Herbal Medicines
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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, 9 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
Earl Howe Excerpts(14 years, 9 months ago)
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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.
Blood and Blood Products
Earl Howe Excerpts(14 years, 9 months ago)
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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.
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.
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?
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.
Health: Parkinson’s Disease
Earl Howe Excerpts(14 years, 9 months ago)
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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(14 years, 10 months ago)
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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.
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.
NHS: Global Health
Earl Howe Excerpts(14 years, 10 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, I thank the noble Lord, Lord Crisp, for calling this debate and express my gratitude for his strong and continuing commitment to issues of global health. I found his speech extremely helpful and thought provoking.
The Government are deeply committed to issues of international development. In this year’s spending review we confirmed that, as well as protecting the NHS budget, we will keep our promise to spend 0.7 per cent of gross national income on aid from 2013, helping the billion people who live in extreme poverty around the world. We are equally committed to doing everything we can to meet the millennium development goals. In particular, we are taking bold action to tackle malaria and to improve reproductive, maternal and newborn health. In answer to the noble Baroness, Lady Thornton, we are currently reviewing the previous Government’s cross-Whitehall global health strategy to ensure its relevance and effectiveness in the coming years.
The noble Lord, Lord Crisp, has linked issues of development with those of the appropriate education of health professionals, which itself has enormous implications both for our nation’s health and for that of the rest of the world. As he knows, there are many aspects of the education of health professionals, encompassing pre- and post-registration training, as well as continued professional development. The responsibility for setting the standards required for professional pre-registration sits with the professional regulators. The higher education institutes then design training curricula to meet these standards in partnership with NHS service providers and the regulators. The Department of Health, along with the local NHS bodies that commission professional training, continues to work with the regulators and higher education institutes to ensure that their standards and curricula reflect the changing needs of patients and service delivery.
In terms of pre-registration education for doctors, we look to the General Medical Council for leadership. Its 2009 publication Tomorrow’s Doctors provides the framework that UK medical schools use to design detailed curricula and methods of assessment. I was glad to see the framework was well received by the authors of the recent Lancet Commission publication, Health Professionals for a New Century. The framework also highlights the importance of a global dimension. New graduates must be able to demonstrate awareness, from a global perspective, of the determinants of health and disease and of the variations in healthcare delivery and medical practice. Postgraduate medical training curricula are developed by the medical royal colleges for approval by the GMC. Most of the topics highlighted in this debate are covered in the foundation programme curriculum and core competence framework for doctors developed by the Academy of Medical Royal Colleges.
We have come a long way since the noble Lord wrote his report on medical training, Global Health Partnerships, in 2007. My noble friend Lord McColl is absolutely right that there is already significant good practice in the UK in terms of incorporating the global dimension into pre- and post-registration training. This is one part of the answer to the noble Lord, Lord Crisp, who asked me to consider what more might be done to support this type of activity. Medical students can study global health; they can spend a year studying international health as part of an intercalated degree or can choose to travel to developing countries for the elective component of their undergraduate training. There are also opportunities for post-registration medical doctors to spend part of their specialty training in developing countries, as part of the out-of-programme training and research arrangements. Here, I reassure my noble friend Lady Tonge and the noble Baroness, Lady Hollins, that, if prospectively approved, training of this type counts towards the certificate of completion of training. Details of this initiative are provided in the Gold Guide, a guide for postgraduate specialty training in the UK agreed by the four UK health departments for core and/or specialty training programmes. This sets out a clear process as a guide for post-graduate deans.
My noble friend Lord McColl—
Earl Howe
Perhaps the noble Lord and I can speak after the debate.
My noble friend Lord McColl stressed the need for taking longer periods overseas and providing greater support for achieving the goals that we have all been talking about. Universities support medical student electives as long as the plans are carefully drawn up to ensure the best possible experience for them and, of course, for the host institution abroad. I emphasise to the noble Lord, Lord Patel, lest there be any doubt in his mind, that we strongly support the principle that trainees should have opportunities to gain experience overseas both for their own benefit and that of the host countries. Also, the noble Baroness, Lady Cox, was right to say that there are opportunities for postgraduate medical doctors to spend part of their specialty training in developing countries, as I have mentioned, and these can count towards clinical medical training.
