Health: Mental Health Strategy

Earl Howe Excerpts

Monday 14th February 2011 Lords Chamber

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

My Lords, it is always instructive and never less than a pleasure to listen to the noble Baroness, Lady Murphy, on the subject of mental health. Mental illness and its consequences affect us all, directly or indirectly. We know that one in four of us will experience mental ill health over our lifetime, and that one in six of us has a common mental illness at any one time. Underlying this is the overall financial cost of mental health which, as noble Lords have pointed out, is staggering—an estimated £105 billion a year to the economy as a whole—and the costs of treatment alone are expected to double in the next 20 years.

This is why we launched our mental health strategy, No Health without Mental Health, on 2 February. To support it we are making around £400 million available for expanding talking therapies through the improving access to psychological therapies programme. This will build up the essential skills base of the NHS and mean that we can start offering talking therapies across a wider range of mental illness and to a broader range of people. I was grateful for the supportive remarks of my noble friend Lord Alderdice in this context.

The noble Earl, Lord Listowel, was right to stress that early intervention is essential. We know that half of those with lifetime mental health problems first experience symptoms before the age of 14. That would be part of my answer to the noble Baroness, Lady Murphy, who voiced disquiet that by focusing on the mental well-being of the nation we were doing so at the expense of those with very serious mental illness. We know that early intervention is important. Also, 25 per cent of older people have symptoms of depression. Those are good reasons why this strategy encompasses the whole population. The strategy acknowledges the dimensions of the problem by covering the full age range of society.

It also makes clear an expectation of parity of esteem between mental and physical health services. Improved mental health and well-being is associated with a range of benefits, from improved physical health and life expectancy to better educational achievement and reduced health risk behaviours. The prerequisite for achieving this is to build the awareness and understanding of mental illness and mental well-being across society. We also need to tackle stigma and discrimination, and we have put this at the heart of the strategy.

Yet to shift public attitudes substantially requires a major and sustained social movement. Already Comic Relief, the Big Lottery Fund and the major anti-stigma campaign, Time to Change, which is led by Mind and Rethink, aim to inspire people to work together to end the discrimination surrounding mental health. We know from discussions with voluntary and private sector organisations that there is an appetite for an even more ambitious programme. We will give this social movement our full support and active participation.

I should make it clear that mental health is a priority across government; this is very much a cross-government strategy. Of course it is easy to set out principles but the big question is how do we make it happen, especially at a time of financial challenge. A number of noble Lords have asked that pertinent question. The ingredients for success will be leadership and collaboration across the country, drawing on the skills and insights of clinicians and partner organisations and involving service users as much as possible to shape services in line with local needs.

The new NHS architecture will provide a clear opportunity to support mental health and drive improvements in care. The three outcomes frameworks—for the NHS, public health and social care—will entrench mental health needs in service priorities and provide clearer accountability for results. At the centre will be Public Health England, which will build up the evidence and expertise around mental health interventions.

Finally, at local level we have GP consortia, driving up standards by bringing resource management together with clinical management for the first time. There is undoubtedly a need to build up the skills and awareness among GPs and we are working with the Royal College of General Practitioners to do so. I do not in the least quarrel with the noble Baroness, Lady Murphy, on that point. However, there are already many GPs with a real interest and expertise in mental health issues. Good commissioning of services must involve collaboration, so that GPs and mental health professionals communicate with and—above all, perhaps—understand one another. Again, I hope that the strategy can be a catalyst for these conversations to take place.

The noble Lord, Lord Touhig, expressed his doubts about the ability of consortia to commission mental health services, as did my noble friend Lady Barker and the noble Baroness, Lady Thornton. The intention is that commissioning GP clusters will commission most mental health services in the same way as they commission other services. However, they will not be doing this on their own; they will do so in line with guidance from both NICE and the NHS commissioning board. I say in particular to my noble friend Lady Barker that we are indeed working with the Royal College of General Practitioners, the Royal College of Psychiatrists, the Association of Directors of Adult Social Services and the NHS Confederation to develop guidance and support for GP consortia in commissioning effective mental health services. In addition, there will be opportunities for third sector and for-profit organisations to provide specialist commissioning advice on mental health to GP consortia.

My noble friend Lord Newton asked what mechanisms will be in place to see all this through. First, the Cabinet sub-committee on public health will oversee the implementation of the strategy. Secondly, we will establish an advisory group for mental health, composed of key stakeholders such as service users and those who care for them. This advisory group will work in partnership in realising the improvement of mental health outcomes for people of all ages. Between 2011 and 2012, the advisory board will identify actions in the transitional year to deliver the mental health strategy. Thereafter, and once the NHS commissioning board and Public Health England have been created, the board will become a focus for all stakeholders to discuss the details of how implementation of the strategy will take place and review progress. The board will advise on improved indicators for tracking progress against the mental health objectives that could be used locally, by the NHS commissioning board and potentially in future iterations of outcomes frameworks. Plans for the all-important structures that need to be there for implementation of the strategy to be successful are already in place.

My noble friend Lord Newton, the noble Lord, Lord Patel of Bradford, and the noble Baroness, Lady Thornton, expressed fears that the £400 million is not strictly speaking ring-fenced and therefore might not be protected. The answer to that is that the NHS operating framework mandates an annual expansion of IAPT services in line with our commitment. PCTs are currently drawing up their plans for next year to implement the operating framework. The plans that we have seen so far are consistent with the Government’s commitments to expand talking therapies. We will hold strategic health authorities to account for managing their delivery. Additionally, we are in the process of making sure that, through a range of communications, PCTs, managers and commissioners are aware of the importance of IAPT and the mental health strategy generally.

Lest there be any doubt, I should say that the £400 million is additional money. It was announced with the publication of the cross-government mental health strategy and is part of the 2010 spending review settlement for the department. It is in addition to the £173 million announced in the spending review in 2007, which is in primary care trust baselines for April 2011.

A number of noble Lords, in particular the noble Lord, Lord Layard, referred to funding cuts that are in prospect. I just say to the noble Lord that, as I am sure he knows, the NHS budget as a whole is protected; it is not going to be cut. I have already referred to the NHS operating framework as a mechanism to ensure that these plans are delivered. Of course, mental health services cannot be exempt from the need to make efficiencies, but any efficiencies made must be based on robust evidence and, more importantly, mental health services must be given parity of esteem with physical health services. That is the answer to one question posed to me—when decisions are made on how to save money. The mental health strategy points to ways in which efficiencies can be made while also improving quality through the programme.

My noble friend Lord Alderdice referred to the lack of focus on suicide and self-harm. We will be publishing a separate suicide prevention strategy soon.

The noble Lord, Lord Patel of Bradford, spoke powerfully about black and minority ethnic issues. On the question of Count Me In, the Care Quality Commission expects to publish the census report in April this year. Incidentally, the census was never intended to continue indefinitely; the mental health minimum data set has the potential to be an even better way in which to monitor what is happening. I understand that the data are to be collected quarterly rather than annually. The noble Lord also asked me whether GP consortia would be subject to the Equality Act, and the answer is yes.

The noble Earl, Lord Listowel, focused in particular on services for young people. One of the first things that we need to do is to develop agreement on the nature of the requirements for psychological therapies in children’s services and the best way in which to meet them. Officials have already held preparatory meetings to do this, and we are in the process of setting up a team to take this forward. It is very important that we get consensus on the way ahead, because we cannot simply use adult psychological therapies programmes as a one-size-fits-all template. The Government have increased the funding available for CAMHS to give an even greater flexibility to those at a local level, investing funds to expand access to psychological therapies for children and young people. That will enable the development and initiation of a stand-alone programme to extend access to psychological therapies, building on learning from the IAPT programme.

The noble Baroness, Lady Greengross, referred to the other end of the age spectrum and older people, and suggested that the strategy does not say quite enough about that dimension of the issue. The mental health strategy talks about the problem of depression among older people and recognises that only one out of six older people with depression discusses their symptoms with their GP. It sets out the importance of early intervention, such as befriending programmes, which can be very helpful in tackling the social isolation associated with depression. In the public health operating framework, we are consulting on indicators that are very relevant to older people’s mental health. The mental health strategy also sets out the importance of ensuring that psychological therapies are accessible to older people as the programme rolls out nationally.

My noble friend Lady Barker referred to community treatment orders. Our view is that they are potentially useful, but we need to be certain, as she rightly said, that they are being used properly in patients’ interests and do not undermine confidence in the Mental Health Act. She was right that the coalition parties expressed doubts about CTOs when we were in opposition. We intend to keep the use of these orders under review, and I would be happy to write to her with further details on that.

The noble Baroness, Lady Hollins, referred to research. The Department of Health, through the National Institute for Health Research and the Policy Research Programme, has invested significantly in mental health research and will continue to support high-quality mental health research. The NIHR will also continue to work with research councils and other funders to co-ordinate research efforts consistent with the recently published MRC review of mental health research. We are increasing spending on health research in real terms over the next four years.

The noble Baroness, Lady Thornton, referred to the closure of the National Mental Health Development Unit. We are clear that at a time when the NHS budget is under pressure, we need to find efficiencies so that we can invest in front-line services. We are working with the Royal College of General Practitioners and the Royal College of Psychiatrists to produce robust guidance for GP commissioners, as I have already mentioned.

I firmly believe that this strategy represents an unprecedented opportunity to improve support, to prevent illness and to make mental health issues a more accepted part of everyday society and everyday life. We intend to put every possible effort into making that happen.

House adjourned at 7.30 pm.

Health: Multiple Sclerosis

Earl Howe Excerpts

Wednesday 2nd February 2011 Lords Chamber

[Lord Walton of Detchant]

To ask Her Majesty’s Government what steps they are taking to increase the proportion of multiple sclerosis patients who receive disease-modifying drugs.

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

My Lords, patients with multiple sclerosis can receive treatment with a number of disease-modifying drugs where their clinicians consider they will benefit. More than 12,000 have benefitted from such drugs through the risk-sharing scheme established in 2002. In addition, another drug, Tysabri, has subsequently been licensed for use in the NHS and recommended by the National Institute for Health and Clinical Excellence.

