Women: Postnatal Depression

Debate between Lord Alderdice and Earl Howe

Thursday 5th February 2015 Lords Chamber

[Earl Howe]

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

[Lord Alderdice (LD)]

My Lords, we know that one of the very important elements in support of women in the pre- and post-partum period is the quality of the relationship between the father and the mother of the child, and that where there is a problem in encouraging that, there is frequently difficulty. Given that, is my noble friend satisfied that this element of the relationship is sufficiently addressed, appreciated and nourished in all our facilities?

[Earl Howe]

The role of the father, as well as of course that of the mother, is emphasised in all the guidance—certainly in the healthy child programme but also in the work done under family nurse partnerships, which targets the most vulnerable families. That programme provides intensive support to young first-time mothers and their babies. It explicitly involves fathers—and/or other family members as well—as long as the mother wants the father to take part.

World Innovation Summit for Health

Debate between Lord Alderdice and Earl Howe

Monday 16th December 2013 Lords Chamber

[Earl Howe]

My Lords, we need to hold the NHS to account by reference to the outcomes that it achieves. I do not belittle the need to spend sufficient sums of money. The National Survey of Investment in Adult Mental Health Services has indicated that reported spend on mental health services has continued to hold reasonably steady over time. I reiterate that mental health and well-being is a priority for the Government, as I hope the noble Baroness knows. We have clear indicators in the NHS outcomes framework, which will ensure that NHS England will need to focus on this area very closely.

[Lord Alderdice (LD)]

My Lords, it is extremely welcome that my noble friend has emphasised again that for the Government, under the Health and Social Care Act, parity of esteem between physical and mental health is to be maintained in this country. Perhaps I might press my noble friend a little further than the noble Lord, Lord Crisp, did. Have there been discussions between the Department of Health and DfID about DfID espousing parity of esteem for physical and mental health in its proposals, and have there been discussions with other government departments, such as the FCO, about the increasing abuse of mental health and psychiatry facilities for political prisoners in various parts of the world, not least in some of those countries with which we have good relations, including Russia?

Health: Talking Therapy

Debate between Lord Alderdice and Earl Howe

Tuesday 3rd December 2013 Lords Chamber

[Earl Howe]

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

[Lord Alderdice (LD)]

My Lords, I entirely support my noble friend’s commitment to good outcomes, but those also require sufficient inputs. If the noble Baroness’s request for a right to talking therapy were implemented tomorrow, it would completely collapse because there simply are not enough trained therapists to provide the care that is required. What measures are the Government taking to ensure that in future there will be sufficient trained therapists to provide the parity of care for those with mental illness that is available to those with physical illness?

[Earl Howe]

I can assure my noble friend that Health Education England has it in its sights to make sure that sufficient numbers of professionals are trained in the talking therapies, and that work is ongoing.

NHS: Health and Social Care Act 2012

Debate between Lord Alderdice and Earl Howe

Wednesday 9th October 2013 Lords Chamber

[Earl Howe]

The noble Lord makes a good point. There is, I think, a desire on everybody’s part not to see competition result in a race to the bottom on price. That is why we have specified that commissioners must make clear what standards they expect and apply those consistently to whoever is tendering for the service in question at a price which reflects a fair value. We believe that the current rules protect the NHS but also protect those bidding. I emphasise that competition will not be pursued as an end in itself; it will be pursued as a means to drive up quality.

[Lord Alderdice (LD)]

My Lords, it is quite clear that there are certain kinds of services that benefit from being grouped together and provided by large providers who can do so economically but to a high quality. However, there are other services that are better provided locally by people who know the circumstances and are often working in relatively small charitable bodies; for example, in the mental health sector. It is very difficult for these to tender in the way that larger companies can. Can my noble friend give me some reassurance that the Government recognise this dilemma and are trying to find ways in which smaller, local, charitable providers in certain areas can be protected, facilitated or encouraged, so that we are not simply taken over by larger corporations, which may not be in the best interests of patients?

[Earl Howe]

My noble friend makes an important point. I think that it is common to all sides of the House that charities and social enterprises play an important part in providing NHS care. They have done so for many years, and give patients more choice of where and how they are treated. We have a set of rules which, at least in theory, should protect those groups of providers. If a commissioner fails to take account of providers who are capable of providing a service and simply, for example, rolls over an existing contract, then it is open to the provider in question to complain to Monitor, which will be the adjudicator of any anti-competitive conduct.

Department of Health: Budget

Debate between Lord Alderdice and Earl Howe

Thursday 6th December 2012 Lords Chamber

[Earl Howe]

My Lords, we did, as the noble Lord would expect, look at the anticipated surplus this time last year and we channelled an extra £150 million into social care then in the near-certain knowledge that the department would generate a surplus during the year. However, as he will know, it is an inexact science to predict in December what the outturn will be in April, and one has to be prudent at that stage.

[Lord Alderdice]

My Lords, my noble friend gave a reassuring Answer a week or two ago about the balancing of expenditure and resources between mental health services and physical health services within the NHS. Is it possible for my noble friend’s department to look to the possibility of any surpluses in the future being used to achieve greater parity between mental health services and the rest of the NHS, given the decisions made in your Lordships’ House regarding the Health and Social Care Act 2012 and the mandate for the NHS Commissioning Board that has flown from it?

[Earl Howe]

My noble friend makes an extremely important point. He will know that the Government have made it clear that mental health problems should be treated as seriously as physical health problems. That commitment has now been made explicit in the Health and Social Care Act 2012. As he mentioned, the Government’s mandate to the NHS Commissioning Board explicitly recognises the importance of putting mental health on a par with physical health. It tasks the NHS Commissioning Board with developing a collaborative programme of action to achieve that and it will be held to account accordingly.

