Public Bodies Bill [HL]

Earl Howe Excerpts

Wednesday 9th March 2011 Lords Chamber

[Lord Patel]

My Lords, I think I have lost my thread, but I have said what I wanted to say.

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

My Lords, I begin by expressing my thanks to all noble Lords for the opportunity to debate these amendments. As the noble Baroness, Lady Thornton, pointed out at the beginning of her remarks, following the Government’s concession in withdrawing Schedule 7 in its entirety, these amendments would have the effect of putting the Human Tissue Authority and Human Fertilisation and Embryology Authority out of scope of the Bill.

Our starting point in approaching these issues is a clear objective to streamline the process of regulation and, consequently, reduce costs and the administrative burden on establishments while continuing to offer the necessary protection for the public. The Bill presents us with an opportunity to achieve that. Our aim is to streamline healthcare and medical research regulation and so reduce bureaucracy. That approach is supported by leading assisted reproduction clinicians and their professional bodies and by the Academy of Medical Sciences.

The scope for streamlining is clear. We estimate that around 80 per cent of the centres currently licensed by the HFEA are also either regulated by the Care Quality Commission or are in premises that the commission regulates. Some 60 per cent of the centres licensed by the HTA are similarly covered by the CQC. It therefore seems unsustainable to continue to have these regulatory systems running in parallel. The question posed by my noble friend Lord Newton of Braintree as to whether the CQC wants to take on this work can best be answered by reference to the regulatory activity that it already performs. In any event, as regards the pace at which we take this, we intend to develop arrangements for the transfer of functions in consultation with the CQC over the next few years, and no transfer of functions will take place until that process is complete. However, the Government recognise that there are number of noble Lords with concerns about the proposal to transfer the functions of these two bodies, and not for a minute would I wish to minimise the nature of those concerns.

Let me be clear—both the HFEA and the HTA are models of regulatory authority that were right for the times in which they were created and which have done an admirable job in meeting the demands placed on them. However, as my noble and learned friend Lord Mackay of Clashfern pointed out, times change, and most pertinently so has the way in which we regulate the delivery of healthcare. With the establishment of the CQC along with the possibility—and I put it no stronger than that at the moment—of the creation of a new regulatory body for medical research, alternative structures are becoming available to ensure a more joined-up system. This provides, as I have said, the opportunity to streamline the process of regulation and reduce costs.

The powers in Clause 5 would allow us to achieve that without disturbing the underlying legislation, which captures the ethical safeguards that Parliament has so carefully set in place. Any future proposals to abolish these two bodies will be provided for in future primary legislation. I am happy to reiterate my assurance that there is no intention to revisit the provisions in either the Human Tissue Act or the Human Fertilisation and Embryology Act that provide the important ethical safeguards necessary to maintain public confidence in these sensitive areas. I would say to my noble friend Lord Willis and to the noble and learned Baroness, Lady Butler-Sloss, and the noble Baroness, Lady Deech, that means that future arrangements to regulate tissue and embryos must adhere strictly to the provisions of the two relevant Acts.

Noble Lords have raised particular concerns about the need to preserve the expertise these bodies have built up in the ethically sensitive subjects they deal with and the need to preserve the confidence of both professionals and the public in the way that these regulatory functions are carried out. The Government recognise the genuine nature of these concerns and we are determined that changes will not be at the expense of regulatory rigour or expertise.

I say to my noble friend Lord Willis that expertise will not be lost. It is envisaged that expertise will follow functions; for instance, through staff transfers and expert reference groups. Noble Lords have questioned the capacity of the CQC to assume these responsibilities. It will be given the capacity and the resources to carry out any widened functions. The CQC already has a proven track record of taking on the oversight of a specialist area. It took on the Mental Health Act Commission functions and I believe has successfully maintained oversight and focus on that area.

The noble Baroness, Lady Thornton, expressed concern that our whole approach in this area seemed unnecessarily complex. The powers that we are debating today will enable us to transfer some of the functions of the HFEA and HTA to other bodies but they do not enable us to do everything that we have set out in the ALB review. In order to abolish the HFEA and HTA or to transfer their research-related functions to any new research agency we will require powers under future primary legislation.

