Food: Regulation and Guidance
Earl Howe Excerpts(15 years ago)
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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(15 years 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(15 years, 3 months ago)
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Health and Social Care Act 2008 (Consequential Amendments No. 3) Order 2010
Earl Howe Excerpts(15 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(15 years, 3 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.
Health: NICE
Earl Howe Excerpts(15 years, 3 months ago)
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Lord Naseby
To ask Her Majesty’s Government whether they plan to review the management and procedures of the National Institute for Health and Clinical Excellence to ensure that patients suffering from the most prevalent conditions of cancer and Alzheimer’s disease are properly treated.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, our White Paper, Equity and Excellence: Liberating the NHS, published on 12 July 2010, sets out our commitment to renew the National Institute for Health and Clinical Excellence and, through primary legislation, to re-establish it as an executive non-departmental public body. Legislation on NICE will be included in a health Bill in the autumn.
Lord Naseby
The Minister’s Answer is extraordinarily welcome. So far as concerns those suffering from cancer and similar problems, is he aware that according to a report called Exceptional Progress?, published in March this year, fewer than four out of nine of the drugs put forward were refused by NICE, which left 16,000 patients with nowhere to go, whereas if they had been French or German those drugs would have been available? Furthermore, is he aware that there is currently great criticism of the processing, structures and methodology used by NICE and that, against that background, his news that the organisation is to be totally reformed is enormously welcome?
Earl Howe
My Lords, I am grateful to my noble friend. It is important for me to state that the Government respect the independent expertise provided by NICE and we think that it should be allowed to continue to issue guidance free from political interference. That is a point of principle. However, we also think that there are failings within the wider system regarding drug pricing and drug access. We are determined to address that but we are clear that NICE plays a vital advisory role.
Baroness Finlay of Llandaff
My Lords, how will the Government ensure that the research, which NICE requires to provide the data on which it can make informed decisions, will be supported in the newly reorganised NHS? The NICE document published today, with its review of Alzheimer’s drugs, has as a major recommendation: co-ordination of research to provide good, long-term, end-of-life care studies of the effects of these new drugs in patients.
Earl Howe
My Lords, the noble Baroness will have seen in the White Paper the emphasis placed on research. A number of paragraphs in it will be of interest to her, as they emphasise the key role that research and research funding play in the long-term agenda of the NHS and as regards the interests of patients.
Baroness Howe of Idlicote
My Lords, does the Minister agree that, if early treatment benefits and enhances the lifestyle of those suffering from dementia, and if the cost of granting such treatment is very low, not only would that enhance the life of the individual, it would give added value to carers, as their caring role and their role in employment and in the exercise of their skills would continue to benefit society and all of us for much longer?
Earl Howe
My Lords, the noble Baroness makes a very important point about dementia. She will be aware that when the Alzheimer’s drugs were appraised by NICE some years ago, there was disquiet that the role played by carers had not received adequate attention in the appraisal process. It is an issue of great importance to many people, but it is very complex. Given the finite, overall health budget, if we give greater weight to one factor, such as carers or getting people back to work, we automatically, by default, give less weight to others, such as people at the end of their lives. We need to look at this, but it is complex. We shall not let it go, but I cannot give the noble Baroness a definitive answer today.
Lord Dubs
My Lords, I wonder whether the Minister can do better than the Prime Minister did in Prime Minister’s Questions earlier today, when he declined to give a guarantee that the 14-day period, within which cancer patients should receive hospital treatment, would be upheld. Can he confirm that the Government will stick to the 14-day period?
Lord Alderdice
My Lords, the treatment of such disorders—particularly cancer, but it is also true of Alzheimer’s disease—requires not just biological but psychological and social interventions. Although the biological research is often funded by pharmaceutical companies, NICE has great difficulty in finding the funding for research for psychological and social treatments. Can my noble friend indicate whether there is any way in which NICE can be assisted to be more broad-ranging in its understanding of a bio-psychosocial approach to treatment of these disorders by facilitating more funding for research in the psychological and social areas?
Earl Howe
My Lords, I am sure that my noble friend will accept, as I hope I made it clear the other day, that the Government are wholly committed to improving the quality of care for people with dementia and their carers. We are standing fully behind the dementia strategy, instituted by the previous Government. That strategy contains a specific objective of improving the quality of dementia care in hospitals. I take on board what my noble friend says about the absence of adequate research in the psychosocial domain. I shall discuss that point with NICE over the next few weeks as I am aware that it is one of its concerns.
Baroness Thornton
My Lords, I welcome the statement that the Minister has made about keeping NICE as an independent voice. That is vital. Will the Government still support NICE in its work not just in medical research, but as regards the broader aspects of disease, social conditions, social care and so on, as mentioned by the noble Lord, Lord Alderdice? NICE has broadened its brief and has taken a much more holistic view about the conditions on which it issues guidance. Will the Government still support it in doing that?
Earl Howe
My Lords, as the noble Baroness will know, in 2005, the then Government charged NICE with producing public health guidance as part of its work. As we establish a more integrated and effective public health service, we will look actively at how NICE can contribute to that agenda, and, in particular, how it can contribute to integrated care provided by health and social care combined.
Health: Diet
Earl Howe Excerpts(15 years, 3 months ago)
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Lord Krebs
To ask Her Majesty’s Government what plans they have for improving the dietary health of the population.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, we believe it is for individuals to take responsibility for their health, including healthy eating. The Government can put in place ways to make this easier and support people. We are developing our proposals to achieve this.
Lord Krebs
My Lords, I thank the Minister for that reply and declare an interest as a former chairman of the Food Standards Agency. The Minister will be aware that dietary ill health contributes to about 100,000 deaths per year in this country and that during the past 10 years the three major initiatives to improve dietary health have been instigated by the Food Standards Agency: improved labelling, restrictions on the marketing of food to children, and the reformulation of processed food. Why does the Minister think the dietary health of the population will be improved by moving responsibility from the Food Standards Agency to the Department of Health, which has so far shown no interest in this matter? I understand health officials have calculated that it will be more costly to consolidate this responsibility in the Department of Health rather than the Food Standards Agency.
