Health: Osteoporosis
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Baroness Cumberlege
To ask Her Majesty’s Government what steps they are taking to reduce the number of fractures which result from osteoporosis.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the steps we are taking in this area include guidance via a commissioning toolkit to support organisations on effective falls and fracture prevention and management, NICE’s published guidance on osteoporosis, falls and fractures—NICE is also working on clinical guidelines for hip fractures for publication in spring 2011—and a best-practice tariff which offers financial incentives to hospitals meeting quality standards for hip fracture patients, including a fracture prevention assessment.
Baroness Cumberlege
My Lords, I thank my noble friend for his comprehensive reply and welcome the progress that has been made. We must bear in mind that last year alone, some 65,000 people were admitted to hospitals for hip fractures, which represents an increase of 17 per cent on the previous decade and is one of the highest figures in Europe. Will my noble friend ensure that the outcomes framework currently under review, which concentrates mostly on hip fractures, also includes indicators to reduce all fragility fractures? That would ensure that the NHS puts a comprehensive fracture preventive service in place.
Earl Howe
My Lords, my noble friend is right to say that the outcomes framework will be central to assessing the performance of the NHS and driving up quality generally. The framework is still in development, and my department is currently looking at the responses to the recent consultation and carrying out the necessary analysis to ensure that it is as balanced and robust as possible. Having said that, the consultation document contained a number of proposed indicators that relate to falls and fragility fractures which are candidates for inclusion in the framework, although the department cannot take any final decisions until we have digested all the consultation responses.
Lord Walton of Detchant
My Lords, is the Minister aware that drugs are now available that can halt the progression of osteoporosis? Is he satisfied that there are sufficient facilities in hospitals across the country to carry out bone density measurements, from which the position can be assessed at an early stage to allow those at risk to be given appropriate treatment?
Earl Howe
My Lords, the NHS in England has invested in additional diagnostic capacity over recent years, including the provision of more DEXA scanners, which are bone density scanners. The most recent data I have show that only 145 people in England waited for more than six weeks for a bone scan, and of those only seven had been waiting for over 13 weeks. That does not suggest that there is undercapacity. However, the noble Lord is right to say that several treatments are available, along with many messages put out by the department to promote a healthy lifestyle in order to prevent fractures.
Baroness Massey of Darwen
My Lords, is the Minister aware that a number of excellent leaflets containing information about the prevention of osteoporosis are available? What initiatives are in place to encourage the distribution of these leaflets in libraries, supermarkets, gyms and so on to enable women and men to get the information they need?
Earl Howe
My Lords, information is produced by the National Health Service on the risk of fragility fracture and, indeed, on how to prevent it. A number of good and authoritative sources of information exist on this topic, not simply from the NHS, but I would just say that information on osteoporosis is available on the NHS Choices website, which of course is accessible on computers, including those in libraries.
Lord Alderdice
My Lords, if the normal communal incidence of osteoporosis were to be applied to your Lordships House, it is likely that half or even more than half of its membership would be suffering from it, even if they were not aware of any symptoms. That tells us what a common disorder we are dealing with. Does my noble friend agree that it is important to raise public awareness not just of diagnosis and treatment, but of how lifestyle changes to diet, smoking behaviour and alcohol consumption are extremely important in making sure that these adverse consequences do not arise?
Earl Howe
My noble friend is right. The job of the NHS in its public health role is to provide information about healthy lifestyle choices. NHS Direct does this at the moment, and in the future we will be looking to the new national public health service to maintain the provision of high quality and authoritative health advice. Moreover, as my noble friend says, that advice includes information about the value of a diet rich in vitamin D from oily fish, liver, cereals, eggs and so forth, as well as from safe exposure—I emphasise the word “safe”—to natural daylight.
Baroness Greengross
My Lords, it is well known that if an elderly or frail person living at home has a fall which results in a hip fracture is monitored, a great deal of future pain, distress and huge expense to the NHS can be avoided. Does the Minister agree that installing a fracture liaison service in every health area would reduce this serious situation and that the Government ought to make public that aim?
Earl Howe
The noble Baroness is correct: fracture services have produced some positive results where they have been used in various parts of the country. I can best answer her question in two brief ways. While decisions about the provision of particular services are best taken locally, it will be the outcomes framework, which I have mentioned, and the incentives that go with it, that will determine the extent to which the NHS locally responds to needs related to this area. Funding for the NHS is protected and will increase above inflation every year of this Parliament. In this difficult climate, that demonstrates the Government’s determination to provide the best outcomes from services, including falls and fractures services.
Human Fertilisation and Embryology: Regulation
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Baroness Deech
To ask Her Majesty’s Government what are their plans for the future regulation of human fertilisation and embryology.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the Government fully recognise the work of the Human Fertilisation and Embryology Authority since 1991. However, as a result of the Department of Health’s review of its arm’s-length bodies, the Government believe that there is scope to streamline healthcare regulation. The HFEA will continue for the time being but we propose that its functions will transfer to other bodies by the end of this Parliament.
Baroness Deech
My Lords, I thank the Minister for that Answer. Will he assure the House that he will stand by the report of the pre-legislative scrutiny committee of three years ago and not endanger the statutory functions of the HFEA, including the all-important database and the guidance to patients, by splitting up the functions between five other committees, thereby saving no money at all and endangering the worldwide reputation of this model of regulation?
Earl Howe
My Lords, I recognise the experience of the noble Baroness and I pay tribute to her time as chair of the HFEA. The review that we have conducted has been based on a close examination of the functions of every arm’s-length body. Whereas some 20 years ago it may have made sense to look at a single body for carrying out the functions undertaken by the HFEA, she will agree that the functions concerned are very different. Times have moved on and we think that there is a more logical way to parcel out those functions which does not dilute in the slightest the efficacy or the efficiency of the regulatory action.
Lord Willis of Knaresborough
My Lords, I beg to disagree with my noble friend. What remains the same, as the noble Baroness, Lady Warnock, said, is the fact that we must enshrine in legislation and through regulation the very special status of the embryo. Since 1991, the HFEA has carried out that function very effectively indeed and it has done so because it has the support of the British people. As regards bringing these regulations in house, will the Minister say why the public should have more confidence in him as the Minister than in an independent regulator?
Earl Howe
My Lords, I need to make it clear that our proposal is not to bring the regulation in house; it is to distribute the regulatory function between several different bodies. I also emphasise that there is absolutely no suggestion that we are changing the special status of the embryo. We have no plans to re-examine those parts of the legislation which recognise that status. We fully recognise the role which the HFEA has played in establishing the UK as a world leader in this area, but times change and so has the way in which we regulate the delivery of healthcare. That is the basis on which we have looked at this.
Baroness Thornton
My Lords, when I was a government Minister and the BMA, the Royal College of Obstetricians and Gynaecologists, the Royal College of Pathologists and the Royal College of Nursing ganged up on me, I always thought it was wise to listen. All those bodies have expressed very serious concerns about the government proposal. Has the Minister had meetings with the royal colleges and the BMA about their concerns? Has he discussed in particular the real risk to loss of specialist expertise and public confidence and the risk to patient safety?