It may help if I try to provide a rough outline as to how and when we expect things to happen. We intend publically to consult on proposals to transfer all of the HFEA and HTA functions to other bodies in the late summer of 2011. Then during 2012-13 we would prepare draft orders for formal consultation under the provisions of this Bill dealing with the transfer of functions other than research functions. If appropriate we would then be able to lay the orders before Parliament. The process would enable noble Lords and other interested parties to see, comment on and debate the proposals as they progress. In order to avoid the piecemeal transfer of functions we would intend to ensure that the timetables for necessary future primary legislation and the commencement date of orders made under this Bill are aligned so that they come into force at the same time.

Without the inclusion of these bodies in Schedule 5 to the Public Bodies Bill we would have to provide for the transfer of their functions entirely within future primary legislation and this would significantly increase the risk that the underlying ethical provisions of the Human Fertilisation and Embryology Act and the Human Tissue Act could be reopened for debate and would afford less time for consideration and comment than the progressive approach which I have just outlined. I seek to impress upon noble Lords that that is a very powerful reason for wishing to grant the Government the powers we are seeking as regards these two bodies.

The noble Lord, Lord Warner, indicated that, in his view, the report by the Academy of Medical Sciences does not give sufficient backing to the idea that embryo research should be covered by the new research regulator. I would simply point him, if I may, towards paragraph 9.5.1 of the report which explicitly refers to the new body, if it is set up, having responsibility,

“for ‘specialist’ approvals and licences within the HRA around data, tissue and embryos, gene therapy and exposure to radiation”.

I think, as I read that, it was very much in the minds of the authors of the report that the research functions of the HFEA should be brought within the scope of a health research regulatory agency.

The noble and learned Baroness, Lady Butler-Sloss, expressed her worries about the information functions of the HFEA and the absence of a clear plan by the Government for what should happen to those functions. She is right, we have not fully made up our minds about where those functions should best sit, but that is one of the main reasons why we wish to consult on this. We need to ask the public and interested parties where these functions should sit, and there will be an impact assessment with the consultation.

My noble friend Lord Willis asked about the possibility of setting up a single research agency without primary legislation. He is technically right; we could do that. I should emphasise that we have not decided whether to accept the AMS recommendation to establish a single research agency—we think that there are merits in the proposal and we will be making an announcement shortly—but if we were to propose setting up such an agency we could do so initially by creating a special health authority. However, we could not legally transfer the research-related functions of either the HTA or the HFEA to that body. We could not make a transfer of functions to a special health authority without amending the 2006 Act.

The case was simply put by my noble and learned friend Lord Mackay of Clashfern. Essentially, we are asking the Committee to agree to grant the Government permission to consult on these matters. I hope that the noble Baroness will not seek to press her amendment today but instead will consider that a good purpose will be served by reflecting on the comments that I have made in response. In view of our concessions—

[Lord Warner]

I am sorry to interrupt the Minister. I have been listening intently to what he has said. I am extremely confused about the order in which things are going to be done. As I understood what he was saying, we are going to get a series of orders that transfer functions through a process of consultation, which I welcome, but we may or may not know at that point what the Government are going to do about setting up a health research agency, either by statute or otherwise. As I understood him, we could be in the position of being asked to agree those orders before we know what the final endgame is. It would be helpful if, before the next stage of the Bill, the Minister could set this out more clearly for us in writing so that we can understand the sequence. I found it rather difficult to understand.

[Earl Howe]

I must apologise to the Committee if I was not sufficiently clear and I will be happy to write to those who have participated in this debate to make the position clearer. I was seeking to say that we do not wish to take a disjointed, piecemeal approach. There is a natural flow of process that, if Parliament agrees, can lead us to a position where we are able in one move, so to speak, to transfer the various functions more or less simultaneously—although I would not wish to undertake that the whole thing would be done on the same day—so as to arrive at that point.

