Health: Midwives

Debate between Earl Howe and Lord Harrison

Tuesday 22nd July 2014 Lords Chamber

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

My Lords, we are committed to improving maternity care and have charged Health Education England with ensuring that staff with the right skills are being trained and developed to meet future needs. Between May 2010 and March 2014, the numbers of full-time equivalent midwives increased by more than 1,700 and over 6,000 are in training. Health and social care is a devolved matter and the responsibility of individual devolved Administrations.

[Lord Harrison (Lab)]

My Lords, what are the Government actively doing to retain experienced, longer-serving midwives at a time of recruitment shortages? Why is it that, according to the National Federation of Women’s Institutes, only one in eight mothers giving birth is helped by a midwife known to her?

[Earl Howe]

My Lords, we attach great importance to choice in maternity care and, in particular, to each mother having a named midwife throughout the care pathway. That is what we are aiming at and what NHS England and Health Education England are charged with delivering. As regards the age profile of midwives, my advice is that there is not a particular age bulge, although we are keen to ensure that we do not lose qualified midwives who, clearly, we can ill afford to lose. However, we have made a commitment to ensure that the number of midwives in training is matched to the birth rate and, so far at least, we have been successful in that.

NHS: Midwives

Debate between Earl Howe and Lord Harrison

Monday 17th March 2014 Lords Chamber

[Lord Harrison]

To ask Her Majesty’s Government what steps they are taking to ensure that a sufficient number of midwives are trained, employed and retained by the National Health Service.

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

My Lords, this Government are committed to improving maternity care. That is why we have charged Health Education England with ensuring that training numbers meet service demand. By reducing attrition rates, record numbers of midwives will be available to the NHS. Since May 2010 the number of full-time equivalent midwives increased by around 1,800 to nearly 22,000. A record number of midwives, some 6,000, are currently in training. New midwife training commissions by HEE for 2014-15 number 2,563.

[Lord Harrison (Lab)]

My Lords, given that the Commons Public Accounts Committee believes that there is a shortfall of around 2,300 midwives and that the NSPCC has computed that number at 5,000, does the Minister acknowledge that we are beginning to get anecdotal evidence, certainly in Chester in the north-west, of maternity services under real pressure? With regard to maternity services, does he recognise that three out of four such services lack any trained mental health midwives to deal with perinatal mental illnesses, which I am afraid are associated with as many as 10% of all pregnancies? Will the Minister look in particular at the question of the training of midwives, where all too often the perinatal mental health services are left off the agenda?

[Earl Howe]

My Lords, I agree that in certain parts of the country maternity services are under pressure, but it is encouraging that the ratio of births per midwife has improved nationally. Indeed, since 2010 the number of midwives has increased by 4% and the number of births by 1%. However, the noble Lord is right to attach importance to mental health services. Improving diagnosis and services for women with pregnancy-related mental health problems is one of the Department of Health’s objectives for maternity care. That is why Health Education England has been tasked with working with partners to ensure that pre-registration and post-registration training in perinatal mental health is available to enable specialist staff to be available to every birthing unit by 2017.

Alcohol: Calorie Labelling

Debate between Earl Howe and Lord Harrison

Thursday 13th March 2014 Lords Chamber

[Earl Howe]

My Lords, I would love to receive details but, once again, it is a question of how much my noble friend consumes rather than how much he pays.

[Lord Harrison (Lab)]

My Lords, the Minister may recall that last September I shared with him my concern at the ever-rising alcoholic content of wines that are on sale in supermarkets and the need for greater provision of lower percentage wines so that the consumer can indeed make a choice. What progress has he made in that area?

[Earl Howe]

My Lords, this area is currently under scrutiny by my ministerial colleagues in the Treasury.

Health: Diabetes

Debate between Earl Howe and Lord Harrison

Wednesday 3rd July 2013 Lords Chamber

[Lord Harrison]

To ask Her Majesty’s Government what assessment they have made of the quality of healthcare available to diabetics with eye problems.

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

My Lords, we have set clear objectives for the NHS and Public Health England to improve the care and quality of life for people with diabetes. The public health outcomes framework includes an indicator on preventable sight loss, which will track three of the commonest causes of preventable sight loss, including diabetic retinopathy, to drive improvements in quality.