[Lord Walton of Detchant]

My Lords, I thank the noble Earl for that Answer. As he made clear, following the introduction of interferons in the past 20 years, a number of effective drugs have been introduced and have been shown by research to have a beneficial effect upon the course of the disease, particularly in the relapsing and remitting form of the condition. However, is he aware that in the UK only 12 per cent of patients with multiple sclerosis are at present receiving these drugs? A recent report from the Department of Health shows that, in that respect, this country stands 13th out of 14 comparator countries. Surely we can do better.

--- Later in debate ---

[Earl Howe]

My Lords, the noble Lord, with his extensive knowledge of neurology, is perhaps the best person in this House to inform us on this subject. He is of course right—and there is considerable comment on the fact—that, particularly as regards the new drug Tysabri that I mentioned, the uptake has been lower than was perhaps expected. Professor Sir Mike Richards’ report on the extent and causes of international variations in drug usage outlines that low use of Tysabri in the UK could be the result of caution and/or scepticism among some neurologists about the benefits of the drug, particularly as regards its side-effects. However, the precise causes of the variations are a matter of speculation.

[Lord Hylton]

Does the noble Earl know—I expect that he does—that there is a treatment which extracts the stem cells from the patient’s blood and reinjects them in crucial spots? This treatment is available in Baghdad, Beirut and Kurdistan. Will the Government make it available in this country, for the benefit of multiple sclerosis sufferers?

[Earl Howe]

My Lords, I have extensive briefing on some upcoming and promising treatments that may or may not emerge in the National Health Service, but I have to say that that is not one of them. I shall go away and ask the department to inform me.

[Lord Winston]

My Lords, in addition to the important point made by the noble Lord, Lord Walton, about drugs that should be available under the National Health Service, is the Minister aware that some years ago a Select Committee for Science and Technology inquiry gave clear evidence that, in small doses, cannabis is of great benefit to some patients who have spasms and other problems with multiple sclerosis? Do the Government have any plans to allow the use of that drug in those circumstances?

[Earl Howe]

My Lords, the noble Lord will know that a drug called Sativex was recently licensed, which is derived from an extract of cannabis, as he will be aware. Having said that, I believe that NICE has issued no guidance to the NHS on the use of Sativex, so it is for local primary care trusts to make funding decisions based on an assessment of the available evidence and on the basis of the patient’s individual circumstances. As the noble Lord rightly said, Sativex treats the symptoms of severe spasticity caused by MS and is not a disease-modifying drug as such.

[Baroness Gardner of Parkes]

My Lords, I declare an interest as I have a daughter who has had multiple sclerosis for 30 years. For the past 13 years, she has been on beta interferon, which has been of great benefit to her. I understand from the press that there is a possibility of oral drugs rather than weekly injections in the future. Can the Minister tell us what stage that is at? I understand that the issue is still being considered by NICE as it is in the early stages. What progress is being made?

[Earl Howe]

My noble friend is absolutely right. There are two drugs, Cladribin and Fingolimod, which are oral treatments but they have not yet received licences. The trial results for Fingolimod are promising, but it is premature to say that the treatment will remove the need for the drugs in the risk-sharing scheme. Clearly, oral treatments are likely to have advantages over alternative treatments given by injection or infusion, but some concern has been expressed about possible side-effects and the likely cost to the NHS.

[Lord Dubs]

My Lords, does the Minister agree that many patients who are on those drugs also need the support of MS nurses, of which there are very few? Indeed, in some parts of the country there are none at all. What can be done about that?

[Earl Howe]

In recent years the number of specialist MS nurses has increased—I understand that the number has almost doubled—partly as a result of the risk-sharing scheme introduced in 2002. However, we hear anecdotal reports that the numbers are dwindling, which is a matter of concern. Under the new NHS architecture, which will be characterised by clinically-led commissioning responding to the health needs of the local area, we will see that the workforce planning that will emerge will lead to the training of more of these specialist nurses.

[Baroness Finlay of Llandaff]

During the current transition phase of the NHS as we move towards the new arrangements, what appeal mechanisms are there for patients who wish to be considered for disease-modifying drugs to be referred for neurological assessment where their general practitioner is not doing so or where they cannot find out who is the person to approve payment?

[Earl Howe]

My Lords, at the moment, the appeal process is to the primary care trust. Under the Government's proposals, the appeal will be, in the first instance, to the GP-led consortium and, thereafter, if appropriate, to the NHS commissioning board.

[Baroness Jolly]

My Lords, medication is clearly critical for patients with MS, but a whole range of aids are also available. How does my noble friend think that those aids might be more readily available under the new, reformed NHS?

[Earl Howe]

Again, my Lords, the requirement for aids will emerge from two driving processes: one will be the clinically led commissioning process and the other will be patient-led groups. Neurological Commissioning Support is already driving forward an extremely coherent and up-to-the-minute commissioning pattern of pathways for the emerging GP consortia. Patient power will have a big influence as well.

Human Fertilisation and Embryology Authority/Human Tissue Authority

Earl Howe Excerpts

Tuesday 1st February 2011 Grand Committee

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

I start by expressing my thanks to the noble Baroness, Lady Thornton, for tabling this debate, and to all speakers for raising their concerns on this very important set of issues. Let me say immediately that the need to maintain public confidence in every part of the NHS is absolutely vital, particularly in areas as delicate as embryology and human tissue.

I can offer your Lordships absolute reassurance today that our plans do not represent any threat to patient safety, nor to the safeguards held within the legislative framework of provisions within the Human Fertilisation and Embryology Act and the Human Tissue Act.

The Department of Health carried out its review of arm’s-length bodies and published its recommendation in July 2010. We recognise the important role that the Human Fertilisation and Embryology Authority and the Human Tissue Authority have played in the regulation of their respective areas over the years. We thank them sincerely for it. Our recommendations in respect of these bodies took account of the complexities and sensitivities attached to the particular areas in which they operate.

We are not rushing. We have allowed for the full length of the planned Parliament to take these changes to their conclusion. That is far longer than any other change proposed within the department’s review, a decision that reflects both the importance of the two bodies and a recognition that we need to consult fully on, and settle, the detail of all the changes. However, we are clear that a more joined-up system needs to be formed.

With the establishment of the Care Quality Commission, and the Academy of Medical Sciences’ recommendation for a new health research agency, new alternative structures have become available to ensure a more cohesive system for both healthcare and health research regulation that will benefit patients, health professionals and researchers. It is therefore our intention that the healthcare-related licensing functions of the HFEA and HTA will transfer to the CQC.

The CQC already regulates a wide range of NHS and independent healthcare providers. It registers them and ensures that they are meeting essential standards of safety and quality. It takes action if services drop below these essential standards and acts quickly if people’s rights or safety are at risk. It undertakes investigations where there are concerns about quality, seeks the views of people who use services and informs people about the quality of those services. Noble Lords will recognise that this is similar to the roles undertaken by the HFEA and HTA, on a smaller scale, in respect of the regulation of infertility treatment and activities involving the use of human tissue.

We estimate that about 80 per cent of the centres currently licensed by the HFEA are either regulated by the CQC or in premises that it regulates. The CQC also covers 60 per cent of the centres licensed by the HTA. It therefore seems wasteful, and indeed unsustainable, to continue to have these regulatory systems running in parallel. It makes sense to streamline, and ultimately to trust the CQC with the responsibility. There is no reason why the CQC should not be able to fulfil that responsibility as effectively as do the HFEA and HTA now.

The noble Baroness, Lady Thornton, asked about the multiple birth policy. That is an issue that concerns the safety of patients and their children, and it would fit very well into the CQC’s remit.

Noble Lords will be aware of the Academy of Medical Sciences’ report on the regulation and governance of medical research. The report has made recommendations for simplifying the complex framework of regulation. In particular, it suggests the introduction of a new health research agency. The report has been embraced by a wide range of groups and experts. It recognises that there are significant benefits in bringing all medical research regulation, including embryo research, within the remit of a single medical research regulatory authority. The Government welcome the report and are considering their response.

The noble Lord, Lord Alton, referred to Lisa Jardine’s comments about the threat to the status of the embryo. I emphasise that the intention is to co-ordinate health research regulation better so that the system is streamlined without changing or compromising the safeguards. Current quality and ethical safeguards for research involving the use of a human embryo, for example, must be necessary for the research to be approved, and will remain very firmly in place. It is worth reflecting that, although the statutory requirement that the use of embryos is necessary and that the research is necessary or desirable will remain in place, a research regulatory authority with a broad outlook across medical research would be well positioned to make that assessment.

The noble Baroness, Lady Thornton, asked who would be the keeper of ethical safeguards. I would say simply that the ethical safeguards are laid out in legislation, as agreed by Parliament.

The noble Baroness, Lady Deech, suggested that those in favour of the Government’s proposals think that they will not be regulated at all. I have not gained that impression. The letters from professional bodies—the British Fertility Society, the Royal College of Obstetricians and Gynaecologists and leading clinicians—show clearly that they understand that regulation and legislative provisions will remain firmly in place.

There are three key points that I want to make at this juncture. First—I say this especially to my noble friend Lord Willis—my department is planning to undertake a public consultation exercise this summer about where HFEA and HTA functions are best transferred. We regard this as a key part of the process. We will consult on any subsequent use of powers agreed in the Public Bodies Bill to effect those transfers. Effectively, therefore, there will be two consultations.

The noble Lord, Lord Alton, understandably said that he would like to see the colour of the Government’s money before reaching a view on these issues. As yet, no final decisions have been reached on exactly which functions will go to the CQC, the potential health research agency, the Health and Social Care Information Centre or elsewhere. The exact detail of how the powers in the Public Bodies Bill might be used will be considered further and in detailed discussion with the HFEA, HTA, CQC and key stakeholders and in public consultation.

Secondly, our plans are about streamlining the functions of the regulatory bodies concerned. I regard that as the precursor to the lighter touch referred to by the noble Lord, Lord Alton. The lighter touch itself will revolve around the design of systems, which will ensure that the burden of bureaucracy is lessened overall for the NHS and other organisations. The CQC and the HFEA will play a leading role in the development of an efficient approach.