In our view it is desirable to consult during the late summer of this year. We will then set about the process of designing statutory instruments based on that consultation and go out to consultation on them. All being well, we will then introduce a second-Session health Bill that will have within it the provisions to establish a single research regulator, assuming that that is what we decide to do. Therefore, the whole process should work in a seamless way. However, I shall be very happy to write to noble Lords setting that out.

I return to the point at which I left off, which is to express the hope that the noble Baroness will not press her amendment this evening. I hope that she will accept our assurance that we have a clear intention to consult on the proposed transfers of functions and that she will be willing to withdraw the amendment.

[Baroness Thornton]

My Lords, I thank everybody who has contributed to this debate. I knew that it would be an interesting debate and a long one. I have been told by my noble friend that I have to be brief, as the Committee still has a lot of things to get through and the rest of us can go home when we have finished this. As I say, I thank all those who have taken part in this debate. The remarks of the noble and learned Baroness, Lady Butler-Sloss, were forensic and, as usual, very helpful. The noble Lord, Lord Walton of Detchant, spoke with great wisdom and knowledge about both the HFEA and the HTA. The noble Lord, Lord Newton, spoke wisely about the CQC. Having been one of the architects of the CQC in the previous Government, I wish to put on record that I very much admire the work that it does. However, it is being asked to do a great deal more, which worries me.

I am pleased that the noble Baroness, Lady Deech, continues to support us as we work towards resolving this matter. The noble and learned Lord, Lord Mackay of Clashfern, my noble friend Lord Winston and the noble Lord, Lord Patel—a trio of very distinguished professionals in their respective ways—said that, although progress has been made, the most important thing is to make more progress. I am not a scientist but in a way the scientists and the experts got us into trouble on both these issues and that led to the creation of the HFEA and the HTA, as imperfect as they might be. Those bodies were established to tackle the need to regulate and to restore public confidence. That is where we came in, as it were. It seems to me that challenges and problems still exist in terms of public confidence, to which I will return in a moment.

I accept that if we need to move to a more overarching medical research body, we need to go through a proper process. I am not convinced that the powers granted to the Government in this Bill are the way to do that or that what looks like a rather complex and very piecemeal process is the right way forward. However, I am grateful to the Minister for explaining this in great detail.

I am worried. A floating ethical framework sprang into my mind because I could not see where the ethical framework of what is being proposed will sit. If we cannot see where it will sit, what hope is there for the public? It seems to me that that is where the Government need to start. It is not a question of having a mechanical process and saying, “We will put this bit here and that bit somewhere else and have a regulation that will make sure that the research goes somewhere else”, because if we cannot understand where the ethics sit we are in very serious trouble.

The Minister has given us a great deal to think about and I am grateful to him for his detailed answer. I will read the record and I look forward to receiving his letter. We will need to think about what he had to say and discuss it further before Report. I will not press the amendment now, so I beg leave to withdraw it.

Health: Care and Compassion?

Earl Howe Excerpts

Thursday 3rd March 2011 Lords Chamber

[Lord Touhig]

To ask Her Majesty’s Government what action they plan to take in response to the Parliamentary and Health Service Ombudsman’s report Care and Compassion?.

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

My Lords, the department has asked the Care Quality Commission to conduct a series of unannounced inspections on NHS trusts, and will report on its findings. The department wrote to NHS chairs on 15 February to raise awareness of this report and to ask them to assure themselves that their own organisations were up to standard. Similarly, the chief nursing officer also raised the report findings at her February meeting with strategic health authority directors of nursing.

[Lord Touhig]

I thank the Minister for his Answer, which is very helpful. We in this country are blessed with a National Health Service staffed by very dedicated and committed people but, as this report highlights, there are instances of neglect and a lack of care for the elderly. The best way to prevent cases like the 10 listed here happening again is to ensure that everyone in the National Health Service, if possible, reads the report. It is available online at www.ombudsman.org.uk, but can the Government find ways to help to distribute the report so that everyone working in the health service can read it?

