NHS: Clinical Negligence

Debate between Earl Howe and Lord Sharkey

Tuesday 20th January 2015 Lords Chamber

[Lord Sharkey]

To ask Her Majesty’s Government what are the causes of the £3.1 billion increase in the National Health Service’s potential liabilities for clinical negligence to £25.7 billion between 31 March 2013 and 31 March 2014.

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

My Lords, there are several factors behind this increase. These include the rise in numbers of patients cared for and the complexity of their care. In addition, there has been a general rise in litigation across a number of sectors, including the NHS, which is driven in part by no-win no-fee agreements. High costs incurred by claimants in bringing civil litigation have also played a role in the increasing clinical negligence cost and associated provisions.

[Lord Sharkey (LD)]

In the last five years, NHS spending has grown by 12%. In the same period, liabilities for negligence have actually doubled. With the current rate of growth, they will take only six years to reach around £50 billion. The Medical Defence Union thinks that is unsustainable and has suggested reducing liabilities by changing the law. It suggests allowing courts to take account of the fact that the NHS and local authorities can provide some of the treatments required by successful claimants. Does the Minister agree that this is part of the way forward?

[Earl Howe]

My Lords, moneys paid in settlement of clinical negligence claims cannot be reclaimed or recycled in the way that my noble friend appears to suggest because, in the nature of NHS care, it is free from the patient’s perspective. We are, however, concentrating on various ways to reduce the number of clinical negligence incidents and, indeed, to improve patient safety, which is of course part of the way in which we can reduce the number of claims in the first place.

NHS: Cancer Diagnosis and Treatment

Debate between Earl Howe and Lord Sharkey

Monday 13th October 2014 Lords Chamber

[Earl Howe]

My Lords, the noble Lord is correct that although most waiting time standards are being maintained there has been a dip in the 62-day pathway standard in the last two quarters. However, survival rates are improving and we are treating a record number of NHS patients for cancer. Last year, 450,000 more patients were referred with suspected cancer than in 2009-10. That is an increase of 51%. In addition, campaigns such as Be Clear on Cancer have been exceptionally successful in raising awareness of symptoms. In large part, that is what has accounted for the pressure on the waiting time standards: in a way, the campaigns are a victim of their own success.

[Lord Sharkey (LD)]

My Lords, it is still true that the chances of surviving cancer can vary dramatically depending on where you live. Can the Minister say what progress has been made in understanding the reasons for those variations and what progress has been made in reducing them?

[Earl Howe]

My Lords, my noble friend is absolutely right. He will know that medical opinion is clear that a variety of reasons such as lifestyle and others account for regional variations. We want to see a uniformity of speedy diagnosis throughout the country. That depends on early presentation by the patient and speedy diagnosis when the GP first sees the patient. It is with those two things in mind that a lot of work has been going on, particularly to support GPs, but also to inform the public.

Health: Secondary Care

Debate between Earl Howe and Lord Sharkey

Thursday 26th June 2014 Lords Chamber

[Earl Howe]

The noble Baroness makes a very good point. We know that GPs in many areas of the country are under pressure and we know how hard they are working. It was with that knowledge that we agreed with the profession that we would remove from the GP contract for 2014-15 more than a third of the quality and outcomes framework’s indicators, which GPs told us were taking up too much time and resulting in a bureaucratic burden. The aim of that was to free up more time for GPs. On top of that we have the Prime Minister’s challenge fund of £50 million, which will test out new ways for GPs to give access to patients—for example, through innovative means such as Skype and e-mail.

[Lord Sharkey (LD)]

My Lords, early treatment is key to improving our low cancer survival rates. Lung cancer remains the biggest cancer killer. It has a 5% 10-year survival rate and 33% of all cases are emergency presentations. What progress has been made on improving early diagnosis?

[Earl Howe]

My noble friend is right. This is absolutely central to raising our performance as a country in successfully treating cancer. We are doing several things. We have piloted a tool to help GPs to identify patients whom they might not otherwise refer urgently for suspected cancer. The tool covered lung cancer, as well as others. Across England, 502 GP practices took part in the pilot. Initial indications are that the tool is extremely helpful. There is also an e-learning tool that offers accredited professional development for GPs. The Royal College of General Practitioners has also identified cancer as an enduring priority. It is working with Cancer Research UK and other partners in promoting models of best practice.