In answer to my noble friend Lady Tonge, we take on board comments about reducing the level of bureaucracy in this process, and we welcome suggestions for improvement. However, we need to ensure both that service can continue to be delivered effectively in the NHS and that training overseas is appropriately recognised, supervised and assessed, which is not necessarily straightforward in every case.
Earlier this month, the Lancet Commission published a report, Health Professionals for a New Century. In response to some of its specific proposals, I should like to highlight the progress that has already been made in a number of areas. For example, the Department of Health is taking forward its technology-enhanced learning strategy to promote greater use of information technology for learning, harnessing and sharing global education resources. The Medical Training Initiative allows a small number of doctors from developing countries to work and train in the NHS before returning home. The National Leadership Council works with clinicians from all professions to develop their leadership skills and embed leadership across all undergraduate and postgraduate curricula. The Health Partnership Scheme, launched in November by my honourable friend in another place, Stephen O’Brien, will enable NHS professionals to share their skills with nurses and doctors in developing countries through teaching, training and practical assistance. We should also mention the report from the noble Baroness, Lady Deech, entitled, Women Doctors: Making a Difference. It makes recommendations on a range of issues that include improving access to mentoring and career advice, improved access to childcare, more flexible and part-time training, and encouraging women into leadership positions.
We must always look to improve the standards of medical education in this country. For this reason, as has been mentioned, we have today published Liberating the NHS: Developing the Healthcare Workforce, the consultation on the education and training aspects of the NHS White Paper, Equity and Excellence: Liberating the NHS. The White Paper signals a new approach to workforce planning, education and training by,
“giving employers greater autonomy and accountability for planning and developing the workforce”,
alongside greater professional ownership of the quality of education and training. The consultation will enable my department to do the second thing proposed by the noble Lord, Lord Crisp, which is to meet with relevant parties to consider the findings of the Lancet Commission report. With the changes set out in the NHS and public health White Papers, the system of healthcare in England is changing, and it is imperative that our system of education and training reflects that change.
The noble Baroness, Lady Hollins, asked whether curricula include global competences. They do, and in acknowledgement of the case presented by Medsin UK, a global health dimension is included in the 2009 GMC guidance, Tomorrow’s Doctors, which states that new graduates must be able to demonstrate,
“an awareness from a global perspective of the determinants of health and disease, and variations in healthcare, delivery and medical practice”.
In fact, most of the topics highlighted by the report of the noble Lord, Lord Crisp, which I mentioned, are covered in the foundation programme curriculum published this year. All topics are at least partly described in the core competences for doctors in the Academy of Medical Royal Colleges’ Common Competences Framework for Doctors, published last year.
The noble Lord, Lord Crisp, urged that we should find ways to give active support for doctors to take part in health partnership schemes. We agree that we need to support doctors and other health professionals to take part in that scheme and I can reassure him that the Department of Health is working closely with the Department for International Development on this initiative. I mentioned the partnership scheme earlier.
The noble Lord, Lord Butler, referred to the role of academic health science centres and I welcome the initiatives taken by the AHSCs, both in teaching and research, in global issues. They can contribute a huge amount but perhaps two things above all: the partnerships which they can and do form overseas and their ability to develop cultural competence in UK graduates.
My noble friend Lady Tonge referred to the need for ethical recruitment. She is absolutely right. She probably knows that the UK was the first country to produce international recruitment guidance based on ethical principles and the first to develop a robust code of practice for employers.
The noble Lord, Lord Crisp, made some extremely constructive and important points, as did all other speakers, for which I am very grateful. I shall make sure that these are taken into account during the consultation process.
In closing, I should like to take this opportunity to invite all interested parties to engage with the consultation to help us develop the recommendations made in the Lancet Commission report and to help shape the future system of education for health professionals.
NHS: Reorganisation
Earl Howe Excerpts(14 years, 10 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, I join other noble Lords in thanking the noble Lord, Lord Touhig, for calling this debate, which has been both wide-ranging and characterised by some extremely thoughtful and eloquent contributions. I welcome the opportunity to discuss these issues, which are so important to us all. Of course, being impressed by eloquence is not the same as being swayed by argument. It will not surprise your Lordships that I cannot identify with the criticisms of the Government’s policy voiced by several speakers. By and large, those criticisms are either misplaced or exaggerated and I hope to show why.