Earl Howe
My Lords, first, I pay tribute to the noble Lord’s distinguished chairmanship of the Food Standards Agency. The Government recognise the important role that the agency plays, and a robust regulatory function will continue to be delivered through the FSA. As part of our wider drive to increase the accountability of public bodies, and reduce their number and cost, we are also looking at where some of the functions of the FSA sit best to ensure that they are delivered most efficiently. No decisions have yet been taken, but we are examining the matter carefully.
Baroness Gardner of Parkes
My Lords, does the Minister agree that one major problem with diet is far too much liquid in the form of alcohol? Is he aware that in the other place, at afternoon tea between 4 pm and 6 pm, many groups hold an event to which many of us are invited, and frequently we are not even offered the option of tea but encouraged by the catering department to have alcohol at four o'clock in the afternoon? Does he not think that we could do something about that, closer to home?
Lord Cunningham of Felling
My Lords, one of the principal reasons for the creation of the Food Standards Agency was to remove such decisions from political and ministerial control. This came about because of the loss of trust of the British people in guidance and statements from Ministers following things such as BSE and other terrible food infections across the country. In the light of that, is not what the Government are now considering a completely retrograde step?
Earl Howe
My Lords, as I said in answer to the noble Lord, Lord Krebs, we fully recognise the important role that the FSA plays. I identify myself fully with his remarks about the reasons why the FSA was created. I speak as a former junior Minister in the department that he led in such a distinguished way, and I realise fully the force of what he said.
Lord Alderdice
My Lords, given that the Government, directly and indirectly, are one of the largest employers in the country, and therefore the provider, directly or indirectly, of lunch and other meals, is there anything they can do to ensure that the meals provided and the diet available to employees, direct or indirect, of the Government are improved in line with what the noble Lord asked?
Earl Howe
My Lords, there is, and I am grateful to my noble friend. He will know that the healthier food mark initiative is one thing that the Government can do to enable the public sector to lead by example, in schools, hospitals and care homes. The healthier food mark has been developed over the past two years as a benchmark to raise the level of nutrition and sustainability of food served in the public sector. It sets clear guidelines on healthier and more sustainable food and recognises achievement, so I hope that it will lead the way.
Baroness Coussins
Will the Minister explain why the Government are scrapping the extension of free school meals when there is such a clear link between nutrition and academic performance? Would it not be better and more cost-effective in the long run to make sure that as many children as possible from low-income families get at least one nutritious meal a day?
Baroness Thornton
They are being abolished. I declare an interest as a former unpaid trustee of the Fifteen training restaurants. Does the Minister think that it was wise of the Secretary of State to attack Jamie Oliver's school meals campaign, particularly given that he was incorrect in saying that the take-up of school meals had gone down when it had gone up? Will the Minister join the rest of the country in applauding Jamie Oliver's campaign to improve the quality and nutrition of school meals?
Earl Howe
My Lords, I do not know whether the noble Baroness saw my right honourable friend on television recently talking about this issue, but this is a good opportunity for me to put the record straight. He has not criticised Jamie Oliver’s work on school meals: on the contrary, he has applauded Mr Oliver and the many people who have worked very hard to improve the standard of school meals. The point that he made was that a very important initiative started by Jamie Oliver to make people more aware of what healthy eating is all about turned into a kind of prescriptive, top-down management process from Whitehall—and that is counterproductive.
Lord Rea
My Lords, how will the Government ensure that the principles of openness, independence and scientific accuracy in their pronouncements and advice, developed by the noble Lord, Lord Krebs, when he was the chair of the FSA, will be continued by whatever successor bodies are appointed to carry on the tasks of the FSA?
Earl Howe
My Lords, the noble Lord is assuming that the Food Standards Agency is going to disappear. I have seen those reports but do not recognise the stories at all. As I have told the noble Lord, Lord Krebs, and others, no decisions have been taken about the future of various functions within the Food Standards Agency, but we are clear that there has to be a role for a body setting standards objectively in the way that he has described.
Nanotechnologies and Food: Science and Technology Committee Report
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, this has been an extremely useful debate. I congratulate the noble Lord, Lord Krebs, and his fellow committee members on their excellent report.
Nanotechnology is a fascinating new field of science. However, it can also be difficult for the lay person—I include myself in that category—to grasp its implications, given its potentially wide range of applications and the difficulty of visualising what it is and how it works. That makes the committee's achievement all the more impressive. It has sifted through a great deal of written and oral evidence to produce a readable and extremely interesting report—one that, I understand, has already been widely cited as a source of authority.
I followed with great interest all the contributions made during the debate, and I will return to some of the specific points raised in a few moments. Nanotechnologies and nanomaterials are clearly important issues for the Government. As I hope noble Lords will understand, we are still in the process of formulating our detailed policies in this area. As the House may know, the previous Government published a UK nanotechnologies strategy this March. Current Ministers, including me, will carefully consider the degree to which we will continue with that strategy. The report of the Science and Technology Committee makes a number of sound and sensible recommendations. For the reasons that I have just given, it would be premature for me to give a formal response on behalf of the Government on all of them. However, the majority of the recommendations fall within the remit of the Food Standards Agency, whose advice remains unchanged. Indeed, work is already under way within the agency to implement relevant recommendations. I shall say more about that in a moment.
My noble friend Lord Selborne speculated about the glittering prizes that may be attained in the future from this technology. The Government keep an open mind about the likely benefits of the use of nanotechnologies and nanomaterials in food. Proponents, as we have heard, point to a range of potential benefits such as improved packaging, better delivery of vitamins, lower-fat foods that have improved taste and texture, and reductions in food spoilage and food-borne disease. While all this sounds promising, the products themselves are very much at the research and development stage, and it remains to be seen how many will actually bear fruit commercially. However, many noble Lords have pointed out that what is clear, and what history tells us, is that unless consumers have full confidence in the safety of the end products, the benefits from innovation will be lost. This requires a combination of informed consumers and an appropriate, proportionate and fully transparent system of regulation.
