Women: Postnatal Depression

Debate between Earl Howe and Baroness Royall of Blaisdon

Thursday 5th February 2015 Lords Chamber

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

My Lords, the Government have prioritised improving mental health care and support for pregnant women and new mothers in their mandate to NHS England, with a clear objective to reduce the incidence and impact of postnatal depression. We have taken steps to improve the size and capability of the workforce—there are 2,000 more midwives and 3,200 more health visitors than in 2010. By 2017, specialist perinatal mental health staff will be available to every birthing unit.

[Baroness Royall of Blaisdon (Lab)]

My Lords, that is welcome news. Too many women who suffer from postnatal depression do not seek help because of the stigma attached to mental illness, together with the guilt and shame attached to feeling that they are not being the sort of mother that society expects. I hear what the noble Earl says about specialist care, but what are the Government doing to ensure that specialist mother and baby units can be accessed by these new mothers wherever they live in this country, so that they do not end up on acute psychiatric wards, separated from their babies or partners, or not receiving the requisite help? At the moment, I fear that parity of esteem for mental health is not a reality for these women.

[Earl Howe]

My Lords, we know there is more to be done. There are perhaps two key actions here. One is having a sufficient number of trained professionals in place—I have mentioned the increase in the number of health visitors and midwives—and the other is raising awareness of the risks and signs of postnatal depression with mothers-to-be. Extensive training is available and delivered to midwives, both during their initial training and afterwards. The programme of family nurse partnerships commenced by the previous Government is tremendously important in the follow-up stage after birth to ensure that new mothers are monitored closely.

Health: Talking Therapy

Debate between Earl Howe and Baroness Royall of Blaisdon

Tuesday 3rd December 2013 Lords Chamber

[Baroness Royall of Blaisdon]

To ask Her Majesty’s Government whether they have plans to create a legal right to talking therapy as part of their commitment to ensure parity of esteem between mental and physical health.

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

My Lords, the department has no plans to create a legal right to talking therapies. Mental health and parity of esteem are key priorities for NHS England. The Government’s mandate to NHS England makes it clear that everyone who needs it should have timely access to evidence-based services, which involves extending access to talking therapies. We are working with NHS England to develop standards on access and waiting times across mental health from 2015.

[Baroness Royall of Blaisdon (Lab)]

My Lords, I am grateful to the noble Earl for his Answer, but I still have serious concerns about the services that mental health patients receive. I do not often quote the noble Lord, Lord Freud, but last month he said that,

“the association between poor mental health and poverty is clear”.—[Official Report, 7/11/13; col. 324.]

However, despite people’s increasing stress due to poverty, the cost of living and zero-hours contracts, the Government have cut mental health spending in real terms in the past two years. Funding for therapies not included in IAPT has been cut by 5%, despite ministerial assurances that this would not happen. Last week, the We Need to Talk coalition released a report that revealed that more than half of mental health patients are waiting at least three months for treatment. Can the Minister commit to reducing those waiting times by March 2015, the date by which time the Government are committed to making progress towards that important parity of esteem?

[Earl Howe]

My Lords, I agree that waiting times for talking therapies are too long, and we are taking energetic steps to address that within the bounds of affordability. In the context of the noble Baroness’s main Question, what surely matters is the quality of outcomes, rather than just the extent of inputs. We set the outcomes that we expect the NHS to achieve in the NHS outcomes framework. There are a number of outcomes in there specifically for people with mental health problems, and others, about the quality of services. It is up to commissioners to prioritise their resources to meet those outcomes for the population based on assessments of need, and we will hold them to account for that.

Abortion

Debate between Earl Howe and Baroness Royall of Blaisdon

Thursday 6th June 2013 Lords Chamber

[Earl Howe]

My noble friend is right. The abortion rate across England and Wales has been static since 2009. The good news is that the abortion rate for women under 18 has gone down. There was a 9.6% decrease in the rate between 2010 and 2011. On repeat abortions, the news is not so good. The proportion of repeat abortions for women who had abortions in 2011 was 36%. The figure was higher than it had been the previous year, which is a matter for concern.

[Baroness Royall of Blaisdon]

My Lords, I very much welcome the figures that the Minister gave on the number of abortions going down for younger women, and regret the figure for repeat abortions. Naturally, we must do everything possible to stop illegal abortions. However, will the Minister confirm that it is important that women who need abortions should not be impeded in any way, and that sex education and education about relationships are terribly important? I hope that the Government will be open to accepting amendments to the forthcoming education Bill on that issue.

[Earl Howe]

I am sure that those issues should be discussed very thoroughly. I agree that young people should be taught about relationships. However, I also believe that access to contraception is very important. Our data show that there has been no decrease in the number of women using contraception, and that more women are turning to extremely effective measures such as long-acting contraception. It is encouraging that the abortion rate for the under-18s is coming down.