Health: Mental Health

Debate between Lord Alderdice and Earl Howe

Wednesday 21st November 2012 Lords Chamber

[Earl Howe]

My Lords, as the noble Baroness made clear, the NHS constitution sets out that patients have the right to drugs and treatments that have been recommended by NICE for use in the NHS if their doctor says that they are clinically appropriate for them; that includes talking therapies for certain problems. The mandate to the NHS Commissioning Board is clear about everyone who needs mental health services having timely access to the best available treatment. The NHS will be expected to demonstrate progress in achieving that by 2015, as I mentioned. For many patients, there are few better therapies than talking therapies. Given that the board must deliver those outcomes, the rest follows.

[Lord Alderdice]

My Lords, I will press the Minister further on this. In his response to my debate on mental health on 8 October, he undertook to write on a number of issues. True to his word, as we have come to expect, he wrote a long, substantial, constructive and positive letter in which he discussed psychological therapies being available for disturbed people. I want to pick up on what the noble Baroness has said about schizophrenic disorders. There is a tendency for people with the schizophrenias simply to be given medication and social management. There are psychological treatments—family therapy and others—that are appropriate. Can my noble friend ensure that those who suffer from the schizophrenias will also receive appropriate psychological therapies and not simply be abandoned to medication and social management?

NHS: Mental Illness

Debate between Lord Alderdice and Earl Howe

Tuesday 17th July 2012 Lords Chamber

[Earl Howe]

My Lords, we have deliberately taken a generic approach to the NHS outcomes framework. That said, the framework for 2012-13 contains three improvement areas relating specifically to mental health: premature mortality in people with serious mental illness; employment of people with mental illness; and patient experience of community mental health services. Therefore, the noble Baroness is not quite right in what she has just said. Many of the indicators in the outcomes framework relate to all patients, including in relation to safety incidents, for example, or experience of primary care. Improving outcomes for people with mental health problems will be a crucial element of success.

[Lord Alderdice]

My Lords, five out of the six recommendations of this excellent report by the noble Lord, Lord Layard, and his colleagues emphasise the importance of IAPT, an excellent initiative begun by the previous Government, which is being built on by the coalition Government. However, from the time of the previous Government to now, I continue to receive reports that psychotherapy departments, particularly those that provide non-cognitive behaviour therapies such as art therapies, psychodynamic psychotherapy, group analytic psychotherapy and family therapy, are closing down or are unable to get contracts. Can my noble friend help me to understand why that might be the case since, while CBT is valuable and helpful in many circumstances, it is not the only approach to treatment that has been demonstrated to be helpful in those who need psychological therapies?

[Earl Howe]

I am very happy to take the advice of my noble friend, who is of course an expert in this area. Historically, it is true to say that access to talking therapies in the broadest sense has been very poor. That is why we have invested £400 million in rolling out the IAPT programme, which makes available a range of NICE-recommended therapies to a much larger cohort of people. However, I will take my noble friend’s point away and, if I can throw any light on the issue that he has raised, I will gladly write to him.

Health: Cardiology

Debate between Lord Alderdice and Earl Howe

Monday 24th October 2011 Lords Chamber

[Lord Alderdice]

My Lords, given that the review of paediatric cardiac surgery services presented earlier this year suggested a requirement for 400 or 500 cases per year, which is a level that cannot be provided in Northern Ireland so the service there would not be allowed to continue, can my noble friend reassure me that the Department of Health has been in discussion with the Department of Health, Social Services and Public Safety in Northern Ireland to see what the Department of Health here can do to ensure that paediatric cardiac surgery services are available to the children and young people of Northern Ireland?

[Earl Howe]

As my noble friend knows, the children’s heart surgery unit in Belfast is not part of the Safe and Sustainable review as it is the responsibility of the healthcare systems in the devolved Administration. It is for the Northern Irish health service to take a view on the safety and sustainability of those services and to consider the recommendations that flow out of the review in this country. We will, of course, share the learning from our experience in England, but I emphasise again that this is a matter for the NHS, and not Ministers, to resolve.

Health: Breast Cancer

Debate between Lord Alderdice and Earl Howe

Monday 3rd October 2011 Lords Chamber

[Earl Howe]

My Lords, the noble Baroness, with her expert knowledge in this area, is absolutely right that access to appropriate treatment, delivered to a high standard, is critical to improving outcomes. We have made a commitment to expanding radiotherapy capacity by investing around £150 million more over the next four years. That is intended specifically to increase the utilisation of existing equipment, establish additional services and make sure that all patients who need the therapy can get it. We are investigating a tariff for IMRT; that is part of our work towards the aspiration to ensure that IMRT is available in at least one centre per cancer network by 2012. It is a matter for local decision-making, but an IMRT development programme is now in place.

[Lord Alderdice]

My Lords, would my noble friend agree that progress in this important area of breast cancer is likely to be found in the identification of molecular markers and the design of appropriate targeted medications, as has been the case in breast cancer with HER2 and Herceptin, for example? Would he acknowledge that it is a very expensive treatment? Although it really improves quality of life as well as mortality and outcome, the expense of not only the medication but the tests themselves is considerable. How will the NHS cope with this important but very expensive progress?

[Earl Howe]

My noble friend makes an extremely important point. That is why we need a body such as NICE, the National Institute for Health and Clinical Excellence, to advise the health service on what treatments represent cost-effective value for money. The tendency of drugs to impose considerable cost on the NHS is very great, as he points out. It is important that clinicians focus on those drugs that really do the best for patients. I am aware that a number of drugs are currently being assessed by NICE with regard to breast cancer.