The report addresses the need for better communication with the public about nanotechnologies in food. Members of the public rightly expect to have access to accurate and balanced information about issues that affect them and their families. This is particularly the case in relation to food, and the Food Standards Agency will work to ensure that information about nanotechnologies is made available in easily accessible ways.
The committee emphasised the importance of transparency. Of course the Government must play their part, but industry must also be open about the nanotechnology-enabled products that are being developed and used. The noble Lord, Lord Krebs, was absolutely right to point out that we know from previous experience with genetically modified foods that innovation cannot be forced on an unwilling or sceptical public. It is therefore in everyone’s interest to promote consumer confidence. This is particularly the case if, as some claim, nanotechnologies can help to tackle major challenges such as healthy eating and waste reduction.
The noble Lord, Lord Krebs, asked what the Government would do to ensure that the food industry is more transparent about its research on nanotechnologies, a question that was echoed by my noble friend Lord Selborne. The Food Standards Agency will work with industry and other stakeholders to ensure that as much information as possible is shared. That will be done, for example, by setting up a nanofoods stakeholder group and through a public list of products containing nanomaterials. Where I hesitate is over the committee’s recommendation of a mandatory reporting system for food products that are under development. As I have indicated, the Government have not agreed their detailed strategy on nanotechnology in general, or on the fine detail of the committee’s recommendations, but I could not but be struck by the arguments advanced by the Food Standards Agency in the previous Government’s response to the report: namely, that mandatory reporting could be counterproductive as it could well have the effect of driving research out of the UK, making it even more difficult to keep abreast of developments. There could be other and less dirigiste ways of achieving the committee’s aims in this area.
In answer to the direct question posed by the noble Lord, Lord Krebs, the noble Baroness, Lady O’Neill, and my noble friend Lord Methuen, I can only repeat what I said earlier in the day about the Food Standards Agency. A robust regulatory function will continue to be delivered through the agency. The Government fully recognise the important role that the agency plays, but we are examining whether some—I emphasise the word “some”—of the functions of the FSA could more sensibly and cost-effectively sit elsewhere. But again, as I indicated earlier, no decisions about that have been taken.
There is a need to co-ordinate and collect information, and I can tell my noble friend Lord Crickhowell that the Food Standards Agency is in the process of setting up a nanofoods stakeholder group, as recommended by the Select Committee, and will consult this group before establishing a register of foods that are currently being manufactured with the use of nanotechnologies later this year.
My noble friend asked about REACH. As far as I am aware, there is no further news to report. However, I will gladly ensure that he is kept informed of any developments.
Food products in the UK must meet the highest safety standards. As the committee concludes, different nanotechnologies raise different questions and so evaluation needs to be conducted on a case-by-case basis. For example, low fat mayonnaise made with a nanoemulsion of oil and water requires a different approach from insoluble nanoparticles of silver in a food supplement or embedded in food packaging.
The existing regulatory system for food ingredients provides a good level of control over new nanomaterials. The legislation will evolve, as it should, and I can say to the noble Lord, Lord Krebs, that the committee’s recommendations about clarifying the legal position of nanomaterials and drawing up appropriate definitions will be taken forward in the relevant fora in Brussels. The aim must be to provide clarity and safeguards against the introduction of new or altered food ingredients that have not undergone an independent safety assessment. This is important. In fact it has already happened in the area of food additives, and other revisions are under way in novel foods and food contact materials.
The noble Baroness, Lady O’ Neill, urged the Government to ensure that regulation should be based on functionality and not only on size. The point is well made and the Government will take it fully into account in our discussions in Brussels. In fact, recent changes to legislation on food additives are not tied to a particular size threshold but to changes in properties due to any change in particle size.
The committee’s report is one of several that highlight the gaps in our knowledge of nanomaterials. There is clearly a need to fill these gaps in order to assess and manage any potential risks effectively. We need to be able to ask the right questions and to draw the right conclusions from the data. The work that is currently under way, with funding from government departments and the research councils, will help to fill these gaps. In that context it is important to note that the various funding bodies do not operate in isolation but collaborate whenever possible. They also form part of a cross-government nanotechnologies research strategy group. This group has recently updated its list of research priorities, which will help to direct research funds in an effective way.
The noble Lord, Lord Krebs, asked specifically about the committee’s concerns relating to the proposed definition of engineered nanomaterial in the amended novel foods regulation proposal. I have touched on this already but I should add that the proposal for an updated EU regulation on novel foods is still under discussion. If a definition is adopted, then the Food Standards Agency will work with the Commission and other member states in monitoring and updating the definition to take account of technical advances and to reflect any international developments.
On the issue of risk assessment, the European Food Safety Authority is producing a guidance document for risk assessment of nanomaterials which will provide practical recommendations on how to assess applications made by industry for the use of engineered nanomaterials. This would apply to food additives, enzymes, flavourings, food contact materials, novel foods, food supplements, feed additives and pesticides. A first draft is due to be completed by July 2010 and will be subject to public consultation before it is finalised.
The noble Lord, Lord Krebs, mentioned that two products are known to be on the UK market. This was true in 2009 but I understand that one product became outlawed in January this year with changes to the law on food supplements.
My noble friends Lord Crickhowell and Lord Selborne questioned whether the research councils were sufficiently proactive in tackling the knowledge gaps in relation to the safety of nanomaterials. The relevant research councils have all taken measures to stimulate research into the safety of nanomaterials. A number of projects have been funded in recent years and these efforts are being intensified. For example, a programme on environmental exposures and human health has been launched jointly by the MRC and the Natural Environment Research Council working with the Department for Health and Defra. The programme specifically highlights nano-scale materials as an area of interest. It will fund four to six strategic collaborative consortiums to a value of £8 million to £10 million. The research proposals are currently under review and it is anticipated that the grants will be awarded in August 2010.