NHS: Private Companies

Debate between Earl Howe and Baroness Royall of Blaisdon

Monday 11th February 2013 Lords Chamber

[Earl Howe]

I am aware that the board of the CQC is looking at that very question at the moment in the light of the Mid Staffordshire review. The noble Baroness is absolutely right. I think the essence of the answer to her question is that a risk-based approach must be adopted so that areas that are deserving of more attention from the CQC receive it and areas that are of lesser concern are allowed to act accordingly without interference.

[Baroness Royall of Blaisdon]

My Lords, the Minister spoke of the possibility of local tariffs. How does that translate into regional pay? Is the Minister in favour of regional pay for people working in health service?

[Earl Howe]

My Lords, regional pay is already allowed for under Agenda for Change, and has been for a number of years. The Government do not intend to change that.

Health and Social Care Bill

Debate between Earl Howe and Baroness Royall of Blaisdon

Monday 12th March 2012 Lords Chamber

[Baroness Royall of Blaisdon]

My Lords, I beg leave to ask a Question of which I have given private notice.

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

My Lords, the tribunal has agreed that the department should not publish its strategic risk register but has upheld the Information Commissioner’s initial decision notice on the transition risk register. However, we await the full judgment, which will contain the detailed reasoning for the decision. This makes it extremely difficult to make a decision on whether the Government wish to appeal this decision. I hope very much that the tribunal will give its full judgment as soon as possible.

[Baroness Royall of Blaisdon]

My Lords, the primary purpose of this House is to scrutinise and improve legislation. I know that the Minister would agree with me on that. In the next 10 days, Parliament has to make critical decisions about the future of the National Health Service. Without the information in the risk register or the transitional risk register, Parliament will be less well informed than it otherwise would be. The information tribunal last week instructed the Government to release the transitional risk register immediately, as I understand it, because the Bill is still under consideration. Why are the Government therefore preventing Parliament from having the best possible information on the NHS so that it can make the best possible decisions about the NHS?

[Earl Howe]

My Lords, many of the risks associated with the Government’s reform programme, as the noble Baroness knows, have already been extensively aired—not least in the impact assessment, in my statement of 28 November last and, indeed, in the whole passage of this Bill—but I fully recognise the concern that we should respond swiftly to the tribunal’s decision. We are making every effort to update noble Lords on our intention as soon as we possibly can. However, as I have always said, this is not a decision for the department alone and any way forward has to be agreed and signed off across Government. I cannot make a decision without agreeing it with my fellow Ministers in other departments and I am sure noble Lords will appreciate that we have only just received the tribunal’s decision.

NHS: Management Consultants

Debate between Earl Howe and Baroness Royall of Blaisdon

Monday 13th February 2012 Lords Chamber

[Baroness Royall of Blaisdon]

My Lords, I beg leave to ask a Question of which I have given private notice.

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

My Lords, the Health and Social Care Bill and all related programmes require input from a wide range of civil servants, lawyers and other experts. Management consultants have been assisting Monitor, the developing Commissioning Board and others on specific issues. Consultancy spend has reduced very substantially since before the election. We have been transparent around spend of over £25,000 and on hospitality received by Ministers and civil servants. We have also answered all Parliamentary Questions and FOI requests on these issues, showing our commitment to openness.

[Baroness Royall of Blaisdon]

My Lords, I am grateful to the noble Earl for that Answer. Following recent press reports, I want to ask him about a specific management consultant, McKinsey. What payments has it received since May 2010 from the Department of Health and all other taxpayer-funded health bodies? If he is not able to tell the House that now, will he undertake to place this information in the Library of the House? Given that McKinsey seems to be setting the rules of the game in relation to the Government’s health Bill and then benefiting from the outcome, can the Minister declare unequivocally that there is no conflict of interest between McKinsey’s role in advising the Government on their health reforms and its commercial relationships with other clients?

[Earl Howe]

My Lords, I received notice of this Question just over an hour ago so I do not have precise figures about McKinsey. What I can say is that whereas the previous Administration in 2008-09 spent £100 million in the Department of Health on consultancy, my department has spent under £10 million on consultancy this year—very considerably less.

I read the article in the press this weekend which probably prompted the noble Baroness’s Question. I think we need to be careful before casting doubt on the integrity of public servants—and, indeed, of McKinsey. The article referred to Monitor. Those at Monitor are bound by very strict rules and procedures to ensure transparency and openness in all their dealings and to avoid any possible conflicts of interest. They follow those rules and procedures to the letter.

Health and Social Care Bill

Debate between Earl Howe and Baroness Royall of Blaisdon

Wednesday 8th February 2012 Lords Chamber

[Earl Howe]

There is no hierarchy but the Secretary of State will be bound to report to Parliament and, in doing so, he must show that he has exercised his functions in a way that fulfil his statutory duties under the Bill. Parliament will no doubt hold him to account for having done so. He must demonstrate across the piece that he has had regard to those duties.

