Alcohol: Impact on Accident and Emergency Services

Debate between Lord Avebury and Earl Howe

Wednesday 21st January 2015 Lords Chamber

[Earl Howe]

My Lords, we are keeping the developing evidence on a minimum unit price under review. It has only ever been part of our alcohol strategy—which, as I said, includes a range of actions. We acknowledge the need to give careful consideration to any possible unintended consequences of MUP, such as its potential to impact on the cost of living, the economic impact of the policy and, importantly, a possible increase in illicit alcohol sales that could ensue.

[Lord Avebury (LD)]

My Lords, is it necessary to refer to the alcohol industry for measures to alleviate the £21 billion-worth of harm that it causes? Should my noble friend not instead refer to the calculations by the University of Sheffield showing the amount by which alcohol harm can be reduced by increases in taxation?

[Earl Howe]

My Lords, we have taken a strong policy on taxation in recent years, particularly to reduce the availability of cheap, strong alcohol. Since the 2010 general election, duties on spirits have risen by more than 18%, which is well above RPI, and on wine by more than 21%, again well above RPI. We have also introduced a ban on the sale of below-cost alcohol, which should stop the worst cases of cheap and discounted alcohol sales.

Alcohol: Addiction

Debate between Lord Avebury and Earl Howe

Monday 12th January 2015 Lords Chamber

[Lord Avebury]

To ask Her Majesty’s Government what are Public Health England’s plans for combatting alcohol addiction.

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

My Lords, Public Health England recognises that the harmful use of alcohol is a major health risk. The harm from alcohol is preventable; alcohol is one of seven key priorities that PHE is focusing on. It is implementing a programme to support national and local government, the NHS and partners to implement evidence-based policies and interventions. Included in this work is the reduction of alcohol addiction.

[Lord Avebury (LD)]

Considering that three years ago, there were 1.1 million alcohol addicts in England and that abuse of alcohol was costing the nation £21 billion—and probably much more than that today—how can the Minister reconcile the fact that we spend only one-tenth as much on treating alcohol addiction as we do on patients suffering from drug addiction? Why is it taking until 2016 to update the guidance on access to mutual aid fellowships such as Alcoholics Anonymous, when the ACMD has shown that there are effective ways of combatting the addiction?

[Earl Howe]

My Lords, my noble friend was kind enough to give me advance warning of those questions. I have to say to him that we do not recognise the figures he quotes; nor do we think that the comparison he makes is like for like. In 2007, an estimated 1.6 million people had some degree of alcohol dependence, including those with a slight dependence. Of those, some 250,000 were believed to be moderately or severely dependent. The specialist treatment centre system continues to work well for many people. Many of the trends in terms of treatment are positive. As regards supportive relationships, I fully agree with what he said; they are a vital element in helping individuals build their own recovery. In October 2013, Public Health England produced a strategic action plan for supporting the treatment sector to strengthen its links with mutual aid organisations to ensure that everyone in treatment can benefit from that support.

Alcohol-related Disease

Debate between Lord Avebury and Earl Howe

Wednesday 17th December 2014 Lords Chamber

[Earl Howe]

The noble Lord was kind enough to give me prior notice of that question just before we came in. I have taken advice on it, and the advice I have received is that there is no wholesale evidence of a shift of funding from drug treatment to alcohol treatment. There may be the odd example of that, but I can tell the noble Lord that Public Health England is monitoring this issue in local areas, to make sure that that shift does not take place in a disproportionate way in relation to the need in those areas.

[Lord Avebury (LD)]

My Lords, the BMA states that the misuse of alcohol is costing the UK £25 billion a year and imposing immense burdens on our overloaded health and criminal justice systems. Is not the answer to increase alcohol duty, starting with the alcohol duty escalator, which was withdrawn by the Chancellor, forfeiting £1 billion in revenue over the next five years, thereby also making it more difficult for us to meet our fiscal commitments? Increases in alcohol duties are the answer, as everybody who has studied the matter agrees.