My noble friend Lord Selborne emphasised the importance of better research co-ordination to address gaps in knowledge and, as I have indicated, the cross-government research group has recently updated its priorities for nanotechnology research. A list of priorities was published after the committee report in March 2010 and provides a new focus for publicly funded research to fill the gaps that we fully acknowledge.
My noble friend Lord Crickhowell asked about progress on international collaboration of research. Government officials continue to work with the OECD programme on the safety of manufactured nanomaterials and I am informed that the underpinning research that has been commissioned with the help of the research councils is progressing well. At EU level the Technology Strategy Board is exploring further interactions with EU counterparts through involvement in a new research network focusing on the safe implementation of innovative nanotechnologies.
We have had a most valuable and constructive debate and I will take away the many points made. In conclusion, I emphasise the Government’s commitment to fostering a responsible attitude towards innovation and in creating the space for new developments, such as nanotechnologies, while ensuring the right level of regulatory oversight. Many have spoken of the importance of transparency. There is much that the Government can do to help the UK to benefit from innovation but none of this will matter if the public are not properly informed or are suspicious of the motives of those who seek to market new and innovative products. That underlines the critical role of transparency if the benefits of nanotechnology are to be realised. The Government, industry and the research community must all play their part.
NHS: White Paper
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, with the leave of the House, I shall now repeat a Statement made in another place by my right honourable friend the Secretary of State for Health.
“With permission, Mr Speaker, I would like to make a Statement on the future of the National Health Service. The NHS is one of our great institutions and a symbol of our society’s solidarity and compassion. It is admired around the world for the comprehensive care it provides and for the quality, skill and dedication of its staff. I begin today by paying tribute to the staff of the NHS and the commitment they show to patients.
This Government will always adhere to the core principles of the NHS; a comprehensive service for all, free at the point of use, based on need not ability to pay. This principle of equity will be maintained, but we need the NHS also consistently to provide excellent care. The NHS today faces great challenges: it must respond to the demands of an increasing and ageing population, advances in medical technology and rising expectations; it remains stifled by a culture of top-down bureaucracy, which blocks the creativity and innovation of its staff; and it does not deliver outcomes in line with the best health services internationally—many of our survival rates for disease are worse than those of our neighbours. The NHS must be equipped to meet these challenges—we believe it can do much better for patients—so today I am publishing this White Paper, Equity and Excellence: Liberating the NHS, so that we can put patients right at the heart of decisions made about their care; put clinicians in the driving seat on decisions about services; and focus the NHS on delivering health outcomes that are comparable with, or even better than, those of our international neighbours.
For too long, processes have come before outcomes as NHS staff have had to contend with 100 targets and more than 260,000 separate data returns to the department each year. We will remove unjustified targets and the bureaucracy which sustains them. In their place, we will introduce an outcomes framework to set out what the service should achieve, leaving the professionals to develop how. We should have clear ambitions, and our approach to this will be set out shortly in a consultation document. For example, our aims could be: to achieve one and five-year cancer survival rates above the European average; to minimise avoidable hospital-acquired infections; to increase the proportion of stroke victims who are able to go home and live independently—in short, care that is effective, safe and meets patients’ expectations. The outcomes framework will be supported by clinically established quality standards, and the NHS will be geared across the board towards meeting them. We will do this by rewarding commissioners for delivering care in line with quality standards; strengthening the regulatory regime, so that patients can be assured that services are safe; and reforming the payment system in the NHS, so that it is not just a driver for activity, but also for quality, efficiency and integrated care.
Patients will be at the heart of the new NHS. Our guiding principle will be, “no decision about me, without me”. We will bring NHS resources and NHS decision-making as close to the patient as possible. We will extend personal budgets, giving patients with long-term conditions real choices about their care. We will introduce real, local democratic accountability to healthcare for the first time in almost 40 years by giving local authorities the power to agree local strategies to bring the NHS, public health and social care together. Local authorities will also be given control over local health-improvement budgets. This will give an unprecedented opportunity to link health and social care services for patients.
We will give general practices, working together in local consortia, the responsibility for commissioning NHS services, so that they are able to respond to the wishes and needs of their patients. This principle is vital, bringing together the management of care with the management of resources. With commissioning support, GPs collectively will lead a bottom-up design of services.
In addition, we will introduce more say for patients at every stage of their care, extending the right to choose far beyond a choice of hospital. Patients will have choice over treatment options, where clinically appropriate, and the consultant-led team by whom they are treated. They will have the right to choose their GP practice. And they will have much greater access to information, including the power to control their patient record.
We must ensure that patients’ voices are heard, so we will establish HealthWatch nationally and locally, based on local involvement networks, to champion the needs of patients and the public at every level of the system.
To achieve these improvements in outcomes, we need to liberate the NHS from the old command-and-control regime. So all NHS trusts will become foundation trusts—freed from the constraints of top-down control, with power increasingly placed in the hands of their employees; and we will allow any willing provider to deliver services to NHS patients, provided that they deliver the high-quality standards of care we expect from them.
Our aim is to create the largest social enterprise sector in the world. But it is not a free-for-all. Monitor will become a stronger economic regulator to ensure that the services being provided are efficient and effective, and that every area of the country has the NHS services it needs to provide a comprehensive service to all. The Care Quality Commission will safeguard standards of safety and quality.
An independent and accountable NHS commissioning board will be established to drive quality improvements through national guidance and standards to inform GP-led commissioning. The board will allocate resources according to the needs of local areas, and lead specialised commissioning.
In the coming weeks, detailed consultation documents will enable people to comment on the implementation of this strategy, leading to the publication of a Health Bill later this year.
I recognise that the scale of today’s reforms is challenging, but they are designed to build on the best of what the NHS is already doing. Clinicians are already working to facilitate patient choice—giving patients the information they need to make an effective decision. GP consortia are already established in some areas of the country, and ready to go. Local authorities in some areas are already working closely with local clinicians to co-ordinate health and social care, and improve public health. Payment by Results already gives us a starting framework for building a payment system that really drives performance. Foundation trusts are already using the freedoms that they have to innovate.