[Earl Howe]

My Lords, I understand and applaud the noble Lord’s reason for making that suggestion. I will overlook the issue of cost, but I am not sure that his idea would necessarily have the desired impact. What is needed here is for local leaders to take charge. That is why the chief executive wrote to every chairman and chairwoman in the NHS asking them to share the report with every member of their board, so that they can examine the services in their particular organisation and assure themselves that these situations are not happening on their watch. Nevertheless, I am certain that boards around the country will wish to take heed of the noble Lord’s suggestion.

[Baroness Knight of Collingtree]

Does the Minister recall the number of legitimate complaints that were made during the period of office of the previous Government about bad treatment within the health service? Nothing was done with urgency. Will he recognise that when there are legitimate complaints, delay causes deaths and great suffering? When there are such complaints, they should be dealt with speedily and deeply.

[Earl Howe]

My Lords, I am sure the whole House will recognise the contribution that my noble friend has made to raising awareness of these very troubling issues, and I pay tribute to her. She is right, which is why our proposals for the NHS place a great deal of emphasis on strengthening accountability at every link in the chain, so that the complaints that she has referred to are dealt with speedily and someone is held accountable for what has happened.

[Baroness Emerton]

My Lords, will the Minister please say whether it is the Government’s intention to respond to the previous Prime Minister’s commission on nursing, which reported in March 2010? There were 21 commissioners, and I declare an interest as one of them. The report made 20 recommendations, 17 of which relate directly to the ombudsman’s report and, if implemented, would go some way to curing some of the types of incidents that were reported. There is a great need on the part of both the employers and the employees, and it was good to hear the Minister say that a letter has gone to the employers. Would it be possible to have an answer to the commission so that we could see the implementation of some of these recommendations? I am ashamed to be named a nurse when such dreadful care and lack of supervision have been identified. We have a responsibility here. I ask the Minister to look at the supervision of untrained staff and the regulation of assistant nurses.

--- Later in debate ---

[Earl Howe]

My Lords, I will look and see where we are on a formal reply to the commission’s report. Again, I pay tribute to the noble Baroness for her work in leading the nursing profession. She is absolutely right that strong nursing leadership at every level, from ward to board, is essential to ensure high-quality care. Ward managers make a critical difference, matrons provide strong leadership on wards and all nurses, I believe, must aspire to continuous quality improvement. That is why we expect directors of nursing to review this report with a view to addressing any areas of improvement in their own organisations.

[Baroness Royall of Blaisdon]

My Lords, we warmly welcome this report and the actions that the Government are going to take upon it. However, how will a fully competitive market in healthcare ensure that older people are looked after properly, with care and compassion?

[Earl Howe]

Perhaps I may elaborate on an answer I gave earlier about our reform proposals, which have at their heart the strengthening of accountability. There will be accountability: for outcomes, through the outcomes framework, to ensure that NHS providers focus first and foremost on quality; through GP commissioning, which will bring commissioning closer to patients and ensure that it is clinically informed; and in strengthened local accountability, not only through the health and well-being boards in local authorities but via the public, through Health Watch, which will ensure that the NHS focuses on what is important to patients and citizens.

Health: Cancer

Earl Howe Excerpts

Wednesday 2nd March 2011 Lords Chamber

[Lord Patel]

To ask Her Majesty’s Government what proposals they have for improving outcomes for cancer patients.

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

My Lords, we published Improving Outcomes: A Strategy for Cancer on 12 January, which sets out a range of actions to improve outcomes for cancer patients. Earlier diagnosis is crucial to improving outcomes, and we have set out plans to deliver this through improving GP access to diagnostic tests, supporting symptom awareness initiatives, and extending cancer screening programmes. We are also improving access to treatment and the quality of support for survivors.

[Lord Patel]

I thank the Minister for his Answer, which is very helpful because it prompts two questions. First, when does he think the procedures which he has put in place will succeed and cancer outcomes will improve, and in the mean time what is likely to happen to cancer outcomes? Secondly, could he also say what the state of radiotherapy treatment in England is?