Earl Howe
My Lords, we intend to engage fully with all interested parties on this matter but it is early days. The noble Baroness quite rightly raises the specialist expertise available to the HFEA. We fully recognise that. We are very keen that the expertise is not lost but is made available to the CQC or to the new research regulator, if we set up one. I understand that, where a function of one organisation transfers to another organisation, it is customary for the relevant staff to transfer as well. I emphasise that matters are at a very early stage.
Lord Harries of Pentregarth
My Lords, given the special ethical status of the early embryo, does the Minister agree that the integrated function of the HFEA, whereby the licensing of the clinics, the licensing of research and the extensive database are held together, minimises the risk of unfortunate incidents? If the HFEA is dismembered, the likelihood of such unfortunate incidents is likely to increase.
Earl Howe
My Lords, I recognise, as will the House, the noble and right reverend Lord’s experience in these matters. At this early stage, we will look very carefully at the design of systems to ensure that the expertise and the scrutiny functions, which we associate so well with the HFEA, are not diluted or lost in any moves that we make in this area.
Baroness Warwick of Undercliffe
My Lords, I declare my interest as chair of the Human Tissue Authority. Just as with the HFEA, the HTA works efficiently and effectively to ensure public and professional confidence in the regulation of human tissue, and to ensure that it is used safely and ethically and with proper consent. Does the Minister agree that it is crucial in any transfer of functions that the confidence of both the public and professionals is maintained; that consent, respect and dignity are maintained; and that any disruption to well-regarded regulation is kept to a minimum?
Earl Ferrers
My Lords, in his Answer, my noble friend referred to an arm’s-length body. What does that look like?
Disabled People: Dementia
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Lord Ashley of Stoke
To ask Her Majesty’s Government what steps they are taking to help people with impaired faculties, such as hearing or vision, and concurrent dementia.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, tackling dementia is an urgent priority and the Government are committed to the delivery of better-quality care for all those with dementia. Ensuring that people with impaired faculties or disabilities receive the best type of care that they require is one of the reasons we are accelerating the pace of improvement through a focus on local delivery and accountability.
Lord Ashley of Stoke
I thank the noble Earl for that response. Is he aware that people with dementia who are also blind and deaf have a really difficult life? They are trapped in a kind of living hell and require urgent attention. The Minister said that the Government are accelerating the process. To what extent is that happening, and can he guarantee that the Government will support a campaign to provide all the facilities necessary for people of this kind?
Earl Howe
The noble Lord, Lord Ashley, as so often, is absolutely right. Those who have dementia and also suffer from sensory impairment have a particularly difficult time. That is why we have signalled, in the recently revised operating framework for the NHS, that improving dementia care will be a priority. However, the noble Lord may also like to know that we have today published a Written Ministerial Statement, which he can read in Hansard, showing that we aim to accelerate the pace of improvement in four ways in particular: by improving early diagnosis and intervention; by improving care in hospitals; by improving the care of dementia patients in care homes; and by reducing the use of anti-psychotic medications. Those are the four priorities that we think will make the most difference.
Lord Laming
My Lords, can the Minister inform the House what steps the Government are taking to ensure an adequate supply of community-based nurses who have been specially trained in dementia care, not least to support carers?
Earl Howe
My Lords, an informed and effective workforce is clearly central to the delivery of the dementia strategy. The Department of Health has recently published reports which map the current level of training, and these have been widely disseminated to key bodies involved in providing education and training. Professor Alistair Burns, who is the National Clinical Director for Dementia, is chairing an advisory group that will aim to ensure the development of proper education and training for all staff involved, and he will be engaging with all the key organisations in doing so.
Baroness Pitkeathley
My Lords, the Minister will be aware that family carers have two main concerns about dementia services. The first is that they are patchy and are not uniform across the country and the second is that they are not co-ordinated across acute voluntary, independent and family care. How will the Minister ensure that those two issues are better addressed under the proposals in the White Paper?
Earl Howe
My Lords, there are several prongs to the strategy which will be needed to meet the concern of the noble Baroness. One is to drive up quality standards through a proper tariff for these services and another is better regulation of providers. As the House will know, the NICE quality standard was published in the summer, which will improve commissioning to deliver greater efficiencies, not simply in a financial sense but also to deliver a better pathway of care for patients, with a focus on outcomes.
Baroness Hussein-Ece
My Lords, can my noble friend tell us whether those with special educational needs have a higher preponderance of dementia? What is being done to address those needs and to drive up standards of care, given that the All-Party Parliamentary Group on Dementia concluded that some care being given to dementia suffers is dehumanising? Can my noble friend please outline what is being done for those people with special needs who are diagnosed?
Earl Howe
My Lords, my noble friend has hit on an extremely sensitive and important area. My answer to her is similar to the one I gave on a previous question: we must focus on outcomes. That is the main theme of the recently published implementation paper. This morning, I was speaking to a representative of the King’s Fund, which has done tremendous work in this area. This is one aspect of its work, of which I am sure we shall be hearing more.
The Lord Bishop of Chester
My Lords, what policy do the Government have for supporting the learning of British sign language?
Earl Howe
My Lords, the right reverend Prelate rightly calls attention to the needs of those with aural disability. The Government’s plans for audiology are in gestation at the moment. Unfortunately, it is too early for me to tell him, but I shall aim to write him a letter at the earliest opportunity.
Baroness Greengross
My Lords, in declaring an interest as chair of the All-Party Parliamentary Group on Dementia, I ask the Minister what plans the Government have to reduce the inappropriate length of stay in hospital of many patients with dementia and other impairments. As that would result in quite a lot of savings, I ask the Government to reinvest those savings in community services.
Earl Howe
My Lords, the noble Baroness is right. The national dementia strategy quite rightly recognises the need to improve the quality of care for people with dementia in hospital and that is identified in the new implementation plan as one of the key priorities for action. Of course, the main priority has to be to avoid admitting dementia patients to hospital in the first place, if possible. We should admit them only when it is strictly necessary and we should discharge them at the earliest opportunity. We have set priority areas for all hospitals to take urgent action, including appointing a senior member of staff to improve the quality of care for people with dementia and to look after the training of staff in hospitals.
Lord Touhig
My Lords, between a half and two-thirds of people with dementia never receive a formal diagnosis. That could be improved if GP practices, the mental health services and the royal colleges were to develop dementia care pathways. That was a recommendation by the Public Accounts Committee in the other place in 2008. What progress has been made in developing those pathways?
Earl Howe
My Lords, progress is being made thanks to the quality standard published by NICE in the summer on dementia care. That will underpin the outcomes framework that we shall look for in the care of dementia patients. He is absolutely right in what he says: two-thirds of people with dementia never receive a diagnosis in the first place; the UK is in the bottom third of countries in Europe for diagnosis and treatment of dementia patients; and GPs do not feel adequately trained in this area. So there is a lot of work to do.
Health: Neurological Conditions
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
I thank my noble friend for calling this debate and for introducing it so authoritatively. As she indicated, this is a welcome opportunity to outline the valuable role that allied health professionals play in health and social care in delivering our ambition for world-class healthcare outcomes and, in particular, for people who have long-term neurological conditions.