We will build on this progress, not dismantle it. With this White Paper, we are shifting power decisively towards patients and clinicians. We will seek out and support clinical leadership. That means simplifying the NHS landscape and taking a further, radical look at the whole range of public bodies. We will reduce the Department of Health’s NHS functions, delivering efficiency savings in administration costs. We will rebalance the NHS, reducing management costs by 45 per cent over the next four years, and abolishing quangos that do not need to exist, in particular if they do not meet the Government’s three tests for public bodies—shifting more than £1 billion from the back office to the front line.
Form will follow function. As we empower the front line, so we must disempower the bureaucracy. After a transitional period, we will phase out the top-down management hierarchy, including both strategic health authorities and primary care trusts. Later in the summer, we will be publishing a report setting out how we see the future of NHS-related quangos. I can say now that this will mean a reduction of at least a third in the number of such bodies. This is part of the wider drive, across government, to increase the accountability of public bodies and reduce their number and cost. The dismantling of this bureaucracy will help the NHS realise up to £20 billion of efficiency savings by 2014—all of which will be reinvested in patient care.
Today’s reforms set out a long-term vision for an NHS which is led by patients and professionals, not by politicians. It sets out a vision for an NHS empowered to deliver health outcomes as good as any in the world. I commend this Statement to the House”.
My Lords, that concludes the Statement.
Earl Howe
My Lords, I am sure that the House will be grateful for the noble Baroness’s questions, although I have to express considerable disappointment that she finds so little to commend in the White Paper, which to me is a very exciting document, and one which builds in many important respects on the structures which her Government put in place. Lest it be thought otherwise, I am the first to knowledge the improvements in the health service which the previous Administration effected. They did so with the benefit of a great deal of extra public funding and no doubt we should be grateful for that. The problem that we perceive is that despite the progress that was undoubtedly made during the 13 years of the Labour Government, one thing did not keep up with funding: the outcomes that we saw emerging from that increased investment. The fact is that we are not matching the performance of our counterparts in Europe in a number of respects: in cancer survival rates and an array of other conditions. That has to change. We have asked ourselves how we can best deliver those outcomes and the quality of care that the noble Lord, Lord Darzi, envisioned in his strategy when he became a Minister. We want to build on the work of the noble Lord, Lord Darzi, and we believe that this programme of action will do that.
Our plans for GP consortia are very much based on practice-based commissioning arrangements and clusters. Our plans for economic regulation build on the work of Monitor. Currently, many of the functions of the NHS commissioning board already exist within the Department of Health. We are carving them out and slimming them down by stripping out avoidable layers of management. We have always been clear that we want to have GP commissioning, and our plans are the logical extension of that.
I must comment on the noble Baroness’s first remarks about the leaks to the press. I very much regret them. We do not know where they came from and are making the kind of investigations that she would expect. Our policy and our aim are always to make announcements of this kind to Parliament in the first instance. I am sorry that that has not happened in some cases. The press coverage has not been accurate in all respects.
I hope that when the noble Baroness digests this White Paper, she will come to view it rather more favourably than she has indicated. She suggested that our proposals are ideologically driven. There are only two pieces of ideology here: the desire to continue the quality agenda that the noble Lord, Lord Darzi, started and a desire to bring health and social care much closer together. The proposals for the role of local authorities will achieve that and, at the same time, they will introduce a greater degree of democratic accountability. Accountability will operate on several levels, and the noble Baroness asked me about it. There will be accountability to Parliament through the Secretary of State via the NHS commissioning board, which will hold GP consortia to account for the money they receive. At a local level, there will be accountability through HealthWatch and local authorities. That dimension of local authorities’ remit to enable them to have a say in the planning and configuration of services at a local level is a very important development because it will enable public health, social care and the NHS to be looked at in the round.
The noble Baroness asked whether we envisage any limit on the use of the private sector by GP consortia. The principle that we will adopt is that GP consortia should take on as much responsibility as they wish. The national commissioning board will support them in developing the necessary expertise but, if they want to, we are proposing that they should be able to seek support from elsewhere, including the private sector, within their budgets. In no sense are we proposing a privatisation of the NHS. In particular, lest anyone should think otherwise, our proposals for foundation trusts do not do this. I refer noble Lords to paragraph 4.21 of the White Paper, which makes this unequivocally clear.
There are certainly risks in managing the transition. Indeed, managing risk is not a new problem in the health service—it has happened since time immemorial—but the NHS chief executive and Ministers are extremely mindful of the need to control and manage risks, particularly during the transition. David Nicholson has set out the framework for implementation, with clear plans to minimise risk such as shadow-running bodies for a period of time.
It will take time for these changes to become fully embedded. That is a good thing. We recognise that not all GPs will be able to go at the pace of the fastest, and those who are not in the vanguard will be supported appropriately, but we are clear that GP commissioning is the way forward. It will align decision-making for clinical care with decision-making for financial flows. These are segregated at the moment. If you bring them together, commissioning is much more likely to be cost-effective and in the better interests of patients. While I recognise that the noble Baroness has anxieties, I hope that my colleagues and I can reassure her over the weeks and months ahead that this is a programme to be excited about, rather than the reverse.
Lord Walton of Detchant
Will the Minister say whether he believes that abolishing all regional planning is absolutely right? I believe that it could be dangerous.
Earl Howe
My Lords, I am grateful to the noble Lord for his questions. He will know that our plans do not constitute reorganisation for its own sake. The only purpose of the reorganisations that we are proposing is to embed higher-quality practice and better outcomes for patients, and for no other reason.
The noble Lord asked several questions about GP commissioning. As he will know, the previous Administration introduced practice-based commissioning more than five years ago. Some consortia are doing an excellent job, but many GPs have been frustrated by not having clear responsibility and control. They find very often that PCTs get in their way rather than help them. I think that it will be music to their ears that they will be able to create structures and management systems for themselves that will help them rather than get in their way. We are going to enable them to learn from the past. We are engaged in talks with the profession about how we implement the change, which will, I emphasise, be bottom up.
