NHS: Health and Social Care Act 2012

Debate between Earl Howe and Countess of Mar

Monday 16th March 2015 Lords Chamber

[Earl Howe]

My Lords, we are back to that one. As the noble Lord knows, the strategic risk register for the department is something that we are entitled to keep confidential, as all Governments have done. The Cabinet took the decision that the transition risk register should remain confidential because of the principle of the need to preserve private space for civil servants when advising Ministers.

[The Countess of Mar (CB)]

My Lords, some months ago I led a debate on the lack of clinical governance between health and social care. I was promised a meeting with the noble Earl by the noble Baroness, Lady Jolly. One of the big problems is the fact that there is no governance framework between health and social care, and as a result a lot of people are falling into a black hole. Can the noble Earl say when that meeting will take place?

[Earl Howe]

My Lords, I should be more than happy, as I always am, to meet the noble Countess. I am sorry if there has been a delay in that respect. I would be happy to talk to her one to one on that matter.

Health: Human Papilloma Virus

Debate between Earl Howe and Countess of Mar

Tuesday 20th January 2015 Lords Chamber

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

My Lords, I begin by congratulating the noble Lord, Lord Patel of Bradford, on securing this debate and on bringing this important subject to your Lordships’ House. I understand the noble Lord’s concerns on this issue. Vaccines provide vital protection from a large number of diseases, including the human papilloma virus. We need to ensure that they are used as effectively as possible and that those who would most benefit from them are included in any vaccination programmes that we implement.

As has been mentioned, the Government are advised on all immunisation matters by the statutory body, the Joint Committee on Vaccination and Immunisation. The JCVI keeps all immunisation matters under review, providing advice and recommendations to Ministers on all current and potential vaccination programmes. It is, therefore, to the JCVI that we look for expert advice when considering issues such as those raised today.

The UK’s current HPV vaccination programme, based on advice from the JCVI, began in 2008, and its aim is to prevent cancers relating to HPV infection, specifically cervical cancer. HPV is a sexually transmitted disease. Our main objective, therefore, is to provide HPV vaccine to young women before they reach an age when exposure to HPV infection increases and vaccination would become less effective because many would have already been infected. For that reason, the vaccine is offered to all girls in school year 8—that is, at ages 12 to 13 years. As HPV is responsible for virtually all cases of cervical cancer, prevention of this disease remains the primary aim of the current programme.

The UK’s HPV vaccination programme has been a considerable success. Almost 8 million doses have been administered across the UK since 2008 and this country has among the highest rates of HPV vaccine coverage achieved in the world. In England, 86.7% of girls eligible for routine vaccination in the 2013-14 academic year completed the three-dose course and 89.8% have received at least two doses of vaccine.

The noble Baroness, Lady Hollins, asked about herd immunity. When recommending introduction of the programme in 2008, the JCVI considered that once 80% coverage among girls was achieved, which we have now attained, the vaccination of boys was likely to provide little additional benefit in preventing cervical cancer in girls. As the noble Lord, Lord Patel, made clear, with high uptake of HPV vaccine among girls, many boys will also be protected against other HPV-related cancers such as anal cancer and head and neck cancers, because transmission of HPV between girls and boys should be substantially lowered.

However, as I mentioned, the JCVI keeps all vaccination programmes under review and has recognised that under the current programme the protection that accrues from reduced HPV transmission from vaccinated girls may not be provided to men who have sex with men, or MSM, because they are less likely to have sexual contact with vaccinated women. Given increasing evidence of the association between HPV infection and oral, throat, anal and penile cancers, and the impact of HPV vaccination on such infections, the JCVI set up an HPV sub-committee in October 2013 to consider a number of key issues around HPV vaccination, including the question of potentially extending the programme to MSM and adolescent boys—that is, to protect those who may go on to become MSM—or to both. The committee has also noted the public, parliamentary and third-sector concern about this issue and agreed that evaluation of potential extensions to the programme to include MSM, adolescent boys, or both, should be a priority.

Your Lordships may be aware that last November, following very careful consideration of the evidence, the JCVI published for consultation provisional advice that a targeted HPV vaccination programme should be introduced for MSM aged between 16 and 40 years attending genitourinary medicine and HIV clinics. The JCVI consultation ended on 7 January 2015 and we await the committee’s final advice on this matter.

The JCVI’s HPV sub-committee is also giving consideration to work modelling the impact and cost-effectiveness of extending HPV vaccination to adolescent boys. I am advised that it is currently anticipated that a model being developed at Warwick University could be presented to the sub-committee in the second half of this year. A separate model being developed by Public Health England may not now be completed until early 2017. I also understand that the JCVI and its HPV sub-committee may need to consider both studies before taking a final view on the impact and cost-effectiveness of extending HPV vaccination to adolescent boys and may therefore not be in a position to do so before early 2017. The JCVI has noted that the cost-effectiveness of an HPV programme for adolescent boys is not certain, because the high coverage rates achieved for adolescent girls are highly likely to interrupt HPV transmission and provide indirect protection for boys to such an extent that there may be little additional benefit to be accrued from extending the programme. However, the committee agreed that a detailed cost-effectiveness analysis was required to fully understand the potential benefits of any proposals.