[Lord Harrison]

My Lords, given the decline in the regular and important annual check-up for diabetics, does the Minister acknowledge that the retinopathy screening for diabetics introduced by the previous Government is being undermined and underresourced? On cataract operations, will the Minister explain why, among our European Union colleagues, we are the most demanding regarding the threshold required to have such operations? Given the importance of cataract operations, especially for older people in retaining their vision, will the Minister meet me and other colleagues to discuss these matters and allied subjects?

[Earl Howe]

I would be happy to meet the noble Lord. I am aware that the whole area of the cataract threshold and, perhaps more importantly, the interpretation of that threshold, is one that NHS England is now actively looking at to ensure greater consistency around the country.

I do not agree with the noble Lord’s interpretation of the screening figures. The UK countries, I believe, lead the world in the area of diabetes eye screening. This is the first time that a population-based screening programme has been introduced on such a large scale. The latest figures show that up to March 2013, 99% of people with diabetes who were eligible for screening were offered it in the previous 12 months.

NHS: Healthcare UK

Debate between Earl Howe and Lord Harrison

Thursday 14th February 2013 Lords Chamber

[Earl Howe]

It is a little too early to say because the business plan for Healthcare UK has yet to be drawn up. We have appointed a managing director in the shape of Howard Lyons who I think will do an excellent job. It remains to be seen what requirements are needed. We are looking at certain target markets at the moment—in particular, the Middle East, the United Arab Emirates, Saudi Arabia, Libya, China and India. But it depends on the requests that we get from those countries as to what skills set might be needed.

[Lord Harrison]

Given that the National Health Service has much to learn from other health services and best practice elsewhere in Europe and the wider world, what methods will the Government adopt to promote that interchange? Will the noble Lord give an example of such an exchange which has benefited medical practice in this country?

[Earl Howe]

The noble Lord makes an extremely important point. This is not only a one-way street in terms of exporting British expertise. I know one very good example in which some of our trauma clinicians have been seconded to hospitals in South Africa where there is tremendous expertise on gunshot wounds, for example. That has been of direct benefit to clinicians in this country.

Diabetes

Debate between Earl Howe and Lord Harrison

Thursday 10th January 2013 Lords Chamber

[Earl Howe]

My Lords, yes, I certainly do. There are a number of positive ways in which we can do that. One is the NHS health check, which should, if it is performed correctly, pick up those with undiagnosed diabetes. Early identification of diabetics is key in this area, particularly for those who are at risk of ulceration. Other ways are targeting preventive services at those most at risk, including those with learning disabilities; early management of foot infection and rapid access to multidisciplinary teams; and having good diabetic foot prevention and ulcer management services in local areas.

[Lord Harrison]

My Lords, the point at issue is surely this: that to prevent the four out of five needless amputations that currently take place, Her Majesty’s Government need to respond to the Question of my noble friend Lord Kennedy by saying how they will ensure that there are those multidisciplinary groups with specialist knowledge of feet and the ability to make sure that there is not a postcode lottery as there is now. They should be properly monitored by the Government to ensure that a proper service is offered to diabetics at a time of decline in the amount of money going into the National Health Service.

[Earl Howe]

My Lords, there is no single magic bullet that will solve this problem, but undoubtedly better monitoring in general practice is one answer; the QOF incentivises that. The NHS outcomes framework will also incentivise clinical commissioning groups to ensure that those with long-term conditions—particularly diabetes—are properly looked after. The benefits of multidisciplinary teams are now proven. The evidence is there and, if we can shine a spotlight on the statistics—and there is, as the noble Lord knows, a wide variation in success rates across the country—that will be the key to driving better performance throughout the health service.

NHS: Walk-in Centres

Debate between Earl Howe and Lord Harrison

Thursday 11th October 2012 Lords Chamber

[Earl Howe]

Many GP surgeries have extended opening hours. Some have walk-in centres attached to them but there is no general rule about that. The decision to open on an extended-hours basis is voluntary for GPs.

[Lord Harrison]

Does the Minister share my surprise that data are not available for the number of closures of such walk-in centres in the past two years?

[Earl Howe]

My Lords, no. The previous Government did not collect the figures and we have chosen not to either. This is a decision for local commissioners and there is a limit to the extent that we can require the NHS to fill in forms and send them to Richmond House.

Health: Diabetes

Debate between Earl Howe and Lord Harrison

Wednesday 25th July 2012 Lords Chamber

[Lord Harrison]

To ask Her Majesty’s Government what actions they are taking to ensure effective treatment of diabetes in minority-ethnic communities.