The noble Lord also referred to GP fund-holding, which as the House will know was a policy introduced by the Conservative Government. There were good points and bad points about fund-holding. The good points were that it empowered GPs and, in many cases, delivered good quality care. But the criticisms revolved around high transaction costs, bureaucracy and, in many ways, inequalities that resulted. We want to avoid those pitfalls. The support that GPs will get will not be prescribed from the centre. A range of support is already available for commissioning, including PCT teams, local authorities and independent commissioning support organisations. There will be no shortage of help out there.
Baroness Northover
My Lords, perhaps I may remind the House, as invited, that this is a brief Statement. We have 20 minutes all together and we are already five minutes in. Many people want to intervene on this extremely important Statement, so if people can be brief we will be able to cover as much as possible.
Baroness Morgan of Drefelin
My Lords, the Minister talked about an NHS that was stifled by top-down bureaucracy. Given the impressive outcomes that we have seen with improvements in cancer treatment, I do not think that many people would recognise that story. Does the Minister accept that medicine is a fast-changing field where innovation needs to be translated into practice on the front line as quickly as possible? Does he further accept that there needs to be leadership in a complex system like this if patients are to have access to the improvements in innovation and care? How does he see that leadership working?
How will patients be represented throughout the system? For example, how will they be represented at the NHS board? How will GPs ensure that they can access fairly and without bias the views of all their patients, not just those they see regularly? How will GPs translate those patient perspectives into commissioning in line with this new strategy that the local authorities will be responsible for developing? I want to hear the Minister answer that important question in some detail.
Earl Howe
My Lords, the noble Baroness makes an important point about innovation. We are clear, as is the White Paper, that driving innovation through the system will remain an extremely important part of what we mean by quality. The QIPP agenda is alive and kicking. For those noble Lords who are not familiar with the acronym, QIPP stands for quality, innovation, productivity and prevention. The innovation part of that will be driven in several ways, not least by the NHS commissioning board, which will have access to sources of advice from NICE, the NHS quality board and many other sources. But we also plan to put in place incentives in the tariff, which will drive innovation and high-quality care. Our proposals for those will be forthcoming.
The noble Baroness asked about patient representation. She was absolutely right about clinical leadership, but she was also correct to say that we need to ensure that the patient’s voice is heard at every level of the health service. At the local authority level, there is no doubt that Health Watch will have a presence as the voice of local patients. We are also creating a national Health Watch, which will act as the national voice for patients, feeding directly into the Care Quality Commission so that assessments of quality can be informed by patient experience on the ground. We are not planning in any way to dilute the duty under Section 242 of the 2006 Act to involve patients in the configuration of services. It is important that local people feel that they have a say in the way that services are developed. Our proposals for this will be laid out in an engagement document that is to be published in a short while.
Baroness Barker
My Lords, I welcome the Statement repeated by the noble Earl, and in particular the fact that it builds on many of the best innovations developed by the previous Government such as the commitment by the noble Lord, Lord Darzi, to clinical excellence as the lead factor in the development of services. What I also welcome is that, unlike under the previous Government, the default position is that power will be vested in local communities rather than with the Secretary of State, particularly the commitment to ring-fenced funding for public health and, even more so, having a public health strategy that includes mental health.
I have two questions for the Minister. The first concerns the choice of provider. A large section of the paper emphasises the right of patients to choose a provider. Is it not the case that, in order for there to be a choice of provider, there has to be overcapacity in the system? Can the noble Earl tell us what estimate the department has made of that, given that the White Paper also talks about the challenging financial position in which these plans will go forward? The second question concerns a statement in the papers that the Government intend to create the biggest social enterprise sector, which no doubt will be welcomed by the noble Baroness, Lady Thornton, as doing such a thing was also a policy of her Government. Can the noble Earl explain whether that means that many, if not most, of the existing providers of health services will cease to be providers of those services in the future?
Earl Howe
My Lords, I am grateful to the noble Baroness for her positive comments. On public health, she will see in the White Paper that we will be publishing a further White Paper later in the year specifically about public health. Quite deliberately, there is only limited information on that subject in this White Paper. As regards choice of provider, she will see in the White Paper that our policy is clear: it is a policy of “any willing provider”. That means that any provider who is able to provide services to the NHS at the right level of quality and at or below the tariff will be allowed to do so. However, as I said in the Statement, this will not be a free-for-all because providers, if they provide services to the NHS, will be subject to the scrutiny of Monitor, and there will be a joint licensing system between Monitor and the CQC in respect of financial systems and quality, so that those providers who offer their services to the NHS will be regulated on a level playing field. I shall take away the concern she raised at the end of her question, and if I have not covered it adequately in my answer, I will write to her.
Lord Snape
Does the Minister accept that this is not a reorganisation of the National Health Service being proposed by the Government, but a balkanisation of that service? Did he not notice the lack of enthusiasm for these proposals of those on the Benches behind him, particularly his junior partners in this alliance? Where is the sense in taking away powers from primary care trusts and strategic health authorities and giving them to individual GPs—ironically, to those in the one group who are not employees of the National Health Service? How will it be possible to continue with a unified National Health Service throughout the United Kingdom if hundreds, if not thousands, of GP practices all promote their own ideas in their own specific areas? These proposals will kill the National Health Service, as the Government well know. Why their allies are supporting them, only they will know.
Earl Howe
My Lords, I am not sure what the noble Lord’s question was but I profoundly disagree with his analysis of the proposals before the House. Far from killing off the National Health Service they will give it added life. What is the National Health Service about? It is there to serve patients. If we take as our guiding principle that patients matter more than anyone else—more than the system and more than PCTs—and that we want to take care of patients in the best possible way, we need to enable doctors and patients, working together, to take ownership of the patients’ state of health and to take decisions together. If you arrive at that conclusion, the structures that we are proposing are the logical outcome. The noble Lord’s concerns are for the system, which has often got in the way of patient care. The whole point of these proposals is to remove those obstacles. I hope he will have cause to change his mind as he reads the White Paper.