First, let me set out some background about the allied health professions. They are a diverse group of 12 professions—in fact, three of the professions mentioned by my noble friend are, strictly speaking, not classified as allied health professions. These registered practitioners deliver high-quality care to patients across a wide range of care pathways and settings from public health through to recovery, rehabilitation, reablement and end-of-life care. Some of the most well known professionals are occupational therapists, physiotherapists, speech and language therapists and podiatrists.
Over 84,000 allied health professionals are working in the NHS in England and just under 2,000 occupational therapists are working in social services. From day one, these are skilled practitioners in their profession of choice. They assess, diagnose, treat and discharge throughout the care pathway from primary prevention through to specialist disease management and rehabilitation. They often work with the more vulnerable and marginalised in society. They treat some of the least recognised problems—for example, incontinence. I agree with my noble friend that their approach is very person-centred. Their particular skills and expertise can be the most significant factor in helping people to maintain their independence through physical and mental rehabilitation.
Long-term neurological conditions affect children, adults and older people. These conditions cover a wide range of care groups and include multiple sclerosis, motor neurone disease, Guillain-Barré syndrome, epilepsy, cerebral palsy and Parkinson’s disease. We know that an estimated 8 million people in England are living with a neurological condition. They account for approximately 20 per cent of acute hospital admissions. Neurological conditions are the third most common reason for seeing a GP. An estimated 350,000 people across the UK need help with activities of daily living because of a neurological condition and 850,000 people care for someone with a neurological condition.
Allied health professionals work with partners in social care, education and voluntary organisations to support individuals with long-term neurological conditions to manage those conditions and to support their carers to manage them. They focus on achieving clinical outcomes that are about maximising the individual’s functional abilities and participation in home, work and social life—for example, enabling a young mother with multiple sclerosis to manage the physical challenges of family life alongside the impact of the condition on mobility and other activities of daily living, or supporting a person with newly diagnosed epilepsy to return to work, often working with the employer in assessing the suitability of the work environment or facilitating a phased return to work.
People with long-term neurological conditions usually require the services of all the allied health professions at some point during the management of their condition. For example, a person with multiple sclerosis might see the physiotherapist for assessment, diagnosis and treatment of mobility problems and an occupational therapist for assessment, diagnosis and treatment of residual impairments impacting on activities of daily living and to be assessed for environmental adaptation in preparation for discharge. A speech and language therapist would assess, diagnose and treat swallowing and communication problems. The arts therapists would use psychotherapeutic interventions to gain insight into and to promote resolution of behavioural and emotional difficulties, such as depression.
When it comes to a health and social care model for long-term conditions, there are three levels. Allied health professionals work at all three levels and their impact is directed to keep patients in the lowest tier appropriate for their condition. Level 1 is self-management, with allied health professionals supporting individuals to take an active role in managing their condition. Level 2 is disease management and the focus for allied health professionals is preventing complications and promoting well-being. At level 3, an individual will have a case manager, who may be an allied health professional, to co-ordinate a multidisciplinary, multiagency care package to meet complex needs.
Perhaps rehabilitation and reablement is where the unique role of allied health professionals lies. It is important not just for people with long-term neurological conditions but for everyone with long-term conditions and, indeed, those with acute health problems to optimise health and well-being. Rehabilitation is aimed at enabling individuals with disabilities to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional levels. Reablement is intensive intervention to optimise function, often focusing on independence in activities of daily living, including acute exacerbations of a long-term condition.
Allied health professionals deliver rehabilitation and reablement and they may train patients, carers, support staff and others to develop their skills in rehabilitation. Rehabilitation and reablement reduce length of stay and minimise hospital readmissions. Vocational rehabilitation supports individuals to return to work and become economically active.
On 5 October, my right honourable friend the Health Secretary announced that £70 million of extra funding will be allocated to primary care trusts to be spent this financial year across the health and social care system to enable the NHS to support people back into their homes after a spell in hospital through reablement. PCTs will work closely with trusts and local authorities in delivering this.
Allied health professionals also have a broader role in public health and health promotion. It is clear that this is important for those with long-term neurological conditions and other long-term conditions. Some allied health professionals work in public health to reduce the risk factors that may impact on health and well-being. Allied health professionals’ services are actively engaging and brokering services with the third sector. An example of this is in County Durham, where the therapy services are working with the Multiple Sclerosis Society to offer a lifestyle programme, including diet and exercise advice, to improve general health and social engagement.
I now turn to some of the questions that were posed in this debate—I suspect that there were too many for me to answer now—not least the extremely important issues raised by the noble Baroness, Lady Finlay, about multidisciplinary teams, on which a lot of work is currently going on in my department. Suffice it to say at the moment that for all the reasons given by the noble Baroness it is imperative that the future commissioning arrangements ensure wide engagement with all clinical professionals, including allied health professionals. As she said, part of this will depend on the development of tariffs for long-term conditions. We are working to improve the tariffs for community services and mental health, in particular, and I undertake to keep the noble Baroness apprised of our progress.
The noble Baroness, Lady Thornton, spoke about the context of the White Paper and questioned whether the architecture outlined in it could satisfactorily address the need to ensure multidisciplinary and integrated working. Effective GP-led commissioning will require the full range of clinical and professional input alongside that of local people. Nurses, allied health professionals and others will all have a vital role to play, with a real opportunity to develop services and improve the health outcomes of their local populations. As the Government have made clear, healthcare will be run from the bottom up, with ownership and decision-making in the hands of professionals and patients. It is only by putting patients first and entrusting professionals to design and configure services that we will drive up standards, deliver better value for money and, ultimately, create a healthier nation.
My noble friend Lord Alderdice talked about key workers and the need to avoid multiple referrals. He is absolutely right. There are many examples of allied health professionals working as key workers, particularly occupational therapists. Multiple referrals can also be avoided through the greater use of self-referral to allied health professional services. This has been available on the NHS for many years but is an option that is perhaps not as well known as it should be. He asked how we can reduce turnover in nursing and physiotherapy and thus ensure long-term continuity of care. We are concerned to ensure this. Through the new architecture of commissioning, I want to see allied health professionals and community nurses re-engaged with commissioning decisions to ensure that services really are commissioned right through the care pathway and across sectors such as health and social care. My noble friend also asked what news there is about the registration of psychotherapists and counsellors. Strictly speaking, so I am advised, they are not classified as allied health professionals. Be that as it may, the news on this has to reach my ears, so I need to write to him about it.
The noble Countess, Lady Mar, asked whether the coalition accepts that CFS/ME is a neurological condition. The Government accept that it is a neurological condition. In many cases, allied health professionals will have a role to play and it goes without saying that all of them should treat patients with respect and dignity, whatever their diagnosis.
The noble Baroness, Lady Finlay, pointed to a shortage of speech and language therapists. Admittedly the latest official figures that I have are rather historic, but I am advised that the vacancy rate as at September 2009 was 0.6 per cent, which does not sound very large to me. The noble Baroness, Lady Greengross, raised the issue of dementia training. This care is covered in the training of all the allied health professions at an appropriate level for the profession concerned.