NHS: Future Forum

Debate between Lord Alderdice and Earl Howe

Tuesday 14th June 2011 Lords Chamber

[Lord Alderdice]

My Lords, I am grateful to my noble friend for repeating this important and welcome Statement. It reaffirms the coalition’s commitment to a reformed NHS, which is patient-centred, clinician-led and outcome-focused. Does he accept that the concerns, which are fully addressed in this Statement, were shared not alone on these Benches but by many Conservative colleagues, as well as patients, professionals and other stakeholders, and others in your Lordships’ House, as exemplified in the national debate instituted by the Government? Will he now confirm that, despite the anxieties that there have been, the duties and responsibilities of the Secretary of State will be reaffirmed in the Bill in the language used when our beloved NHS was established? Will he confirm that there will now be a level playing field and that private providers will not be advantaged against public providers, as was the case under the previous Labour Government? Will he further confirm that Monitor will be redesigned to be more than a mere economic utility regulator but will facilitate co-operation and integration, as well as competition on quality rather than on price?

[Earl Howe]

I am most grateful to my noble friend. He is right that the concerns that arose in relation to the Bill stemmed from many quarters—certainly from my own Benches and his but also from the wider public. I think we took on board those concerns almost as soon as the Bill was published. They were reflected in a large volume of correspondence, a high proportion of which I dealt with. I was keenly aware of the issues occupying people’s minds. I believe and hope that in the Future Forum’s report, and in our acceptance of that report, we have the basis for allaying most of those concerns.

My noble friend asked three questions. The first was around the duties of the Secretary of State. The Statement made clear that, as now, the Secretary of State will remain responsible for promoting a comprehensive health service. It has never been our intention to do anything else. Indeed, the Bill did not specify anything else. That will be underpinned by the new duties that the Bill already places on the Secretary of State around promoting quality improvement and reducing inequalities. We shall be setting out other duties on the Secretary of State to strengthen his accountability.

On private providers, the noble Lord is right. We are clear that private providers should not be advantaged over the NHS. Indeed, the amendments that we will make to the Bill will put that concern to rest, I hope, once and for all.

Monitor will have its duties rephrased. As the Statement also made clear, the duty to promote competition, which is now in the Bill, will be replaced by a different set of duties around patients, integration and the promotion of quality. There will be quite a different flavour to Monitor's duties.

Health: Brittle Bone Society

Debate between Lord Alderdice and Earl Howe

Monday 6th June 2011 Lords Chamber

[Earl Howe]

My Lords, I should be more than happy to see the noble Lord and representatives of the Brittle Bone Society to discuss those matters. I am well aware of the issue he raises. I understand that when an application was made to designate specialised services for children with brittle bone disease as a national specialised service, no similar case was made for adult services. However, if the society or leading clinicians in this field now feel that an application should be made, we would be pleased to refer it to the Advisory Group for National Specialised Services against the normal criteria.

[Lord Alderdice]

My Lords, given that osteogenesis imperfecta is a genetic disorder and that real progress in proactive treatment for sufferers will require progress in genetic medicine, is my noble friend reassured that we retain in this country sufficient researchers, funding and facilities to ensure that sufferers from osteogenesis imperfecta and their families can look to research from this country to see progress in proactive treatment rather than simply to elsewhere, particularly the United States of America?

[Earl Howe]

My noble friend is absolutely right. As he knows, the UK is one of the pioneers of genetic research; it takes a lead role in the international human genome project and its application to medicine. The human genome project has sequenced the 25,000 or so genes that make us human and research is now looking at how groups of genes interact not only with each other but with environmental factors to cause disease. We remain absolutely committed to genetics research and aim to make the UK the best place in the world for that research to continue. If there are proposals relating to this specific condition, my department will be very pleased to receive them.

Health: Cancer

Debate between Lord Alderdice and Earl Howe

Tuesday 10th May 2011 Lords Chamber

[Earl Howe]

My Lords, I pay tribute, first of all, to the James Whale Fund for Kidney Cancer, which is an organisation that I know quite well, as the noble Lord is aware. It is doing tremendous work, not least in the field of specialist cancer nursing but also as regards its care line, on which I congratulate it. The noble Lord asked whether I would agree to meet the fund. For my own part I would be very happy to do so, but it may be more appropriate for my colleague in the department, who deals with cancer services, to do so as well. We recognise that more needs to be done to raise awareness of the signs and symptoms of rarer cancers such as kidney cancer. Our strategy for cancer sets out our commitment to work with a number of cancer-focused charities. Officials have already met such charities and more meetings are planned over the summer.

[Lord Alderdice]

My Lords, the noble Lord, Lord Davies, raised the question of National Institute for Health and Clinical Excellence approval of chemotherapeutic drugs. After a nephrectomy, not much else is available, because radiotherapy is generally not terribly helpful in renal cell carcinoma and other cancers of the kidney. The National Institute for Health and Clinical Excellence has to look, with these often quite expensive drugs, at how much benefit is being achieved for the cost of the drug. It is not an easy decision, which is why the noble Lord, Lord Davies, raised the question of some non-approved drugs. Is the Minister satisfied about the judgments being made by NICE about the benefit as against the cost? They are difficult judgments, but is he satisfied with the judgments being made?

[Earl Howe]

I am grateful to my noble friend. He is absolutely right; these are very difficult decisions to make. NICE issues final guidance on the use of a drug only after very careful consideration of the evidence and wide consultation with stakeholders. The noble Lord, Lord Davies, and, I am sure, my noble friend will be aware that one particular drug has been refused or not recommended by NICE. However, we have established the cancer drugs fund, which will enable individual clinicians on a patient-by-patient basis to apply to access drugs even though they have not been recommended by NICE.