It is perhaps appropriate to start with the question posed by the noble Lord, Lord Hunt of Kings Heath, about why we are reforming the NHS. First, as good as the NHS is, in what is most important for patients and many health outcomes—for many cancers, respiratory disease and heart attacks—we lag behind. Secondly, in its current state, the NHS is unsustainable. We can no longer meet increasing demand by spending ever more money. In every western economy, cost pressures from healthcare exceed GDP growth. There is a basic challenge of affordability. Without reform, the NHS will quickly bend until it breaks.
We seek to address a good part of that challenge through the four pillars of the QIPP programme—quality, innovation, productivity and prevention. In many ways the White Paper is a vehicle for the QIPP reforms, squeezing the most out of every penny invested and creating a better-value and entrepreneurial NHS. Looking more particularly at the prevention agenda, our focus on public health through Public Health England will do as much to keep people healthy as the NHS does to make them well.
Although some see the reforms as a big step—I do not disguise the fact that there will be some big changes—they amount in several other respects to a series of small steps. GP-led commissioning builds on the experience gained from previous reforms, particularly practice-based commissioning and GP fundholding. Our any willing provider policy is an extension of the choice agenda initiated by the previous Government. Without lowering the quality bar—I say that particularly to the noble Lord, Lord Touhig—we are completing the rollout of foundation trusts, only this time with robust arrangements for provider failure. The reforms resolve and bring coherence to a series of sometimes disjointed measures rolled out under the previous Administration. Our aim in doing this is very clear: it is to transform the health service into a sustainable system with outcomes as good as any in the world.
Noble Lords need to ask themselves what the alternative would be. Without reform, the alternative is to salami-slice the health service as it is now, with obvious risk and detriment to patients. We know that the previous Administration put aside £1.7 billion for NHS reorganisation of some sort. We will never know what precisely they would have done, but if it was not something similar to our proposals then I wonder what it was.
The other vital strand to the new NHS—again, this was a clear ambition of the previous Administration—is the genuine integration of health and social care, which was mentioned by a number of noble Lords, including the noble Baroness, Lady Sherlock, and the noble Lords, Lord Turnberg and Lord Beecham. We are putting a lot of money into integrated care. I say to the noble Baroness, Lady Sherlock, that the involvement of social care in commissioning will be a key role of the health and well-being boards and the related joint strategic needs assessments that will need to be undertaken by consortia and local authorities working together. What she will see, based on those joint strategic needs assessments, will be better, more integrated health and social care services for patients.
The Government’s response to the White Paper consultations was also published yesterday. This sets out the legislative framework and next steps for the White Paper as we move towards publishing a health and social care Bill in the new year. I wish to pick out two or three issues from this. First, as regards commissioning, the best decisions are those taken closest to those whom they affect. Unfortunately, time prevents me from expatiating on the excellent theme of the noble Lord, Lord Mawson. However, GP-led commissioning will place decisions about the future design of local health services in the hands of clinicians—GPs and their colleagues across the NHS and social care working together. These are people who see their patients and service users every day.
Last week, in response to the consultation, we announced the first 52 in a rolling programme of GP consortia pathfinders. These are in essence the pilots to which the noble Baroness, Lady Williams, urged us to direct our efforts. This first batch involves more than 1,800 GP practices and covers a quarter of the population—some 12.8 million people. The noble Lord, Lord Turnberg, doubted whether integrated care was truly achievable. I visited a pathfinder last week in Nottinghamshire and came away completely inspired by what I saw there in terms of joint working, creative thinking and the breaking down of professional barriers. Noble Lords who have thus far viewed the Government’s proposals solely from the printed word should consider experiencing what is actually happening on the ground. Pathfinders will enable emerging consortia to become more involved more quickly in commissioning. They will explore the issues involved in effective implementation before consortia take on their statutory duties in 2012-13.