[Earl Howe]

My Lords, we have acted on alcohol pricing. We have to look at this in the round and in relation to what is happening. Alcohol consumption per head has fallen in recent years. Reduced affordability of alcohol—influenced, I may say, by tax rises above the RPI each year to 2013—has certainly been one factor in that, we believe. We are committed to reducing alcohol-related harm. We have already banned alcohol sales below the level of duty plus VAT, meaning that it will no longer be legal to sell a can of ordinary lager for less than about 40p.

Health: Pneumococcal Disease

Debate between Lord Avebury and Earl Howe

Monday 3rd November 2014 Lords Chamber

[Lord Avebury]

To ask Her Majesty’s Government what assessment they have made of the progress of the Joint Committee on Vaccination and Immunisation in its review of the adult pneumococcal disease programme.

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

The Joint Committee on Vaccination and Immunisation concluded a review of the adult pneumococcal vaccination programme in 2012. The committee will begin the next review in early 2015, taking into account the latest information on the epidemiology, cost effectiveness and impact of adult pneumococcal vaccination. It is anticipated that the review will take six months to complete, subject to the availability of the necessary evidence.

[Lord Avebury (LD)]

My Lords, the JCVI looked at the situation in its June meeting and said that it would like to see the results of recent trials on the effectiveness of PPV in adults, but the subject was not on the agenda for the October meeting. Why are those trials not in the public domain? Since it is likely that the vaccination would be effective against the 5,000 cases diagnosed in adults every year in England, with some savings to the National Health Service, what steps are being taken to accelerate the introduction of the PPV vaccine?

[Earl Howe]

My noble friend is right to highlight the burden of disease caused by pneumonia in particular in the elderly. As I said in my Answer, what happened at the October meeting of the JVCI was an agreement that a pneumococcal sub-committee should be formed to fully consider the latest evidence on adult pneumococcal vaccination, including the evolving epidemiology of pneumococcal disease in the UK following the introduction of the conjugate vaccine into the childhood vaccination programme. In addition, the review will consider the latest data on the use of the conjugate vaccine in adults. This was discussed at the October meeting, the minutes of which are due to be published next week.

NHS: Cancer Diagnosis and Treatment

Debate between Lord Avebury and Earl Howe

Monday 13th October 2014 Lords Chamber

[Earl Howe]

My Lords, I am aware that in some areas of the country access to GPs is proving problematic and a number of work streams are under way to address that. But we are confident in the light of the statistics that patients are not holding back in presenting to their GPs. As I said, referrals have gone up dramatically over the last few years and the NHS is treating a record number of patients.

[Lord Avebury (LD)]

My Lords, I declare an interest as a cancer patient. What arrangements are made for determining eligibility for treatment by the CyberKnife at the Royal Marsden and UCLH and does it involve any financial assessment of the likely cost to the NHS of the treatment of a particular patient?

[Earl Howe]

My Lords, my noble friend mentions a particular type of radiotherapy, the CyberKnife. At present there is only limited research evidence of the clinical and cost effectiveness of stereotactic ablative body radiotherapy—the full name. Therefore, it is available only for certain patients with lung cancer. Having said that, NHS England has agreed to make £6 million available over the next few years for new clinical trials which will involve trials on prostate cancer, lung cancer, pancreatic cancer and biliary tract cancers. It is important that we generate that clinical evidence before encouraging the NHS to apply this form of radiotherapy to those cancers.

Health: Meningitis B Vaccine

Debate between Lord Avebury and Earl Howe

Monday 24th February 2014 Lords Chamber

[Earl Howe]

I can give the noble Lord an assurance on the latter point. We will take a decision as rapidly as we can once we receive the JCVI advice. I appreciate that the JCVI’s interim position statement will have been disappointing to many people. I know the noble Lord recognises that it is important that decisions about the introduction of new vaccines into the national immunisation programme take account of evidence of their effectiveness, safety and cost-effectiveness compared to other healthcare interventions. We need to wait and see what the JCVI’s final advice is. I am aware that it is looking at the cost-effectiveness methodology that is used for vaccines of this type.