NHS Reform

Debate between Lord Alderdice and Earl Howe

Monday 4th April 2011 Lords Chamber

[Lord Alderdice]

My Lords, I am grateful to my noble friend for repeating the Statement made in another place and I will not rehearse our support on these Benches for reform of the health service. Some of those reasons were wonderfully spelt out by the noble Lord, Lord Turnberg, in his debate on the NHS last week. However, it is no secret that Members on these Benches do not regard the Bill as it presently stands as perfect. Despite the fact that it did not receive a great deal of attention in the speculative narrative of the noble Baroness, Lady Thornton, it is known that my colleagues want to see changes and indeed have welcomed some of the changes that we have already seen.

I wonder if I may press my noble friend on two issues. The first was also raised by the noble Baroness—the timescale. My noble friend indicated that he sees the timescale as using the Recess, but the Health Secretary wishes to engage and consult with a substantial number of people. Given that, when the Bill comes back after Report in the other place with amendments, which we would welcome, can we expect it to come to this House before the Summer Recess or will the natural break take us a little further? That may be necessary, and some clarity would be helpful, if my noble friend can provide it.

Secondly, in repeating the Statement my noble friend mentioned increasing accountability,

“locally, through the democratic input to the Health and Wellbeing Boards”.

I and my colleagues welcome this, but can he spell it out a little further? At present, the locally elected democratic input to health and well-being boards is extremely modest, so we would be keen to see an indication that something rather more substantial might be possible.

[Earl Howe]

I am grateful to my noble friend. In answer to his first question, it is likely that the period of listening and engagement will extend through the Easter Recess and beyond. The precise duration of the intermission has not been fixed yet because much will depend on the volume of feedback that we receive. While I have not spoken to the usual channels about this, I am still working on the premise that your Lordships’ House will receive the Bill prior to the Summer Recess. I believe that, if the House agrees, we can thereby reach the Bill’s conclusion within a reasonable space of time. That will enable us to adhere to the current timetable for the implementation of our proposals. But that statement does come with what I might call a health warning because we are clear that we want to listen to the opinions of everybody who counts in this, and it could be that the period of reflection may extend into the late spring. But no doubt I will be able to enlighten him further in due course.

My noble friend mentioned the democratic input at health and well-being board level. This is one of the issues that we will want to receive opinions about because I know there has been disquiet on this front. He knows that his party was instrumental in building into our plans the democratic element of health and well-being boards and the fact that they should be situated at local authority level. That was a very positive contribution made by the Liberal Democrat Party which has, by and large, been widely accepted. If there are ways we can bolster that democratic accountability without cutting through the core principles that we have articulated for decision-making in the health service, then we are willing to look at them.

Health: Cancer

Debate between Lord Alderdice and Earl Howe

Wednesday 2nd March 2011 Lords Chamber

[Lord Alderdice]

My noble friend introduced the question of diagnosis, which is increasingly a multi-professional matter, involving pathologists, surgeons, radiologists and so on. This seems self-evidently a good thing. However, is the department accumulating evidence to show that it is actually improving the outcomes? It is of course an expensive procedure to involve so many senior professionals together.

[Earl Howe]

My noble friend is quite right. It does involve often a number of senior clinicians. The key to diagnosis, however, is to get in early, as I am sure he would recognise. The outcomes strategy commits us to saving the additional 5,000 lives very largely through additional identification of early cancer. In fact, 3,000 of the 5,000 lives that we are hoping to save will be saved, we hope, by earlier diagnosis. A good example of that is that over 90 per cent of bowel cancer patients diagnosed with the earliest stage of the disease survive five years from diagnosis, compared to only 6.6 per cent of those diagnosed with the advanced disease.

NHS: Targets

Debate between Lord Alderdice and Earl Howe

Monday 20th December 2010 Lords Chamber

[Earl Howe]

My Lords, I do not accept that. The previous Government recognised that contestability in the provision of care was a very powerful driver to improve quality of services. I do not think that privatisation of the health service will result from the proposals. We will reach a better stage of quality in provision of care only if we allow the best providers out there to compete for services. As long as the principles of the NHS remain—which they will do under this Government—for a service free at the point of need without being based on ability to pay, we will have the NHS that we all know and love.

[Lord Alderdice]

My Lords—

Health: Passive Smoking

Debate between Lord Alderdice and Earl Howe

Tuesday 30th November 2010 Lords Chamber

[Lord Alderdice]

My Lords, on Her Majesty’s Government’s commitment after ratification in 2004 to produce a five-year implementation report, I note that the WHO website gives no indication that the report due on 16 March this year was in fact forwarded to the WHO. Will my noble friend confirm whether the report has been forwarded?

In addition, given the enormous amount of smuggled tobacco—accounting for some half of hand-rolled tobacco and 10 per cent of cigarette tobacco in the United Kingdom—what has happened to our commitment under Article 15 to deal with illicit tobacco and, indeed, to the protocol mentioned in the commitment in the Uruguay meeting of earlier this month to ensure that, by 2012, others will also fulfil their responsibilities?

[Earl Howe]

In answer to my noble friend’s first question, yes, the report has been forwarded to the WHO.

On illicit trade, HMRC leads on tackling the availability of illicit tobacco and has carried out—as I am sure my noble friend knows—a great deal of activity to tackle that market through its overseas network of fiscal crime liaison officers, as well as through activity at the border and inland detection work. HMRC also works closely with local authority trading standards officers. Those efforts have led to a decline in the market share of illicit cigarettes from 21 per cent in 2000 to 11 per cent, according to the latest available figures. However, he is right that hand-rolling tobacco in particular remains a problem.