The noble Baronesses, Lady Gould and Lady Wheeler, asked why there has to be this two-year delay. Work to model the impact and cost-effectiveness of vaccinating adolescent boys with HPV vaccine is dependent on the completion of work by PHE on an individual-based model for HPV screening, as the intention was to use the completed screening model as a basis on which to model adolescent male vaccination. An individual-based model is critical to proper assessment of an adolescent boys’ vaccination programme. Individual-based models are very complex and mathematical; they simulate the impact of an intervention on individuals within a population through time and take a considerable amount of time and resource to develop. The screening model is now not due to be completed until early this year. Although disappointed that modelling work on the cost-effectiveness of HPV vaccination of adolescent boys by PHE will not begin until early 2015, the JCVI agreed that in order to expedite the work it would not be advisable to take any shortcuts, which could undermine the validity of the outputs. As I said, the PHE model may not now be completed until early 2017. The HPV sub-committee will meet during 2015 to review the progress of these studies and will report its findings to the JCVI following consideration of work modelling the impact and cost-effectiveness of extending HPV vaccination to adolescent boys.

Your Lordships will be aware that the NHS budget is a finite resource. New vaccination programmes and extensions to existing programmes will usually represent a significant cost to the health service, in terms of both vaccine purchase and its administration to individuals. It is therefore essential that any advice or recommendations from the JCVI on changes to the national vaccination programme be supported by evidence to show that they would be a cost-effective use of resources.

The noble Lord, Lord Patel, asked about an equalities assessment. An equality impact assessment was completed in 2008 for the introduction of the national HPV vaccination programme for girls. At that time, vaccination for boys for HPV was considered to be not cost-effective for the prevention of cervical cancer.

The noble Countess, Lady Mar, raised the issue of the Japanese experience. HPV vaccines, in fact, remain licensed for use in Japan and continue to be available for girls and women who wish to receive them. The decision of the Japanese authorities temporarily to stop their active recommendation for immunisation due to reports of chronic pain was a precautionary move while they gathered more data. However, EU regulators have reviewed the issue and concluded that there is currently insufficient evidence to indicate that HPV vaccines may be a cause of chronic pain or chronic pain syndrome, which has also been associated with needle injection itself—that is to say, not specific to the vaccine. It remains the case that a causal relationship with HPV vaccines has not been established.

[The Countess of Mar]

My Lords, I am sorry to interrupt, but even the manufacturers recognise autoimmune dysfunction as a result of their vaccines.

[Earl Howe]

My Lords, I will take that point away and respond to the noble Countess in writing, as I do not have briefing on it. Suffice it to say, lest there be any doubt, we consider vaccine safety to be of paramount importance. The Medicines and Healthcare products Regulatory Agency has closely evaluated the safety of the HPV vaccine since it was first introduced in this country. The agency takes every report of suspected adverse reactions very seriously and keeps safety under continual review. Again, the view remains that there is currently insufficient evidence to indicate that illnesses are a side-effect of the vaccine.

The MHRA recently completed an epidemiological study of myalgic encephalomyelitis and chronic fatigue syndrome following HPV vaccination. This found no evidence to suggest that the vaccine may be a cause of the condition. The results of the study were published in a peer-reviewed scientific journal in 2013, as I am sure the noble Countess is aware. It is estimated that more than 30 million females worldwide have been vaccinated with HPV vaccine. The United States health authorities have also extensively reviewed HPV vaccine safety and the World Health Organization is assured by its safety.

Time is against me, so I will write to noble Lords on those points that I have not been able to cover. Let me just say that this is very much work in progress. Clarity on timelines cannot be achieved until the JCVI HPV sub-committee has met and reviewed the available evidence. We anticipate that sufficient evidence for the JCVI to be able to offer final advice on the vaccination of men who have sex with men will become available during 2015 but that sufficient evidence for the JCVI to be able to offer advice on the vaccination of adolescent boys may not now become available until 2017 at the earliest. I am afraid that I cannot give any comfort on an earlier date. I recognise that 2017 seems a long way off. However, I hope that the noble Lord will agree that it is essential that the JCVI does its work thoroughly and comprehensively before finalising its advice to the Government. He asked whether Ministers will meet the JCVI to discuss this. I will pass that recommendation to my honourable friend Jane Ellison MP, the Minister for Public Health.

The noble Baroness, Lady Hollins, requested that the issue of men with learning difficulties should specifically be brought to the attention of the JCVI. All girls are covered, regardless of disability, so this is an issue that could be brought to the attention of the JCVI and officials will do that.

Finally, I thank the noble Lord once again for initiating today’s debate. I very much hope that the discussion has been helpful in providing reassurance of our commitment.

Ebola

Debate between Earl Howe and Countess of Mar

Monday 13th October 2014 Lords Chamber

[Earl Howe]

My Lords, I am grateful to the noble Lord. Existing technology used by the Border Force can inform it about individual passengers coming to this country and identify those who have recently travelled from Liberia, Sierra Leone and Guinea on routes with onward connections to the UK. Systems are therefore in place. We know that fewer than 1,000 passengers arrived by air from the affected countries in September. We are not therefore dealing with huge numbers. We know that around 85% of such people arrive at Heathrow, which is why we are starting there. However, it is important to look as widely as we can; the noble Lord is right. Again we should be reassured by the fact that there is screening on departure from Liberia, Sierra Leone and Guinea but we are starting the in-country screening in the UK at the three ports I mentioned, with the intention of scaling up screening, based on our experience. Plans are in place for a further rollout to other UK ports, if that should prove necessary.