The noble Lords, Lord Hunt and Lord Touhig, and others somewhat poured cold water on the whole concept of GP-led commissioning. However, it will remove the current disconnect between clinical decision-making and financial decision-making by putting both in the same place. Those who question the wisdom of that approach should speak to some of the pathfinder GPs. They do not see themselves as being presented with a problem; they see themselves as being able at long last to manage budgets in a way that will change services and bring maximum benefit to all their patients without “the system” getting in their way. The brutal truth is that a budget that is subject to the kind of managerialism referred to by my noble friend Lord Alderdice risks depriving some patients of the care that they need. To those who question the enthusiasm of GPs, I say that the first application for becoming a pathfinder was oversubscribed. More will be coming on stream. By the middle of 2011, we believe that the vast majority of GP practices will be members of pathfinder consortia.
At the centre of everything should be the patient. The noble Baroness, Lady Masham, was right in her general point, although I did not agree with everything that she said subsequently. The NHS should be accountable to the people whom it serves. Patients and the public should have a say in how local NHS services are shaped and should be able to hold them to account in a meaningful way. Beyond a straightforward legal duty for NHS organisations to consult the public, the new local patient champion, HealthWatch, will ensure that people’s voices are heard and acted on. It will be supported by a new national patient voice, HealthWatch England—a short step from what we have at the moment with local LINks, but an absolutely crucial one. The patient voice will also be vital for the new health and well-being boards, which will join up the local NHS, public health and social care. The fact that these boards will be based in local authorities will, of itself, inject a high degree of local democratic accountability into commissioning.
The noble Lord, Lord Touhig, and others referred to the trend towards competition, arguing that there is little evidence of its benefits. As we set out in the White Paper, choice and competition can be powerful drivers for quality and efficiency and can force providers to develop services that genuinely meet patients’ needs and preferences. However, we do not want to introduce the choice of any willing provider for its own sake. That makes sense only where it is likely to deliver real benefits. Competition should not be at the expense of co-operation and there is no reason why it should be. There will still be a duty in the health Bill for NHS organisations to co-operate in patients’ interests.
The noble Baronesses, Lady Williams and Lady Finlay, and, indeed, the noble Lord, Lord Rea, with his arboricultural hat on, suggested that we keep PCTs and simply populate them differently. Let me say why that would not have delivered the outcomes that we want. PCTs are administrative units. The way in which they are configured bears no automatic relationship to the way in which clinicians want to deliver services, and clinicians feel no sense of ownership of them. The pathfinder consortium that I visited in Nottinghamshire last week is configured in a way that takes account of patient flows between primary and secondary care, is logical in terms of how health and social care services are best integrated and works on the ground in terms of close professional relationships. Doctors and other health professionals have designed it; they own it and they believe in it. That is the difference.
The noble Lord, Lord Touhig, referred to fundholding, which I agree was not a successful enterprise in some respects, although it had some valuable lessons which we are now picking up on. Fundholding had a conflict of interests because, as the noble Lord said, underspends of the commissioning budgets tended to go to the practice involved. This will not be the case for GP consortia. The only way in which GPs will be able to benefit is if they can improve outcomes for patients.
The noble Lord, Lord Turnberg, and the noble Lord, Lord Touhig, referred to the risk of recreating or accentuating the postcode lottery. Perhaps I may say that the prime purpose of the National Health Service commissioning board will be to inject two main things, consistency and quality, into commissioning. The NHS commissioning board, supported by NICE, will develop a commissioning outcomes framework so that there is clear, publicly available information on the quality of healthcare services commissioned by consortia. It will include measures to reflect a consortium’s duties to promote equality and to assess progress in reducing health inequalities.
The noble Baroness, Lady Finlay, and the noble Lords, Lord Touhig, Lord Patel and Lord Beecham, criticised the injection of competition and choice into local health economies and expressed fears about cherry-picking. In the new system, the NHS board and Monitor will develop packages of services and tariffs for services, taking account of the need for individual providers or partnerships of providers to deliver integrated care. Monitor will have a duty to ensure that competition, where it is appropriate, functions effectively, which means developing systems where providers cannot cherry-pick the easiest patient groups.
The noble Lord, Lord Hunt of Kings Heath, and others raised various issues concerning accountability and governance. I suspect that we will get into the weeds of this when the health and social care Bill reaches your Lordships’ House, as there is no time to do so today. We think that consortia should be free to define their own governance processes but within a broad framework that will be set out in the legislation. Noble Lords will have to wait to see what that legislation says but I can tell the House that the NHS commissioning board will have a role in establishing consortia and, in doing so, it will seek to ensure that consortia have the systems in place to fulfil their statutory functions in a proper way that takes account of the stewardship of public money.