[Lord Avebury (LD)]

My Lords, do the options now being developed by Public Health England at the request of the Government include a population-based evaluation of the meningitis B vaccination, taking into account the discounted lifetime cost to the public sector of supporting children who are disabled by the disease? Will my noble friend also explain why the Department of Health assumed that the carriage effects achieved with meningitis C do not read across to this variant of the disease?

[Earl Howe]

I can tell my noble friend that the JCVI has been considering both those issues: first, the possible need for a population-based evaluation of the MenB vaccine to address uncertainties in its effectiveness; and, secondly, what the possible effect of the MenB vaccine on the carriage of meningitis B bacteria might be. I say again that we need to wait for the JCVI’s final statement of advice to get clarity on either of those issues.

Mesothelioma

Debate between Lord Avebury and Earl Howe

Thursday 5th December 2013 Lords Chamber

[Earl Howe]

My Lords, we have committed to doing four things, the first of which will be to set up a partnership to bring together patients, carers and clinicians to identify what the priorities in research are. Secondly, the NIHR will highlight to the research community that it wants to encourage research applications in this area. The NIHR Research Design Service will be able to help prospective applicants develop competitive research proposals, and we will convene a meeting of leading researchers to discuss and develop new proposals for studies. I think that those four measures together will deliver what the noble Lord seeks.

[Lord Avebury (LD)]

My Lords, does my noble friend acknowledge that the £3 million has run out and that there is a danger that the talented clinicians who have been working on mesothelioma as a result of that fund will move on to other subjects? However, the Association of British Insurers has told me that it would be prepared to consider a new scheme funded jointly by all employer’s liability insurers and the Government, so I wonder if the Government will approach the ABI to see if that scheme could be taken a little further.

[Earl Howe]

I am very grateful to my noble friend and that is certainly something I can undertake to do, perhaps in conjunction with the British Lung Foundation.

Cigarette Packaging

Debate between Lord Avebury and Earl Howe

Thursday 25th July 2013 Lords Chamber

[Earl Howe]

My Lords, I am aware that officials in my department—not Ministers, I emphasise—had face-to-face meetings with certain tobacco companies in the context of the consultation on plain packaging. That was done to clarify certain aspects of their written submissions and is as far as it went. I am not aware of which companies those were, but if I can enlighten the noble Lord I will write to him.

[Lord Avebury]

My Lords, does my noble friend agree that it is harmful to public health in the United Kingdom for Mr Crosby to have any dealings whatever with government departments while exercising a malign influence in the background, and that he should be got rid of and sent back to Australia?

[Earl Howe]

The latter matter is not one on which I will have any influence, nor do I wish to. However, on my noble friend’s point, I cannot say more than I have already: Mr Crosby has had no dealings with Ministers or the Department of Health on the issue of tobacco.

Medical Research: International Rare Diseases Research Consortium

Debate between Lord Avebury and Earl Howe

Thursday 28th February 2013 Lords Chamber

[Lord Avebury]

To ask Her Majesty’s Government what support, if any, they are providing for the International Rare Diseases Research Consortium.

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

My Lords, the UK is a global leader in rare diseases research. The Government are pleased to be engaged with activities marking Rare Disease Day today. The Department of Health supports the International Rare Diseases Research Consortium. The National Institute for Health Research is a member of the consortium and has actively engaged with the work of the consortium from the outset. The Government are committed to providing faster diagnosis and better treatments for people with a rare disease. We recognise the importance of international collaboration in rare diseases research, and of its translation, in achieving this goal.

[Lord Avebury]

My Lords, I declare an interest as a sufferer from myelofibrosis, which is one of the 6,000-plus rare diseases that have been identified which affect 3.5 million people in the UK. May I ask my noble friend to comment on how the £100 million genome sequencing project is expected to contribute to the understanding of rare diseases? Secondly, will the rare diseases stakeholder forum that he announced yesterday consider the value to both patients and the NHS of care co-ordinators, which was emphasised by the NGO Rare Disease UK?