[The Countess of Mar (CB)]

My Lords, my noble friend Lady Finlay of Llandaff has asked me to apologise to the House for her absence; she had to go to Wolverhampton. I hear the noble Earl saying that the department will consult the BMA and the RCGP about getting the message across to GPs. My noble friend asked me to ask whether a diagnostic algorithm was going to be posted on all appropriate websites, including those of the royal colleges and the BMA.

[Earl Howe]

I am not aware that the system being conveyed to GPs, which is not for diagnosis but for the referral of patients, can be called an algorithm, but there is a checklist of questions that we are recommending GPs use. That advice has been adapted for use in all healthcare settings, including NHS 111, as I mentioned in the Statement. Naturally, we shall take advice on whether the questionnaire and the sequence of questions are adequate. If it needs amending, we shall certainly not hesitate to do that.

NHS: District Nurses

Debate between Earl Howe and Countess of Mar

Thursday 10th July 2014 Lords Chamber

[Earl Howe]

I do not have the figures, but of course this process started under the previous Government with the “Transforming Community Services” programme, which very often hived off the community provision into social enterprises. If I have statistics on this I will gladly send them to the noble Baroness.

[The Countess of Mar (CB)]

My Lords, I recently received a letter from a lady whose daughter has ME and is confined to bed. She is under the age of 16, and was given a male care assistant who would not perform certain tasks for her. When her mother went to the surgery to ask if a district nurse could come and do those tasks, she was told no because the girl was under 16. Is this correct?

[Earl Howe]

I am happy to look into that case, but clearly we need to ensure that there are the right skills for the right patients, and this is what the health service increasingly aims to achieve. The district nursing team has to contain those multidisciplinary skills. If there is a case of someone being inappropriately looked after, then that is certainly a cause for concern.

NHS: Rural General Practitioner Dispensing

Debate between Earl Howe and Countess of Mar

Tuesday 8th July 2014 Lords Chamber

[Earl Howe]

My Lords, the phasing out of the minimum practice income guarantee is being gradually implemented over seven years to give adequate time for GP practices to adjust. In fact, most practices stand to gain under that arrangement. I would encourage any practice to take the matter up with the local area team at NHS England if it has particular concerns. The provisions governing whether a doctor can continue to provide dispensing services to eligible patients when a new pharmacy opens nearby, which is a separate issue, have been in place for a long time and are subject to a long-standing agreement. If an application for a new NHS pharmacy is made to NHS England that would affect, for example, the noble Lord’s dispensing practice, that practice is able to make its views known. There is an appeals process as well. If a new pharmacy were approved that does affect the practice’s dispensing patients, it is open to NHS England to phase in gradually the shift from using the practice’s dispensary to a pharmacy for those patients affected.

[The Countess of Mar (CB)]

My Lords, does the Minister agree that this agreement arose from the 1911 Act—well over 100 years ago—and that there is extreme unrest among patients who are forced to go to a pharmacy when they have been used to using a dispensing doctor? Does the Minister intend to continue subsidising what are known as essential small pharmacies and not give patients a choice?

[Earl Howe]

My Lords, I do not think that it is a question of opposing choice against the rules that we have in place. The rules are there as a result of very long-standing agreements between the medical profession and the pharmacists. I do not think that there is an appetite on either side to open those rules up for renegotiation. A balance has to be struck somewhere and the professions are content with the balance that has been struck.

Health: Folic Acid

Debate between Earl Howe and Countess of Mar

Monday 24th February 2014 Lords Chamber

[Earl Howe]

My Lords, the Scientific Advisory Committee on Nutrition is the body charged by government to advise Ministers, and the decision will be taken by Ministers. But we have thought it prudent and sensible to take into account the latest data on the folate status of the population. The information that SACN drew from is more than a decade old, and we do not think that that is a sensible basis on which to take a decision one way or the other. So we must wait for that evaluation.

[The Countess of Mar (CB)]

My Lords, does the Minister agree that there is an equal conundrum with adding fluoride to water? Her Majesty’s Government seem to be quite happy that fluoride should be added to water, yet there is a possibility of overdose if people have fluoride tablets, fluoride toothpaste and all sorts of other things. What is the difference between that and folates?

[Earl Howe]

My Lords, as the noble Countess says, the issues are in many ways similar. As she knows, in the case of fluoride, Parliament has taken the decision that it should be a local matter and that is how the system now works.

Health: Anorexia and Bulimia Nervosa

Debate between Earl Howe and Countess of Mar

Thursday 11th July 2013 Lords Chamber

[Earl Howe]

My noble friend is absolutely right. However, it is encouraging to see that in recent years a range of information and support has become available. The Royal College of Psychiatrists has published a fact sheet on eating disorders, which is aimed not just at the profession but particularly at parents, teachers and young people themselves. It is called Mental Health and Growing Up. The fact sheet discusses the causes of eating disorders, how to recognise them and gives advice on how to cope with a child who has an eating disorder.