[Earl Howe]

My Lords, the strategy we have laid out is an ambitious one. It aims to save an additional 5,000 lives every year by 2014-15. That programme is supported by over £750 million of additional money over the next four years. It sets out actions to prevent cancer incidence and to improve the quality and efficiency of cancer services and of patients’ experiences of care. We are giving ourselves a little time, but we are under no illusions, and this is an agenda to be pursued very energetically. We are putting considerable additional money—from memory, it is £150 million—into radiotherapy services, but we also feel that there is an important issue around the use of existing radiotherapy equipment, which is often not utilised as effectively as it could be.

[Baroness Hughes of Stretford]

My Lords, would the noble Earl agree that the regional networks of specialist cancer services, established through the co-operation of clinicians themselves, have been instrumental in improving outcomes for patients? If so, how does he think that essentially collaborative model fits with the rigid and mandatory price competition that the Government now want to introduce into the NHS?

[Earl Howe]

My Lords, the Government are not introducing price competition, it has never been our intention to do so, and the Bill that will come before the House will make it absolutely and abundantly clear that price competition is out of range. As regards the cancer networks, the noble Baroness is absolutely right. Over the past 10 years, these have played a crucial role in improving the quality of cancer treatment and the patient experience of care. The outcomes strategy that we have published explicitly states that next year there will be funding for cancer networks to support commissioning.

[Lord Mawhinney]

My Lords—

[Lord Alderdice]

My noble friend introduced the question of diagnosis, which is increasingly a multi-professional matter, involving pathologists, surgeons, radiologists and so on. This seems self-evidently a good thing. However, is the department accumulating evidence to show that it is actually improving the outcomes? It is of course an expensive procedure to involve so many senior professionals together.

[Earl Howe]

My noble friend is quite right. It does involve often a number of senior clinicians. The key to diagnosis, however, is to get in early, as I am sure he would recognise. The outcomes strategy commits us to saving the additional 5,000 lives very largely through additional identification of early cancer. In fact, 3,000 of the 5,000 lives that we are hoping to save will be saved, we hope, by earlier diagnosis. A good example of that is that over 90 per cent of bowel cancer patients diagnosed with the earliest stage of the disease survive five years from diagnosis, compared to only 6.6 per cent of those diagnosed with the advanced disease.

[Lord Harris of Haringey]

My Lords—

[Lord Walton of Detchant]

Would the noble Earl accept that this country has had a very proud record in carrying out clinical trials, not least in the field of cancer; and that since the passage of the European directive on clinical trials, the problem of getting ethical approval for multi-centred trials—in a variety of different centres—has become immense? Is he aware of the recent report of the Academy of Medical Sciences, from a committee chaired by Sir Michael Rawlins, which has made a number of crucial recommendations? If accepted by the Government, those would make the performance of these trials very much easier.

[Earl Howe]

My Lords, I am indeed aware of that excellent report. It is being studied with care in my department. We hope to make an announcement reasonably soon in response to it. It contains some extremely important recommendations which, if implemented, should do a great deal to restore the country's position as a destination of choice for clinical trials.

[Lord Roberts of Llandudno]

My Lords—

--- Later in debate ---

[Lord Mawhinney]

My noble friend, in his original Answer, talked about the importance of early diagnosis. Is he not concerned at the cascade of cases reported in the media of GPs sending patients home with flu symptoms and indigestion and not detecting the cancer until it is too late? What does my noble friend intend to do to improve GP training to assist the earlier diagnosis on which he rightly lays so much emphasis?

[Earl Howe]

My Lords, of course those reports are a matter for concern, which is why we are clear that GP consortia should be supported as much as possible in terms of commissioning guidelines and information. One of the tasks of the NHS commissioning board will be to provide that support and information based on quality standards produced by the National Institute for Health and Clinical Excellence.