Public Health Responsibility Deal

Debate between Earl Howe and Lord Sharkey

Tuesday 14th January 2014 Lords Chamber

[Lord Sharkey]

To ask Her Majesty’s Government what progress they have made in persuading further fast food chains to sign up to the Public Health Responsibility Deal pledge on calorie reduction.

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

We are working hard to persuade other fast food chains to join the wide range of food businesses which have already signed up to the public health responsibility deal calorie reduction pledge and to sign up to other food network pledges. Eleven fast food partners are signatories of the responsibility deal and are taking action in a range of areas including calorie reduction. These partners cover most of the food sold in the fast food sector.

[Lord Sharkey (LD)]

I think the Minister will agree that these public health responsibility deal pledges are very useful. Given the dangers of excessive sugar in our diets, will the Minister consider adding a specific sugar-reduction pledge to the current list—with specific targets, as is already the case for salt—and will he help reduce sugar consumption by following the latest advice of Dr Susan Jebb, chair of the department’s public health responsibility deal food network, and removing fruit juice from the five-a-day recommendations?

[Earl Howe]

My Lords, I shall take my noble friend’s final question back with me. We will certainly look at it. However, I stress that our current emphasis is on overall calorie reduction, of which sugar can form a part. The scope for a reformulation to reduce sugar levels varies widely depending on the food and a reduction in sugar levels does not always mean that the overall calorie content is reduced—for example, when sugar is replaced by starch or other ingredients. The Scientific Advisory Committee on Nutrition—SACN—is currently undertaking a review of carbo- hydrates and is looking at sugar as part of that. Its report will inform our future thinking.

NHS: Children’s Congenital Heart Services

Debate between Earl Howe and Lord Sharkey

Tuesday 23rd July 2013 Lords Chamber

[Lord Sharkey]

To ask Her Majesty’s Government what assessment they have made of the recommendation of the Independent Reconfiguration Panel in its report of 30 April on children’s congenital heart services that NHS England must ensure that any new review process properly involves all stakeholders.

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

My Lords, NHS England is taking forward the new national review of congenital heart services as quickly and effectively as possible, basing its actions on the recommendations of the Independent Reconfiguration Panel. I am advised by NHS England that it will ensure that all stakeholders have a chance to contribute to its review. Any decisions must carry the confidence of the public and be focused on the best outcomes for all patients.

--- Later in debate ---

[Lord Sharkey]

My Lords, the now discredited Safe and Sustainable review proposed closing the Royal Brompton Hospital children’s heart surgery unit, yet over the past three years this unit, along with Newcastle, has been the best performing in the country. Will the Minister reassure me that, before there is another proposal to close this or any other unit, he will publish a detailed model showing exactly what factors will be taken into account in any future proposal and how each factor will be weighted?

[Earl Howe]

My Lords, the first point to emphasise to my noble friend is that the new review is the responsibility of NHS England. It is not a piece of work that Ministers are in charge of. NHS England’s advice to me is that it is too soon to describe what the exact process will be. However, I can say that NHS England is developing a process that is, in its words, “rigorous, transparent and inclusive”, particularly in the use of evidence and data. As I have said, there will be opportunities for all stakeholders to participate in the review—including, importantly, the current providers of children’s congenital heart services.

Care Bill [HL]

Debate between Earl Howe and Lord Sharkey

Tuesday 16th July 2013 Lords Chamber

[Earl Howe]

My Lords, potentially, everyone in need of care and support may benefit from these reforms. We want to make it as widely known and as apparent as possible that planning is an important matter, whatever a person’s means. If I have misunderstood the noble Lord’s question, I will review that answer and write to him, but that is the main point.

I come back to the point I made earlier: this is just the beginning and it is why we will shortly be consulting on all these implementation issues. With those comments, I hope that my noble friend will feel able to withdraw his amendment and that other noble Lords will not press theirs.