I stress again that, despite what some commentators have said, there is no intention to revisit the ethical provisions and safeguards in the HFE Act, the principles set out in the Warnock report, or the principles of consent underpinning the Human Tissue Act. The proposed powers in the Public Bodies Bill could not be used to do any of those things. The noble Baroness, Lady Thornton, asked what had changed regarding the principles that were debated at length in both Houses of Parliament. The answer is: nothing. The HFE Act provisions that recognise the special status of the human embryo will remain in place, entirely as they are now, as will the provisions in the Human Tissue Act that ensure that donors’ and families’ rights and safety are protected.

The noble Baroness, Lady Thornton, said that she did not have a closed mind to some sort of reorganisation of functions, and I am hope I am right in detecting the same message from the noble Baronesses, Lady Deech and Lady Warwick, and my noble friend Lord Willis. That is welcome. All would say, as I have explained on previous occasions, is that if we cannot secure a place for the HFEA and HTA with the Public Bodies Bill then we will have to look to a future health Bill to support the transfer of functions, however we decide that that transfer should be conducted. However, to move into primary legislation would mean that the safeguards enshrined within the HFEA and HTA Acts would then be open to parliamentary scrutiny and vulnerable to amendment. I know that very few noble Lords would relish that scenario.

Thirdly, we envisage that our proposals should offer benefits to patients, healthcare professionals and researchers. We want the streamlining of regulation and reduction in the number of regulators to mean a less burdensome and bureaucratic system, both for the NHS and for the independent sector. We will work with the HFEA and HTA to try to ensure that those with the necessary expertise will follow their functions to the new arrangements so that it is not lost.

We have received significant numbers of representations from professional bodies and clinicians who are directly regulated by the HFEA, expressing support for the Government’s proposal to include the HFEA in the Public Bodies Bill. Many also expressed concern about the HFEA’s current approach to regulation. I have placed these in the Library.

My noble friend Lady Williams asked about legitimate public concerns about patient safety. I point out that the EU tissues and cell directive sets out robust provisions for safety and quality, covering assisted reproduction and the human application of tissue and cells. The role of competent authority to regulate against the requirements of the directive and standards for quality and safety will remain in place to ensure that patient safety remains a key consideration.

The noble Lord, Lord Alton, asked where the Government saw the information functions going. We will have to consult on that issue carefully with all the bodies concerned. We will give due regard to the sensitivity and confidentiality of the nature of the information currently held by the HFEA and HTA, and we envisage that it will be a key area on which we will consult.

My noble and learned friend Lord Mackay and my noble friend Lord Willis referred to the proposal two or three years ago to form RATE. This is a completely different proposal; RATE simply involved replacing the HFEA and HTA with a single organisation that would undertake all the functions of the two bodies in their entirety. The proposal was rejected because the benefits of doing so for embryo research, for example, were not apparent. The current proposal to indentify where individual functions might best be placed is a different approach and has more potential obvious benefits, such as more streamlining and cohesion.

My noble friend Lady Williams asked why the Government did not set up a national bioethics committee. The consideration of specific ethical issues by bodies such as Nuffield and parliamentary scrutiny committees remains the preferred approach.

Health: Influenza Vaccination

Earl Howe Excerpts

Thursday 20th January 2011 Lords Chamber

[Lord Kennedy of Southwark]

To ask Her Majesty’s Government what plans they have to review the advice on the availability of the flu vaccination.

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

My Lords, the Government’s policy on flu vaccination is informed by the expert advice of the Joint Committee on Vaccination and Immunisation. The JCVI last met on 30 December to review the latest evidence. The committee decided that there were no grounds to change the risk groups that are offered vaccination and recommended that efforts be focused on maximising vaccine uptake among all those in the risk groups. As with all vaccination programmes, the JCVI will keep this matter under review.

[Lord Kennedy of Southwark]

I thank the noble Earl for his response. The latest figures show that approximately 780 people are in critical care, and there is still a long winter ahead of us. What steps are the Government taking in case the numbers continue to rise? Secondly, what steps have been taken to address the reported shortages of flu vaccines in some areas, with GPs and pharmacies running out of stocks?

[Earl Howe]

My Lords, the noble Lord’s figures are slightly historic. Figures due to be published today will give a better picture. I spoke yesterday to the Chief Medical Officer, who told me that the rates to be published at 2 pm today will show a decrease from the figure that he mentioned. There has also been a further decrease since the new figure and it appears that the worst is over as regards the incidence of flu. On the second question, there have been reports of vaccine shortages. We have taken steps to address that by releasing stocks of the monovalent H1N1 vaccine from our national stock. That system is working well. There is an online ordering system, which GPs are using. They are also ordering stock directly from the manufacturers and we understand that that system is working well, too. The reports of shortages are, I hope, a matter of history.

[Lord Skelmersdale]

My Lords, is my noble friend aware—I am sure that he is not—that over Christmas I presented myself at my GP’s for a flu vaccination? There was no vaccine in the surgery. He gave me a prescription, but there was no vaccine in the pharmacy, where I was informed that the general flu vaccine in this country had run out because the suppliers had run out of stock. I am delighted that the swine flu vaccine is still available, but surely that does not help any attempt to be vaccinated against general flu.

[Earl Howe]

My Lords, we are very clear that the amount of vaccine produced for this season’s flu to address the probable need for vaccination was more than adequate. It is up to GPs to order the quantity of vaccine that they see as appropriate for their patients. That is what has happened over the past couple of years. Supplies are also ordered independently by private pharmacies. As regards my noble friend’s point on the H1N1 monovalent vaccine, I am afraid that 90 per cent of deaths have been from what is called swine flu, so that is a very appropriate vaccine to use in these circumstances.

[Lord Hughes of Woodside]

Will the Minister comment on reports in today’s press that the Department of Health is intending to take back in house the ordering of flu vaccines because GPs have not done it properly?

[Earl Howe]

My Lords, almost all vaccines, except the seasonal flu vaccines, are procured centrally because central procurement provides a cost-effective arrangement that can take account of the variation in supply and demand. It also gives us the ability to track where the batches of vaccine have gone. We are therefore looking at taking into the department the procurement of the seasonal flu vaccine.

[Lord Patel]

Last time we discussed this subject, I asked the Minister why the advice given by the Centers for Disease Control and Prevention in the United States was so different from the advice from our committee on vaccination. My question this time is: is the Minister sure that the advice that he gets from our committee takes into account evidence that other countries gather and on which they base their advice? The CDC’s advice in the United States is to vaccinate everybody over the age of six months.

[Earl Howe]

Yes, I am satisfied. The expert advice provided by the JCVI takes into consideration first and foremost the epidemiology of the disease in the UK, which may well differ from that in other countries. The noble Lord may be interested to know that, while the UK is experiencing H1N1 as the most prevalent flu strain, the prevalent flu strains in the United States are H3N2 and influenza B, so a very different situation applies in that country.

[Lord Newton of Braintree]

My Lords, I declare an interest as a member of an at-risk group who got vaccinated fairly early at the request of his doctor, which I acknowledge was based on expert advice. To follow on from the previous question, the plain fact is that that expert advice proved, in effect, to be politically unsustainable in one way or another. I think that that needs to be taken into account when we look at what we do next year.

[Earl Howe]

I can reassure my noble friend that the advice that the JCVI gives is subject to regular review. Clearly, before the next flu season, it will be looking again at the experience of the current flu season.

[Lord Campbell-Savours]

What lessons have Ministers learnt from the management of the vaccine programme over the past six months? Is there anything that they may be prepared to do differently next year?

--- Later in debate ---

[Earl Howe]

My Lords, the main lesson is one to which I referred a minute ago. We are considering bringing back into central procurement the purchasing of the seasonal flu vaccine, which is an exception to the normal rule. We purchase most vaccines centrally, apart from that one. There is a lot to be said for changing the ordering system so that we can keep better track of supplies and, perhaps, have more cost-effective procurement at the same time.

[Baroness Hussein-Ece]

My Lords, I read a report in the media last week saying that, in light of the high incidence of children under five contracting flu, the Government are preparing to examine new evidence from the advisory group that could allow for all under-fives to be vaccinated. Have the Government reached a view on this?

[Earl Howe]

We have not reached a view on this because the JCVI’s advice remains unchanged. In fact, current evidence shows that children under five are not the age group with the highest risk of death. The age group with the highest risk of death from the flu that is circulating currently is middle-aged adults. Nevertheless, those with risk factors have the highest risk of severe disease and death from flu compared with healthy age groups. However, I can tell my noble friend that nothing is set in stone. We do not wish to constrain the JCVI in any way and we will listen to its advice, as we always do.

[Baroness Thornton]

My Lords, during the H1N1 pandemic, two organisations stood out as being essential to delivering a pandemic strategy: the Health Protection Agency, for its science, strategic planning and advice; and the PCTs, for their support and co-ordination on the ground. Both are due to be abolished in the next two years. Can the Minister inform the House about the Government’s pandemic plans, including, for example, the ordering of sufficient vaccine, both after the abolition and during the transition?

[Earl Howe]

The noble Baroness asks an important question. The Government’s plans are to create what we are calling Public Health England, which will be the new public health service based centrally, linked closely to public health efforts in local authorities with local directors of public health. A pandemic vaccination campaign would be mobilised through those channels. I am clear that we have proper plans for the transition, which the noble Baroness rightly mentions as being a time when we need to have a specific focus on public health protection. The present plan, as she knows, is to bring the Health Protection Agency functions within the Department of Health so that there is a clear line of accountability from the Secretary of State downwards. I am clear that that is right. We will still have the expert advice that we do now from the people who are currently employed in the Health Protection Agency. That is an additional safeguard.

Herbal Medicines

Earl Howe Excerpts

Thursday 13th January 2011 Lords Chamber

[Lord Pearson of Rannoch]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I declare an interest as the unpaid patron of the Register of Chinese Herbal Medicine.

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

My Lords, I can confirm that, while final decisions have yet to be taken, the Government are actively exploring the establishment of a statutory register for herbal practitioners. We are currently in discussion with the devolved Administrations, the Health Professions Council and the Complementary and Natural Healthcare Council about the feasibility of such a register and we expect to make an announcement shortly. I can assure the House that the Government are treating this issue as a priority.