Homelessness: Tuberculosis

Earl Howe Excerpts

Tuesday 1st March 2011 Lords Chamber

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

My Lords, from 1 April, the National Health Service in London will fund continued provision of the Find and Treat outreach service to detect TB among the homeless, including rough sleepers, and to help to ensure treatment completion. There are also initiatives for TB testing among the homeless in cities such as Liverpool and Leicester. The National Institute for Health and Clinical Excellence is developing guidance on tuberculosis among hard-to-reach groups, including rough sleepers.

[Baroness Sharples]

I thank my noble friend for that encouraging reply, but is he aware that the chaotic lifestyle of homeless people with very poor immune systems means that they are extremely difficult to diagnose and to treat for the six-month period for which they need antibiotics? Are Her Majesty’s Government working with other organisations to help these homeless people?

[Earl Howe]

My noble friend is absolutely right: this is a particularly difficult group of people in that they are hard to reach. There is a high incidence of TB among the homeless in London and a service of the kind to which I have referred appears to be cost-effective in reaching those people. On my noble friend’s second question, we are engaging with the Mayor of London’s office to see how it can become involved in helping to deliver cost-effective services to this group of people.

[Lord Faulkner of Worcester]

My Lords, will the Minister invite Westminster City Council to think again about the proposed by-law, on which it is consulting, which will make it illegal not only for rough sleepers to live on the streets around Westminster Cathedral but for charities such as Housing Justice to distribute food and soup to them? It describes the Westminster City Council proposal as an over-the-top response. Is it not right to say that? Does he agree that the problems of tuberculosis, which are the subject of this Question, will be much more difficult to identify if rough sleepers are driven off the streets and forced to live elsewhere?

[Earl Howe]

My Lords, I very much see the force of the noble Lord’s point. We are very much committed to preventing homelessness and to protecting the most vulnerable. We have maintained the funding for the homelessness grant at the levels of the current year— £400 million over the spending review period, which is £100 million over each of the next four years. We are specifically providing £18.5 million a year to support the voluntary sector. This is a priority, but I will take away the point that he has made about Westminster City Council.

[Baroness Knight of Collingtree]

My Lords, is it possible for a person who has no fixed address to have a doctor or to get immediate medical attention?

[Earl Howe]

My noble friend puts her finger on a key difficulty with this group of people, who are often very difficult to keep track of. I heard of one case where a patient required 800 interventions, sometimes with the police involved. Clearly a lot of effort has to go into this group. However, it is possible, if the patient is willing, to register that person with a GP. The challenge is whether they actually return to complete their treatment, which of course extends over many months.

[Baroness Armstrong of Hill Top]

My Lords, I ought to declare an interest in that I chair the Cyrenians in the north-east. We have been working on a programme that has been identifying and keeping contact with these most vulnerable and disaffected people and we have reduced the number who have become, as they are called, “frequent flyers”. However, does the noble Lord acknowledge that there simply is not a straightforward system in the National Health Service to deal with people who do not have a fixed address and do not have regular contact with a particular locality or GP? Is it not about time that we looked at this much more holistically? There are some good individual examples around the country, but there is no guarantee that we will intervene sufficiently early to stop what is now known, which is that most people who sleep rough will be dead long before they are 50.

[Earl Howe]

My Lords, I was very interested to hear about the noble Baroness’s experiences in the north-east and I would like to hear more. The points that she raises lie behind our intention in the Health and Social Care Bill to make GP consortia responsible not just for the patients on the GP lists but for all the population in the local area. The health and well-being boards, which we propose should be set up at local authority level, will bring together all the relevant stakeholders to look at how the health needs of an area can best be met and prioritised.

[Lord Laming]

My Lords, this is a group of our fellow citizens who are particularly vulnerable and can so easily be lost in the system. At a time when there is considerable pressure on budgets, will the noble Lord use whatever good offices he can to ensure that this remains a priority in all the public services and is not seen as a soft option?

[Earl Howe]

My Lords, the short answer to the noble Lord’s question is yes. We have committed to ring-fence the public health budget and I think that there is no better earnest of our intentions for public health than that.

