MacKenzie, spoke about nurse education. Planning the number of nurses and the size and shape of the workforce has to be based on the needs of the people in our care. Services must be properly designed around the care and treatment that people need and these decisions could result in the need for nursing numbers to change, and very often they do.
At present, SHAs work with local employers to determine nurse training commissions. From April next year, Health Education England assumes national leadership for a new system of planning and developing the entire healthcare and public health workforce. HEE will ensure that the shape and skills of the future health and public health workforce evolve to sustain high-quality health outcomes in the face of demographic and technological change.
From 2013 all nurse education programmes will need to meet the new education standards set by the NMC and we support the NMC’s decision, as I have mentioned. It is the right direction of travel if we are to make all nursing degree level and if we are to fulfil our ambition to provide high-quality care for all.
Time is against me, so I will endeavour to cover just a few more questions but I will write to noble Lords with answers to other points.
The noble Lord, Lord Kakkar, asked me about preceptorship and I listened to his remarks with interest. Preceptorship is a development framework for newly qualified practitioners which, as he outlined, aims to ensure the smooth transition from student to qualified, accountable practitioner through a programme of bespoke support. It is predominantly administered through employment. We plan to develop the preceptorship framework further during 2012-13 within a clinical leadership framework. Work has commenced on that project and should be delivered by next April.
The noble Lord asked about deans of nursing schools signing off candidates after a period of preceptorship. That is an interesting idea which I do not believe has been fully discussed across the profession. I will ask officials to test the proposal with the Nursing and Midwifery Council and the Council of Deans of Health.
Will we support schemes for the fast-tracking of nurse leaders? That idea is most definitely supported and we have committed to £40 million in 2013-15 for leadership development that will assist aspiring and talented nurse leaders. Unfortunately, time prevents me from expanding on that, which I would like to have done.
The noble Lord, Lord Hunt, asked about monitoring standards of care by students. It is right that nurse education is a partnership between the NHS and universities, as I have mentioned, and it is true that the NHS must be more involved with the selection of students. Health Education England will work on that.
I think my time is now up. I thank noble Lords for a very rich and rewarding debate which, as I have mentioned, I will follow up in writing to all noble Lords who have spoken.