NHS: Prebiotics

Debate between Lord Alderdice and Earl Howe

Wednesday 17th November 2010 Lords Chamber

[Earl Howe]

The noble Baroness is absolutely right, not for the first time, about the devastating incidence of C. difficile infection. More than 25,000 cases of C. difficile infection are reported annually and there remain significant variations in outcomes among organisations.

In principle, prebiotics should be beneficial, but there is in fact little good evidence to show that they work or that food can provide a prebiotic effect. There is likely to be considerable inter-patient variation in the gut flora response to prebiotics, which could be exacerbated by differences in diet. However, as I have already indicated, we will look closely at the issue.

[Lord Alderdice]

My Lords, given the difficulties and dangers of Clostridium difficile, can my noble friend reassure me that the Department of Health has noted that the Food and Drug Administration has in recent days approved fast-track designation for a parenteral toxoid vaccine, which thus opens the possibility—I hope—that immunisation will be possible, in particular for elderly, vulnerable people who are in danger of developing Clostridium difficile infection?

[Earl Howe]

My Lords, I am aware of the interesting development of a vaccine for C. difficile, but I understand that the vaccine is still in clinical trials. As my noble friend indicated, the company may be seeking agreement from the US FDA to fast-track the application when the development programme is complete, as that would give them access to the US market. It is of course for the manufacturer to decide when and if it wishes to seek access to the market in the UK and the wider EU.

Healthcare: Costs

Debate between Lord Alderdice and Earl Howe

Monday 15th November 2010 Lords Chamber

[Earl Howe]

My Lords, creating a seven-day service is a particular concern of mine, and the noble Baroness is quite right to raise it, particularly given her long experience in the health service. As for Agenda for Change, any alterations to existing terms and conditions, such as the unsocial hours payment or sick pay, would need to be negotiated in partnership with NHS Employers and trade unions, through the NHS Staff Council.

[Lord Alderdice]

My Lords, I know it is extremely difficult, but has my noble friend had the opportunity to explore how much of the increase in health service costs in recent years has come about because of the increase in administration and management costs? I refer not simply to the salaries of administrators and managers but to the administration for the administrators, and to the amount of time that clinical and professional staff must spend in servicing the requirements put on them by administrators and management.

[Earl Howe]

My noble friend is right to pinpoint this area. If my memory serves me correctly, the average annual increase in management and administration costs over the past 10 years has been 6.2 per cent per year, which is by far and away higher than the increase in costs in clinical areas, for example. That is why we are determined to reduce the administrative cost of running the NHS, and we are in the process of planning for exactly that.

Mental Health

Debate between Lord Alderdice and Earl Howe

Wednesday 10th November 2010 Lords Chamber

[Earl Howe]

My Lords, yes. We know that people with severe mental illness die on average 20 years sooner than others and that the majority of these deaths are smoking related. Improving public health is at the core of the Government’s health policy, as I expect the noble Baroness is aware. We will make clear our priorities in this area when the public health White Paper is published.

[Lord Alderdice]

My Lords, we know that early years development is absolutely critical to whether adults will be vulnerable to mental illness later. What things do the Government intend to do in terms of early development, not just in health but across departments, to try to ensure less vulnerability not only in young people, although that is important, but also in adults, since these vulnerabilities develop early on?

[Earl Howe]

My Lords, my noble friend is absolutely right: this is a cross-government effort. It is not simply for the Department of Health to deal with the issue because just about every department has some sort of remit in this area. I would say that, in particular on the attainment of children at school, we will focus very much on children from disadvantaged backgrounds because there is a high correlation between mental ill health and poverty, and mental ill health and deprivation. That will be a major focus.

Health: Chronic Fatigue Syndrome

Debate between Lord Alderdice and Earl Howe

Monday 8th November 2010 Lords Chamber

[Earl Howe]

My Lords, this is a pragmatic decision by the advisory committee on donation. In the case of CFS/ME, which we are looking at at the moment, the committee recommended that the donation policy should be brought into line with other relapsing conditions, where the rule is that we do not take blood from people with such conditions.

[Lord Alderdice]

My Lords, given that there is no medical test that is pathognomonic for this disorder or group of disorders, how do the authorities propose to police its exclusion other than simply by hoping that people will come forward with the information themselves?

[Earl Howe]

My noble friend is right to say that there is no diagnostic test for CFS/ME other than a process of elimination and watching the symptoms. It is largely on a self-reporting basis that the blood transfusion authorities will be alerted to the condition unless, of course, a patient’s GP is involved and can report his or her opinion.

Health: NICE

Debate between Lord Alderdice and Earl Howe

Wednesday 3rd November 2010 Lords Chamber

[Earl Howe]

My Lords, currently the NHS is faced with the decision of whether to say in effect yes or no to a new drug at the price that is proposed by a pharmaceutical company. We want to change that so that the price of a drug to the NHS is based on an assessment of its value, rather than pharmaceutical companies being free to set whatever price they choose and expecting the NHS to pay. So value-based pricing, which is the term we have used, will ensure that licensed and effective drugs are available to NHS clinicians and patients at a price to the NHS that reflects the value that they bring. That should get rid of the postcode lottery.

[Lord Alderdice]

My Lords, of course we already have four NHSs in our United Kingdom. What discussions are there among the authorities of the four NHSs when decisions are being taken about medications of this kind?

[Earl Howe]

My noble friend is, as ever, on the case. My officials in the Department of Health are in active discussions with their counterparts in each of the devolved Administrations on the kinds of changes that we envisage to the pricing of medicines.