[The Countess of Mar]

My Lords, I am sure that the noble Earl accepts that some young girls have an eating disorder that is not anorexia or bulimia—they may have CFS/ME or reactions to HPV vaccines. Very often, they are incarcerated in mental hospitals when they should receive a different form of treatment. I have spoken to the noble Earl about this but perhaps he could say what progress is being made in ensuring that such young people are not mistreated?

[Earl Howe]

My Lords, I am sure that this is an area that NICE will need to look at when it refreshes its guidance to the clinical community. The noble Countess is absolutely right to raise the issue. CFS/ME can often be misdiagnosed; it can be mistaken for other conditions without proper differential diagnosis having taken place. We know that there is more work to be done in this area. However, the range of programmes now available to GPs, some of which I have referred to, can be helpful in this area.

NHS: GP Dispensing

Debate between Earl Howe and Countess of Mar

Thursday 16th May 2013 Lords Chamber

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

My Lords, the current NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 continue an agreement reached between representatives of pharmacist and GP contractors setting out the circumstances under which patients living in designated rural areas are eligible to receive dispensing services from their GP. To make any significant change in the regulations would mean reopening complex and lengthy discussions. We believe that contractors’ representatives are satisfied with the current regulatory arrangements and would not support an extensive review.

[The Countess of Mar]

My Lords, does the Minister agree that “no decision about me without me” and the freedom of patient choice have been pivotal to the Government’s NHS reforms? Does he not think it crazy that I, as a patient of a dispensing doctor, can either ask my doctor for a prescription which I can take to a pharmacist in the nearest town or have my prescription dispensed by his staff, whereas my neighbour, who might live just within that 1.6 kilometre boundary, is allowed to get his prescription dispensed only in a pharmacy in the town? Does the Minister agree that the reasons for this rule are now obsolete? It was created in 1911 when there could have been corruption between doctors and patients, and that possibility no longer exists because of the controls.

[Earl Howe]

My Lords, there is a balance of interests here, not least the interests of the patient. We therefore need a set of rules which reflects those interests. Patients who live in a rural area can be dispensed to by their GP if there is no pharmacy within 1.6 kilometres of where the patient lives, or within 1.6 kilometres of the GP practice. Without these rules, it would rarely be viable for new pharmacies to open to serve rural areas. That would deprive people living in rural areas of the opportunity to benefit from the more comprehensive health service that a combination of a GP practice and a pharmacy can provide.

NHS: Clinical Networks

Debate between Earl Howe and Countess of Mar

Wednesday 12th December 2012 Lords Chamber

[Earl Howe]

My Lords, in some cases, yes, but we anticipate that many members of existing networks will be transferred across into the new ones.

[The Countess of Mar]

My Lords, the people with CFSME were greatly heartened in 2008 when the Chief Medical Officer ring-fenced £8 million to set up clinical networks on their behalf. They have become disillusioned as the funding of these networks has gradually been cut. There is also no provision for children in the clinical networks. What priority is given to CFSME?

[Earl Howe]

My Lords, strategic clinical networks are only one category of network in the new system. There is nothing to stop professional groups coming together to share best practice and support professional development. In addition, clinical commissioning groups may well wish to establish networks to support local priorities and ways of working; and providers may use a network model to enable the joint delivery of a service, such as pathology. The noble Baroness, Lady Thornton, rightly referred to the extent to which local providers and commissioners already support strategic clinical networks. So there is a variety of ways of doing this.

Diabetes

Debate between Earl Howe and Countess of Mar

Tuesday 10th July 2012 Lords Chamber

[Earl Howe]

My Lords, I am aware of that research, which my department is looking at very carefully, but I should put a health warning on it in that we do not yet accept the conclusion that sugar is addictive, although clearly in the case of young children those who get into the habit of consuming sugar are likely to continue doing so, so the noble Baroness is quite right that it is a risk factor in the young. The advice from the School Food Trust is of course to have a healthy diet at school. Many schools are adhering to that, and we are doing our best to promote that with our colleagues in the Department for Education.

[The Countess of Mar]

My Lords, the Minister mentioned unexpected consequences. Does he agree that people who are afraid of eating too much sugar because they might get fat will turn to sugar substitutes such as aspartame? Is he aware that aspartame contains 10% methanol, which, uniquely in the human body, is turned into formaldehyde and has its own neurological hazards? Would he recommend having sugar or sweeteners?

[Earl Howe]

My Lords, the Department of Health recognises that artificially sweetened or low-calorie drinks can play a role in helping people to reduce the number of calories they consume and offer a wide choice of low-calorie options. As for the safety of artificial sweeteners, all food additives, including sweeteners, are thoroughly tested for safety prior to approval and are subject to review by independent expert bodies. The Food Standards Agency considers that all approved sweeteners can be safely consumed at current permitted levels.

NHS: Dental Care

Debate between Earl Howe and Countess of Mar

Tuesday 26th June 2012 Lords Chamber

[Earl Howe]

My Lords, I referred earlier to NHS Choices, the website that patients and the public can access. It contains the most up-to-date information on dental treatment costs and entitlements. The dental section of NHS Choices was updated at the end of February following suggestions and comments submitted by the public through the website itself and these changes include new pages that clearly explain dental charges and exemptions and inform patients how to get help with dental costs.