[Lord Pearson of Rannoch]

My Lords, I am grateful to the noble Earl for that reply, from which it would appear that a definite decision has not yet been taken. Is he aware that some 5.8 million British people rely on herbal medicines for their well-being, that thousands of businesses and practitioners supply them and that none of this can continue as at present after 1 May if the Government do not meet the terms of the EU directive by then? Secondly, does the Minister agree that we owe this predicament entirely to our membership of the European Union—

[Lord Pearson of Rannoch]

We do, my Lords, we do. The EU has yet again ignored its own subsidiarity law to impose this diktat. Why cannot the British Government simply tell Brussels that we will decide this matter for ourselves?

[Earl Howe]

My Lords, on the noble Lord’s first point, the Government are acutely aware of how important an issue this is for many millions of consumers. That is why we are working to reach what I hope will be a workable solution to ensure continuing access to popular and widely used products. I am sure that the House is well aware of the noble Lord’s position as regards the European Union. I simply say that the medicines legislation framework is set at a Community level for a good reason. It exists both to protect public health in relation to medicines placed on the EU market and to ensure a level playing field for operators. But within that European framework there is flexibility for EU member states to operate national arrangements for the regulation of medicines in situations where an authorised health professional determines that an individual patient has special needs. We are considering the case for using that flexibility in relation to herbal medicines.

[Lord Taverne]

My Lords, do not most of the senior professional bodies, such as the MRC, the royal colleges and the Physiological Society, oppose registration because it gives a spurious authority to practices that are not based on science? Do the Government ignore these representations and listen instead to lobbyists such as the Prince of Wales, who believes in traditional medicine? Do they not recognise that medical practice is not like a piece of antique furniture that grows in value with age?

[Earl Howe]

My Lords, again I think that the House is well aware of the noble Lord’s views, which I know are sincerely held, although personally I regret his comments about the Prince of Wales. However, I am sure that, with regard to herbal medicines, he will be aware that there is an international trade in sometimes poor-quality, unregulated and unlicensed herbal preparations. Some of these have been found to contain banned substances, heavy metals or pharmaceutical ingredients or substances from outside the UK that may not be subject to any form of regulation at all, so there is a public safety issue.

[Baroness Pitkeathley]

My Lords, does the noble Earl agree that, while statutory regulation has its place, regulation in healthcare and anything else should always be proportionate? Would he therefore endorse the concept of light-touch regulation, which is promoted by the Council for Healthcare Regulatory Excellence? I declare an interest as its chair.

[Earl Howe]

My Lords, I pay tribute to the noble Baroness for the work that she does and I entirely endorse the approach to regulation that she has outlined. Certainly, we need to adopt a targeted, risk-based approach to regulation.

[Baroness Sharples]

Is the noble Earl aware that I owe my good health to a great extent to herbal medicine?

[Earl Howe]

My Lords, that news is a source of pleasure to me and I am sure to the whole House.

[The Countess of Mar]

My Lords, I concur with the noble Baroness, Lady Sharples, because I do, too. How many people have died from adverse reactions to herbal medicines compared with the number of people who have died from adverse reactions to prescribed drugs?

[Earl Howe]

My Lords, I do not have the figures, but I am aware of a notorious case on the continent some years ago involving adulterated herbal medicines, which resulted in very serious illness for a number of women. Since 2005, the MHRA has identified 282 cases where products typically marketed as herbal or traditional remedies have been found to be adulterated with random quantities of pharmaceutical substances.

[Lord Harris of Haringey]

My Lords, would it not be more sensible for the noble Earl to present to the House the scientific and medical evidence that suggests that it is indeed sensible to provide any sort of regulatory framework? In the absence of that scientific evidence, would it not be simpler to make it very clear that it is illegal to make false, unfounded health claims in support of any substances and that, if they contain dangerous materials, the individuals promoting them should go to jail?

[Earl Howe]

That is precisely why we want to consider the possibility of a statutory register for practitioners, to make sure that those who prescribe unlicensed medicines that have been prepared by third parties are fit and proper people to do so. When we make the announcement, as I hope we will shortly, the rationale for it will be set out.

[Baroness Browning]

Is my noble friend aware that it is common practice in many GP practices to make recommendations for alternative medicines, such as tea tree oil for ingrowing toenails and arnica cream for bruises? In my former constituency, one GP practice actually grew its own herbs in the garden.

[Earl Howe]

My Lords, it is a long-standing practice and tradition in this country that medical professionals should be able to take it upon themselves to prescribe freely, as they see fit, in the interests of the particular patient in front of them.

NHS: Front-line and Specialised Services

Earl Howe Excerpts

Thursday 13th January 2011 Lords Chamber

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

My Lords, this has been a wide-ranging and well informed debate. I thank the noble Lord, Lord Turnberg, for calling it and all noble Lords who have spoken so eloquently. It is particularly right that I should single out for special praise my noble friend Lady Jolly, who I am delighted to welcome to your Lordships’ House and our health debates.

The wording of the question that we are debating hints at some nervousness about the Government’s reform proposals. I understand and appreciate many of the concerns that have been articulated today. There is, however, one simple truth about the reforms: they are necessary to create a sustainable NHS for the future. To make efficiency savings you have to improve commissioning and address the long-standing problems in a minority of challenged providers. It is for the long-term as well as the short-term future of the health service that we are working, and I remain exceedingly optimistic about that future.

The Government are fully committed to the NHS and its values and principles. We have prioritised its budget. Total health funding will rise by more than 10 per cent over the spending period. We are also starting to cut spend on administration to focus funding on the front line. The right reverend Prelate voiced some perfectly legitimate concerns about implementing change at a time of financial challenge. I agree with him that the future will see a great deal of change for the NHS. We are not shying away from the difficulties this will present, even within a protected budget. Increasing demands on the NHS mean that we will need to make the budget stretch further than ever before. However, I do not agree that a tighter budget necessarily leads to worse care.

Our reform agenda is entirely focused on improving the quality of healthcare services. Our vision is to improve health outcomes so that they are among the best in the world, and to bring about a genuine shift in power away from the state and towards the front-line staff and the people who use services. The reforms are designed to lead to better quality and more consistent commissioning so that outcomes for patients improve; drive up the quality of care through patient empowerment and choice; give providers greater freedom to innovate; and create a level playing field with fair pricing, encouraging services to be more responsive to patients’ needs.

There is a clear focus on quality throughout our reforms. To name but a few, there will be payment incentives for quality through the Quality and Outcomes Framework, CQUIN and the tariff. Under the health and social care Bill, which will be introduced shortly, the Secretary of State, the NHS commissioning board and GP consortia will also be required to act with a view to securing continuous quality improvement in services provided by the NHS.

To achieve optimum outcomes for patients, we are transforming how quality is measured and how the NHS is held to account, shifting the focus away from centrally driven process targets towards improved outcomes, with the NHS held to account against a new NHS outcomes framework. Patient choice is not an end in itself but the focus on choice will drive up the quality of services and therefore improve outcomes. There will be greater access to information and—not least for chronic disease, which was mentioned by the noble Lord, Lord Kakkar—patients should have a greater feeling of empowerment.

The noble Baroness, Lady Masham, focused on specialised services, particularly for spinal injury. I will write to her on the detail of her questions. We recognised the needs of patients for specialised services when we drew up the reform programme last summer. Patients accessing specialised services should receive high-quality, effective, evidence-based treatment and care with improved outcomes. Our proposal is that the NHS commissioning board should commission specialised services. Responses to the public consultation have generally supported this proposal. However, the system will allow for flexibility in who commissions which services, allowing for changes over time as needed.

The noble Lord, Lord Kakkar, asked me about definitions. There will be the flexibility to change the definition of specialised services so that more or fewer services are commissioned by the board. This will allow the system to align with changing patterns of care. Additionally, there will be flexibility for consortia to decide how to commission other low-volume services; for example, by federating together.

The key point here is that we recognise that there is no one-size-fits-all organisational structure that will work for all services equally. Therefore, we are moving away from specifying a fixed number of local or regional commissioning bodies to create a much more flexible structure where consortia can grow or shrink and can work together and with the NHS commissioning board in order to commission high-quality care most effectively. I say to the right reverend Prelate in particular that we will maintain our focus on the quality of care throughout the transition to the new system. Transition will occur through a carefully designed and managed process allowing for rapid adoption, system-wide learning and effective risk-management. We are determined fully to support the NHS during these changes.

The noble Lord, Lord Turnberg, asked me some specific questions about whether there were to be any cuts in the number of trainee doctors. The number of trainee doctors should be appropriate to meet the estimates of future demand for trained doctors. This year the entry to postgraduate medical training will be around 6,800 in total. That is in line with the recommendations from the Centre for Workforce Intelligence report on 2011 training numbers that analysed trainee doctor intakes in the context of long-term demand for consultants. The Centre for Workforce Intelligence will continue to provide that kind of analysis to us. The noble Lord asked about GP pathfinders. We are engaging with the first group of pathfinders to consider some of the very questions that he posed. We will be hosting a learning event for pathfinders later this month to explore those issues and to showcase the early impact of emerging consortia. It will be the responsibility of the NHS commissioning board to produce and publish an analysis of the findings of the pathfinder programme and set out the lessons learnt but we are also setting up a learning network to ensure that the experience of pathfinders can be quickly shared through the wider GP community. The learning from the pathfinders will touch on both the areas that the noble Lord raised. One will be to look at some of the structural principles such as the successes and obstacles that consortia of different sizes come up against. But we want pathfinders to start making a difference for their patients now, and so improving services for patients is the area into which pathfinders will be putting most of their efforts.

The noble Lord also raised the issue of integrating care and the spread of good practice and how that will be incorporated into contracts. One of the key roles of the board will be to provide national leadership for driving up the quality of care. I say that also to the noble Baroness, Lady Sharp, who asked me about this. It will help spread best practice by publishing commissioning guidance and model care pathways based on the evidence-based quality standards that it has asked NICE to develop. It will develop model contracts and standard contractual terms for providers. It will also develop the commissioning outcomes framework. I could go on about more areas of support that consortia will get from the board but I hope this reassures the noble Lord that our reforms will mean that good practice is embedded far more widely and more quickly than it is in the current system.