[Lord Sharkey]

My Lords, I thank all noble Lords who have spoken in favour of a comprehensive, national and centrally funded information and advice campaign under the direct control of the Secretary of State. I am sorry that my noble friend the Minister did not seem entirely convinced by that. I was very puzzled by one thing that the Minister said about the cost of an annual report on how well we were making progress in generating awareness of the terms and implications of Dilnot. I cannot see that the cost could be anything but essentially trivial. I may be wrong about that, but I should be very grateful if the Minister would clarify, perhaps in writing later, why he thinks that the cost would be substantial at all.

I continue to feel that the whole issue of providing information and understanding is much too important to be left to local authorities and for the Secretary of State not to have direct responsibility for it. The task facing any information campaign in this area is enormous. The last survey that I saw showed, for example, that only 17% of UK adults understand what a percentage is—even that may be an overstatement—and Dilnot’s implications are much more complicated than that. We need the best communication with the most money and we need obvious accountability. That means central government and the Secretary of State having responsibility.

Given the opinions expressed around the Chamber today, we may well want to return to this issue on Report. I beg leave to withdraw the amendment.

Food: Fast Food

Debate between Earl Howe and Lord Sharkey

Thursday 21st March 2013 Lords Chamber

[Lord Sharkey]

To ask Her Majesty’s Government what is their assessment of the effectiveness of the Responsibility Deal for Calorie Reduction in achieving significant product reformulation in food sold by fast food operators.

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

My Lords, the responsibility deal’s calorie-reduction pledge challenges businesses, including fast food companies, to take action to help people eat fewer calories. This includes product reformulation. Responsibility deal partners report annually on the progress that they have made against their pledges. Annual updates for 2012-13 will be published on the responsibility deal website in summer 2013.

[Lord Sharkey]

My Lords, the plain fact is that not a single fast food operator has signed up to the calorie-reduction pledge. I asked McDonald’s why and it said that it was because of concerns about the lack of clarity and vagueness in some of the Government’s definitions. If the calorie-reduction pledge does not work with fast food operators, how else can we make certain that they reduce calories in the 5.5 billion meals they serve every year in the UK?

[Earl Howe]

In fact, my Lords, 32 businesses have signed up to the pledge to help people consume fewer calories, which is a responsibility deal priority. They include seven of our major retailers and some of the nation’s biggest food manufacturers, as well as Subway, which is a fast food company—so we do have one. It is a deliberately wide-ranging pledge, allowing companies and their customers to reduce calories through a broad range of actions. I say to my noble friend, however, that we will have fast food companies very much in our sights over the coming months.

Children: Obesity

Debate between Earl Howe and Lord Sharkey

Wednesday 6th February 2013 Lords Chamber

[Lord Sharkey]

To ask Her Majesty’s Government what assessment they have made of the factors contributing to the rise in childhood obesity.

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

My Lords, obesity is a complex issue, and there are many factors that contribute to children becoming obese. We are committed to tackling obesity in children. Our call to action on obesity sets out the actions that everyone needs to take. For our part we will continue investing in the Change4Life programme, the national child measurement programme, and the School Games.

[Lord Sharkey]

My Lords, one-third of our children are already obese, and the fact is that cheap fast food can be a major contributor to obesity. The Government’s responsibility deal for calorie reduction has signed up 31 companies, which have promised to reformulate their products to make them less fattening. However, according to the Department of Health’s website, not one of these signatories is a fast-food operator. Does this not suggest a failure of the voluntary approach and that we need regulation, as the BMA says, to make food companies play their proper part in reducing obesity?

[Earl Howe]

My Lords, I am grateful to my noble friend. In fact, the responsibility deal has led to a number of very important gains and benefits, not least from food companies: food retailers as well as food manufacturers. Calorie labelling, for example, has expanded rapidly in out-of-home settings; we now have labelling in around 9,000 outlets across the country, which is to be welcomed. As my noble friend said, 31 companies, some of them household names, have signed up to the responsibility deal calorie reduction pledge. However, this is an area that we continue to work on, and I think my noble friend’s comments are well placed.

Health: Cancer

Debate between Earl Howe and Lord Sharkey

Monday 14th January 2013 Lords Chamber

[Earl Howe]

My Lords, via the Medical Research Council we are supporting a study to assess the effectiveness of a new test called the Mcm5 protein test to see if it can help to diagnose cancer of the pancreas, bile duct and gall bladder. I am also aware of a number of other research projects that my department is funding in the field of pancreatic cancer and I would be happy to write to the noble Lord with the details.