[The Countess of Mar]

My Lords, am I right in my understanding that children and young people get all NHS dental treatment free of charge? If so, what improvements have there been in dental health among this group?

[Earl Howe]

The noble Countess is quite right. The oral health of children, particularly those from disadvantaged families, is one of the biggest challenges we have and one of the main priorities in this policy area. While two-thirds of five year-olds are now caries free, the remaining one-third have an average of 3.45 decayed, missing or filled teeth. We are piloting new ways of supporting dentists to identify children at risk of tooth decay to get them the care and preventive advice they need, including engagement through schools, the wider community and local authorities.

Tobacco

Debate between Earl Howe and Countess of Mar

Monday 6th February 2012 Lords Chamber

[Earl Howe]

My Lords, Her Majesty’s Revenue and Customs and the UK Border Agency published a renewed strategy in April last year to tackle the illicit trade in tobacco products. Our tobacco control plan complemented that strategy by stressing the importance of cracking down on illicit tobacco sales, which will in turn reduce tobacco consumption and organised crime, and support legitimate retailers. In fact, the latest figures show that fewer and fewer people are using illicit tobacco. The market for illicit cigarettes was down to 10 per cent in 2010 from 21 per cent in 2000.

[The Countess of Mar]

My Lords, some years ago I was given a statutory instrument, the Sheep Scab Order, which was dated about 1914 and had an excellent recipe for sheep dip made from tobacco. I wonder whether the current tobacco problem could be relieved by diverting tobacco from smoking to sheep dip.

[Earl Howe]

My Lords, I wonder too.

Health: Children and Young People

Debate between Earl Howe and Countess of Mar

Monday 6th February 2012 Lords Chamber

[Earl Howe]

My Lords, the Secretary of State will retain ultimate accountability for children's health services. Under the Bill, as the noble Baroness knows, the functions will be conferred directly by Parliament on specific organisations. That will strengthen accountability. In answer to the first part of her question, the reform of the health system offers a real opportunity to address some of the well documented challenges that the current system presents. We are moving, through the Bill and through our reforms, to a system that will focus on promoting good health, which we see as important as delivering good care. Informed and expert knowledge will underpin the commissioning of integrated services, where we will measure success on improvements in the outcomes that are achieved. Treatment will be evidence-based and children will be involved in decisions about their care. All these things are embodied in the Bill.

[The Countess of Mar]

My Lords, recent research at Bristol indicated that as many as one in 100 children who are absent from school long-term suffers from CFS/ME. There is a dearth of centres for the treatment and diagnosis of children with CFS/ME. Does the Minister envisage this improving under the new proposals?

[Earl Howe]

My Lords, it is yet to be decided finally which services will be commissioned at a national level. I cannot give the noble Countess a definitive answer on where services for CFS/ME will be commissioned. However, we are sure that the arrangements will provide much better, more locally responsive ways of commissioning services generally. Whether clinical commissioning groups join together in commissioning services, whether lead commissioners do that or whether commissioning takes place at a higher level, we are clear that in all services this needs to improve.

Health and Social Care Bill

Debate between Earl Howe and Countess of Mar

Wednesday 16th November 2011 Lords Chamber

[The Countess of Mar]

My Lords, I rise briefly to support Amendment 79 moved by the noble Lord, Lord Warner, although he should not have moved it at this stage perhaps; he should have just spoken to it.

As the Minister knows, I am concerned about people with CFS/ME. They are the most neglected, denigrated and discriminated-against group in the country and there are some 60,000 of them who are severely ill, which means that they are homebound and bed-bound. They have multi-system symptoms, which are far too often neglected. They have co-morbidities—one person that I know of, who has had ME since she was 15 and is now 30, has severe gynaecological problems but because she has ME they are not going look at those. Also, she gets no social care. It is very important that these services are thoroughly integrated and that people understand that because you have ME it does not mean to say that all you need is a little bit of CBT and GET and you can get up and go. We have got to provide for people who are severely ill. So I support the noble Lord, Lord Warner, and the noble Baroness, Lady Pitkeathley.

[Earl Howe]

My Lords, CCGs will be under a duty to arrange for services to meet the reasonable requirements of patients for whom they are responsible. This is the language of the current duty on the Secretary of State in Section 3 of the 2006 Act and will remain one of the fundamental principles in the future. Additionally, under their discretionary power in new Section 3A inserted by Clause 11, CCGs will have the power to arrange the provision of services and facilities for the people for whom they are responsible where that will improve physical and mental health or improve the prevention, diagnosis and treatment of illness in those people. However, CCGs do not have commissioning responsibility for all services—for instance, those that the NHS Commissioning Board will commission. For that reason, Amendment 60A would be inappropriate. However, the Bill is already expressly designed to ensure that the comprehensive health service is maintained and that patients’ needs are meet.