I hope that, in the time available, I have illustrated the valuable contribution that these professionals make not only to people with long-term neurological conditions but also in meeting the health and social care needs of the wider population. I recognise that allied health professionals could and should be playing a greater role in service redesign to deliver the true outcomes that people want from healthcare, as well as improving productivity.
Health Protection Agency
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Baroness Thornton
To ask Her Majesty’s Government how they will ensure that emergencies and pandemics are dealt with properly in the period before the abolition of the Health Protection Agency.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
The Health Protection Agency is one of many resources used by the Government to prepare for emergencies and pandemics. We propose to abolish the HPA as a statutory body but its functions will continue as a key part of the planned public health service. The Government continue to prepare and strengthen the UK’s resilience to emergencies, and we will ensure that this is maintained both before and after the HPA’s functions are incorporated into the public health service.
Baroness Thornton
I thank the Minister for that Answer but I am not sure it offered the reassurance that I was seeking. I raise the issue of the independent expert advice of the HPA, which from time to time might be uncomfortable for Ministers to hear. How will the Government ensure that the independence of the HPA is guaranteed, and will the scientific advice be made publicly available? For example, scientific advisory committees such as the one on dangerous pathogens are obliged to publish their agendas, minutes and papers and to have a dedicated website. If these committees are subsumed into the department, will they lose their independence? This is a very important matter and the Government need to provide some clarity.
Earl Howe
My Lords, transparency is one of the aims of our proposals. As regards independence, the Government will continue to rely on their scientific advisory committees, the members of which, as the noble Baroness knows, are drawn from the foremost experts in their respective fields. The fact that the scientific secretariat to each committee is provided by experts formerly within the department, instead of within the HPA, will not prevent the committees reporting as they judge to be appropriate.
Lord Alderdice
My Lords, one of the most important elements in dealing with emergencies and pandemics is the communication of accurate, concise and timely information to the community. The HPA website is a very good facility for providing information to professionals during the ordinary way of things but is not particularly good at providing emergency information to the community as a whole, nor is it adequate on its own. Will my noble friend assure me that when the public health service takes over it will concentrate on this question of emergency communication to the public as a whole?
Earl Howe
My noble friend makes a good point about communications. Indeed, the idea of creating a public health service is to have in the Department of Health a joined-up means of having advice, surveillance, training and planning that will then feed out to local authorities, which will be responsible for prioritising action on the ground. An essential part of that will be to get the communications right.
Baroness Turner of Camden
My Lords, can we have an assurance from the Minister that health and safety at work will be protected? Some industries—the construction industry is one such industry—have high levels of industrial injury and, of course, it is a human right not to suffer injury, or indeed death, while at work.
Lord Patel
My Lords, which of the tasks currently carried out by the HPA will not be carried out in the future?
Earl Howe
My Lords, I have to defer an answer to that because we will shortly publish a White Paper about our plans for the public health service. Following that the public and interested professionals will be invited to feed in their views on exactly how that service should be configured.
Baroness Pitkeathley
My Lords, I know that the Minister is always very concerned about the needs of patients. Will he assure the House how two things will be addressed: first, how the patients themselves will be protected during the inevitable turbulence of a period of transition; and, secondly, how the Government intend to deal with the possibility of the leaching away of scientific expertise during such a period of turbulence?
Earl Howe
My Lords, I should emphasise that the functions of the Health Protection Agency will be transferred into the department. In the mean time, we intend to make it business as usual throughout the transition process, with an emphasis on the smooth transition both of functions and of individuals on whom we rely to give advice. The functions of the HPA will not be lost in the wake of its abolition. It will continue to contribute to the Government’s response to emergencies and other areas of responsibility. I assure the noble Baroness that we have her concerns very much in mind.
Lord Soulsby of Swaffham Prior
My Lords, it is very disappointing news that the HPA is to be abolished. I believe that it has done excellent and timely work in an independent manner. It was set up following a report by the Science and Technology Committee, which I had the privilege to chair, on fighting infection. In the debate that followed that report, this House agreed that the funding for the HPA should be totally safeguarded because of the possibility of infection occurring. Though the Minister has said that its functions will be taken over by the department, there is the danger that the independence and timeliness that is typical of the HPA will be lost. Will the Government reconsider the issue because the HPA has done such valuable work over the past 12 to 15 years?
Earl Howe
My Lords, perhaps I can reassure the noble Lord that the decision to bring the functions of the HPA into the department is absolutely no reflection on the quality of the work that the agency has done and continues to do. This means that the Secretary of State will take personal responsibility for public health in our country, with a direct line of sight from the Department of Health right down to the local level. That should give everybody confidence that public health is high on the Government's agenda. When the public health service is formed, it will bring together key professionals who are involved in planning, advice, surveillance and strategy-making from national to local level. I do not see this as a dilution of the quality of public health work in this country.
Food: Regulation and Guidance
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, I thank the noble Lord, Lord Whitty, for calling this debate on food standards and the role of regulation and guidance in the food chain. As your Lordships may know, this is an area for which the noble Lord and I have, at one time or another, both been responsible in our previous roles as agriculture ministers, his experience being much more recent than my own. Along with other noble Lords I pay tribute to the noble Lord’s work as the chair of Consumer Focus.
The food that we eat is fundamental to who we are. It is, of course, a source of essential sustenance necessary for basic survival. But food can also be much more. A meal made with the finest ingredients, prepared with skill and care and shared with loved ones can be one of life’s great pleasures. Yet no matter what our culinary preference, we all expect our food to be safe. It is no longer enough that we do not expect to be taken ill with a mild dose of salmonella or to have our lives put at serious risk by botulism; we also need to pay attention to the less acute causes of harm which noble Lords have rightly highlighted—the high levels of salt, sugar and fat that can do so much harm over the course of our lives.
While I do not believe that the role of the Secretary of State is to tell people what they can and cannot eat, there is a role in making sure that the food we eat is safe; that we make people fully aware of any long-term risks from our diets; and that those risks are minimised as far as possible. The sensible use of appropriate regulation and guidance is essential to this. The warnings sounded by the noble Lord, Lord Patel, are well founded. Far too many people in this country eat far too much salt, saturated fat and sugar, and nowhere near enough fruit, vegetables and oily fish. The personal costs to our health and the high financial costs to business and, through the National Health Service, to the taxpayer are huge. If everyone ate a diet that matched national nutritional guidelines we could prevent around 70,000 deaths every year. The current cost to the NHS of those deaths is thought to be around £8 billion a year. This does not include the further costs to the wider economy in lost productivity.
As the noble Lord, Lord Giddens, for one, pointed out, obesity in particular is a serious and growing problem. Nearly three-quarters of a million people in the UK are classified as morbidly obese—overweight enough to cause real long-term damage to their health. As such, they increase their risk of being diagnosed with diabetes, some cancers and cardiovascular disease, as well as a wide range of conditions that have a significant negative impact on a person’s quality of life.