My noble friend Lord Rodgers of Quarry Bank asked whether there will be a regional role for the NHS commissioning board. It will be for the board itself to decide how it designs the most effective and cost-effective operating model. The board will determine the optimal configuration of its sub-structures with the freedom to adapt over time.
The noble Lord, Lord Kakkar, spoke, as he always does, about education and training, particularly their impact on research and academic medicine. We shall shortly be publishing a consultation document on future arrangements for education and training, which I hope will begin to answer his questions. The noble Lord talked about the importance of research. As Research Minister, I am enthusiastically on his side on that score. Supporting and promoting research and development will be a core function of the future Department of Health, and the Government remain committed to providing the right environment for innovation to flourish. I think that the increased funding for health research in the recent spending review gives us a strong platform to fulfil that ambition.
The noble Baroness, Lady Masham, asked about the position of the 10 specialised commissioning groups, and the noble Earl, Lord Listowel, referred in particular to specialist mental health services. The new NHS commissioning board will commission national and regional specialised services. The consultation has highlighted the need for criteria to be developed to determine which services should be commissioned by the board or by a lead consortium across a population. We will consider the best way to keep the specialised services portfolio under regular review and, as Minister for specialised services, I can tell the House that I will keep a close personal eye on those issues.
The noble Baroness, Lady Masham, doubted whether the HealthWatch model was the way to proceed and she referred to the constant reinvention of patient and public involvement. While local HealthWatch organisations will retain the current functions of LINks, they will also gain additional functions, providing advice and signposting, as well as advocacy, for NHS complaints. We are continuing to work with LINks to build on the valuable work that volunteers have taken forward. As I mentioned, HealthWatch England will be established as a national consumer champion both to give patients and the public a voice at a national level and to provide advice and support for the new local HealthWatch organisations.
The noble Baroness, in her criticism, was doubtful that the local LINks and HealthWatch, as they are to become, will be up to the job. The Command Paper sets out that, while HealthWatch should have an advocacy role, which is one of the roles that we envisage for it, this will not have to be through its own staff. Local authorities will have the flexibility to commission services from other providers, which could include citizens advice bureaux, for example. We have done this. We have created that flexibility, as we recognised the expertise that is required in advocacy services.
The noble Lord, Lord Kakkar, asked what arrangements there were for the sustained development of clinical leaders. Clinicians with leadership skills are central to our efforts to deliver better outcomes for patients and a critical part of successful commissioning. The National Leadership Council’s commissioning work scheme will provide targeted development for GPs who wish to lead consortia. Its work will ensure that, with the advent of consortia in 2013, there will be a suitably skilled group of individuals prepared to lead these organisations.
The noble Lord, Lord Turnberg, spoke about the role of NICE. There is no time for me to reply in detail, except to say that on this subject he was 100 per cent wrong. I will write to reassure him. He also asked about the likely number of GP-led consortia, as did the noble Lord, Lord Beecham. We are intending this to be a bottom-up process, so we have no set expectations of how many consortia there may be. There are, as I mentioned, 52 pathfinders, which we announced the other day, covering 25 per cent of the population. What we will see emerging is the pathfinders exploring the issues involved, including which services are best commissioned at which level.
The noble Lord, Lord Patel, asked what the key essential services will be and how we will make sure that they are available. We will set out the definition of essential services in the health Bill, but broadly a service will be defined as essential if the commissioner could not turn to a suitable alternative service for patients if the incumbent provider stopped offering it. Monitor will be responsible for the process of identifying essential services and ensuring that they are protected, working closely with the board, consortia and other stakeholders.
As the noble Baroness, Lady Sherlock, suggested, we will return to these issues. The Government are committed to the values of the National Health Service: healthcare for all, free at the point of need. In view of all the talk about privatisation, that needs stating. But we are equally committed to doing everything possible to ensure that the quality of that healthcare, as measured by clinical outcomes, is as good as it is possible to be. I believe that our reforms will enable us to achieve exactly that.