Health: Osteoporosis

Debate between Lord Alderdice and Earl Howe

Tuesday 19th October 2010 Lords Chamber

[Earl Howe]

My Lords, information is produced by the National Health Service on the risk of fragility fracture and, indeed, on how to prevent it. A number of good and authoritative sources of information exist on this topic, not simply from the NHS, but I would just say that information on osteoporosis is available on the NHS Choices website, which of course is accessible on computers, including those in libraries.

[Lord Alderdice]

My Lords, if the normal communal incidence of osteoporosis were to be applied to your Lordships House, it is likely that half or even more than half of its membership would be suffering from it, even if they were not aware of any symptoms. That tells us what a common disorder we are dealing with. Does my noble friend agree that it is important to raise public awareness not just of diagnosis and treatment, but of how lifestyle changes to diet, smoking behaviour and alcohol consumption are extremely important in making sure that these adverse consequences do not arise?

[Earl Howe]

My noble friend is right. The job of the NHS in its public health role is to provide information about healthy lifestyle choices. NHS Direct does this at the moment, and in the future we will be looking to the new national public health service to maintain the provision of high quality and authoritative health advice. Moreover, as my noble friend says, that advice includes information about the value of a diet rich in vitamin D from oily fish, liver, cereals, eggs and so forth, as well as from safe exposure—I emphasise the word “safe”—to natural daylight.

Health Protection Agency

Debate between Lord Alderdice and Earl Howe

Thursday 7th October 2010 Lords Chamber

[Earl Howe]

My Lords, transparency is one of the aims of our proposals. As regards independence, the Government will continue to rely on their scientific advisory committees, the members of which, as the noble Baroness knows, are drawn from the foremost experts in their respective fields. The fact that the scientific secretariat to each committee is provided by experts formerly within the department, instead of within the HPA, will not prevent the committees reporting as they judge to be appropriate.

[Lord Alderdice]

My Lords, one of the most important elements in dealing with emergencies and pandemics is the communication of accurate, concise and timely information to the community. The HPA website is a very good facility for providing information to professionals during the ordinary way of things but is not particularly good at providing emergency information to the community as a whole, nor is it adequate on its own. Will my noble friend assure me that when the public health service takes over it will concentrate on this question of emergency communication to the public as a whole?

[Earl Howe]

My noble friend makes a good point about communications. Indeed, the idea of creating a public health service is to have in the Department of Health a joined-up means of having advice, surveillance, training and planning that will then feed out to local authorities, which will be responsible for prioritising action on the ground. An essential part of that will be to get the communications right.

Health: Prostate Cancer

Debate between Lord Alderdice and Earl Howe

Monday 19th July 2010 Lords Chamber

[Earl Howe]

My Lords, there will be plenty of support for GP consortia in the area of cancer diagnosis and treatment, not least from the commercial support units but also from the cancer networks. However, the noble Baroness is right that we are not doing well enough in this country in picking up cases of prostate cancer. Late diagnosis is likely to be a significant contributor to that and is, in itself, the result of a number of factors, poor public awareness being one. Late presentation to primary care is another and, as the noble Baroness hinted, poor detection in primary care is a third. Therefore, supporting GPs in detecting cancer earlier will be a key part of the work that we have to do.

[Lord Alderdice]

My Lords, given that the prostate-specific antigen test is not in fact pathognomonic of cancer of the prostate but simply of disturbance of the prostate and that significantly high levels of the antigen are likely to lead to an investigative biopsy by a urological surgeon, is the Minister content that we have enough urological surgeons in the country to undertake the level of investigative biopsy that is likely to arise from the higher index of suspicion by general practitioners indicated by the noble Baroness? Entirely separate from that is the question of whether we have enough urological surgeons to carry out the treatment for prostate cancer when it is diagnosed.

[Earl Howe]

My Lords, I am not aware that there is thought to be a significant shortage of urological surgeons or expertise around the country, although the coverage varies from region to region, as the noble Lord will know. However, I shall take his concerns back with me and make suitable inquiries. If I can write to him further, I shall certainly do so.

Health: NICE

Debate between Lord Alderdice and Earl Howe

Wednesday 14th July 2010 Lords Chamber

[Earl Howe]

My Lords, that target of a 14-day referral period has a definite clinical underpinning. There are certainly no plans to abolish it.

[Lord Alderdice]

My Lords, the treatment of such disorders—particularly cancer, but it is also true of Alzheimer’s disease—requires not just biological but psychological and social interventions. Although the biological research is often funded by pharmaceutical companies, NICE has great difficulty in finding the funding for research for psychological and social treatments. Can my noble friend indicate whether there is any way in which NICE can be assisted to be more broad-ranging in its understanding of a bio-psychosocial approach to treatment of these disorders by facilitating more funding for research in the psychological and social areas?

[Earl Howe]

My Lords, I am sure that my noble friend will accept, as I hope I made it clear the other day, that the Government are wholly committed to improving the quality of care for people with dementia and their carers. We are standing fully behind the dementia strategy, instituted by the previous Government. That strategy contains a specific objective of improving the quality of dementia care in hospitals. I take on board what my noble friend says about the absence of adequate research in the psychosocial domain. I shall discuss that point with NICE over the next few weeks as I am aware that it is one of its concerns.

Health: Diet

Debate between Lord Alderdice and Earl Howe

Tuesday 13th July 2010 Lords Chamber

[Earl Howe]

My Lords, as I said in answer to the noble Lord, Lord Krebs, we fully recognise the important role that the FSA plays. I identify myself fully with his remarks about the reasons why the FSA was created. I speak as a former junior Minister in the department that he led in such a distinguished way, and I realise fully the force of what he said.