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

My Lords, the Government are aware of the growing issue of diabetes in minority-ethnic groups. The NHS is taking a range of actions to ensure effective treatment. The recent publication of clinical guidance on type 2 diabetes by the National Institute for Health and Clinical Excellence identifies those at high risk and how best to manage the risk. It specifically mentions ethnic minorities and identifies pathways to ensure effective management.

[Lord Harrison]

My Lords, given that the worrying rise of type 2 diabetes among our ethnic communities is absorbing an ever increasing share of 10% of the NHS budget, which itself is shrinking for diabetes care, will the noble Earl institute an increase in the number of diabetes nurses, who are at the heart of communities, support the Diabetes UK campaign for ethnic-community champions and, finally, heed the advice coming from the dedicated research team at the University of Warwick that matching health professionals tutored in the cultural knowledge and understanding of our ethnic communities can give enormous benefits?

[Earl Howe]

My Lords, I agree wholeheartedly with the thrust of the noble Lord’s question. As he will know, Diabetes UK has pioneered a programme of diabetes community champions from ethnic-minority communities to raise awareness of the condition in their communities. The Department of Health has awarded Diabetes UK a grant through the volunteering fund national awards for the programme to be rolled out across 12 English cities over the next two years. I gather that 111 community champions have already been recruited in London. This is exactly the sort of initiative that we need if we are to reach those who are most at risk of developing or, indeed, being diagnosed with diabetes.

NHS: General Practitioners

Debate between Earl Howe and Lord Harrison

Wednesday 23rd May 2012 Lords Chamber

[Earl Howe]

My noble friend is extremely familiar with this area. I have also come across some extremely effective practice-based patient groups that are enormously valuable, and are valued by the GPs and other primary care staff with whom they interact. It is very much part of the world of the NHS today and we wish to see it continue.

[Lord Harrison]

My Lords—

[Baroness Wheeler]

My Lords, at the conference this week we heard the growing concern of GP leaders and delegates that grass-roots GPs were being excluded from involvement in clinical commissioning groups. How will the Minister address this, and will he ensure that CCG guidance includes best practice on how their involvement can be ensured?

Health: Diabetes

Debate between Earl Howe and Lord Harrison

Wednesday 1st February 2012 Lords Chamber

[Earl Howe]

The noble Lord is to be congratulated on bringing me back to the very important subject of the labelling of alcoholic drinks. I hope that the House will feel that he was a little unfair in blaming the Government for the line that they have taken on this. As the noble Lord knows, labelling is an area that is very largely a matter of EU competence. However, he is right that type 2 diabetes is closely linked to obesity and insufficient physical activity. We would like to see businesses use a more consistent front-of-pack nutrition labelling approach than has been achieved in the past, particularly with food.

[Lord Harrison]

Will the noble Earl recognise another acronym, the DAFNE programme, and give greater government support to rolling out such a programme, as illustrated by the noble Lord, Lord Rennard? Will be also reply to the Danish Government, who have made diabetes a priority under their presidency for the coming six months? What is being done with our Danish colleagues to promote a better understanding of diabetes and its treatment?

[Earl Howe]

The noble Lord is right to emphasise the role of DAFNE. The 2011-12 NHS operating framework signals the need to commission patient-structured education for people newly diagnosed with diabetes, and at appropriate points in their life as their condition progresses. I do not have a briefing on the dialogue with our Danish colleagues on their programme of action, but I will write to the noble Lord on that.

Health: Diabetes

Debate between Earl Howe and Lord Harrison

Thursday 14th July 2011 Lords Chamber

[Earl Howe]

My Lords, I am grateful to my noble friend. I have an astonishing figure in my brief. On average, 73 amputations of lower limbs occur every week in England because of complications to do with diabetes. It is estimated that, with the right care, 80 per cent of amputations carried out on patients suffering from diabetes would be preventable. That is the scale of the challenge. We are clear that this is a major issue for diabetes. NICE has published guidelines on in-patient management of people with diabetic foot ulcers and infection. That is vital because amputations are often preceded by ulceration. That is also why the national clinical director for diabetes considers diabetic foot care and prevention to be a major priority.

[Lord Harrison]

My Lords, will the Minister give an assurance that the retinopathy screening that was introduced by the previous Labour Government, and which has been so successful, will continue apace to match his own ambition of ensuring prevention by identifying diabetic disease of the eye at an early stage?

[Earl Howe]

The noble Lord, Lord Harrison, is quite right. England, along with the devolved Administrations, leads the world in this area. It is the first time that a population-based screening programme has been introduced on such a large scale. We are committed to continuing it. More people with diabetes are now being offered retinopathy screening than ever before and to higher standards, despite the increasing number of people with diabetes. The latest data that I have show that 98 per cent of people with diabetes have been offered screening for diabetic retinopathy during the past 12 months.