The noble Lord asked how the expertise and knowledge of clinicians in secondary care would be built into this process. That was an issue raised also by the noble Baroness, Lady Sharp, and, in a different way, by the noble Lord, Lord Touhig, in relation to dementia care. It was also alluded to by the noble Lord, Lord Kakkar. We have consistently emphasised the importance of multi-professional involvement in commissioning and we expect that this will be one of the areas that will be examined as part of the pathfinder programme. Good commissioning and the designing of care pathways will naturally involve a wide range of professionals and we would expect GP consortia to engage other health and care professionals in their commissioning work. Incidentally, I say to the noble Lord, Lord Kakkar, that we will continue to support the previous Government’s programme of integrated care pilots.

The noble Baroness, Lady Sharp, asked me how health and local government services will be joined up. For the first time local authorities will have a lead role in improving the strategic co-ordination of commissioning across the NHS, social care and related children’s and public health services. The new health and well-being boards will bring together the key leaders across these services to work in partnership and to develop a joint health and well-being strategy for their area. I hope that that partly reassures her that the services she particularly mentioned will certainly not be lost sight of in that process, because there is a fundamental synergy in the structures that I have referred to.

The noble Lord, Lord Turnberg, asked what is to happen to OSCHR, the Office for Strategic Co-ordination of Health Research. It has done a fine job over the past three years. It is a very useful mechanism for facilitating processes for joint working, focusing particularly on translational research. That body will continue with an increased focus on co-ordination and foresight.

The noble Lord also asked how GP consortia will be incentivised to be involved in health research. I recognise his concerns. There is not time for me to say a lot, but the department is funding the National Institute for Health Research Primary Care Research Network. This brings together a wide range of primary care health professionals and is dedicated to expanding clinical research in primary care. The Academy of Medical Science’s report, which the noble Lord referred to, was published this week. We welcome the report and we are carefully considering how to implement its recommendations. I will write to him further on that.

The noble Lord, Lord Winston, asked in particular about how academic medicine will be protected. The Government recognise the crucial importance of academic medicine; we are increasing funding for health research, as has been mentioned, part of which supports lectureships and other awards, and we are currently consulting on our proposals for education and training. However, again, perhaps I may write to the noble Lord with further and better particulars.

My noble friend Lord Colwyn spoke on his specialist subject of dentistry, and perhaps I can make some amends for my previous omissions on this score. The Government are committed to piloting the new contracts before introducing any of them at scale, to ensure that lessons are learnt and acted on. The design and introduction of a new contract will be a key part of the piloting process. The BDA has welcomed that. Representatives from the profession have been closely involved in the work to develop our proposals. The intention is for the National Health Service commissioning board to commission secondary care to ensure consistency of approach. Again, time prevents me answering some of his further questions.

On herbal medicine and the possible regulation of authorised practitioners, I cannot go much further than I did in my earlier Answer to the noble Lord, Lord Pearson, other than to acknowledge my noble friend’s rightful concerns and to re-emphasise that we are taking our deliberations forward as a matter of urgency.

The noble Baroness, Lady Sharp, asked who will oversee hospital expenditure. The answer is that that will be done by governors in foundation trusts, who will scrutinise trust board expenditure. She also asked me about NICE, as did the noble Baroness, Lady Meacher. NICE is recognised as an international leader in the evaluation of drugs and health technologies and will continue to have an important advisory role, including assessing the incremental therapeutic benefits of new medicines. However, as we implement our plans for value-based pricing from 2014—a little way ahead—NICE’s role will inevitably evolve. Its work will increasingly focus on giving authoritative advice to clinicians on how to deliver the most effective treatments and on the development of quality standards.

I am conscious that I have overshot my time. Although there is technically time in hand, it would not be courteous to the House if I continued. I have many further answers and I apologise to noble Lords whose questions I have not reached. I will write to them as fully as I can. I apologise in particular to the noble Baroness, Lady Finlay, whose questions I was very keen to answer.

I recognise that these reforms will be undertaken in a challenging context in which staff and leaders across the NHS face personal and professional uncertainty about their futures. However, the enthusiasm shown by commissioners, providers, managers and clinicians to bring the new system into being makes me certain that success is achievable.

Health: Influenza

Earl Howe Excerpts

Tuesday 11th January 2011 Lords Chamber

[Baroness Thornton]

To ask Her Majesty’s Government what is the reported increase in the incidence of influenza since the end of November; and how many adults and children suffering from influenza were admitted to hospital or died in December.

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

My Lords, influenza-like illness, or ILI, has increased from 13 to 98 GP consultations per 100,000 people since November. The department does not currently collect data on hospital admissions. As of 6 January, there were 783 patients with ILI in critical care beds in England, and 50 flu- related fatal cases verified by the Health Protection Agency in the UK.

[Baroness Thornton]

I thank the Minister for that Answer. Last June, I asked him about the 50 per cent cut in the communications budget for the Department of Health. He said that,

“every programme of communication or marketing has to be justified by the evidence that it will do some good”.—[Official Report, 30/6/10; col. 1798.]

We know that pregnant women are particularly vulnerable to the H1N1 strain of influenza, and HPA’s data show that the risk of mortality for pregnant women is sevenfold greater than that for non-pregnant women. Even so, midwives received a letter from Andrew Lansley, dated 16 December, encouraging them to vaccinate pregnant women. Does the Minister think that it is possible that, had the Government acted earlier and had a public campaign, had they not cut their public health communications budget, and had Andrew Lansley sent a letter in October rather than December, the lifes of at least one pregnant woman might have been saved?

[Earl Howe]

My Lords, it is quite difficult to substantiate that suggestion, because the immunisation figures do not bear out the noble Baroness’s argument. The level of vaccine uptake in the over-65s is 70 per cent, which is better than in most countries of Europe. Among the at-risk under-65s, it is 45.5 per cent, which is comparable to the past two years. Therefore, it is not clear that a generalised campaign would have added value.

On the question of pregnant women, the normal procedure is for the Chief Medical Officer to write to all GPs in the summer, setting out all the at-risk groups. She did that in June. We were then alerted in December by the Health Protection Agency to a worryingly high number of pregnant women who had contracted influenza, so we wrote to both the BMA and the Royal College of Midwives to emphasise the desirability of encouraging that group of patients to get vaccinated. We did the right thing, which was to respond to emerging data.

[Baroness Hussein-Ece]

My Lords, is it the case that the highest rate of flu has been among those aged one to four? Have the parents of children in that age group been encouraged to have their children vaccinated over and above others? Also, have the Government changed their policy of publicising the need for the flu jab, which they did during last year’s outbreak?

[Earl Howe]

We did see a higher than expected number of under-fives contracting influenza, so we took urgent advice from the Joint Committee on Vaccination and Immunisation in December and asked it to confirm its previous advice that not all under-fives need get vaccinated unless they were in an at-risk group. It confirmed that advice and we have followed it.

[Baroness O’Loan]

There have been 14 deaths from swine flu in Northern Ireland from a population of 1.7 million. How would the Minister respond to the statement from the health protection agency in Northern Ireland, in which Dr Carolyn Harper said:

“Our sense and discussions with colleagues in the UK is that our reporting systems are more complete than in England so therefore we are more likely to capture more deaths here. England concede they have a larger degree of under reporting than we have here so you really cannot compare them”?

Will the Minister advise whether he is satisfied with the validity of the statistics that are available?

[Earl Howe]

I am satisfied with the validity of the statistics. The problem is, of course, that there is always a lag. The statistics that I read out earlier in my main Answer were supplied to us by the Health Protection Agency and regard verified laboratory tested results. We have another method of assessing the number of deaths that is retrospective. After the end of the flu season we can assess whether the number of deaths has been higher than expected. Of course, we are endeavouring to improve our statistical base all the time and no doubt lessons will be learnt from this season, as they are from every season.

[Lord Patel]

My Lords, what is the basis for the differing advice in the United Kingdom about the group of people who should be vaccinated compared with that given in the United States from the Centers for Disease Control and Prevention, which advise that everyone over the age of six months should be vaccinated?

[Earl Howe]

That is precisely why we have an independent Joint Committee on Vaccination and Immunisation: to advise Ministers on these matters. Ministers are bound to take that advice. Indeed, the previous Government determined that they were legally obliged to take the committee’s advice, which is what we have done.

[Lord Winston]

My Lords, is the Minister aware that many pregnant women are particularly nervous about all kinds of vaccination during pregnancy, including the flu vaccination? I know that from first-hand experience. Does he feel that the Government are doing enough to inform pregnant women about the risks or otherwise in that instance? Could more be done?

[Earl Howe]

I am sure, as I have just said, that lessons can always be learnt about what more can be done. As I mentioned, we saw a lower than desirable uptake of the vaccine in the early weeks among pregnant women. I am happy to say that that has now been rectified and a lot more pregnant women are coming forward. However, it emphasises the noble Lord’s central point that perhaps GPs have a special duty at the moment to encourage pregnant women and to reassure them that the vaccine is absolutely safe.

Blood and Blood Products

Earl Howe Excerpts

Monday 10th January 2011 Lords Chamber

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

My Lords, I should now like to repeat a Statement made earlier by my right honourable friend the Secretary of State for Health in another place. The Statement is as follows.

“With permission, I should like to make a Statement on hepatitis C and HIV infected blood.

Mr Speaker, what happened during the 1970s and 1980s when thousands of patients contracted hepatitis C and HIV from NHS blood and blood products is one of the great tragedies in modern healthcare. It is desperately sad to recall that during this period the best efforts of the NHS to restore people to health actually consigned so many to a life of illness and hardship. As the current Health Secretary, and on behalf of Governments extending back to the 1970s, I begin by saying how sorry I am that this happened and express my deep regret for the pain and misery that many have suffered as a result.

It is now almost two decades since the full extent of the infection was established and two years since the independent inquiry led by the noble and learned Lord, Lord Archer of Sandwell, reported. The majority of the noble and learned Lord’s recommendations are in place, as are programmes of ex gratia payments, administered by the Macfarlane Trust and the Eileen Trust for the HIV infected and by the Skipton Fund for those with hepatitis C. But significant anomalies remain and I pay tribute to the noble and learned Lord, Lord Archer, to other noble Lords, and to honourable Members from all parties for highlighting them.