[Baroness Royall of Blaisdon]

My Lords, I am grateful to the noble Earl, Lord Howe, for his reply, and for the support for my amendments around the Chamber. I have a couple of comments. First, in terms of quality standards, like the noble Baroness, Lady Finlay, I wonder about a GP’s ability to fulfil his duties both as a clinician and a commissioner. Currently GPs often find diagnosis quite difficult and I am concerned about them having to commission as well as diagnose. If they do not fulfil their tasks as both clinicians and commissioners, the patients will suffer.

My noble friends Lord Hunt and Lord Harris asked who takes the leadership and responsibility for ensuring that quality standards are adhered to when they are brought forward by NICE. The Minister said that localism is one of the answers. I find that a frightening prospect rather than a reassuring one. I think it is a recipe for chaos rather than quality, but perhaps that is a personal view.

I pay huge tribute to NICE, which I think does excellent work, but I recognise that it is very stretched. It has immense burdens and responsibilities. I hope that this very short but excellent debate will be a catalyst for swifter action in terms of quality standards, but I recognise that there is always a balance to be struck between quality and speed. However, in five years, an awful lot of people can die while waiting for quality standards. Having said that, I am grateful to the Minister for his response, and I beg leave to withdraw the amendment.

Health and Social Care Bill

Debate between Earl Howe and Baroness Royall of Blaisdon

Wednesday 12th October 2011 Lords Chamber

[Earl Howe]

My Lords, I very much welcome that offer, which has come rather late in the day. My understanding is that discussions over the timetabling of the Bill have taken place over the past week. However, we are faced with the amendment that is on the Order Paper and must vote on it as it stands.

[Baroness Royall of Blaisdon]

I beg your Lordships’ pardon but I have to say that we are and have been entirely open to this suggestion. I was not aware of it until yesterday. I give the House my pledge that the Bill will come out of Committee by mid-January, which is, I think, when the noble Earl was thinking of. We should be delighted to give our firm assurance that the Bill will come out in mid-January.

[Earl Howe]

My Lords, that is an extremely welcome offer, which we accept. I am grateful to the noble Baroness.

It is right for me to conclude, with your Lordships’ agreement. I bring this extended debate to an end by returning to the point of the Bill, which is to improve the quality of care for patients. For all the generosity of the noble Baroness’s offer, the amendment of the noble Lord, Lord Owen, would not help patients. It would insert additional uncertainty into the parliamentary passage of the Bill. As my noble friend Lord Fowler rightly emphasised, the amendment of the noble Lord, Lord Rea, would leave the NHS in far greater uncertainty. It would also leave it unprotected from both the present and future challenges that it faces.

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[Baroness Royall of Blaisdon]

My Lords, I crave the indulgence of the House to confirm one point that was clarified by the noble Lord. I do not advocate any timetabling Motion: that would not be appropriate for the House. I give the assurance that, were the noble Lord’s amendment to be agreed, my Benches would wish the Bill to be out of Committee by mid-January. However, if the amendment is not accepted, it will be right and proper for the usual channels to discuss the appropriate number of days needed in the light of this excellent Second Reading debate. I cite the excellent speeches made by many noble Lords, including the wise words of the noble Lord, Lord Walton of Detchant, who spoke before me last night and who said that enough time must be given. He is absolutely right. I have no intention of delaying the Bill. My intention is to ensure that there is proper agreement between the usual channels on the appropriate amount of time that the Bill needs in Committee.

[Earl Howe]

My Lords, I will make three very brief points. The provisions that the noble Lord, Lord Owen, asks us to send to a special Select Committee affect the entire Bill. The twin-track approach that he advocates carries a major risk: the potential disconnect between the special Select Committee and the Committee of the whole House. The Select Committee might recommend amendments to parts of the Bill that have already been debated by the Committee of the whole House. The result could be that, notwithstanding the offer made in good faith by the noble Baroness, Lady Royall, we could see a slippage of the timetable of the Bill that would be most unwelcome.

I repeat my assurance that I am entirely open to considering the concerns that have been raised about the issue and to make any necessary amendment to put it beyond doubt that the Secretary of State will remain responsible and accountable for a comprehensive health service.

Health: Care and Compassion?

Debate between Earl Howe and Baroness Royall of Blaisdon

Thursday 3rd March 2011 Lords Chamber

[Earl Howe]

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

[Baroness Royall of Blaisdon]

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

[Earl Howe]

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

Health: Prostate Cancer

Debate between Earl Howe and Baroness Royall of Blaisdon

Monday 19th July 2010 Lords Chamber

[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.

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[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.