[Lord Sharkey]

My Lords, where you live will dramatically affect your chances of surviving pancreatic cancer. In south-west London the one-year survival rate is 22% while in north Trent it is 11%. Do we know why this is? What are we getting right in south-west London but not in north Trent?

[Earl Howe]

My noble friend is absolutely right to raise the point. To support the NHS in tackling regional variations in cancer survival rates, we are providing data to providers and commissioners that allow them to benchmark their services and outcomes against one another and to identify where improvements need to be made. Surgical resection is currently the best curative intervention for pancreatic cancer, and through the National Cancer Intelligence Network we have already made available data collections on the survival rates and surgical resection rates across a range of cancers, including pancreatic cancer.

NHS: Clinical Networks

Debate between Earl Howe and Lord Sharkey

Wednesday 12th December 2012 Lords Chamber

[Lord Sharkey]

My Lords, I declare an interest as a lay member of a cancer network lung cancer group. I know the Minister is aware that our survival scores for lung cancer need improvement and that early diagnosis is the key to that improvement. In the light of that, what steps are being taken to make absolutely certain that any reduction in the number, staff or funding of cancer networks does not damage the efforts to improve early diagnosis?

[Earl Howe]

My Lords, I am grateful to my noble friend. As regards cancer, it is important to look at what the Government are doing across the piece. As the noble Lord may recall, the cancer strategy that we published a while ago is backed by more than £450 million of investment. This is specifically to target earlier diagnosis of cancer; to give GPs increased access to diagnostic tests; to allow for the increased testing and treatment costs in secondary care; to support campaigns; and so on. That is a large sum of money and it is committed.

NHS: Women Doctors

Debate between Earl Howe and Lord Sharkey

Tuesday 6th November 2012 Lords Chamber

[Earl Howe]

The noble Baroness raises another very important issue. Unfortunately, I do not have any information in my brief on that point, but if I can obtain it I shall be happy to write to her.

[Lord Sharkey]

Does the Minister agree that monitoring the number of women in leadership roles in the NHS from consultant upwards will be a marker of appropriate career progression?

[Earl Howe]

Yes, indeed, my Lords. The noble Baroness, Lady Deech, raised that in her report as an action point. It can be done at a trust level or at a higher level in the health service. But it is certainly important to monitor—I understand that the term is “credentialing” —the skill sets of those doctors, who may move out of the health service and want to move back in again, so that jobs can be found for them more easily.

Diabetes

Debate between Earl Howe and Lord Sharkey

Tuesday 10th July 2012 Lords Chamber

[Lord Sharkey]

To ask Her Majesty’s Government what data they have on, or what best estimate they can give of, the extent to which the consumption of sugar will contribute to the substantial increase predicted in the incidence of diabetes in England and Wales.

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

My Lords, the Government currently cannot provide an estimate of the extent to which sugar intake will lead to future incidence of diabetes in England and Wales, because, on balance, there is no clear evidence that sugar intake alone specifically causes diabetes. Obesity increases the risk of type 2 diabetes. The habitual consumption of calories in excess of needs for a healthy body weight results in weight gain, irrespective of whether these are from sugar or fat.

[Lord Sharkey]

My Lords, by 2050, on current trends, at least half of adults and a quarter of children are predicted to be obese, which will cause a huge epidemic of diabetes. Many experts agree that the excessive consumption of sugar is a factor in obesity and in diabetes. In fact, US scientists have concluded that sugar consumption levels are now so harmful that sugar should be controlled and taxed in the same way as alcohol and tobacco. Will the Minister give urgent consideration to taxing sugar in processed foods to help avert an imminent public health disaster?

[Earl Howe]

My Lords, we keep the question of taxation under review in the light of emerging international evidence on its impact. That will include looking at the experience of the recently introduced tax on saturated fat in Denmark and what effect it has had on diet and health. With any fiscal measure, there is always a risk of unintended consequences, so we would have to look at this particularly carefully.