In October, my honourable friend the Member for Guildford announced a review into the current support arrangements to look at reducing the differences between the hepatitis C and HIV financial support schemes and to explore other issues raised by Members during the recent Back-Bench debate, including prescription charges and wider support for those affected. We also asked clinical experts to advise on the impact of hepatitis C infection on a person’s health and quality of life and to consider whether an increase in financial support was needed.

My honourable friend the Member for Guildford met with representative groups to understand the impact that these infections were having on people’s lives. She also met many right honourable and honourable Members and noble Lords who have been strong advocates on behalf of those affected.

We have now considered the findings of the clinical expert group and accept that the needs of those with advanced liver disease from hepatitis C merit higher levels of support. At present, the amount of money paid to this group depends on the seriousness of the infection.

There are two stages at which the Skipton Fund will make a payment. The first is when the person develops chronic hepatitis C infection. At this point, a person is eligible for a stage 1 relief payment—currently a lump sum payment of £20,000. Some may reach a second stage of developing advanced liver disease, such as cirrhosis or cancer, or require a liver transplant. They then become eligible for a stage 2 payment, which is currently another lump sum payment, of £25,000. Under the new arrangements that we will introduce, this second-stage payment will increase from £25,000 to £50,000. This will apply retrospectively. So if a person has already received an initial stage 2 payment of £25,000, they will now get another £25,000 lump sum, bringing the total to £50,000. In addition to this, we will also introduce a new, annual payment of £12,800 for those with hepatitis C reaching the second stage. This is the same amount that those who were infected with HIV receive.

Those infected with both HIV and hepatitis C from contaminated blood will now receive two annual payments of £12,800 if they meet the stage 2 criteria—one payment for each infection—along with the respective lump sums. All annual payments made to both those so infected with HIV and those with hepatitis C will now be uprated annually in line with the consumer prices index to keep pace with living costs.

We know that some of those infected with HIV or hepatitis C from NHS blood and blood products face particular hardship and poverty. Those infected with HIV can already apply for additional discretionary payments from the Eileen Trust and the Macfarlane Trust, but no equivalent arrangements are in place for those infected with hepatitis C. Therefore, we will now establish a new charitable trust to make similar payments to those with hepatitis C who are in serious financial need. These payments will be available for those at all stages of their illness, based on individual circumstances. Discretionary payments will also be available to support dependants of those infected with hepatitis C, including dependants of those who have since died. Again, this will echo the arrangements in place for those infected with HIV and enable us to give more to those in greatest need.

We must also ensure that those infected through NHS blood and blood products get the right medical and psychological support. I can therefore announce two further measures. First, those infected with hepatitis C or HIV will no longer pay for their prescriptions. They will now receive the cost of an annual prescription prepayment certificate if they are currently charged for prescriptions. Secondly, the representative groups raised the issue of counselling support for those infected through blood and blood products. We fully recognise the emotional distress that they experience. As a result, we will provide £300,000 over the next three years, allowing for around 6,000 hours of counselling to help these groups.

While we focus on those still living with infections, we must also recognise the bereaved families of those who have died. At present, no payment can be made to those infected with hepatitis C who passed away before the Skipton Fund was established. This is a source of understandable distress for those who survive them and it is something that we now want to put right. I can therefore announce that, until the end of March 2011, there will be a window of opportunity where a posthumous claim of up to £70,000 can be made on behalf of those infected with hepatitis C who died before 29 August 2003.

A single payment of £20,000 will be available if the individual had reached the first stage of chronic infection and another single payment of £50,000 will be made if their condition had deteriorated to the second stage where they suffered serious liver disease or required a liver transplant. We will work with the Skipton Fund and various patient groups to publicise this new payment to those who may benefit. These new payments, which will go to the individual’s estate, should help more families to get the support that they deserve.

Taken together, these announcements represent a significant rise in the support available to those affected by this tragedy. Putting an exact figure on the package is difficult, as there is some uncertainty about how many will be eligible and how their illnesses may progress. However, we believe that these new arrangements could provide from £100 million to £130 million-worth of additional support over the course of this Parliament.

All payments will be disregarded for calculating income tax and eligibility for other state benefits, including social care, and while these changes apply only to those infected in England I will be speaking to the devolved Administrations to see if we can extend this across the UK.

Today’s announcements cannot remove the pain and distress that these individuals and families have suffered over the years, but I hope that these measures can at least bring some comfort, some consolation and perhaps some closure for those affected. I commend this Statement to the House”.

My Lords, that concludes the Statement.

--- Later in debate ---

[Earl Howe]

My Lords, I am heartened by and grateful for the welcome given by the noble Baroness to this Statement and the package of support that was announced in it. We think that it represents a fair and reasonable recognition of the suffering that many of these victims endure. We wanted to recognise that and I hope, as I said in the Statement, that it will be of some comfort to them and their families that they will receive better support.

The noble Baroness asked me some specific questions. She asked me first about the new trust and in what respects it will be different from the trusts that currently exist. I can say to her that we intend to set up the new charitable trust as quickly as possible. Its primary task will be to administer the discretionary elements of the payments that we have announced. In the mean time, the payments will begin immediately; in other words, there will be an in-year pro rata payment for the current financial year where people are due for an annual payment, and we can proceed with that speedily. As she will see in the paper that we have published, our advice is that those who feel that they have a claim should contact the Skipton Fund. There will also be a notice on the department’s website to direct them appropriately. The new trust will be essentially a charitable trust with the kind of mandate that we have seen with the Macfarlane and Eileen trusts and the Skipton Fund, but for a different cohort of people.

The noble Baroness also asked me about prescription charges. What we concluded was that, while many of the victims of this tragedy are already in receipt of free prescriptions, there are some who are not. We have received vociferous representations from them and their representatives. Therefore, we will make arrangements through one of the charitable trusts, probably the new one, to pay those who are eligible a sum equivalent to the cost of an annual prepayment certificate, so that in practice all their prescriptions will be free of charge.

The noble Baroness asked about insurance and what consideration we had given to the requests made by campaigning groups on that score. The review highlighted to us that making provision for access to insurance was, first, unlikely to represent value for money because the administrative costs would be enormous in comparison with the benefits obtained. Also, and crucially, it would have been fraught with difficulty, including administrative complexity. There is no need to remind the noble Baroness that the current fiscal context makes it even more imperative that we achieve value for money in everything that we do. We judged that it was more important to set up a discretionary fund where, if necessary, people who were in particular hardship could look for additional support and perhaps fund insurance premiums from that support. However, an across-the-board arrangement for insurance premiums, as will be apparent from the report that we have published—I should also tell her that we took advice on this from the Association of British Insurers and various specialist insurers—ruled itself out for a number of reasons.

We intend support for the Haemophilia Society to continue. The noble Baroness also asked where the money is coming from. There will be a significant immediate cost to the departmental budget during this current year. I am pleased to say that we have found savings in our current expenditure for this year, which enables us to make room for these payments. We have had this in mind for some considerable time and I am pleased that it has come to fruition. In future years, we have found room in our central budgets for the ongoing annual payments.

As regards Scotland, Wales and Northern Ireland, obviously it would have been preferable if there could have been a UK-wide announcement, but clearly it is not for us to prescribe to the devolved Administrations what they should do. However, as I indicated, we are talking to them actively and it is up to them to consider whether this is something that they wish to do for those infected in hospitals in the various devolved regions.

[Lord Morris of Manchester]

My Lords, I have two interests to declare, both non-pecuniary: as president of the Haemophilia Society, and as the architect of the independent public inquiry into the contaminated blood disaster headed by my noble and learned friend Lord Archer of Sandwell.

Is the Minister aware that, of the 1,241 haemophilia patients infected with HIV, only 361—29 per cent—are still alive, and that the number of deaths in the hepatitis C-infected community is much higher and continues to rise? Is he further aware that, as of now, an estimated 2,007 people have died from being treated with contaminated NHS blood and blood products? I congratulate the Minister on the progress that he has made, but will he now meet the haemophilia community and listen again to its plea for a response that is more in keeping with the scale of the disaster?

[Earl Howe]

My Lords, the noble Lord, Lord Morris of Manchester, to whose efforts I pay particular tribute in the context of this debate, as in many other contexts, has reminded us of the devastating effect of this tragedy on individuals and families. The previous Government recognised this and significantly improved the payments that were available to the victims of this disaster. We felt that there was still further to go, hence today’s Statement. We have arrived at this point following a brief but nevertheless thorough review of the arrangements, informed by a scientific report which is also published today—noble Lords can read the advice that we received—to enable us to understand rather better the suffering that these victims endure in clinical terms as well as in human terms. On the basis of that, we have arrived at the arrangements whose details I have repeated.

We believe that this is a fair and reasonable package of support for these poor victims. We do not intend to revisit it in the future. I acknowledge that some people might have different views on the appropriate level of payments for this patient group, but the package needs to be considered in the context of the whole range of support that is available for the group, especially Department for Work and Pensions benefits, the care available under the NHS and the care available from social services. Having consulted widely, we consider that the sums announced in this package, taken in the round with the other support available to this patient group, are both appropriate and reasonable. So, while I understand the noble Lord’s request, I am not in a position to accede to it at this point.

[Baroness Hussein-Ece]

My Lords, I congratulate my noble friend the Minister on the package announced in the Statement today. We very much welcome both it and, as the noble Baroness, Lady Thornton, said, the huge progress that has been made. Given that the commitment to review the current arrangements was made just last October, the Minister is to be congratulated on the swiftness with which this matter has been brought back to your Lordships' House. I hope that it serves to bring some comfort to those who have for so many years campaigned for justice, and particularly to the relatives of the deceased and the many other victims of this tragic episode.

The Minister announced that there would be a window for posthumous claims until the end of March 2011. There is concern that that is not a very big window and that it does not offer a lot of time to locate people and, for the many who may need assistance, to put a claim together. Perhaps the Minister can say why it is such a small window. Is he satisfied that it is sufficient time in which to track down as many people as possible who may have lost out?