[Earl Howe]

My Lords, we have just announced the establishment of a rare diseases stakeholder forum. As my noble friend rightly mentions, it will be established shortly to bring together a wide range of stakeholders, including organisations representing those with rare diseases, to ensure that the patient voice is part of the discussion that we must have leading up the publication of the UK plan for rare diseases. The 100,000 genomes initiative, which my Department is funding, is about pump-priming—the sequencing of the genomes of 100,000 NHS patients—with the purpose of translating genomics into the NHS. This capacity will be allocated specifically to cancer, rare diseases and infectious diseases. The service design work will be completed by June and we aim to put contracts in place by April next year.

Health: Midwives

Debate between Lord Avebury and Earl Howe

Monday 25th February 2013 Lords Chamber

[Earl Howe]

My Lords, women should expect to have one-to-one care from a midwife during labour, birth and immediately after birth, and to continue to have the support of their midwife after the birth. This is especially important for those women who are susceptible to, or have, depression during pregnancy or postnatal depression. My noble friend is absolutely right about continuity. This depends on each woman having an individualised postnatal plan of care, taking into account her circumstances. To assist the NHS, the department has asked the National Institute for Health and Clinical Excellence to develop a quality standard for postnatal care, which it is anticipated will be published in July this year.

[Lord Avebury]

My Lords, my noble friend may have had a chance to look at the report published today by the Refugee Council and Maternity Action on the deficiencies in the support for pregnant asylum seekers. Will his department hold discussions with the Home Office on amendments to the guidance for those women to make it compatible with NICE guidance on the maternity care of women with complex social factors? Will the department and the UK Border Agency jointly look into the negative impact of the current dispersal and relocation policies on the healthcare of women asylum seekers?

[Earl Howe]

My noble friend raises a number of complex and important issues. My department provides approximately £1 million a year for health assessments of asylum seekers in UKBA initial accommodation in England. The aim of the health assessment is to identify and address immediate healthcare needs, including pregnancy, and to recognise ongoing and non-urgent care needs for attention in the dispersal areas. The use of experienced health teams and interpreting services to record medical history also avoids more expensive arrangements at GP-registration stage later on. My officials met Maternity Action on 19 February to discuss the report’s recommendations and were assured that the maternity care provided by NHS midwives was appropriate and in accordance with NICE guidelines. Following that meeting, officials have briefed the Home Office.

Health and Social Care Bill

Debate between Lord Avebury and Earl Howe

Thursday 8th March 2012 Lords Chamber

[Lord Avebury]

I am sorry if I am a little late in raising this point. The Minister was talking about the burden that would be placed on the accounting system by having separate accounts for the private sector when it was a small proportion of the total. How will the person scrutinising these accounts know what the profitability of that private work is when that small amount of the total is not separately itemised in the accounts?

[Earl Howe]

We would certainly expect boards of directors to satisfy themselves on that point through management accounting systems and, if necessary, produce the relevant evidence to governors, if a question were asked about that. I think that the point that we were alive to was the cost involved in compelling all foundation trusts—some of them hardly have any private income at all—to go to the trouble of producing statutory accounts and separating out those two income streams. Although my noble friend’s question is well placed, it is perhaps a different question from the one that I was addressing.

We can allay all these anxieties in this area through one simple principle, and that is transparency. Today, I have tried to set out an open and transparent regime for the oversight of a foundation trust’s planned increase to non-NHS income. The governors, as representatives of local communities, would hold the directors to account for ensuring that non-NHS activity does not significantly interfere with their foundation trust’s principal legal purpose to provide NHS services. I think our proposals strike the right balance between the powers of the directors—

NHS: Hinchingbrooke Hospital

Debate between Lord Avebury and Earl Howe

Thursday 10th November 2011 Lords Chamber

[Earl Howe]

No, I cannot, but I shall write to the noble Baroness.

[Lord Avebury]

My Lords, if it is this easy for a private company to make the necessary economies to put this hospital back on course without compromising patient care, as was claimed by the spokesman on the “Today” programme this morning, can the noble Lord say why—a question that was not answered on that programme—the NHS could not make those economies itself?