The Government are committed to improving the health of the nation. We consider public health to be a high priority and to be everyone’s business. Much has already been achieved—and here I pay tribute to a great deal of the work done by the previous Government: there is clearer and easier to understand information on the front of food packaging than ever before, helping people to make healthy choices at a glance; there are national guidelines to protect the most vulnerable and ensure high-quality food in places such as schools, hospitals, care homes and prisons; voluntary initiatives with the food industry have seen significant reductions in the amount of salt in our foods; we have put in place a new Change4Life strategy; we are working with industry on appropriate safeguards for marketing food and drink to children—I shall say more about that in a minute; and we will continue the national child measurement programme.
Something that many of these achievements have in common is that they stretch beyond the limitations of purely government actions. We recognise that public health is not a social good that can somehow be mandated from the centre. The way to make real progress is through a coalition of partners—government departments, private companies, charities and individuals all taking responsibility for their own actions. We want business to do more to help meet public health challenges. We want all partners to be joint owners of a long-term public health strategy and for each to play its part in improving people’s health. This is the thinking behind the Responsibility Deal, our response to the challenges that cannot be resolved through legislation or regulation alone. The Responsibility Deal is a partnership between government and business that balances proportionate regulation with corporate responsibility to tackle the health problems associated with poor diet, alcohol abuse and a lack of exercise.
The noble Lord, Lord Whitty, raised the specific issue of nutrition. Providing clear, easy-to-understand nutritional information for consumers is essential if people are to make informed choices. This is also true when eating out. We have challenged the food industry to give its customers this information. From a traditional bag of fish and chips to a special treat for the whole family, eating out has become an important part of our culture and must be included in any serious attempt to influence it.
In this and in all areas of regulation, guidance and food standards, there is a balance to be found between the impact on health outcomes and the impact on business. We need always to take a proportionate approach and to try to get the balance right. Food is the UK’s largest manufacturing sector. It is a real success story, bringing billions of pounds into the Exchequer and employing tens of thousands of people. We must be careful not to strangle this particular golden goose with excessive regulation. We want a light touch wherever possible. Where we can achieve our objectives through voluntary agreements, we should do so. We also need to be realistic about what is within our gift to do. Much food regulation is EU-wide, so we need to negotiate and agree certain changes at an EU level. I need hardly say that we should also avoid gold-plating any legislation when implementing it.
One other key plank of public health policy is informed consumer choice. The noble Lord, Lord Whitty, is a particularly strong advocate for consumers and their rights in his role as chair of Consumer Focus. Often, people’s health and well-being are rooted in their daily lifestyle choices. To improve public health, we need to support people in changing their behaviour, making the healthy choice the easy choice. Public health must not be about nannying consumers or demonising particular foods. We need to find new approaches, founded in behavioural science, which nudge people in the right direction.
While we have made some progress, we have only really started to scratch the surface. Our average salt intake is down almost 10 per cent over the past decade, which will save the lives of 6,000 people each year as well as saving the economy around £1.5 billion. But we still have a long way to go before we reach the recommended level.
Early indications suggest that people are starting to reduce their intake of saturated fat, but we are still a very long way from the ideal level. Although levels have fallen substantially in young children, we are still eating far too much added sugar. Sadly, the consumption of fruit and vegetables remains poor, with only a third of people eating the recommended five a day. For all these reasons, we will publish later this year a public health White Paper. It will set out in detail our plans to transform public health: a good, balanced diet, more exercise, drinking responsibly and stopping smoking.
The noble Lord, Lord Whitty, and other noble Lords dwelt to a considerable extent on the decision by the Government to move nutrition policy to the Department of Health from the Food Standards Agency, a transfer which took effect from 1 October. The main reason for doing that is not only to ensure that nutrition policy is delivered coherently and consistently in relation to nutrition—although nutrition is certainly part of it—but also to recognise the direct interrelationship between nutrition policy and public health policy in areas such as obesity, diabetes and coronary heart disease. It is an early step towards realising the Government’s vision of drawing together the diverse arrangements for delivering public health into an inclusive public health service. The transfer will mean that the Government can give the general public more consistent information. It will also mean, as I have indicated, a more co-ordinated and coherent policy-making process and a more effective partnership between Government and external stakeholders.
I agree with the noble Lord, Lord Whitty, that the creation of the Food Standards Agency was sensible and necessary in the context of public confidence at the time in the Government’s advice on food safety. I am not so sure that I agree with him that there was any lack of consumer confidence in the Government’s advice on nutrition. The main problem, I think, lay in issues around food safety.
I assure the noble Lord, Lord Rea, that the Food Standards Agency will continue to ensure the public’s safety by maintaining its essential and robust regulatory role on food safety, covering all aspects of development, implementation and delivery. In the context of consumer confidence, what matters is surely transparency. The Government are committed to provide evidence-based advice to consumers in order for them to make healthier lifestyle choices. We understand the need for transparency in our policy-making and the need for independent advice and scientific accuracy. The Government will continue to be advised by independent experts to ensure high-quality, trustworthy advice to consumers.
The noble Lord, Lord Rea, mentioned the press report that appeared on 24 September that suggested that various public bodies would be axed, including the Government’s independent Scientific Advisory Committee on Nutrition. In fact, discussions are still on-going and we will be in a position to make an announcement on the matter in due course. In the mean time, SACN will continue to provide expert advice on nutrition to the Government. Again let me reassure the noble Lord that our expert scientific committees, of which we have several, will continue to operate in line with government principles of scientific advice and codes of practice for scientific advisory committees. Those will ensure transparency in their work, and the minutes of those committees will be published.
The noble Baroness, Lady Thornton, questioned the evidence that food labelling belongs in Defra. She will recognise, I believe, that there was a division of responsibility for food labelling. We will now have a more consistent delivery of food labelling policy that will bring together general labelling and issues such as country-of-origin labelling.
The noble Lord, Lord Giddens, asked me to give the Government’s view of the FSA in general. I hope that I have indicated that we think very highly of the FSA. We recognise the good work that it has achieved as well as the principles that it has established of openness, transparency and evidence-based policy. At the same time, it is important in delivering the Government’s objectives on public health to draw together nutrition policy so that it can be delivered more coherently.
Much has been said this afternoon—not least by the noble Lord, Lord Patel—about saturated fat and salt and their connection with ill health. Two key dietary influences in the development of cardiovascular disease are the levels of saturated fat and salt in the diet. High intakes of saturated fat can cause increased cholesterol levels, which are a major risk factor for CVD. Similarly, high salt intake contributes to high blood pressure, which is also a risk factor. I say to the noble Earl, Lord Erroll, that there is strong international agreement with UK expert opinion on what constitutes a healthy balanced diet that is low in salt and saturated fat. The substantial body of scientific evidence supporting that view includes long-term epidemiological studies, which conclude that a healthy balanced diet has a positive effect on the prevention of diet-related chronic disease.
The noble Lords, Lord Patel and Lord Rea, suggested that there should be a stronger regulatory approach to such matters rather than simply a continuation of the voluntary approach. The UK is moving further and faster on salt, saturated fat and sugar reduction than most other countries, even those that have taken a regulatory approach. The responsibility deal aims to build on that and to challenge industry to play its part in improving people’s health. Legislation would undoubtedly produce an additional burden, which could stifle industry innovation. Industry ought to have the flexibility to decide how it delivers public health benefits. Consumers also need to take responsibility. We need to find ways in which to support people in changing their behaviour and improving their diets. The Food Standards Agency is fully on board with this voluntary approach. It has worked with the food industry to deliver voluntary reductions and to secure public commitments to the reformulation of food.