Amendments 76 to 78 seek to revise the commissioning responsibilities of CCGs, as set out in Clauses 10 and 11. In effect, Amendment 76 would give each CCG responsibility for commissioning for everyone normally resident in its area, removing the link between the provider of primary medical services with whom a person is registered and the CCG responsible for commissioning services for them. We think it is important to maintain this link. PCT responsibilities currently include people who may be registered with a GP in that area but who live outside the geographic boundaries of the PCT, so this is not something new. Clause 10 also includes some necessary provisions for the Secretary of State to clarify the responsibilities of CCGs in regulations—for example, when a CCG has ongoing responsibility for a patient’s care even if they are no longer a registered patient of a member of that CCG, which is an important element of the policy of continuing healthcare, and when somebody might be excluded from their responsibility, which might apply to patients registered with a GP in England but living in another part of the United Kingdom.

Amendment 78 would change the discretionary power that CCGs would have under new Section 3A into an obligation. That would go much further than the current discretionary powers of the Secretary of State. It would place CCGs in the situation of being legally obliged to arrange any services that it felt were appropriate to meet a patient’s needs. This would conflict with their duty under Section 14P to exercise their functions effectively, efficiently and economically, and could leave them open to challenge. These are judgments that commissioners, as now, need to be able to weigh up themselves in order to achieve the best possible services for their patients with the resources that they have available.

NHS: Medical Records

Debate between Earl Howe and Countess of Mar

Wednesday 7th September 2011 Lords Chamber

[Earl Howe]

The noble Baroness makes a very good point. I said that the top-down approach to local service provision has not worked when it has come to local service provider systems. We think that local requirements are best judged and best met by decisions being taken locally but that does not mean that they will be left on their own. There will be the necessary support from the centre wherever needed. She is again right that the key will be that these local systems must be interoperable.

[The Countess of Mar]

My Lords—

--- Later in debate ---

[The Countess of Mar]

My Lords, does the Minister agree that while technology is incredibly beneficial to the National Health Service, we must be wary of people working within the health service depending too much upon technology and ignoring the human aspects of care for people who are in hospital—talking to patients, touching them and holding their hands when they have problems? My recent experiences in hospital have been very unpleasant because people have relied entirely on technology and not listened to what I have had to say.

[Earl Howe]

The noble Countess is of course correct that good patient care is about humane and sensitive treatment by the staff who serve in the National Health Service. At the same time, I think we are all clear that technology has a role to play in enhancing patient safety and improving the quality of care that the good staff of the NHS can deliver.

Abattoirs

Debate between Earl Howe and Countess of Mar

Monday 11th July 2011 Lords Chamber

[Earl Howe]

My Lords, it is certainly the ambition of the agency to move to a more risk-based approach but, as my noble friend will know, that has considerable implications in terms of EU law and it will take some time for such an approach to be worked through. On her second question, I am aware that the agency will discuss tomorrow the findings of the Macdonald taskforce, so it is probably premature for me to say more on that point.

[The Countess of Mar]

My Lords, I declare my interest as a farmer. Would the noble Earl agree that small and medium-sized abattoirs are essential to our communities? There are serious animal welfare concerns in having to drive animals for miles to gets them slaughtered. The stress on the animals also causes the meat to be not so good. In Worcestershire, we have one abattoir left, and the nearest one to us is in fact in Herefordshire. Do the Government intend to encourage small abattoirs to stay open? Is there any possibility for mobile abattoirs to be developed?

[Earl Howe]

My Lords, smaller abattoirs are extremely important to the rural economy, as the noble Countess rightly says. They are more likely to be rural. The support to be provided to those abattoirs processing up to 5,000 cattle—a higher threshold than was previously proposed—is intended to help preserve the provision of local services to the livestock industry. That will helpfully reduce the impact on small livestock producers, the rural economy, animal welfare and indeed consumer choice. As regards mobile abattoirs, I am not aware what initiatives are being undertaken, although I believe that there are a few around, so it will be necessary for me to seek further advice on that point.

Health: Transmissible Spongiform Encephalopathies

Debate between Earl Howe and Countess of Mar

Monday 13th June 2011 Lords Chamber

[The Countess of Mar]

To ask Her Majesty’s Government what are their proposals for continuing research into human and animal transmissible spongiform encephalopathies.

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

My Lords, the Government continue to invest considerable funds in this research. I am pleased to note that the risk from BSE has declined significantly, and that cases of variant CJD peaked in 1999 and have declined ever since. The Government intend to continue to fund this research in order to ensure that policies are based on the best possible science and that there is evidence of efficacy, safety and cost-benefit for any measures implemented.

[The Countess of Mar]

My Lords, I am grateful to the noble Earl for that encouraging reply, because there have been rumours that the TSE research by the Health Protection Agency at Porton Down was to be “downsized”, as they say. Does the noble Earl agree that it is very important that we retain our knowledge acquired since the 1950s, when researchers were looking at scrapie, and that it is rather dangerous to put all our eggs in one basket? We ought to encourage lots of researchers to keep up to date, because these little prions seem to have naughty ways. What is happening to the archives for TSE conditions, which really ought to be called neurodegenerative diseases?

[Earl Howe]

My Lords, the Government are committed to continuing research in TSEs. Many fundamental questions remain unanswered and the research is, by its nature, long term. Considerable funding is provided by a number of bodies—not only the Department of Health, but the Medical Research Council, the Biotechnology and Biological Sciences Research Council, Defra and the Food Standards Agency. The total funding last year was in excess of £20 million, and I should add that the DoH funding is ring-fenced. That funding to key institutions ensures that expertise is maintained and continued in the UK.