Hospices and Palliative Care Services
Earl Howe Excerpts(14 years, 10 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, I begin by thanking my noble friend for tabling this Question for debate and introducing the subject so ably. I very much recognise the considerable knowledge that he brings to this subject, not least as a result of his past chairmanship of St John’s Hospice in London.
Thanks to the dedicated work of hospices, many people do die well: where they choose, with the people they love, and with all the medical, psychological and spiritual care they need. The Government are committed to supporting the work of hospices. We have confirmed the £40 million hospice capital grant for 2010-11, allocated under the end-of-life care strategy, supporting 123 projects in 116 hospices. More generally, we are determined that care should be compassionate and appropriate and that it should support personal choice. We will do that by putting patients, their families and carers at the heart of everything we do.
The end-of-life care strategy aims to improve care for all adults approaching the end of their lives, whatever their diagnosis and wherever they are, including enabling more people to be cared for and to die at home if they so wish. However, while many people receive excellent care, others do not. There are still variations in people’s experience by region, by age and, as my noble friend Lord Cavendish, pointed out, by disease, with greater emphasis given to people with certain conditions, particularly cancer. We can and must do better. We are taking forward a number of initiatives to improve end-of-life care services for everyone.
The issue of funding was introduced by many noble Lords, not least the noble Lord, Lord Faulkner of Worcester. I agree with much of what he said. End-of-life care needs a long-term system of sustainable funding. We committed, in the coalition agreement, to a per-patient funding model for palliative care. I listened with care to what the noble Baroness, Lady Finlay, said in that connection and I am grateful to her for the points that she made. My right honourable friend the Secretary of State for Health has asked Tom Hughes-Hallett, chief executive of Marie Curie Cancer Care, to chair an independent review of palliative care funding. I am sure that he will wish to take account of the experience and expertise of the noble Baroness in this area.
The review, covering services for both adults and children, is looking at options to make sure that the funding of hospices and other palliative care providers is fair. It will make recommendations for a funding system that will cover care provided by the NHS, a hospice or any appropriate provider, which encourages more community-based care so people can remain in their own homes, if they wish. It will be fair and transparent to all organisations involved in end-of-life care. The review is making good progress and I know that many in the hospice movement including, as my noble friend Lord Howard will be pleased to know, Help the Hospices, have provided evidence to inform its work.
The review’s interim report, published on 3 December, sets out a definition of dedicated palliative care and initial thoughts on a national funding system, stressing the importance of 24/7 community services. I look forward to receiving the final report and its detailed recommendations for funding in the summer. Of course, the funding review comes with a caveat that it has to be affordable within the constraints of the current financial climate.
Beyond sustainable funding, we need to consider how we will deliver end-of-life services. The NHS operating framework, published today, emphasises the importance of implementing the end of life care strategy and of developing round-the-clock, community-based services. The best services already know that good end-of-life care is not only more effective, but can be less expensive than poor care. A recent National Audit Office report found that in a typical PCT, around 40 per cent of the people who died in hospital had no medical need to be there. They could have been cared for at home or in their care home if the community-based support had been in place to support them and their family or carers.
We want services that enable people to have more control over the care they receive when they are dying. As one way of achieving this, our intention is for people to be able to add their end-of-life care plans to their own summary care record. We need to develop the services that allow people to die in a place and in a manner of their choosing. I recognise that this is not easy. Nor can it be done overnight. There is a great deal of work to do. In 2013 therefore, we shall review our progress and see how close we are to giving people the control that they clearly wish for.
We need more imagination, more radicalism, more courage in commissioning. We need to shift the landscape of end-of-life care in favour of the service user. The best commissioners are already challenging old conventions, finding new ways of designing services, and new ways of bringing hospices and other community organisations together to meet patients’ needs. Soon, new GP consortia will commission services. GP-led commissioning has clear advantages over the current model for end-of-life care. GPs have a better understanding of patient needs and better connections within the local community. They know what is available locally to support patients at the end of their lives. I firmly believe GP consortia will be advocates of hospices, not their enemy. But hospices themselves should be proactive. They should talk with their local GPs. 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.
My noble friend Lord Bridgeman dwelt with some emphasis on funding. The Department of Health is providing £286 million of additional funding to support implementation of the end-of-life care strategy over the two years 2009-11. A huge amount of money is being spent on end-of-life and palliative care. We know that it is often not used as it should be. That is why the palliative care funding review is looking at how we can better deploy the resources that we currently provide.