[Baroness Thornton]

Following on from that very helpful question, may I ask specifically about the mobile X-ray units in London, which we have discussed before in your Lordships’ House? These were funded through pooling relatively small amounts of funding from the PCTs across London, organised by the strategic health authority. Those bodies are about to disappear, so what will happen in the transition period to those mobile units and how will the new arrangements work with the consortia that are being planned?

[Earl Howe]

My Lords, the position for 2011-12 is that the NHS in London will fund Find and Treat. During the next year, the NHS will consider future funding, taking into account the final evaluation of the service by the Health Protection Agency and the emerging guidance from NICE. As regards the more medium-term agenda, the Government’s strategy is for a much more joined-up service. We will have the public health service working both locally and nationally. We will also have the GP consortia commissioning treatment at a local level. I hope that, as the system evolves, the noble Baroness will see that there is no loss of momentum in this very important area.

Health: Alcohol Minimum Pricing

Earl Howe Excerpts

Tuesday 1st March 2011 Lords Chamber

[Baroness Wheeler]

To ask Her Majesty’s Government what is their assessment of the impact of minimum pricing policy on the level of alcohol-related conditions and admissions to hospital.

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

My Lords, the Home Office review of pricing policy found that increases in alcohol prices are linked to decreases in alcohol-related harms. The review also highlighted that this is a complex issue. The Government intend to ban sales of alcohol below the rate of duty plus VAT. This is a pragmatic first step towards setting the lowest level at which different strengths of alcohol can be sold. We estimate that it would mean about 1,500 fewer alcohol-related hospital admissions per year.

[Baroness Wheeler]

I thank the Minister for his response. However, two leading advisers from the Department of Health’s own network of experts recently wrote in the Lancet that the Government,

“lacks clear aspiration to reduce the impact of cheap, readily available, and heavily marketed alcohol on individuals and on society”.

They estimate that failure to tackle drink-related problems could cost 250,000 lives over the next 20 years. How will the Minister ensure that in future the health, well-being and recovery of people with drink-related problems take precedence over the lobbying of the drinks industry?

[Earl Howe]

My Lords, I make it clear that we neither have nor intend to have any sort of cosy arrangement with the drinks industry. The view that we have taken is that the food, drink and fitness industries, together with charities and public health experts, all have a huge role to play in improving our health. The industry has enormous influence in its own right. However, more than that, we believe that we have a collective responsibility to do something about this problem. That is why the industry has joined the Government in a partnership to promote and empower us all to adopt a healthier lifestyle. Through the public health responsibility deal, we are challenging industry to take action that will help consumers to live healthier lives in some areas where it is not possible or effective to regulate.

[Lord Walton of Detchant]

My Lords, is the Minister aware that experts on liver disease such as Professor Sir Ian Gilmore in Liverpool and Professor Chris Day and Dr Chris Record in Newcastle have identified an alarming increase in the incidence of liver disease in young people? No doubt he has read the letter in the Times this morning from representatives of the drinks industry, who say that the total consumption of alcohol in this country has fallen by 11 per cent during the past two years. However, consumption by young people is steadily increasing. Can he think of any solution by which he can overcome the problem of proxy purchasing, whereby people above the minimum age buy alcohol in bulk and pass it on to young people, who are being damaged by this process?

[Earl Howe]

My Lords, as ever, the noble Lord is absolutely right. Overall consumption of alcohol is going down, but we are seeing very alarming rates of consumption among certain groups of young people. As Sir Ian Gilmore has pointed out, liver disease is appearing among the young, which is extremely worrying. The Government are determined to grasp this issue. Public health policy generally is co-ordinated by a public health Cabinet sub-committee. It will work on an alcohol strategy, which we will publish in the summer in the wake of our White Paper on public health. There is no single solution to this problem. The issue of proxy purchases, which for alcohol, I believe, is already an offence, is difficult to police and enforce. However, the noble Lord is right that we need to focus on it in our strategy.