The noble Lord, Lord Patel, spoke eloquently about trans fats. Action by the food industry in the UK has reduced average trans fatty acid intakes to less than half the maximum level set for public health. We understand the public concern over artificial trans fats and will continue to encourage the food industry to eliminate their use. The Government’s public health White Paper and the responsibility deal will set out more of the strategy, but my right honourable friend Andrew Lansley has stated that the Government will continue to encourage the food industry to eliminate the use of artificial trans fats.
Lord Giddens
In the light of what the noble Earl has said, will the Government consider completely banning trans fats?
Earl Howe
My Lords, the whole matter of trans fats is under review. I expect that we will be in a position to say something in the public health White Paper. In the context of the noble Lord’s question, it is instructive to look at the experience of other countries. The United States took legislative action on trans fats only after voluntary measures had failed and because intakes by New York citizens in particular were much higher than those recommended and much, much higher than those in the UK. Denmark acted to ensure that individual food products did not contain high levels. We believe that much of this can be achieved by voluntary measures, which will be considered as part of the responsibility deal.
The noble Lord, Lord Giddens, suggested in his speech that the ban of trans fats in Denmark has directly reduced the incidence of chronic diseases. I would be interested to see the evidence that he has for that. We are not aware of published scientific evidence of a direct linkage between reducing trans fat intakes and changes in disease rates in the population in Denmark, so I should be glad to communicate with him on that topic.
The noble Lord, Lord Patel, questioned whether the voluntary approach would be enough. Voluntary action by industry so far has shown that it can be successful. As I indicated, we want to make industry joint owners of the long-term public health strategy. That includes our drive to reduce salt levels in food, about which the noble Baroness, Lady Thornton, asked.
The noble Baroness, Lady Hayter, asked for reassurance that protection of the consumer will be a watchword for the Government. I can tell her that the responsibility deal most certainly includes representation from consumer-focused organisations, to make sure that consumers’ interests are protected. She also spoke about the impact of poverty on diet. We recognise the action that retailers have taken to ensure that the nutritional qualities of value food lines and premium food lines are comparable. The Government’s responsibility deal can take into account these types of issue to help to promote good nutritional standards.
I say to the noble Lord, Lord Patel, that the Government are committed to working with the industry, as I indicated. We have seen a great deal of progress with children’s diets, as he will know in relation to foods that are high in fat, salt and sugar.
The noble Baroness, Lady Finlay, asked what action the Government will take to help educate consumers, particularly about food labelling. The Government fully support consumer education to help achieve a balanced diet. That will continue with the “Change for Life” brand, which can evolve in response to evidence and the economic climate. We recognise the role of simple nutritional labelling on pre-packed foods and are supportive of measures that support its usefulness. We would like to see front-of-pack labels that include percentage guideline daily amounts for the five nutrients which are of particular dietary importance.
I shall write to noble Lords with answers to other points. Perhaps I may conclude by briefly emphasising that more than any other area of health, public health has the potential to change people’s lives for the better. It cannot be seen as an add-on, or as somehow secondary to the important business of saving lives. It is saving lives and, at a time of tightening budgets, by preventing people from becoming ill in the first place it saves money as well.
Health: Addiction to Prescribed Drugs
Earl Howe Excerpts(14 years, 1 month ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, I join other speakers in thanking the noble Earl for having called this debate, which has prompted some excellent contributions from all speakers. This is an issue of considerable importance and I am well aware that it is of great concern to the noble Earl’s own family. I know that he made a moving statement on this question to the All-Party Parliamentary Group on Drug Misuse last December. I commend the all-party group for its report on dependence on prescribed and over-the-counter medicine.
When most people consider the harmful effects of drugs and drug addiction, they will tend to think of illegal drugs such as cocaine and heroin. They will be less likely to think of the drugs that are available perfectly legally from their GP or over the counter at their local pharmacy. The harmful effects of addiction to medicines for pain relief, anxiety or insomnia do not make for lurid headlines. People assume that if your doctor has prescribed a drug, or if you can buy it at the local chemist, it must be safe. In most cases, it is, but this is not the whole story. Unfortunately, some people suffer the consequences of dependence on medicine. At the Department of Health, we receive a steady stream of letters from people whose lives, or the lives of their loved ones, have been badly affected by addiction to tranquillisers or other prescribed medicines. To them, I say that we acknowledge the problems that they face and are working systematically to understand how services can be improved.
I should also like to pay tribute to the NHS and voluntary organisations that are already doing so much to help people withdraw from prescribed and over-the-counter drugs, but we need to know more about how well placed these services are to meet the needs that exist and what support might improve them.
To tackle this problem properly, we must first understand it. The Department of Health has asked the National Addiction Centre to conduct a literature review to identify and assess the existing medical and scientific evidence about the scale and nature of the problem and how it can be treated. We also need reliable information about how many people are dependent on medicine and how many need help to withdraw.
The true scale of the problem is hard to quantify. I will say a little more about that in a minute, although I recognise that the APPG offered an estimate. To a large extent, the misuse of prescribed and over-the-counter drugs is a hidden problem. Some people do not realise that they need help, so do not ask for it; others do not know where to go for advice and support; some will not admit that they have a problem and need help, and as a result are simply not counted. We need to gauge the true extent of clinical dependence and the need for help in withdrawing from dependence on legal medicine. The Department of Health has asked the National Treatment Agency for Substance Misuse to conduct an audit of GP prescribing which, I can tell my noble friend Lord Mancroft, will indeed be thorough.
The department has also asked the NTASM to map the extent of current service provision to help people withdraw from dependence on legal medicine. We have asked to see the results of this work by the end of this year. After Ministers have had an opportunity to consider the findings, we will share them with interested individuals and organisations to inform a debate about where we go from here. In advance of their publication, I shall set out how the initiatives already announced will help to improve services for this group of people. The Secretary of State for Health plans to create a new, integrated public health service to promote public health and encourage behaviour change to help people live healthier lives. The treatment of dependency will be a priority of a public health service. The public health White Paper, due for publication later this year, will set out the service’s role in the rehabilitation of people whether they are dependent on illicit drugs, alcohol or legal medicines.
Later this year, we will publish a new drugs strategy; the consultation on that closed last week. We are now looking at the responses received to inform the development of that strategy, but we are clear that we want to achieve a closer integration of services to help people, regardless of the substances on which they are dependent, to live full lives, participating actively in society. I mention those forthcoming policy statements because they will set the context for our future work.
I referred to the letters we received from those affected by addiction to medicines. The letters are often heartbreaking. If there are more people affected in the same way, we need to know and to act. Equally, if we are to intervene and make this a priority for the health service, we need to ensure that we provide the right help in the right way. We all know that funding is extraordinarily tight; there will be difficult choices to make. Before local commissioners commit resources to dedicated medicine addiction services, they need the evidence that that spending will be effective.
