Health: Cancer
Earl Howe Excerpts(14 years, 4 months ago)
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Lord Patel
To ask Her Majesty’s Government what proposals they have for improving outcomes for cancer patients.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, we published Improving Outcomes: A Strategy for Cancer on 12 January, which sets out a range of actions to improve outcomes for cancer patients. Earlier diagnosis is crucial to improving outcomes, and we have set out plans to deliver this through improving GP access to diagnostic tests, supporting symptom awareness initiatives, and extending cancer screening programmes. We are also improving access to treatment and the quality of support for survivors.
Lord Patel
I thank the Minister for his Answer, which is very helpful because it prompts two questions. First, when does he think the procedures which he has put in place will succeed and cancer outcomes will improve, and in the mean time what is likely to happen to cancer outcomes? Secondly, could he also say what the state of radiotherapy treatment in England is?
Earl Howe
My Lords, the strategy we have laid out is an ambitious one. It aims to save an additional 5,000 lives every year by 2014-15. That programme is supported by over £750 million of additional money over the next four years. It sets out actions to prevent cancer incidence and to improve the quality and efficiency of cancer services and of patients’ experiences of care. We are giving ourselves a little time, but we are under no illusions, and this is an agenda to be pursued very energetically. We are putting considerable additional money—from memory, it is £150 million—into radiotherapy services, but we also feel that there is an important issue around the use of existing radiotherapy equipment, which is often not utilised as effectively as it could be.
Baroness Hughes of Stretford
My Lords, would the noble Earl agree that the regional networks of specialist cancer services, established through the co-operation of clinicians themselves, have been instrumental in improving outcomes for patients? If so, how does he think that essentially collaborative model fits with the rigid and mandatory price competition that the Government now want to introduce into the NHS?
Earl Howe
My Lords, the Government are not introducing price competition, it has never been our intention to do so, and the Bill that will come before the House will make it absolutely and abundantly clear that price competition is out of range. As regards the cancer networks, the noble Baroness is absolutely right. Over the past 10 years, these have played a crucial role in improving the quality of cancer treatment and the patient experience of care. The outcomes strategy that we have published explicitly states that next year there will be funding for cancer networks to support commissioning.
Lord Alderdice
My noble friend introduced the question of diagnosis, which is increasingly a multi-professional matter, involving pathologists, surgeons, radiologists and so on. This seems self-evidently a good thing. However, is the department accumulating evidence to show that it is actually improving the outcomes? It is of course an expensive procedure to involve so many senior professionals together.
Earl Howe
My noble friend is quite right. It does involve often a number of senior clinicians. The key to diagnosis, however, is to get in early, as I am sure he would recognise. The outcomes strategy commits us to saving the additional 5,000 lives very largely through additional identification of early cancer. In fact, 3,000 of the 5,000 lives that we are hoping to save will be saved, we hope, by earlier diagnosis. A good example of that is that over 90 per cent of bowel cancer patients diagnosed with the earliest stage of the disease survive five years from diagnosis, compared to only 6.6 per cent of those diagnosed with the advanced disease.
Lord Walton of Detchant
Would the noble Earl accept that this country has had a very proud record in carrying out clinical trials, not least in the field of cancer; and that since the passage of the European directive on clinical trials, the problem of getting ethical approval for multi-centred trials—in a variety of different centres—has become immense? Is he aware of the recent report of the Academy of Medical Sciences, from a committee chaired by Sir Michael Rawlins, which has made a number of crucial recommendations? If accepted by the Government, those would make the performance of these trials very much easier.
Earl Howe
My Lords, I am indeed aware of that excellent report. It is being studied with care in my department. We hope to make an announcement reasonably soon in response to it. It contains some extremely important recommendations which, if implemented, should do a great deal to restore the country's position as a destination of choice for clinical trials.
Lord Mawhinney
My noble friend, in his original Answer, talked about the importance of early diagnosis. Is he not concerned at the cascade of cases reported in the media of GPs sending patients home with flu symptoms and indigestion and not detecting the cancer until it is too late? What does my noble friend intend to do to improve GP training to assist the earlier diagnosis on which he rightly lays so much emphasis?
Earl Howe
My Lords, of course those reports are a matter for concern, which is why we are clear that GP consortia should be supported as much as possible in terms of commissioning guidelines and information. One of the tasks of the NHS commissioning board will be to provide that support and information based on quality standards produced by the National Institute for Health and Clinical Excellence.
Homelessness: Tuberculosis
Earl Howe Excerpts(14 years, 4 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, from 1 April, the National Health Service in London will fund continued provision of the Find and Treat outreach service to detect TB among the homeless, including rough sleepers, and to help to ensure treatment completion. There are also initiatives for TB testing among the homeless in cities such as Liverpool and Leicester. The National Institute for Health and Clinical Excellence is developing guidance on tuberculosis among hard-to-reach groups, including rough sleepers.