As for the archive of research data, I agree with the noble Countess. The Government are committed to this research, as I have mentioned, and to surveillance, so our data and resources will remain accessible through peer-review publication systems for sharing material and through continuing liaison with the research community.

Health: Multiple Sclerosis

Debate between Earl Howe and Countess of Mar

Tuesday 7th June 2011 Lords Chamber

[Earl Howe]

My Lords, I am personally involved with Dame Carol Black in a work stream under the Responsibility Deal, which covers health in the workplace. Under that banner, we are emphasising to employers how important it is to understand the circumstances and needs of employees with a long-term condition. I will, however, go back and see whether I can provide my noble friend with a fuller reply.

[The Countess of Mar]

My Lords, is the noble Earl aware that today I have received two letters, both from ME sufferers who have long-term neurological conditions? One of them has just been sacked by the National Health Service and the other has just been sacked by local government, for which she works. Can the noble Earl say what protection these people have in their workplace? Neither the NHS nor local government seems to understand that ME is a fluctuating condition and that the disability Acts require employers to make allowances for this.

[Earl Howe]

My Lords, I hope the noble Countess will allow that ME is a different issue from MS. I would be very happy to answer a question on ME on another occasion.

Herbal Medicines

Debate between Earl Howe and Countess of Mar

Thursday 13th January 2011 Lords Chamber

[Earl Howe]

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

[The Countess of Mar]

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

[Earl Howe]

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

Public Health

Debate between Earl Howe and Countess of Mar

Tuesday 30th November 2010 Lords Chamber

[The Countess of Mar]

I am awfully sorry to disturb the noble Earl and I am sorry to have to ask two very venerable noble Lords if they would mind having their conversation outside the Chamber as suggested in the Companion to the Standing Orders. I cannot concentrate on what the Minister is saying.

[Earl Howe]

The Statement continues:

“It will also develop health protection plans and screening programmes to protect people from health risks. Because we also know that the foundations of good health are rooted in the community, often at a neighbourhood level, we must strengthen and renew local leadership to ensure that these efforts reach deeply into communities and match their unique circumstances.

Under this White Paper, the lead responsibility for improving health will pass to local government for the first time in 40 years. We intend to give local authorities new powers to plan, co-ordinate and deliver local strategies with the NHS and other partners and to embed the foundations of good health in ways that fit local circumstances. Directors of public health will provide strong and consistent leadership within local councils.

We also intend to establish the new local statutory health and well-being boards as a way of bringing together the NHS and local government. Whereas before, public health budgets were constantly raided by other parts of the NHS, we will prioritise public health spending through a new ring-fenced budget. We will look to the highest standards of evidence and evaluation to ensure that this money is spent wisely. The new outcomes framework for public health, on which we will consult shortly, will provide consistent measures to judge progress on key elements across all parts of the system—nationally and locally. The framework will emphasise the need to reduce health inequalities and will be supported by a new health premium incentivising councils which demonstrate progress in improving outcomes.

We have learnt over the last decade that state interventions alone cannot achieve success. We need a new sense of collective endeavour—a partnership between communities, businesses and individuals, which transforms not only the way we deliver public health, but also the way we think about it.

Through the public health responsibility deal, the Government will work with industry to help people make informed decisions about their diet and lifestyle, to improve the environment for health, and to make healthy choices easier. Through greater use of voluntary and community organisations, we will reach out to families and individuals and develop new ways to target the foundations of good health. Reflecting the framework in the ladder of interventions developed by the Nuffield Council on Bioethics, we will adopt voluntary and less intrusive approaches so that we can make more progress, more quickly and resort to regulation only where we cannot make progress in partnership.

This is a time when the NHS and social care are under intense pressure from an ageing population and higher costs. It is a time when we must therefore put as much emphasis on preventing illness as we do on treating it. In the past, public health has been a fragmented and forgotten branch of the health service. This White Paper will make it a central part of everything we do, and we will bring forward legislation in the new year to enact these changes.

By empowering local authorities, by strengthening our knowledge of what works and by establishing the right incentives to drive better outcomes, the White Paper will deliver the strategy and support needed to reduce health inequalities and to improve the nation’s health. I commend this Statement to the House”.

My Lords, that concludes the Statement.

--- Later in debate ---

[Earl Howe]

My Lords, the noble Baroness asked me a number of questions there. I may not be able to answer all of them now, but I will certainly write on those that I cannot.

As I mentioned earlier, it is important to recognise that in part the status of directors of public health will be confirmed by virtue of not simply being appointed locally, but also by being appointed from the centre by Public Health England. That will confer an added status to them. With the dual accountability that I referred to, primary accountability would be to their employer, the local authority, but the Secretary of State would have a backstop power to dismiss directors of public health on the basis of a failure to discharge local authority responsibilities in the area of health protection. Again, while one does not want to dwell on that power, it signifies that this is a person who will be there very much as the representative of the Secretary of State.