There are good examples of areas where local commissioners have recognised a need in the area and have commissioned dedicated services. Bristol's Battle Against Tranquillisers, or BAT, is working with primary care trusts and mental health trusts across the West Country to provide dedicated counselling group therapy and telephone advice for people dependent on medicines. It is also educating GPs about the risks of tranquillisers and safe and effective methods of withdrawal. BAT also provides advice and counselling sessions at a number of prisons where benzodiazepine use is particularly high among older inmates. I commend the hard work of local NHS and third-sector organisations like BAT, and similar organisations across the country, in helping to deliver these vital services.
There may be a greater role for chemists and practice nurses to help in planning and delivering withdrawal programmes. There was already a great deal of advice available to GPs about the risk of addiction in prescribing benzodiazepines, sleeping pills and painkillers. Advice is also available to help clinicians manage patients’ safe withdrawal, and is set out in the British National Formulary, in clinical knowledge summaries and on the Patient UK website.
I was asked by more than one noble Lord about the scale of the problem of people addicted to benzodiazepines. Evidence to the All-Party Group on Drug Misuse estimated that 1.5 million people were so addicted. However, further work is needed to reach a more statistically reliable estimate of the scale of dependence on these medicines. That estimate was worked out by researchers for a television programme broadcast 10 years ago using prescribing figures for one primary care trust, which were then extrapolated to arrive at a national estimate. It can easily be seen that we need to revisit this question.
In any event, overall numbers of prescriptions do not by themselves show the scale of the dependence. Many prescriptions, including long-term prescripts, are clinically appropriate: that is, they are based on the doctor’s full knowledge of their patient’s condition and deemed by the doctor to be beneficial. In some cases, tranquillisers are prescribed as part of a full package of medication for conditions such as epilepsy or multiple sclerosis. It is also important to note that prescription numbers overstate the true numbers of patients, as those figures will include repeat prescriptions for the same patients.
A number of noble Lords questioned whether the NTASM was the appropriate body to be commissioning the services for people who become addicted. In fact, as I am sure your Lordships will know, the NTASM does not directly provide treatment services. NHS drug and alcohol services are there to do that job. I do not agree that drug and alcohol action teams are not best placed to help people addicted to drugs. DAATs commission to provide help for a wide range of drug users, including people dependent on medicines such as tranquillisers. In many cases, services for people hooked on such drugs are provided at different sites than those for people hooked on illicit drugs. Case workers are fully qualified to advise people who need advice on withdrawing from prescribed and over-the-counter drugs. Services for people trying to withdraw from benzodiazepines are offered in a sympathetic way, with sessions held at separate sites or at different times by some PCTs to make users feel more comfortable. When I asked about this, the advice was that treatment providers would typically treat each case on its individual clinical merits, both psychosocially and pharmacologically. Examples of these services are established in specialist clinics to treat those with addiction to medicines such as benzodiazepines.
Mention was also made of the 2004 Health Select Committee report. The previous Government published a response to that report in 2005, replying to all the recommendations in it. As a result, the MHRA has made a number of improvements given the concerns in the report. Time prevents me from reading them out, but they are significant. Noble Lords also asked me what the timetable for this review was. I have already indicated when Ministers have asked for the report to be on their desks. The review is considering services across the board, both in the NHS and the third sector. As regards the latter, the Government will allocate funding centrally for third-sector organisations only from the third-sector investment programme.
The noble Baroness, Lady Thornton, criticised the Government for not involving people directly affected by dependence on benzodiazepines. In fact, the review under the previous Government, which as she knows was not a formal public consultation—there was therefore no formal requirement to consult external stakeholders—nevertheless included a programme in which officials contacted most of the main patients’ organisations and obtained their views on the way forward. That was very helpful background to the work that we are now doing.
The noble Earl asked about support for the voluntary services in Liverpool, Oldham, Bristol, Belfast and elsewhere. He will know that decisions about funding of local services for people dependent on medicine are based on local needs. We are aware of several PCTs that fund withdrawal counselling.
Time prevents me from going further, although I do have further information and will write to noble Lords whose questions remain unanswered. I apologise for not being able to do so now. Contributions made in today’s debate illustrate graphically the concern felt by this House on the issue, which I and my ministerial colleagues take extremely seriously. I look forward to sharing the results of our reviews with noble Lords as we develop policies and services in the light of evidence.
Health and Social Care Act 2008 (Consequential Amendments No. 3) Order 2010
Earl Howe Excerpts(14 years, 3 months ago)
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Health and Social Care Act 2008 (Consequential Amendments No. 3) Order 2010
Earl Howe Excerpts(14 years, 3 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, this order makes a consequential amendment to the Water Industry Act 1991. The amendment is required as a result of the implementation of a new registration system under the Health and Social Care Act 2008, which set out a system of registration for providers of health and adult social care that the Care Quality Commission operates. To manage the registration process, providers are being brought into the new system in stages. The dates for these stages are set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
As of 1 April this year, all NHS providers were subject to the new system of registration. It will cover private and voluntary healthcare providers, and adult social care providers, from 1 October 2010. The providers are registered under the Care Standards Act 2000. Therefore, on 1 October, certain provisions of the Care Standards Act will be repealed. One of these will be the definition, in Section 2 of the Act, of an “independent hospital in England”. A previous order—the Health and Social Care Act 2008 (Consequential Amendments No. 2) Order 2010—made a number of consequential amendments to primary legislation using this definition. Unfortunately, an amendment to the Water Industry Act 1991 was missed, so this order is necessary because of that omission. Anyone who buys, or has bought, the earlier order will be entitled to a copy of this order free of charge.
A further order, subject to the negative parliamentary procedure, has been laid today and will make the necessary amendments to secondary legislation. Schedule 4A to the Water Industry Act 1991 contains a list of premises that should not be disconnected for the non-payment of water charges, including,
“an independent hospital within the meaning of the Care Standards Act 2000”.
As the definition of “independent hospital” in the Care Standards Act 2000 will no longer be applicable in England, this order makes a consequential amendment to the definition in the Water Industry Act 1991. It replaces the current cross-reference to the Care Standards Act 2000 with a new definition of an “independent hospital” for England. This new definition covers the same kinds of premises that were previously covered, but does not rely on a reference to the definition in the Care Standards Act 2000. The definition for Wales remains unchanged. I commend this order to the Committee.
Baroness Thornton
I thank the Minister for explaining this small order arising out of Section 162 of the Health and Social Care Act 2008. I suppose that I should apologise to the Committee for the earlier omission, which is why we are here. Section 162 is a part that confers power on the Minister to ensure that the Act is in compliance with existing legislation, and indeed that is what the Minister explained in a more than adequate fashion.
I confess that I was not sure that I could see the necessity of this order until I realised that the healthcare facilities mentioned can have their water cut off as a result of non-payment. Can the Minister confirm whether this has happened in the interim period?
The key matter on which I should like further clarification is the definition of an “independent hospital”. I think that I heard the Minister confirm that this covers the public, private and charitable sectors, any one of which may be providing healthcare as listed in new paragraph (5). Am I right to assume that this does not cover care homes or nursing homes, and that they are covered elsewhere?