Baroness Sharples
I thank my noble friend for that encouraging reply, but is he aware that the chaotic lifestyle of homeless people with very poor immune systems means that they are extremely difficult to diagnose and to treat for the six-month period for which they need antibiotics? Are Her Majesty’s Government working with other organisations to help these homeless people?
Earl Howe
My noble friend is absolutely right: this is a particularly difficult group of people in that they are hard to reach. There is a high incidence of TB among the homeless in London and a service of the kind to which I have referred appears to be cost-effective in reaching those people. On my noble friend’s second question, we are engaging with the Mayor of London’s office to see how it can become involved in helping to deliver cost-effective services to this group of people.
Lord Faulkner of Worcester
My Lords, will the Minister invite Westminster City Council to think again about the proposed by-law, on which it is consulting, which will make it illegal not only for rough sleepers to live on the streets around Westminster Cathedral but for charities such as Housing Justice to distribute food and soup to them? It describes the Westminster City Council proposal as an over-the-top response. Is it not right to say that? Does he agree that the problems of tuberculosis, which are the subject of this Question, will be much more difficult to identify if rough sleepers are driven off the streets and forced to live elsewhere?
Earl Howe
My Lords, I very much see the force of the noble Lord’s point. We are very much committed to preventing homelessness and to protecting the most vulnerable. We have maintained the funding for the homelessness grant at the levels of the current year— £400 million over the spending review period, which is £100 million over each of the next four years. We are specifically providing £18.5 million a year to support the voluntary sector. This is a priority, but I will take away the point that he has made about Westminster City Council.
Baroness Knight of Collingtree
My Lords, is it possible for a person who has no fixed address to have a doctor or to get immediate medical attention?
Earl Howe
My noble friend puts her finger on a key difficulty with this group of people, who are often very difficult to keep track of. I heard of one case where a patient required 800 interventions, sometimes with the police involved. Clearly a lot of effort has to go into this group. However, it is possible, if the patient is willing, to register that person with a GP. The challenge is whether they actually return to complete their treatment, which of course extends over many months.
Baroness Armstrong of Hill Top
My Lords, I ought to declare an interest in that I chair the Cyrenians in the north-east. We have been working on a programme that has been identifying and keeping contact with these most vulnerable and disaffected people and we have reduced the number who have become, as they are called, “frequent flyers”. However, does the noble Lord acknowledge that there simply is not a straightforward system in the National Health Service to deal with people who do not have a fixed address and do not have regular contact with a particular locality or GP? Is it not about time that we looked at this much more holistically? There are some good individual examples around the country, but there is no guarantee that we will intervene sufficiently early to stop what is now known, which is that most people who sleep rough will be dead long before they are 50.
Earl Howe
My Lords, I was very interested to hear about the noble Baroness’s experiences in the north-east and I would like to hear more. The points that she raises lie behind our intention in the Health and Social Care Bill to make GP consortia responsible not just for the patients on the GP lists but for all the population in the local area. The health and well-being boards, which we propose should be set up at local authority level, will bring together all the relevant stakeholders to look at how the health needs of an area can best be met and prioritised.
Lord Laming
My Lords, this is a group of our fellow citizens who are particularly vulnerable and can so easily be lost in the system. At a time when there is considerable pressure on budgets, will the noble Lord use whatever good offices he can to ensure that this remains a priority in all the public services and is not seen as a soft option?
Baroness Thornton
Following on from that very helpful question, may I ask specifically about the mobile X-ray units in London, which we have discussed before in your Lordships’ House? These were funded through pooling relatively small amounts of funding from the PCTs across London, organised by the strategic health authority. Those bodies are about to disappear, so what will happen in the transition period to those mobile units and how will the new arrangements work with the consortia that are being planned?
Earl Howe
My Lords, the position for 2011-12 is that the NHS in London will fund Find and Treat. During the next year, the NHS will consider future funding, taking into account the final evaluation of the service by the Health Protection Agency and the emerging guidance from NICE. As regards the more medium-term agenda, the Government’s strategy is for a much more joined-up service. We will have the public health service working both locally and nationally. We will also have the GP consortia commissioning treatment at a local level. I hope that, as the system evolves, the noble Baroness will see that there is no loss of momentum in this very important area.
Health: Alcohol Minimum Pricing
Earl Howe Excerpts(14 years, 4 months ago)
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Baroness Wheeler
To ask Her Majesty’s Government what is their assessment of the impact of minimum pricing policy on the level of alcohol-related conditions and admissions to hospital.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the Home Office review of pricing policy found that increases in alcohol prices are linked to decreases in alcohol-related harms. The review also highlighted that this is a complex issue. The Government intend to ban sales of alcohol below the rate of duty plus VAT. This is a pragmatic first step towards setting the lowest level at which different strengths of alcohol can be sold. We estimate that it would mean about 1,500 fewer alcohol-related hospital admissions per year.