Lord Newton of Braintree
My Lords, I preface my three questions by declaring that I am the chair of an NHS trust. First, does the Minister think there is scope for organisational reconfiguration, to use an awful phrase, to contribute to the achievement of the Government’s objective of higher quality in a cost-effective way? Secondly, if he does, does he think—as I do—that such experience as there is suggests that the road to such reconfiguration is strewn with bureaucratic obstacles, delays and unnecessary costs? Thirdly, if he agrees with that, will he do something about it?
Earl Howe
My Lords, I agree with my noble friend. There is no doubt scope for reconfiguration but we are not going to prescribe it from Whitehall. The structures that we propose in the White Paper will facilitate reconfiguration in a much more coherent and structured way on a local level because, with the buy-in of patients, local authorities will have a major say in the way in which services are configured, as will GPs, acting in consortia, jointly. The key issue is whether reconfiguration makes sense from a clinical perspective. Politicians are not in the best position to decide that. Having said that, there will be occasions when people will be unable to agree at a local level and we have plans to cater for that situation: ultimately, the Secretary of State will stand as arbiter in such difficult cases. However, in the majority of cases, we see decisions as properly lying at a local level.
Baroness Finlay of Llandaff
I have two brief questions. First, in the Statement the Minister referred to outcomes. Given that secondary care sometimes has patients—sadly too often—referred late because of delayed diagnosis in primary care, how is the clinical care of the general practitioner going to be held to account in this system? My second question relates to the Minister’s mention of “any willing provider”. What security will there be to ensure that a provider cannot introduce a loss-leader service with clearly defined boundaries in order to gain a market share, and to prevent complex and difficult cases not covered by that provider being dumped on the NHS? This has been the experience with some private practices where patients are in private hospitals but, when things become too complicated, they are shipped down the road to the local NHS intensive care unit.
Earl Howe
My Lords, the noble Baroness identifies two particularly important issues. How will GPs be held to account for the clinical care that they provide? The data emanating from their performance will be transparent and published. The consortia will monitor the performance of each practice. They will identify outliers, whether good or bad, and act accordingly. We do not have those information systems sufficiently in place—I hope that, over the next 18 months or so, there will be time to develop the systems needed for consortia to do this—but it is vital that GPs are held to account for their performance and they will be incentivised in their remuneration to provide high quality.
The noble Baroness made an important point about loss leaders among providers. The NHS commissioning board will license a provider only if it is satisfied that the quality of care delivered by that body is of an adequate standard. I think that the board will look with great care at the practice of introducing loss-leader services and rule out, if there is any doubt at all, quality being compromised in the process.
Lord Warner
My Lords, I warmly welcome some of those ideas in the White Paper that build on the previous Government’s reforms such as choice and competition. However, is the Minister aware—as am I from my own experience as a Minister—that many in the NHS do not wish to be liberated? What will be his approach to those areas where GPs’ consortia do not live up to the standards required of the commissioning board? What will he do to ensure that we do not lose the benefits of regional specialised commissioning, which it has taken many years to bring to the level of quality that exists today?
Earl Howe
My Lords, I shall be brief because time is against us. I agree with the noble Lord that we must not lose the gains that we have made in specialised commissioning following the Carter reforms. He will see that the national commissioning board will retain responsibility not only for national specialised commissioning but for regional specialised commissioning. That will safeguard the quality of those services.
The noble Lord referred to GPs who do not wish to commission or who are in some way found wanting in their performance. Our experience to date—a number of consortia have been formed around the country, all of which are working encouragingly well—suggests that those GPs within the consortium who are in the lead and are the most go-ahead are best placed to bring up to standard their colleagues who are perhaps struggling. We have witnessed that in a number of instances. Those GPs who are incapable of being brought up to an adequate standard may be subject to a question over their future. In certain consortia, we have seen GPs retiring from NHS service.
NHS: Pain Management Services
Earl Howe Excerpts(15 years, 3 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, this has been an excellent debate. I begin by expressing my gratitude to the noble Lord, Lord Luce, for calling it and congratulating him on the eloquent way in which he has introduced a topic which I know is close to his heart.
Chronic pain can be a devastating condition, as many of your Lordships have testified. It affects a large proportion of the population, especially those of advancing years. The noble Lord has already quoted a number of relevant statistics; let me just add another. Data from the Health Survey for England suggested that more than half of the total impact of disease on quality of life is due to pain.
There are examples of really effective, joined-up, multidisciplinary pain services providing support to patients as and when they need it. As the noble Baroness, Lady Pitkeathley, said, that is how it should be. But, all too often, patients do not get the support and the treatment that they need.
In his 2008 annual report, the then Chief Medical Officer, Sir Liam Donaldson, described how the system was failing to give sufficient priority to chronic pain. A key response from the previous Government was to agree funding for a national pain audit. We are maintaining support for this initiative, which is led by the British Pain Society in collaboration with Dr Foster. More than 200 pain clinics are already signed up to provide data. The work is being piloted and data collection will begin later this year. We are expecting a report in the early part of 2012. The audit will not only assess the organisation of local services—location, staffing and equipment—but also assess the quality of patient care across NHS providers by measuring activities and outcomes.
What can the Government do? Our vision for the NHS is for a transfer of power away from the centre down to the people who really understand what is needed: to patients, GPs and other front-line health professionals. It is only by doing that that we will fashion a health service that is truly patient-centred. This is why we intend to devolve budgets to GP commissioners, working in small local consortia. They are best placed to understand their patients’ needs and to prioritise and commission appropriate services, including multidisciplinary pain management services.
On average, someone with chronic pain will have direct contact with a health professional for only around three hours a year. The rest of the time they care for themselves. Patients therefore need to be informed. By our educating people about their condition and ensuring that they have access to support from others in a similar situation, people’s health can be significantly improved. This also helps to reduce the number of GP visits and prevent unnecessary hospital admissions as well as reducing the length of any hospital stays.