It is not quite clear from the Statement who will receive posthumous payments. Will widows, partners and children be included in the arrangements? I would appreciate clarification on those points.

--- Later in debate ---

[Earl Howe]

I am very grateful to my noble friend. The window of opportunity referred to in the Statement—until the end of March, which is the best part of three months—should be sufficient to enable those with a valid claim to come forward. On the whole, we believe that, in the haemophiliac community, the victims’ families know who they are. I acknowledge that there is more difficulty with those who were in receipt of whole blood, but, again, we believe that the victims’ families know who those individuals were as well. Our job now is to publicise these arrangements so that the families are aware of the support that is currently available to them. We think that the window is sufficient.

My noble friend asked who is to be included in posthumous claims. One claim per deceased estate will be considered. The deceased person may have left his or her estate to a spouse or, indeed, to charity, but whoever it is, the beneficiary of that estate is the person entitled to come forward to claim the money. We will deal with claims on the basis that the validity of the claim is proven in relation to the estate of the deceased person. That is a matter of public record.

[Lord Archer of Sandwell]

I thank the noble Earl for repeating the Statement and recognise his readiness to listen to and act on representations, but will he also recognise the efforts of a vast number of people of all political parties and none who have worked assiduously for a very long time to ensure that financial relief of a proper order is made available to those who have suffered from the tragedy and to their dependants? If it is in order, I would also like to pay tribute to the work of my noble friend Lady Thornton, who throughout this has shown a ready ear and sympathy for those who are affected. Of course I also pay tribute to my noble friend Lord Morris, who has worked tirelessly throughout so many years.

I congratulate the Government on addressing one very important anomaly that is suffered by the dependants of deceased recipients of the Skipton Fund. Do I take it that that is the only anomaly that the Government are proposing to address, or will their ears be open throughout the discussions to some of the other anomalies that have been uncovered? I am grateful for the increased benefits, but will the Minister explain why they are paid through charitable trusts and not directly from government offices as a direct entitlement of the beneficiary? There may be good reasons for that, but, so far as I am aware, they have never been given.

Finally, since this announcement was in the form of a Statement, does that foreclose further discussion on what is to be done, or will there continue to be discussions about the proposals during their progress through Parliament and into the future?

[Earl Howe]

My Lords, the noble and learned Lord, Lord Archer, is himself to be thanked and congratulated on the immense amount of work he did to inform the thinking of the previous Government and the current Government in these matters. I immediately echo his tribute to the work of so many people—people, as he said, of all political parties and none—who enabled us to gain a proper understanding of these issues. I am also well aware that the noble Baroness, Lady Thornton, was working very hard up to the time of the last general election to see whether a better package could be delivered. I was particularly pleased to hear her support for this series of announcements.

The noble and learned Lord asked me about the benefits for deceased victims and whether these were the only anomaly that we sought to correct. We identified two principal anomalies in the situation that has pertained hitherto: the first was the one to which he referred in relation to those who died prior to 29 August 2003, which was an arbitrary cut-off date; and the second was the clear imbalance of benefits for those who suffer hepatitis C as a result of receipt of contaminated blood. There was a gap to be filled there, and we were even clearer on that having read the scientific report that we received. We therefore sought to redress that particular imbalance. There are a number of other new elements in the package, but I have identified the two main ones that stood out to us.

The noble and learned Lord asked why we were choosing to use charitable trusts as the mechanism for payment. We feel that the arrangements have worked well so far through charitable trusts and we do not think it appropriate for these benefits to be paid through the Department for Work and Pensions. It is not really in the department’s remit to do that; it is there to pay benefits and certainly not to decide on discretionary payments. We hope and believe that the victims who are currently in receipt of the benefits have good relationships with the trustees of all the funds.

As for the practical arrangements for paying these new sums, if there are queries we will endeavour to answer them. As I have indicated, we are directing people towards the Skipton Fund as the point of information on this, but the package that my right honourable friend announced today should be regarded as the final one because we believe that it settles the outstanding issues that we needed to address.

[Lord Reid of Cardowan]

My Lords, I thank the Minister and welcome the Statement today. As a former Health Secretary, I took some interest in this matter, but, like the Minister, I would like to congratulate my colleagues who have been involved in the issue in recent years. The one thing that I came to understand was that this was not only an intractable problem but an increasingly intractable problem. There are two reasons for that: first, as time passed, the human tragedy of the people afflicted became more and more obvious; and secondly, the scientific evidence became more and more complicated and difficult for the Government to avoid.

I have two quick questions. First, we have finally reached a stage which may not be completely the end and may not be completely satisfactory, but which is much fairer than the previous one. But does he accept that if there is a disparity between Scotland, England and Wales in terms of the treatment of victims and there is seen to be inequality and unfairness, it will detract greatly from any value that this has created? Secondly, as my noble friend and colleague Lord Morris said, although this goes a long way, there may still be outstanding issues. Will he not close the door completely to further discussions that could arise in the light of further scientific evidence?

--- Later in debate ---

[Earl Howe]

My Lords, I am grateful to the noble Lord, who comes to this with considerable knowledge and experience as a former Secretary of State for Health. He is right: it has been a difficult if not an intractable problem for successive Secretaries of State. He is also right to say that the human tragedy has become more obvious as the years have passed. For one thing, it was not so obvious in the early days that there would be so many victims of hepatitis C, because that condition only tends to emerge after a considerable lapse of time. The HIV infection was more immediate and more obvious.

The noble Lord is right that in making this announcement for England, we are creating an immediate disparity with the devolved Administrations. As I indicated, I hope that in our discussions with the devolved Administrations—who are, after all, autonomous—we can arrive at a more equitable package for all victims across the United Kingdom. I am sure, without wishing to appear to interfere in the affairs of the devolved Administrations, that that is something that, as human beings, we would like to see. But I cannot pre-empt the decisions that will be taken in those Administrations.

[Baroness Masham of Ilton]

My Lords, I declare an interest as a vice-president of the Haemophilia Society. I am very pleased that the Government have recognised the plight of so many people and families who have suffered this disaster. But what safeguards are in place to prevent any infections from blood transfusions or blood products happening in the future? Prevention is so important and one never knows what is on the horizon.

[Earl Howe]

My Lords, the noble Baroness is, as always, absolutely on the mark. This has been an important issue not just for the current Government but for the previous one.

The measures in place to ensure the safety and quality of human blood, blood components and the blood products manufactured from them have developed significantly since the mid-1980s. We test for viral markers. Donations contribute to a plasma pool which is also tested for viral markers. In 1985, the introduction of heat treatment in the UK removed the risk of both HIV and hepatitis from blood products. Testing of all donations for HIV was also introduced in 1985. Testing for hepatitis C was introduced in 1991 when tests became available. The European directive is now in force. As of 2002, it sets standards of quality and safety for the collection, testing, processing and storage and distribution of human blood and blood components. We have a Community code for medicinal products which affects blood products such as clotting factors. On completion of manufacture, blood products are tested for compliance with specification by the manufacturer. All batches of blood products undergo independent testing by an EU official medicines control laboratory. We are in a different world entirely now from that of the 1970s and 80s.

[Lord Corbett of Castle Vale]

My Lords, can I ask—

Health: Parkinson’s Disease

Earl Howe Excerpts

Monday 10th January 2011 Lords Chamber

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

My Lords, I begin by thanking the noble Baroness, Lady Gale, for tabling this Question for Short Debate. I very much recognise the considerable personal insight that she brings to this subject, not least as chair of the all-party parliamentary group.

Noble Lords have spoken eloquently this evening about Parkinson’s and the devastating impact that it can have. The all-party group’s report paints a compelling picture of the many failings of the health and social care system: limited information for patients and poor access to expert nursing and therapy services, underpinned by a failure to deliver joined-up services. The previous Government produced a number of policy documents designed to improve services and support people with Parkinson’s disease. The National Service Framework for Long-Term Conditions, to which noble Lords have referred, and the NICE clinical guideline are both strong statements, which this Government support. The problem, made clear in this evening’s debate, not least by the noble Lord, Lord Walton, is that all too often the vision of these documents is not put into practice and areas such as Parkinson’s services find themselves at a disadvantage when competing for attention and resources. We want to put that right. Our reforms to the NHS will ensure that patients have far more information about services, more choice about their treatments and more influence over how healthcare is shaped in their community.

Local Health Watch organisations, building on local involvement networks, will ensure that the views and feedback of patients and carers feed into decisions about local health and social care services. Devolving responsibility for commissioning to GP consortia will mean that decision-making is closer to patients and more responsive to their individual needs. The noble Baroness, Lady Gale, is right: we will have to ensure that GP commissioners are ready and have the skills and awareness that they need to take these decisions. The noble Baroness, Lady Thornton, referred to that matter, as did the noble Baroness, Lady Masham.

As noble Lords are aware, poor commissioning is one of the main reasons for the low quality of some Parkinson’s services and the patchwork quilt of standards about which we have heard. I know that some patient groups have expressed concerns about the skills and knowledge of GP commissioners. The key to this will be creating better care pathways. That is my main answer to the noble Lord, Lord Walton, who expressed his scepticism on this score. We will expect consortia to involve relevant health and social care professionals in helping to design care pathways or care packages for those with Parkinson’s that achieve more integrated delivery of care, higher quality and more efficient use of resources. They should also talk with their local authorities, which will play an increasingly important role in co-ordinating care as we move toward joint commissioning and planning through health and well-being boards. There are certainly opportunities for patient groups to contribute to developing GPs’ understanding of the condition and how to commission for it effectively. Regional neurological alliances, to which a number of noble Lords referred, have an important role to play, working with the NHS and councils, to make sure that patient needs are being met locally.

The noble Baroness, Lady Gale, referred to outcomes. The new NHS outcomes framework will help to deliver care that is safer and more effective and provides a better experience for patients. The outcomes and indicators in the NHS outcomes framework have been chosen specifically to capture the full range of NHS responsibilities. Where appropriate, they are not condition specific, but rather seek to capture those outcomes that an individual with any condition would consider important.