NHS: Public Information and Advice

Debate between Earl Howe and Lord Sharkey

Tuesday 12th June 2012 Lords Chamber

[Lord Sharkey]

To ask Her Majesty’s Government whether they plan to review, after an appropriate interval, the comparative performances of public health information and advice campaigns under (1) the new, and (2) the former, NHS architectures; and, if so, when and whether the findings of that review will be made public.

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

My Lords, the department continuously reviews the performance of its public health information and advice campaigns. Our investment in campaigns reflects evidence of their effectiveness. Summaries of campaign research are published online as part of our freedom of information publication scheme. Publication typically occurs six months to a year after receipt of the final research report. As evaluation is ongoing, we have no plans to review the impact of campaigns against specific changes to NHS architecture.

[Lord Sharkey]

I thank the Minister for that Answer. He will be aware that the country faces an epidemic of obesity, with predictions that nearly a half of all adults could be obese by 2030. He will also know that changing childhood eating habits is the key to addressing this problem. What long-term plans do the Government have for information and advice campaigns aimed at influencing childhood eating habits?

[Earl Howe]

My Lords, my noble friend is absolutely correct to highlight the importance of preventing obesity, particularly obesity in the young. He will be reassured to know that the Change4Life Campaign, which we have continued from the previous Government, will include this as a major focus into the future.

Health: Oral Cancer Detection

Debate between Earl Howe and Lord Sharkey

Tuesday 6th December 2011 Lords Chamber

[Earl Howe]

My Lords, my understanding is that HIV needs to be fairly far advanced before it manifests itself in the mouth. However, the noble Baroness is absolutely right with regard to HPV—human papilloma virus—because since 2009 there has been further research suggesting a link between HPV and oral cancer. There is now a sufficient evidence base to suggest that infection with HPV is a risk factor, particularly for the soft tissues at the back of the mouth. Her point about dentists picking this up is very well made. My understanding is that dentists are very much on the lookout for these symptoms.

[Lord Sharkey]

My Lords, according to Macmillan Cancer Support, mean survival times for cancers of the stomach, oesophagus, pancreas, brain and lung have barely increased in the last 40 years. These cancers account for 39 per cent of all cancer deaths, but attract only 13 per cent of all cancer research funding. Does the Minister think this is a satisfactory balance and, if not, can he tell us how the Government might be able to help remedy the situation?

[Earl Howe]

My Lords, I agree with my noble friend that it is not satisfactory. However, the position with research funding from government sources is that proposals are evaluated on the basis of merit; there is no predisposition to any particular kind of research as long as it is high quality. Both the MRC and my department, with the National Institute for Health Research, are open to proposals of high quality to address unmet areas of research.

Health: Early Diagnosis

Debate between Earl Howe and Lord Sharkey

Monday 21st November 2011 Lords Chamber

[Lord Sharkey]

To ask Her Majesty’s Government what provision there will be for national early diagnosis campaigns for serious diseases following the enactment of the Health and Social Care Bill.

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

My Lords, both Public Health England and the NHS Commissioning Board, subject to the passage of the Bill, will have a clear interest in ensuring that early diagnosis supports improved outcomes in line with the NHS outcomes framework, the public health outcomes framework and the Secretary of State’s mandate. The Government, as set out in Healthy Lives, Healthy People: Update and Way Forward, continue to reflect on where commissioning responsibility for early diagnosis campaigns should rest.

[Lord Sharkey]

The Minister will know that there have been recent and very welcome significant advances in the early diagnosis of bowel and oesophagal cancers, but not in lung cancer, which is the most common cause of cancer deaths in men and women. Cancer Research UK points out that early diagnosis would make a significant difference to the current 5 per cent 10-year survival rate. Given that, can the Minister tell the House how much money will be spent on lung cancer early diagnosis campaigns in this financial year and how much is planned for next year?

[Earl Howe]

My Lords, we have provided funding for a number of local lung cancer awareness campaigns. On 10 October, we launched a five-week regional lung cancer awareness campaign in the Midlands, using TV, radio, press and face-to-face events. All those campaigns are aimed at improving public awareness of the signs and symptoms of lung cancer and to encourage people to visit their GP when they have symptoms. An evaluation of the impact of those campaigns is now taking place. I do not have the figure in front of me of the cost of those specific campaigns, but I shall let my noble friend know.