NHS: Chiropody and Podiatry Services

Debate between Earl Howe and Lord Harrison

Tuesday 26th April 2011 Lords Chamber

[Earl Howe]

My Lords, let me first make it clear to my noble friend that GP consortia will not be responsible for commissioning training—at a local level that will be the responsibility of the skills networks, made up of healthcare providers. Health Education England will be a new organisation with new executive powers. It will provide national leadership on planning and developing the healthcare workforce and promoting high-quality education and training that is responsive to the changing needs of patients and local communities.

[Lord Harrison]

Is the noble Earl aware of the recent study by the American Podiatric Medical Association which demonstrates that early recognition of foot ulcers or foot problems in diabetics can prevent hospitalisation, or indeed amputation, if action is taken early and resources are commanded to deal with potential problems?

[Earl Howe]

My Lords, I am aware of that study. If we apply the lessons learnt to the UK, the noble Lord may already know that approximately 100 people have an amputation due to foot ulceration, as a complication of diabetes, every week. The International Diabetes Federation has estimated that 85 per cent of these amputations could be prevented through early intervention by a diabetic foot team that includes a specialist podiatrist. Indeed, the diabetes foot protection team in Southampton, to take one area, reduced in-patient stays from 50 to 18 bed days and saved £1.2 million in the first three years.

Health: Spending Cuts

Debate between Earl Howe and Lord Harrison

Wednesday 30th June 2010 Lords Chamber

[Lord Harrison]

To ask Her Majesty’s Government what is their response to the report in the British Medical Journal on the effect of spending cuts on public health.

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

The Government are committed to improving the prevention of ill-health and will publish detailed proposals later this year. The determinants of public health are complex and we welcome this research. The spending review will set budgets for the years ahead and, in making savings, we will ensure that services work collaboratively and that the wider impacts of spending cuts are considered to avoid false economies.

[Lord Harrison]

Does the Minister acknowledge that it is impossible to ring-fence NHS spending from the surrounding cutpurse policies of this increasingly cut-price Government, as illustrated in the recent report? Will he tell his friends in the Treasury that decent jobs, decent housing, proper programmes for family welfare and protection of pensioners are integral to a proper and comprehensive health policy in this country? Will he slam the back door on these insidious back-door cuts?

[Earl Howe]

My Lords, the Government are conscious that the health and well-being of the population are affected by a number of factors outside the strict confines of the healthcare system. At the same time, we should not underplay the role of the NHS in tackling health inequalities, and not least the role of primary care. In that context, my department is privileged in being able to look forward to a budget that is not going to be cut over the course of this Parliament.

First Aid

Debate between Earl Howe and Lord Harrison

Thursday 17th June 2010 Lords Chamber

[Lord Harrison]

To ask Her Majesty’s Government what is their response to the St John Ambulance campaign, entitled “The Difference”, promoting better public understanding and practice of first aid.

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

My Lords, the Government admire the work undertaken by health organisations such as St John Ambulance and the Red Cross, and warmly welcome the contribution that “The Difference” can make to the treatment of the ill and injured.

[Lord Harrison]

Given that the St John Ambulance report suggests that some 150,000 lives could be saved if there was a rudimentary understanding of first aid, and given the paucity of understanding in this country—where only seven out of 100 of us have such knowledge, compared to four out of five of our German colleagues—will the Government redouble their efforts and consider including first aid in the PSHE part of the national curriculum? Will the Minister also study the work being done in the north-west, in a crucial project in Greater Manchester, where ambulancemen and paramedics teach primary schoolchildren about the work of providing and administering first aid? That has gone down very well indeed.

[Earl Howe]

My Lords, the noble Lord asks several questions there. As I have indicated, we are extremely grateful to organisations such as St John Ambulance, the Red Cross and the British Heart Foundation for the extensive and excellent work that they do. As a general approach, we are clear that the NHS locally is best placed to assess and address what is needed in its areas, as indeed in other areas of healthcare. However, we encourage NHS providers to consider the kind of partnerships that work so well.

As regards schools and PSHE, as the noble Lord will know, first aid is included in the PSHE part of the school curriculum. It is not a mandatory module, though it is often included in key stages 3 and 4. What I can do is convey the noble Lord’s concerns to my colleagues in the Department for Education.