In these financially challenging times, it is important that we make the most of the resources available. Parkinson’s services are a good example of where much more can be done and where inadequate services waste resources. With an ageing population, the number of people with Parkinson’s is increasing and, as the Fair Care campaign highlights, the best way to save money is to deliver good-quality Parkinson’s services when and where people need them.

Better, more effective care does not necessarily mean more resources. Doing things differently, good multidisciplinary teamwork, specialist support, early interventions and care planning can all make a significant difference. High-quality information, combined with the right support, is the key to achieving better care, better outcomes and reduced costs. We have been consulting on a new information strategy to improve the range and quality of information available to patients, professionals and the public, to increase transparency and strengthen accountability in the system.

Good social care is vital for people living with Parkinson’s. It enables them and their carers to live the independent life that most of us take for granted. We want to build a social care system that is fair and sustainable—one that reflects individual autonomy and ensures that everybody is treated with dignity and respect. In November, we published our vision for social care, setting the future direction for adult social care in England. The vision looks at the role of social care in contributing to the development of the big society and includes a new leadership role for local councils to improve preventive services and develop community capacity, which is in part an answer to the question posed by the noble Baroness, Lady Thornton—in other words, inspiring and supporting communities to look after themselves. The vision encourages care and support to be delivered in a partnership between individuals, communities, the voluntary sector, the NHS and councils, including wider support services, such as housing.

Carers exemplify the big society. They provide care and support entirely from their own time and resources. In government, we need to reciprocate this commitment with measures that support carers. Last year, we published an update to the National Carers Strategy—Next Steps for the Carers Strategy. It provides a clear plan of action for the next four years, focusing on what will have the biggest impact on carers’ lives.

A number of noble Lords, including the noble Baroness, Lady Gale, my noble friend Lady Hussein-Ece and the noble Baroness, Lady Masham, referred enthusiastically to the role of specialist Parkinson’s nurses. Specialist nurses provide a very important source of support and advice to patients with Parkinson’s disease and enable many patients to manage their condition effectively. It is of course the responsibility of local health bodies to make decisions on the funding of Parkinson’s nursing posts. The Long-Term Conditions Delivery Support Team has, however, developed a guide to writing a business case for epilepsy specialist nurses for commissioners to use in making the case for improving those services. This guide could be adapted to make the case for specialist nurses for other long-term neurological conditions, including Parkinson’s. The new commissioning arrangements will take all the evidence into account in deciding to what extent specialist nursing will be commissioned.

The noble Baroness, Lady Gale, asked whether all areas will retain their levels of Parkinson’s nurses. We think that localism is the best way of holding local organisations to account. These decisions should in the end be made locally and will be influenced by the important inquiry that she has chaired.

The noble Baroness, Lady Gale, and others referred to the national service framework. While the vision of the NSF reflects that of the White Paper, the new NHS architecture, and particularly the arrangements for commissioning, will render somewhat outdated any lessons learnt from the review. Better outcomes for people with long-term neurological conditions will in future be achieved through the NHS outcomes framework. The framework will enable patients to judge the overall performance of the NHS and to hold the Government to account for progress. Through the Long-Term Neurological Conditions Research Initiative, the department has funded the development of Quality Neurology, a comprehensive audit tool for local health and social care economies to use in assessing their current status in meeting the quality requirements of the NSF for long-term conditions.

The noble Lords, Lord Harrison and Lord Walton of Detchant, referred to GP consortia needing to involve the third sector. I have already referred to this issue. The onus is on regional neurological alliances and patient groups to engage with GP consortia in the first instance. Through the then Section 64 scheme, the department funded the Neurological Alliance to establish a network of RNAs across England. The case for developing a quality standard for Parkinson’s disease will be considered as part of the development of the comprehensive library of standards, in line with the plan set out in the White Paper. The longer-term aim is to develop a broad library of quality standards covering the majority of NHS activity.

The noble Baroness, Lady Gale, and my noble friend Lady Hussein-Ece asked about the status of the NSF for long-term conditions. The Government’s health reforms place outcomes at its heart, as I mentioned. That fits very well with the aspirations of the NSF for long-term conditions. The issue is not the delivery mechanism—in other words, the NSF versus the Government’s health reforms—but, rather, ensuring that services for people with a long-term neurological condition achieve the best possible outcomes.

The noble Baroness, Lady Gale, asked how we can ensure that money for carers would be spent as intended. It is for PCTs and, after them, GP consortia to manage their budgets and make decisions about how best to meet the health needs of their local populations, but we are looking at how we can make decision-making more transparent. That includes using the NHS operating framework, which sets out the priorities for the year ahead and makes it clear that breaks for carers are important. The NHS outcomes framework and the outcomes framework for adult social care will also push for clear and unambiguous accountability in this area.

As so often happens, the clock is moving against me. I have much material here to answer every question posed by noble Lords. I apologise that I will not have time to do that in my allocated slot and I will write to all noble Lords with answers. Suffice it to say that, while tonight’s debate has highlighted variations in the quality of care, the fact is that there are some very good examples of Parkinson’s services. In Barnsley, for example, there is an holistic, multidisciplinary service in a range of locations tailored to meet the needs of patients. We need to replicate such models, ensuring that everybody has access to comprehensive services and expert multidisciplinary care. Through our health reforms, we are determined to continue to transform standards and to achieve better outcomes for people with Parkinson’s disease.

NHS: Targets

Earl Howe Excerpts

Monday 20th December 2010 Lords Chamber

[Lord Wills]

To ask Her Majesty’s Government what they propose the role of targets in the National Health Service should be.

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

My Lords, from 2012-13 the NHS commissioning board will be responsible for the delivery of NHS services, based on the NHS outcomes framework. The operating framework for the NHS published last week sets out the priorities for the NHS for the transition year of 2011-12 and details how the NHS will move to a health economy driven by outcomes for 2012-13.

[Lord Wills]

I am grateful to the Minister for that Answer. He will recall that, in October, the Health Secretary said that the coalition never committed to a one-week target for cancer patients to get their test results

“because there is not enough clinical evidence to support it”.

However, in November, the noble Earl the Minister told this House that a

“one-week access target would not be the best use of the resources that we have”.—[Official Report, 11/11/10; col. 319.]

Why exactly did the Government scrap the target? Was it the cost, or was there a clinical justification? If it was both, which justification was the most important? If the clinical evidence played any part in this decision, could he please place the evidence in the Library of the House?

[Earl Howe]

My Lords, the announcement made by the previous Government for the one-week target was an unfunded, as well as very expensive, commitment. At the moment, the median wait for the 15 key diagnostic tests is 1.8 weeks—it fluctuates between 1.5 weeks and thereabouts. To bring that down to a maximum of one week would have cost many hundreds of millions of pounds. We judged that there are better ways in which to speed up access to diagnostic tests for a lot less money. That is why we recently announced that £25 million will be made available next year to help GPs to get direct access to tests for cancer without first having to make an appointment with a specialist. That money will buy up to 150,000 extra tests. We have thought round this problem—if I may put it that way—and thought around the conventional referral pathways. I believe that we will arrive at a very satisfactory result.

[Baroness Gardner of Parkes]

Can the Minister tell me his view as to how exactly things will work? Although some targets were considered bad, unnecessary and unproductive, others produced some good results. Will the targets be replaced by a code of practice or guidance, or will people simply be left to manage as best they can?

[Earl Howe]

My noble friend is right. Of course the waiting time target achieved a great deal in bringing down waits for elective procedures, but the target had some unwanted effects in that it distorted clinical priorities and, many people felt, took the focus away from many areas of care that deserved greater focus. We need to focus on outcomes for patients. Therefore, instead of setting process-based targets, our aim will be to ensure that, wherever possible, the NHS uses the measures that clinicians themselves use as a basis for improving their services—in other words, measures that are clinically credible and evidence based. That is how we have tried to frame the outcomes framework.

[Lord Davies of Coity]

Does not the Minister agree that the Secretary of State’s proposals for competitiveness within the health service will in effect privatise the NHS?

[Earl Howe]

My Lords, I do not accept that. The previous Government recognised that contestability in the provision of care was a very powerful driver to improve quality of services. I do not think that privatisation of the health service will result from the proposals. We will reach a better stage of quality in provision of care only if we allow the best providers out there to compete for services. As long as the principles of the NHS remain—which they will do under this Government—for a service free at the point of need without being based on ability to pay, we will have the NHS that we all know and love.

[Lord Alderdice]

My Lords—

--- Later in debate ---

[Earl Howe]

My Lords, many of the data that will underpin the monitoring of the outcomes framework are already collected as a matter of routine but are just not used. In the outcomes framework, we shall reduce the number of outcomes to many fewer than have been in play under the previous Government’s process-based targets. We do not see our proposals as imposing unnecessary or impossible extra burdens on the NHS.

[Lord Patel]

I need to cultivate a louder voice, obviously. Can the Minister give an example of where competition in healthcare delivery has improved outcomes?

[Earl Howe]

I am sorry that the noble Lord is a sceptic on these matters. In the field of mental health care, for example, where there is a long-standing position of private sector contestability, we have seen that standards have been driven up. There is no doubt that the foundation trust model has also paved the way for higher quality in healthcare.

[Baroness Thornton]

My Lords, turning to waiting lists for accident and emergency services, which we obviously want to provide the highest possible care, I want to ask how the newly proposed scheme will improve the quality of care. For example, how will the abolition of the 19-minute response time to a 999 call that is not life threatening affect the health outcome for an elderly lady who has slipped and broken her wrist on the ice? Such a slip may not be life threatening, but the elderly lady may wait for quite some time for an ambulance and then wait considerably longer than four hours in accident and emergency. Is the waiting time not an outcome here? If the Government do not intend to introduce a new outcomes framework for two years, would the Government not be better to leave the current guarantees in place because we know that they ensure patient safety?

[Earl Howe]

My Lords, on ambulance response times, the existing eight-minute target will remain in place for category A calls. For category B calls, which are serious but not immediately life threatening, Peter Bradley, who is the national ambulance director, has been working with Professor Cooke to develop a set of 11 clinical quality indicators for the ambulance service. We are clear that those indicators will provide a much better and more rounded set of objectives than a mere 19-minute response time. Of course response times are important, but there are other things that should be focused on as well. We hope to improve standards in this way as from April next year.