Finally, I am relieved that body piercing and tattooing parlours are exempt from the order. I also wonder whether chemical peels, which are fashionable now, are covered under paragraph (5)(e)(iii) and (iv) for the purposes of this order.
This order is otherwise perfectly straightforward and I support the Minister in moving the Motion.
Earl Howe
My Lords, I am grateful to the noble Baroness for her questions. The first point to make is that we are in time with this order, because the operative date is 1 October, so there is no retrospective element. There is therefore no question of any hospital having fallen between two stools, so to speak, as regards water disconnection. I am not aware that there has been a problem on that front.
The noble Baroness asked about the definition. Schedule 4A to the Water Industry Act 1991 lists a number of premises that are not to be disconnected for non-payment of water charges. These include, among other premises, NHS hospitals, premises used to provide medical or dental services by registered practitioners, children’s homes, schools and care homes. These premises will continue to be protected from disconnection for the non-payment of water charges. No changes are being made to these parts of the schedule.
The noble Baroness also asked whether chemical peels were excluded under new paragraph (5)(e). As that procedure is not counted as surgery, chemical peels are not included and therefore do not receive protection from disconnection under paragraph (5)(e).
Baroness Hussein-Ece
I should like to ask my noble friend a couple of questions. I understand completely the need for this order. It is a sensible step and an important one to ensure that the establishments mentioned do not suddenly have their water cut off. However, I want to ask what penalties are in place for water companies that do not follow these regulations and how are they enforced. Further, what review mechanism is in place if other establishments need to be added to the list in due course?
Earl Howe
My Lords, as regards the penalties, I am going to have to write to the noble Baroness because, as she will understand, those are a matter for another department. I know that I am here to speak for the Government as a whole, but I am afraid that I do not have that information in my brief. On a review of the list of those premises that are exempt from disconnection, again, I will write to her.
Health: Prostate Cancer
Earl Howe Excerpts(14 years, 4 months ago)
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Baroness Royall of Blaisdon
To ask Her Majesty’s Government what steps they are taking to increase general practitioners’ awareness of the symptoms of prostate cancer.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, in 2005 the National Institute for Health and Clinical Excellence published referral guidelines for suspected cancer. These include symptoms that GPs should be aware of when considering whether to refer a patient urgently for suspected prostate cancer. It is important that we continue to support primary healthcare professionals in detecting the signs and symptoms of cancer and referring patients quickly. We will consider how best to do this as we review the cancer reform strategy.
Baroness Royall of Blaisdon
My Lords, I welcome that Answer and am glad to hear that NICE gave the appropriate guidelines, but I believe that too many GPs are still not vigilant enough and do not recognise the symptoms. Does the Minister agree that it might be sensible for me to ask my PCT to ensure that there is greater awareness-raising about prostate cancer among GPs and patients? Does he share my concern that, with GP commissioning, the necessary strategic view of these issues will no longer be taken in areas of the country, that improvements made to date may be undermined and that control could be put into the hands of the very people who, I believe, have not done the best for their patients to date?
Earl Howe
My Lords, there will be plenty of support for GP consortia in the area of cancer diagnosis and treatment, not least from the commercial support units but also from the cancer networks. However, the noble Baroness is right that we are not doing well enough in this country in picking up cases of prostate cancer. Late diagnosis is likely to be a significant contributor to that and is, in itself, the result of a number of factors, poor public awareness being one. Late presentation to primary care is another and, as the noble Baroness hinted, poor detection in primary care is a third. Therefore, supporting GPs in detecting cancer earlier will be a key part of the work that we have to do.
Lord Alderdice
My Lords, given that the prostate-specific antigen test is not in fact pathognomonic of cancer of the prostate but simply of disturbance of the prostate and that significantly high levels of the antigen are likely to lead to an investigative biopsy by a urological surgeon, is the Minister content that we have enough urological surgeons in the country to undertake the level of investigative biopsy that is likely to arise from the higher index of suspicion by general practitioners indicated by the noble Baroness? Entirely separate from that is the question of whether we have enough urological surgeons to carry out the treatment for prostate cancer when it is diagnosed.
Earl Howe
My Lords, I am not aware that there is thought to be a significant shortage of urological surgeons or expertise around the country, although the coverage varies from region to region, as the noble Lord will know. However, I shall take his concerns back with me and make suitable inquiries. If I can write to him further, I shall certainly do so.
Lord Campbell-Savours
My Lords, why cannot we have a national PSA screening programme? Would that not help to avoid late diagnosis?
Lord Williamson of Horton
Will the noble Earl say whether there has been any progress in the development of a test that is more accurate than the PSA test that is currently used?
Earl Howe
My Lords, there is quite a bit of ongoing work to devise such a test but I am advised that no reliable test exists at the moment. The PSA test is the best that we have. The noble Lord will know that the results of tests show that you have to screen about 1,400 men and treat 48 unnecessarily to save one life. It is not an easy equation.
Lord Lloyd-Webber
My Lords, the Prostate UK charity reckons that 10,000 men a year die needlessly as a result of not being diagnosed with prostate cancer. I agree that the current PSA test is not wholly reliable, but will the Minister agree that all men over 50 should have the test and that their GPs should encourage them to do so?
Earl Howe
My Lords, my noble friend raises an extremely important point. He may like to know that last year the department wrote to primary care trusts to remind them that any man without symptoms of prostate cancer who wishes to have a PSA test is entitled to have one. However, it is important that anyone availing themselves of the test does so on a fully informed basis, because, as I said, it is unreliable and can lead to unpleasant side effects.
Lord Winston
My Lords, is not one of the problems with the PSA test the fact that it produces a vast number of false positives, meaning that a number of people could be at risk of mutilating treatment? Will the Minister give an answer to the question about advances in genomics, which might help in the long term with regard to prostate cancer?
Earl Howe
My Lords, the noble Lord, Lord Winston, is probably in a better position to advise the House on advances in that area of research. I can tell the House that the National Cancer Research Network, set up by the Department of Health in 2001, has brought about a tripling of the number of cancer patients entered into clinical trials. About 12 per cent of cancer patients in England enter NCRN trials, which is the highest per capita rate of cancer-trial participation in the world. The network currently supports about 51 prostate cancer studies, so there is no shortage of research going on.
Baroness Wall of New Barnet
My Lords, does the noble Lord agree that the recording and quality standards around prostate cancer ought to be considered by the Care Quality Commission? Does he also agree that it is a shame that the CQC has decided not to report at the end of this year on the state of the hospitals that it has been working with across the piece? My own hospital, Barnet and Chase Farm, is predicted to be excellent, but it has been told that the Care Quality Commission will not announce those positions at all.
Earl Howe
My Lords, the main reason for that decision is our belief that the regulatory effort should be directed to where it is most needed. Trusts such as the noble Baroness’s, which have been rated excellent, perhaps do not comprise a good use of the CQC’s time. However, it is important to recognise that the CQC is concerned with minimum standards. I think that everyone would want to see more than the minimum achieved across the NHS. We need to aim for excellence everywhere.