[Baroness Gardner of Parkes]

My Lords, the original questioner mentioned public health in general, but is the Minister aware that alcohol is a cause of great disturbance in accident and emergency departments in all hospitals, particularly on Friday and Saturday nights, when ordinary people who go in with injuries are subjected to very unpleasant treatment by those who are brought in following an alcohol-related incident?

[Earl Howe]

My noble friend makes an extremely important point. We estimate that alcohol harm costs the NHS around £2.7 billion a year. Forty per cent of all accident and emergency admissions are in some way connected with alcohol—I think a higher percentage on Friday and Saturday nights—and 7 per cent of all hospital admissions are accounted for in some way by alcohol. This is a very serious problem: 8,500 people die from alcohol in the UK every year and there are over 1 million hospital admissions relating to alcohol.

[Lord Brooke of Alverthorpe]

My Lords—

[Lord Brooke of Alverthorpe]

My Lords, now that the Minister and the Government have accepted that raising the price of alcohol is one of the ways in which we can minimise harm to those who are abusing alcohol, why have the Government’s recent proposals been so minimal? The cost of a can of lager will be increased, or minimised, to 38p under the new arrangements. This is hardly going to make any change whatsoever. We have to wait for the White Paper in the summer, but in the mean time why could a more positive approach to raising the cost of alcohol not have been taken and more fundamental changes made to the ever increasing easy access to alcohol, which is another problem that needs addressing?

[Earl Howe]

My Lords, we view the decision to ban below-cost sales of alcohol as very much a first step. We have announced a number of other measures, as the noble Lord may know, particularly a rise in the rate of alcohol duty by 2 per cent above inflation over each of the next four years, additional duty on high-strength beers and greater powers for local authorities over local licensing decisions. As I mentioned, there is no single solution to this problem, but we are looking at a number of additional measures.

Health: Mental Health Strategy

Earl Howe Excerpts

Monday 14th February 2011 Lords Chamber

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

House adjourned at 7.30 pm.

Health: Multiple Sclerosis

Earl Howe Excerpts

Wednesday 2nd February 2011 Lords Chamber

[Lord Walton of Detchant]

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

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

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

[Lord Walton of Detchant]

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

--- Later in debate ---

[Earl Howe]

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

[Lord Hylton]

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

[Earl Howe]

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

[Lord Winston]

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

[Earl Howe]

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

[Baroness Gardner of Parkes]

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

[Earl Howe]

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

[Lord Dubs]

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

[Earl Howe]

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

[Baroness Finlay of Llandaff]

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

[Earl Howe]

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

[Baroness Jolly]

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

[Earl Howe]

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

Human Fertilisation and Embryology Authority/Human Tissue Authority

Earl Howe Excerpts

Tuesday 1st February 2011 Grand Committee

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Health: Influenza Vaccination

Earl Howe Excerpts

Thursday 20th January 2011 Lords Chamber

[Lord Kennedy of Southwark]

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

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

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

[Lord Kennedy of Southwark]

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

[Earl Howe]

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

[Lord Skelmersdale]

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

[Earl Howe]

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

[Lord Hughes of Woodside]

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

[Earl Howe]

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

[Lord Patel]

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

[Earl Howe]

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

[Lord Newton of Braintree]

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

[Earl Howe]

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

[Lord Campbell-Savours]

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

--- Later in debate ---

[Earl Howe]

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

[Baroness Hussein-Ece]

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

[Earl Howe]

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

[Baroness Thornton]

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

[Earl Howe]

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

Herbal Medicines

Earl Howe Excerpts

Thursday 13th January 2011 Lords Chamber

[Lord Pearson of Rannoch]

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

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

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

[Lord Pearson of Rannoch]

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

[Lord Pearson of Rannoch]

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

[Earl Howe]

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

[Lord Taverne]

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

[Earl Howe]

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

[Baroness Pitkeathley]

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

[Earl Howe]

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

[Baroness Sharples]

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

[Earl Howe]

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

[The Countess of Mar]

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

[Earl Howe]

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

[Lord Harris of Haringey]

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

[Earl Howe]

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

[Baroness Browning]

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

[Earl Howe]

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