My noble friend Lord Bridgeman and others were right to highlight the particular issues surrounding palliative care for children. The Coalition: Our Programme for Government, states that the Government will provide,
“£10 million a year beyond 2011 from within the budget of the Department of Health to support children’s hospices in their vital work”.
As I have already mentioned, the children’s palliative care services are being specifically considered by the palliative care funding review.
My noble friend Lord Bridgeman also asked me about 24/7 community services. The end-of-life care strategy encourages commissioners and providers to develop 24/7 community-based services for medical, nursing and personal care which people need to enable this to happen. The funding review has already highlighted the importance of treating 24/7 community services as a priority.
The noble Lord, Lord Faulkner, asked about future funding. I have already referred to our intention to introduce a per-patient funding system. More generally, the strategy makes clear the responsibilities of the NHS to ensure adequate support for hospices, including through stronger commissioning and adhering to the principles of the compact code of good practice. That should mean more funding stability, including longer-term contracts, for hospices. My noble friend Lord Howard referred, quite rightly, to the cost-effectiveness of palliative care. The new health and well-being boards will follow on from the current commissioning arrangements that are already directed at end-of-life care because improving quality and improving productivity are, effectively, the same things.
The noble Lord, Lord Patel, asked me about commissioning in the future and the noble Baroness, Lady Thornton, questioned the Government’s commitment in this area. The NHS commissioning board will determine how best to deliver high-quality services, including end-of-life care, by working with GP commissioning consortia and making use of the various tools and levers it will have available. The board will commission NICE to develop quality standards to define the quality of care necessary to deliver the desired outcomes and use those standards to produce a commissioning outcomes framework. That framework will then be used to hold GP consortia to account. NICE has already begun the process to develop an end-of-life quality standard and we look forward to seeing the fruits of that work.
My noble friend Lord Bridgeman asked about the extent to which choice will be embedded in the system. We recognise how important it is to give people choice over the care that they get when they are dying and the place in which they receive that care but, as I have mentioned, we also recognise that it is not an easy task and cannot be done overnight. We need to do a lot of work and, as I have mentioned, we will be reviewing progress in 2013 so as to be sure of what we are capable of committing ourselves to on the issue of choice.
My noble friends Lord Patten and Lord Cavendish and the right reverend Prelate stressed the importance of spiritual care. The end-of-life strategy recognised that each person has spiritual, religious or emotional needs and that spiritual care is an important, integral part of the care given to people at the end of their life and to their carers and families. The department has produced a set of quality markers for end-of-life care and in the strategy’s second annual report, published in August, we said that we would consult on the effectiveness of the quality markers and revise them. Those will include spiritual care and consultation will begin in the new year.
My noble friend Lord Bridgeman referred to the importance of training and education. The department has taken forward a number of initiatives to develop the workforce, including: the development of core competences and principles; publishing an e-learning package on end-of-life care, which is free to access for health and social care staff, and supporting communication skills so there is a lot going on in this area.
To conclude, my noble friend Lord Cavendish referred to hospices as places where patients receive the best kind of care and I would not wish to disagree with him. Having said that, surveys consistently show that up to 75 per cent of people would prefer to die at home but at present only about 20 per cent do so, with a further 17 per cent dying in a care home. It is about choice; however, I take note of the powerful points that he made. Lest any noble Lord should think otherwise, the Government remain committed to delivering good- quality end-of-life and palliative care services and we believe that the action we are taking will improve the quality and range of options available to those in England at the end of their lives, including the many who receive such excellent care from hospices.
Autism
Earl Howe Excerpts(14 years, 10 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, yes, I believe that the planning guidance will be effective in delivering the strategy for adults with autism. This guidance has been developed with advice from health and social care professionals, people with autism and their carers and the voluntary groups representing them. Only by such a transparent, mutual approach can we achieve the vision that the Government have set out for adults with autism: fulfilling and rewarding lives within a society that accepts and understands them.