[Lord Alderdice]

My Lords, given that the Government, directly and indirectly, are one of the largest employers in the country, and therefore the provider, directly or indirectly, of lunch and other meals, is there anything they can do to ensure that the meals provided and the diet available to employees, direct or indirect, of the Government are improved in line with what the noble Lord asked?

[Earl Howe]

My Lords, there is, and I am grateful to my noble friend. He will know that the healthier food mark initiative is one thing that the Government can do to enable the public sector to lead by example, in schools, hospitals and care homes. The healthier food mark has been developed over the past two years as a benchmark to raise the level of nutrition and sustainability of food served in the public sector. It sets clear guidelines on healthier and more sustainable food and recognises achievement, so I hope that it will lead the way.

NHS: Patient Targets

Debate between Lord Alderdice and Earl Howe

Wednesday 23rd June 2010 Lords Chamber

[Earl Howe]

My Lords, the noble Baroness is quite right. For example, on the waiting time targets for cancer referrals, we have made no changes because there is a clinical underpinning to those targets. She is also right to say that there is often insufficient information for patients on which to base decisions. We are very keen to build and develop information channels so that patients can be better informed and are able to make better choices about their care.

[Lord Alderdice]

My Lords, is my noble friend aware that one of the difficulties with targets for waiting times was that clinicians were forced to ensure that all patients fitted into the waiting times, when they were aware that some were a great deal more urgent and some not so urgent at all? Can he reassure me that in devolving more power back to clinicians and more opportunities back to local people—patients and carers—those differences between people’s requirements will be taken full account of rather than simply some artificial and arbitrary time limit?

[Earl Howe]

My noble friend is right because, when all is said and done, many of the centrally imposed targets were quite arbitrary. For example, why 18 weeks, not 17 or 19? It is worth saying that the targets that clinicians and managers set themselves are often a great deal more stringent than the ones that politicians are likely to set.

Health: Cancer

Debate between Lord Alderdice and Earl Howe

Monday 21st June 2010 Lords Chamber

[Earl Howe]

The noble Baroness is quite right that screening plays a very important part in the detection of cancer. However, it is not universally applicable to every cancer. In terms of oral cancer, which was the particular subject of my noble friend’s Question, there are difficulties. For example, there is considerable uncertainty about how the disease progresses—its natural history—and we cannot predict which lesions will be malignant and which will not. We need clear guidelines—for dentists, for example—and we do not have those. There is also no clear evidence base for the management of malignant lesions when we find them. However, the National Screening Committee will review its position again in about three years’ time and will no doubt take all the current evidence into account.

[Lord Alderdice]

My Lords, does my noble friend accept that when we are trying to improve treatments for cancer, we are looking for non-invasive approaches and specific and, so far as possible, less expensive approaches? Photodynamic therapy has been very useful not just for oral cancer but for skin cancers of various kinds, particularly squamous cell carcinoma. Does he accept that encouraging not just dermatologists but also general practitioners to move in this direction will mean that we can have specific, non-invasive and generally quite efficient treatment, and that that is to be encouraged by the Government?

[Earl Howe]

I am very grateful to my noble friend. It may help the House if I briefly explain what PDT is. It is a technique that uses laser or other light sources combined with a light-sensitive drug, which in combination destroy cancer cells. When the light is directed in the area of the cancer, the drug is activated. As my noble friend indicated, although this is an invasive procedure, it is minimally so; and its advantage is that, unlike radiotherapy, no cumulative toxicity is involved, so someone can be treated with PDT repeatedly. However, there are difficulties, one of which is that there is no obvious clinical leadership in this field, and that has to be addressed. There need to be centres of excellence in order for the right lessons to be learnt and the right research to be done.

Health: Government Spending

Debate between Lord Alderdice and Earl Howe

Monday 14th June 2010 Lords Chamber

[Earl Howe]

My Lords, smoking cessation is extremely important as a public health measure. I am sure the noble Lord will know that the coalition Government have set great store by their public health agenda. I cannot imagine that smoking cessation is going to disappear off the radar.

[Lord Alderdice]

My Lords, in respect of a number of agencies within the health and social care field, it is clear to practitioners that some of them have been inadequate in their regulatory and monitoring function and others have gold-plated way over the top in a quite counterproductive way. In his search for which agencies could be brought together and their experience shared or which could be changed in other ways, what are the principles that the Minister intends to use to produce a better and more appropriate regulatory monitoring framework within health and social care?

[Earl Howe]

My Lords, there are several principles. A reduction in the number of arm’s-length bodies is only one of the possible outcomes. As I have said, we are not looking necessarily for a large-scale reduction in numbers, but we want to see both efficiency and the delivery of quality. With those two ends in view, the bodies that we end up with have to make sense in terms of what matters in our wider system reform, which is, as I have said, to deliver quality.

Health: Isle of Man

Debate between Lord Alderdice and Earl Howe

Monday 14th June 2010 Lords Chamber

[Earl Howe]

My Lords, it might be helpful if I were to clarify the current position. If the noble Lord were to go the Isle of Man, the agreement in place at the moment would enable him to receive emergency healthcare there—that is, healthcare that is immediately necessary—free of charge should he need it. The only reason for requiring travel insurance in addition would be to cover the cost of, let us say, an air ambulance back to the mainland or any extra costs that were non-medical arising out of the emergency. In that sense, the Isle of Man is no different as a travel destination than, let us say, the United States.