The noble Baroness asked what happens if there is a difference of view. Differences of view will arise but the important point to emphasise here is that we want to see them sorted out at a local level wherever possible. That will not always be possible but it should be the aim that health and well-being boards and consortia should decide, in the light of the joint strategic needs assessment and other factors, what the priorities are locally and how the budget is to be spent. It has to be that way: second-guessing from the centre is bound to lead to perverse consequences. However, there will be mechanisms available to ensure that the NHS commissioning board will have a role in trying to resolve these issues and the noble Baroness will see, when we publish the health and social care Bill, that the Secretary of State will have a backstop power in extremis.

She asked about the health premium. We will be publishing a document for discussion on this. We want to hear the views of everybody as to how this should work. Clearly, if a health premium is paid it has to reflect a measure of genuine progress in reducing health inequalities, while recognising that some areas start off with the handicap of having particularly deprived communities to work with and that the task is thereby more difficult. It is important that the department receives the views of interested parties to see how this is going to work.

On sexual health, we are looking to see what more can be done to increase the awareness of risks, prevent infection and promote access to screening and treatment. The consultation documents, which will be issued shortly, will set out the proposed funding and commissioning routes for public health services, including how comprehensive sexual health services might best be commissioned. I hope the noble Baroness will feed into that.

[The Countess of Mar]

My Lords, the noble Earl mentioned looking at the causes of the causes very early on in his Statement. I think it is now well accepted that a foetus is not protected by either the placenta or the blood-brain barrier from environmental assaults. I am concerned that a lot of the obesity that we see now in young children who run around normally and cannot be described as couch potatoes—although perhaps their diet is deficient—may have originated in the womb from oestrogen-mimicking hormones and by chemicals such as bisphenol A and phthalates. It seems to me that we disregard these factors at our peril and we are blaming people for factors that are beyond their ability to control. Another point is the effect of maternal stress on the foetus. High cortisol levels in the mother affect the child and cause ADHD and educational problems later on in their lives. What is the Minister doing to look at what is happening to babies in the womb and the effects on them in their future life?

[Earl Howe]

I shall need to write to the noble Countess on exactly what work programmes are in train in that area but she is absolutely right—this is an area that I have taken a close interest in over the years. It is fundamental to understanding both health in childhood and later on in adulthood, and behaviour in children.

We fully recognise that good nutritional status is important at all stages of life. That includes the role of the diet in pre-maternal health, and affects teenagers in particular and the elderly, where there are concerns about malnutrition; I know that is not the focus of the noble Countess’s question. The national diet and nutrition survey will allow us to continue monitoring the status of the diet in the UK population and to target interventions where they are needed. I will write to the noble Countess to give her further particulars.

Health: Chronic Fatigue Syndrome

Debate between Earl Howe and Countess of Mar

Monday 8th November 2010 Lords Chamber

[The Countess of Mar]

To ask Her Majesty’s Government what event precipitated the Department of Health decision to exclude all people who have or have had myalgic encephalomyelitis/chronic fatigue syndrome from donating blood from 1 November 2010.

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

My Lords, this decision by the UK blood services was prompted by a recent independent expert risk assessment of a possible link between a murine retrovirus and CFS/ME. Although the risk assessment found no evidence of a link or of a risk to transfusion recipients, the UK blood services recognised that practice for CFS/ME should be brought in line with other conditions where individuals are permanently excluded from blood donation to protect their own health.

[The Countess of Mar]

My Lords, I am grateful to the noble Earl for that reply. I offer my congratulations on the precautionary principle being called on in this instance, but ask him why the Department of Health did not say this in its press release. The notice said only that it was for the benefit of patients and no one, but no one, believed it. In the light of the findings on various viruses, not just XMRV, in the blood of patients suffering from ME, what new biological research as opposed to psychological research is being conducted into this terrible illness?

[Earl Howe]

My Lords, it is important to make clear to the noble Countess that no definite picture has yet emerged from the published literature on whether the virus in question, XMRV, is implicated in CFS/ME. The National Expert Panel on New and Emerging Infections has considered all the available evidence about XMRV and has reported that no public health action is required at this time. The Advisory Committee on the Safety of Blood, Tissues and Organs, on the basis of current evidence,

“does not recommend further measures at present, but wishes to continue to monitor the situation”.

As regards research into CFS/ME, the Medical Research Council is committed to supporting scientific research into all its aspects, including studies into the biological basis of the condition and evaluation of treatments. In 2009-10, the MRC spent £109,000 on research directly related to the condition.

Health: Government Spending

Debate between Earl Howe and Countess of Mar

Monday 14th June 2010 Lords Chamber

[Earl Howe]

My Lords, strictly speaking, primary care trusts are not considered to be arm’s-length bodies, but the coalition agreement, which I am sure the noble Lord has read from cover to cover, indicates the new role and the functions envisaged for PCTs. Further details of our plans will be announced very soon.

[The Countess of Mar]

My Lords, will the Minister be prepared to consider joining together animal and human medicines and health? With global warming, with so many of our illnesses now zoonoses—in other words, caused by animals—and with so many antibiotics and other drugs used in common, would it not be a good idea?

[Earl Howe]

My Lords, I am grateful to the noble Countess, particularly given her wealth of knowledge and experience in this area, for putting forward that suggestion, which I shall certainly take back with me.