Baroness Wheeler
I thank the Minister for his response. However, two leading advisers from the Department of Health’s own network of experts recently wrote in the Lancet that the Government,
“lacks clear aspiration to reduce the impact of cheap, readily available, and heavily marketed alcohol on individuals and on society”.
They estimate that failure to tackle drink-related problems could cost 250,000 lives over the next 20 years. How will the Minister ensure that in future the health, well-being and recovery of people with drink-related problems take precedence over the lobbying of the drinks industry?
Earl Howe
My Lords, I make it clear that we neither have nor intend to have any sort of cosy arrangement with the drinks industry. The view that we have taken is that the food, drink and fitness industries, together with charities and public health experts, all have a huge role to play in improving our health. The industry has enormous influence in its own right. However, more than that, we believe that we have a collective responsibility to do something about this problem. That is why the industry has joined the Government in a partnership to promote and empower us all to adopt a healthier lifestyle. Through the public health responsibility deal, we are challenging industry to take action that will help consumers to live healthier lives in some areas where it is not possible or effective to regulate.
Lord Walton of Detchant
My Lords, is the Minister aware that experts on liver disease such as Professor Sir Ian Gilmore in Liverpool and Professor Chris Day and Dr Chris Record in Newcastle have identified an alarming increase in the incidence of liver disease in young people? No doubt he has read the letter in the Times this morning from representatives of the drinks industry, who say that the total consumption of alcohol in this country has fallen by 11 per cent during the past two years. However, consumption by young people is steadily increasing. Can he think of any solution by which he can overcome the problem of proxy purchasing, whereby people above the minimum age buy alcohol in bulk and pass it on to young people, who are being damaged by this process?
Earl Howe
My Lords, as ever, the noble Lord is absolutely right. Overall consumption of alcohol is going down, but we are seeing very alarming rates of consumption among certain groups of young people. As Sir Ian Gilmore has pointed out, liver disease is appearing among the young, which is extremely worrying. The Government are determined to grasp this issue. Public health policy generally is co-ordinated by a public health Cabinet sub-committee. It will work on an alcohol strategy, which we will publish in the summer in the wake of our White Paper on public health. There is no single solution to this problem. The issue of proxy purchases, which for alcohol, I believe, is already an offence, is difficult to police and enforce. However, the noble Lord is right that we need to focus on it in our strategy.
Baroness Gardner of Parkes
My Lords, the original questioner mentioned public health in general, but is the Minister aware that alcohol is a cause of great disturbance in accident and emergency departments in all hospitals, particularly on Friday and Saturday nights, when ordinary people who go in with injuries are subjected to very unpleasant treatment by those who are brought in following an alcohol-related incident?
Earl Howe
My noble friend makes an extremely important point. We estimate that alcohol harm costs the NHS around £2.7 billion a year. Forty per cent of all accident and emergency admissions are in some way connected with alcohol—I think a higher percentage on Friday and Saturday nights—and 7 per cent of all hospital admissions are accounted for in some way by alcohol. This is a very serious problem: 8,500 people die from alcohol in the UK every year and there are over 1 million hospital admissions relating to alcohol.
Lord Brooke of Alverthorpe
My Lords, now that the Minister and the Government have accepted that raising the price of alcohol is one of the ways in which we can minimise harm to those who are abusing alcohol, why have the Government’s recent proposals been so minimal? The cost of a can of lager will be increased, or minimised, to 38p under the new arrangements. This is hardly going to make any change whatsoever. We have to wait for the White Paper in the summer, but in the mean time why could a more positive approach to raising the cost of alcohol not have been taken and more fundamental changes made to the ever increasing easy access to alcohol, which is another problem that needs addressing?
Earl Howe
My Lords, we view the decision to ban below-cost sales of alcohol as very much a first step. We have announced a number of other measures, as the noble Lord may know, particularly a rise in the rate of alcohol duty by 2 per cent above inflation over each of the next four years, additional duty on high-strength beers and greater powers for local authorities over local licensing decisions. As I mentioned, there is no single solution to this problem, but we are looking at a number of additional measures.
Health: Mental Health Strategy
Earl Howe Excerpts(14 years, 4 months ago)
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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.
Health: Multiple Sclerosis
Earl Howe Excerpts(14 years, 5 months ago)
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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.
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?
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.
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?
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(14 years, 5 months ago)
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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(14 years, 5 months ago)
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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.
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?
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(14 years, 5 months ago)
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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.
Baroness Sharples
Is the noble Earl aware that I owe my good health to a great extent to herbal medicine?
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.
NHS: Front-line and Specialised Services
Earl Howe Excerpts(14 years, 5 months ago)
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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
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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.