Lord Touhig
I thank the Minister for that reply. I am sure he agrees that, when planning services, it is important to know what services are needed and how many people need them. I do not know whether the Minister is aware of the National Audit Office report which has revealed that 80 per cent of councils have no idea how many people with autistic spectrum disorders live in their areas. Will the Minister therefore agree to meet our colleague, the noble Baroness, Lady Browning, myself and members of the National Autistic Society to discuss ways in which we can ensure that local authorities meet their statutory duties towards people with autism?
Earl Howe
My Lords, I should be very happy to meet the noble Lord to discuss those issues. Although we do not have definitive figures for the number of people with autism in England, we have commissioned a study into the prevalence of autism among adults to inform strategic planning at central and local levels to benefit adults with autism as they access public services. We have commissioned that study from the University of Leicester and it is due to report by March 2011.
Baroness Browning
Can my noble friend confirm that part of the strategy will entitle people on the autistic spectrum to an assessment if they have an IQ of over 70? For many years, Department of Health circulars have given them this entitlement but they have been ignored in most parts of the country by social services departments. How will my noble friend ensure that this new strategy is properly implemented and that people with IQs of over 70 get the assessment to which they are entitled?
Earl Howe
My Lords, I am very grateful to my noble friend for raising that issue. I can reassure her that under Section 47(1) of the National Health Service and Community Care Act 1990 local authorities have a duty to assess a person who may be in need of community care services. This duty applies to people with autism. The revised Fair Access to Care Services guidance already makes it clear that an assessment of eligibility for care services cannot be denied on the grounds of a person’s IQ. We intend to reiterate this very clearly in the autism statutory guidance.
Baroness Pitkeathley
My Lords, does the Minister agree that delivering the vision for people with autism and their families is, in many cases, dependent on local authority resources? Has he any anxiety about that, especially as many of the services are delivered in the voluntary and community sector, which is already reporting major cuts to its grants?
Earl Howe
My Lords, clearly, local government grants will come under pressure over the coming years. To my mind, that makes it even more important that decisions about priorities are taken at a local level and the joint strategic needs assessment is, of course, the tool which will enable local authorities to decide on their priorities locally.
Lord Low of Dalston
My Lords, training for awareness of autistic spectrum disorder among frontline professionals is key to improving services. Following the publication of the guidance, when does the Minister expect that all lead professionals involved in commissioning community care assessments and GPs will have received autism training?
Earl Howe
My Lords, the statutory guidance that already exists—it has been revised in light of the response to the consultation—makes it explicitly clear that in addition to general autism awareness-raising training for staff, local areas should develop or provide specialist training for those in key roles who have a direct impact on access to services for adults with autism, such as GPs, community care assessors and commissioners and service planners.
Baroness Thornton
My Lords, I congratulate the Minister on continuing to make progress in this matter. As he will know, commissioning for autism services requires expert knowledge and, as my noble friend said, a recent National Audit Office survey found that 80 per cent of GPs said that they needed more training in autism awareness. Can the Minister outline whether any progress is being made to change that situation because, if it applies to GPs, it probably applies to other health workers? Is the Minister also supportive of the call from the National Autistic Society for NICE guidelines and for the inclusion of autism as one of the future quality standards currently under consideration by the National Quality Board?
Earl Howe
My Lords, we cannot mandate to NICE what quality standards are produced. However, the case for developing a quality standard for autism will be considered as part of work to commission a comprehensive library of such standards from NICE in line with our plans in the White Paper. NICE is already developing clinical guidelines on diagnostic pathways for autism, including one for children and young people with autism. That is scheduled to be published in September next year. On training, I cannot really add much to what I have already said to the noble Lord, Lord Low, but it is very high on the agenda.
Baroness Hollins
My Lords, in respect of the training of medical students to be able to provide, in their future careers, adequate and reasonable adjustments for people with autism, what does the Minister think can be done to develop sufficiently existing equality and diversity training so that there will be adequate understanding and adequate adjustments will be made?
Baroness Hussein-Ece
My Lords, how will the Minister ensure that the guidance ties in with the reforms to the NHS, for example, ensuring that the NHS bodies have due regard to any quality standards on autism that will be produced by NICE?
Earl Howe
My Lords, when the National Health Service commissioning board is established, it will have a duty to promote quality in the NHS. One way of doing that will be to utilise the quality standards produced by NICE, to produce commissioning guidance based on those quality standards and, in that way, to promote consistency of commissioning across the health and social care sector.