I recognise that some patients cannot take decisions for themselves or express themselves, among whom are children, as my noble friend Lord Alderdice rightly pointed out. The detection of children's pain can, however, be improved by strategies to facilitate their expression of pain in ways that are appropriate to their cognitive development and that can be understood by the adults caring for them. So there is work going on in this area.
Good management of chronic pain takes account of the whole person. People agree goals and actions to be taken in a personalised care plan. This allows people to make choices about the care that they receive. The issue of choice was rightly mentioned by a number of noble Lords. It puts people at the centre of any decisions about their care. As my right honourable friend the Secretary of State put it recently,
“no decision is made about me, without me”.
Information from care plans can also help commissioners consider how to use funds most efficiently to support people to self care and identify services that are successfully meeting patients’ needs and expectations. It also enables them to recognise gaps where there is unmet need. This is an important way for the patient voice to have direct influence over the design and commissioning of services in a particular locality.
Of course, devolving decision-making in this way does not mean that the Government are devoid of responsibility. There are a number of ways in which the Government and other organisations can support patients and front-line staff, ensuring that funding is spent on appropriate and effective services. First, we can ensure that clinicians and commissioners have up-to-date, evidence-based clinical guidance. The National Institute for Health and Clinical Excellence plays a key role here. As the noble Lord, Lord Luce, mentioned, NICE issued a clinical guideline last year on lower back pain and has more recently published a guideline on neuropathic pain. Over time, NICE will create a library of quality standards that support NHS organisations as they look for evidence on how to improve outcomes for patients.
Secondly, we can promote the development and diffusion of ideas on the service models that work best for patients. Patients with long-term conditions want services that are based in the community and which support and affirm their ability to manage their own conditions. They want to be referred to secondary and tertiary care only when really necessary. That requires excellent co-ordination between all levels of the system. One of the workstreams of the quality, innovation, productivity and prevention programme is focused on delivering this approach for people living with long-term conditions such as chronic pain.
Thirdly, we can promote the development of indicators of the quality and outcome of services. Outcome indicators will help patients to exercise choice and hold providers to account. They will help service providers to benchmark their performance against their peers and improve the services that they offer. They will help to ensure that any serious failure in quality is identified quickly and action taken to ensure the safety of patients.
An aim of the national pain audit will be to measure patient outcomes using the brief pain inventory scale—an accepted pain management assessment tool. This, combined with an assessment of patients’ outcomes using other patient-reported outcome measures, will make for a comprehensive review of the quality of care. The audit will help to identify indicators that could be suitable for routine use.
Finally, we can ensure that the right financial incentives are in place. The tariff system already ensures, in broad terms, that money follows the patient and that providers are rewarded for delivering best practice. We will build on that by increasing the proportion of provider income that is responsive to the quality, not just the quantity, of care provided. It is just worth adding that in due course, patients with long-term conditions may be able to influence their choice of treatment and provider even more directly through the use of personal health budgets, which are being piloted at the moment.
My noble friend Lady Morris spoke about acupuncture. Use of acupuncture in the NHS is quite limited. The National Institute for Health and Clinical Excellence provides guidelines to the NHS on the use of treatments and it currently recommends that acupuncture is considered as a treatment option for lower back pain. However, it is often used to treat musculoskeletal conditions and a wide variety of pain conditions. Unfortunately there is an absence of clinical evidence in this area. We simply do not have the evidence base to be sure that it works for many of the conditions for which it is often used. More scientific research is undoubtedly needed to establish whether acupuncture is effective against many conditions.
My noble friend also referred to the problem of gaining access to hospital appointments at weekends. There is an important case for services such as pain control to be provided outside working hours. We would encourage local commissioners to continue to develop services such as this to meet the needs of the working public. The noble Baroness, Lady Greengross, with her wide experience, pointed out that the elderly frequently suffer worse treatment than those in other age groups. Those who commission services locally clearly have a duty to ensure that the needs of the whole community are met, with particular attention given to vulnerable older people. The multidisciplinary nature of teams is pivotal in making pain relief available to all age groups in society.
The noble Lord, Lord Luce, asked whether we would consider a national strategy for chronic pain or indeed a tsar. I am not persuaded at the moment that a tsar or a national strategy for chronic pain over and above our current policies for improving the quality of services is necessary. We need to liberate front-line staff as a first priority to enable them to work with their patients to improve the quality of services that they provide or commission. We need to ensure, too, that they have access to the guidance that is available. As I mentioned, there is a wealth of available guidance, including a commissioning pathway published by the Department of Health, and guidance for secondary care and primary care has been published by the British Pain Society, as he will know.
The noble Lord and the noble Baroness, Lady Emerton, asked whether a pain score should become part of the vital signs that are monitored for patients in hospital. Current guidance from NICE recommends that all patients admitted to hospital should be assessed and a decision made on which clinical indicators should be monitored. A pain score is one of the indicators that should be considered.
The noble Baroness, Lady Emerton, referred to nurse prescribing and how that might be improved in this area. In prescribing medication it is essential that the right person gives the right medication at the right time and that stands to reason. Nurse prescribing is a welcome development that can benefit patients significantly. She would agree that services should continue to look at what professional mix can best deliver safe, timely and effective treatments for patients. She also referred to the need for risk assessment among nurses. I have every sympathy with that point. Back pain among nurses as a result of injury at work is a great concern, both for the nurses and their families. Local employers also have a duty of care to provide safe working environments and prevent unnecessary and avoidable harm.
The noble Lord, Lord Tunnicliffe, asked about investment in services at a local population level. We share a commitment to improve health and healthcare. This is our driving principle and our proposals for reconfiguration of the NHS will drive the improvement for all patients.
I conclude by reassuring noble Lords that I should be happy to meet the noble Lord, Lord Luce, and the Chronic Pain Policy Coalition to discuss these issues further.