[Lord Alderdice]

My Lords, the previous Government rightly trumpeted one of the important advances of the Good Friday agreement: the establishment of the British-Irish Council, bringing together government representatives and Ministers from England, Scotland, Wales, Northern Ireland, the Republic of Ireland, the Channel Islands and the Isle of Man. Did the previous Administration raise this question at the British-Irish Council, which would seem the appropriate place to explore it? If they did, what was the response?

[Earl Howe]

My Lords, I am afraid that I cannot help my noble friend as I have not had access to the papers relating to the previous Administration. However, I can tell him that very cordial discussions and negotiations are proceeding at the moment, and the devolved Administrations will be consulted.

Mid Staffordshire NHS Foundation Trust

Debate between Lord Alderdice and Earl Howe

Wednesday 9th June 2010 Lords Chamber

[Lord Alderdice]

My Lords, the immediate response of my honourable friend Norman Lamb in the other place to the 2009 Healthcare Commission report was to call for a public inquiry. My noble colleague the Minister can be absolutely confident of the warm welcome on these Benches to the decision to have a public inquiry, a request that was refused by the previous Government. One has to suspect that it was refused because of the likelihood of exposing the inadequacies not just of a particular hospital and trust board but of the regulatory system that had been put in place and the culture of target and finance-driven managerialism that the previous Government championed.

I am sure that the noble Earl expects that this will be exposed in the public inquiry, but is it not important that we should not only protect whistleblowers—he has announced important developments in that regard—but address the whole culture that regarded professionals and commissions raising questions and concerns as troublesome and disloyal rather than as wanting to improve the standards and quality of the service? What is needed is a change in the culture, so that the views of clinicians of all professions are valued, welcomed and encouraged. The priority of managers is not to dominate the service and to impose politically driven targets but to provide it with high levels of patient care.

[Earl Howe]

My Lords, I agree wholeheartedly with my noble friend that in many parts of the NHS we need a culture change—a culture that puts patients first. We need an NHS that listens to patients and responds to their concerns and needs. We must prioritise the people whom the NHS serves and we must listen to the doctors and nurses who work in it. The measures that we are taking today on whistleblowing are important. Last week, we began to publish more transparent data about the NHS so that people can hold their local services to account in a more meaningful way. We are looking also at reducing the number of hospital readmissions, as I am sure my noble friend is aware.

The culture change that is needed will not happen in a hurry and I would not want to give the impression that it is required everywhere in the NHS. Mid Staffordshire was an unusual event, but unless we get to the bottom of why it happened there must be a fear that it may happen again. As we move forward and propose to Parliament changes in the way in which the NHS is regulated and care is commissioned, we must not lay ourselves open to unintended traps. I therefore concur with all that my noble friend said. I think that he will find, as we bring forward our proposals, that the emphasis on transparency, openness and the patient’s voice will do much to address the concerns raised.

Health: Dementia

Debate between Lord Alderdice and Earl Howe

Thursday 3rd June 2010 Lords Chamber

[Earl Howe]

My Lords, the answer to the specific question about whether the money is safe this year is yes, but we want to ensure that the strategy is sustainable over the following three years. We will do that principally by driving up quality standards through a tariff for dementia patients, by better regulation of providers and by better commissioning of services, including public health interventions. Alongside that, as I said to the noble Baroness, Lady Greengross, we plan to provide better information to people with dementia so that they have a good understanding of their local services, and local organisations will be expected to publish how they are delivering on those standards.

[Lord Alderdice]

My Lords, the strategy is set out in an ambitious and sophisticated document that says that it is not just for five years, but that:

“There is no expectation therefore that all areas will necessarily be able to implement the Strategy within five years”.

I wonder if, even at this early stage of the coalition Government, my noble colleague has been able to identify whether all 17 objectives are to be carried forward at the same time or any priority areas that might be moved forward more quickly.

[Earl Howe]

We are looking at the implementation plan at the moment. I say to my noble friend that there are perhaps four key dementia priorities for us. One is promoting awareness and early diagnosis and referral; the second is the care of people in hospital; the third is the care of those in care homes; and the fourth is a reduction in the use of anti-psychotic medication. That is not to say that the other objectives are trivial—by no means—but we think that these will yield the most tangible results in the shorter term.

Health: Contaminated Blood Products

Debate between Lord Alderdice and Earl Howe

Wednesday 2nd June 2010 Lords Chamber

[Earl Howe]

My Lords, I am well aware of the noble Baroness’s personal interest in this matter and feel deeply for her. She is of course correct that the Skipton Fund was not designed to support bereaved relatives. It was designed to alleviate the suffering of those infected with hepatitis C. Sympathetic as I am towards those who have lost their loved ones in this tragedy, that fund does have a specific purpose and it would require a major review to alter that purpose. However, I note her concern on this matter.

[Lord Alderdice]

My Lords, I share in the congratulations and good wishes to the noble Earl, who has served this House so well on health issues, and offer my congratulations to the noble Lord, Lord Morris of Manchester, and the noble and learned Lord, Lord Archer of Sandwell, on their tenacious pursuit of this issue. Does the noble Earl agree that the High Court judgment shows a confusion of thinking on the part of the Department of Health not only in regard to this matter but on the whole question of dealing with adverse health events? Does he accept, as the Scottish Executive have done, as the Chief Medical Officer did in 2003 and the National Audit Office did in its report in 2004, that much more money would be available in compensation if it were not being spent on legal fees and court cases, and that the introduction of a no-fault compensation scheme could achieve that?

[Earl Howe]

My Lords, I share the noble Lord’s antipathy to taxpayers’ money being shelled out in legal fees, but what has happened has happened. In the current constrained financial climate, every department of Government will look very carefully at its legal activity.