HIV/AIDS
Lord Collins of Highbury Excerpts(9 years, 4 months ago)
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Lord Collins of Highbury (Lab)
My Lords, I, too, pay tribute to the noble Lord, Lord Fowler, for his outstanding work on HIV and AIDS both here and globally, advocating action on prevention, treatment and care while attacking discrimination and stigma. As we have heard in this debate, it is estimated that 35 million people are living with HIV worldwide, with 1.5 million AIDS-related deaths in 2013. Here, 6,000 people were diagnosed as carrying the HIV infection in 2013, and 320 people were reported as having AIDS. An estimated 107,800 people are now living with HIV.
As we have heard in the debate, the UK is one of the world’s leading funders of global health. If we are to move beyond investments to control HIV and towards eradication, we desperately need new tools. Where there is an affluent market, as is the case with adult HIV drugs, we can see significant private investment. By contrast, there are very few formulations of paediatric HIV drugs, where the market is smaller and more heavily based in developing countries. UNAIDS highlights the fact that only 24% of children living with HIV currently have access to HIV treatment. Will the Minister support within government the recommendation from the HIV/AIDS APPG that the UK commissions an economic paper to contrast the total costs of developing and purchasing medical tools using the current R&D model with the costs of a delinked model?
As was asked by other noble Lords, including the noble Lord, Lord Crisp, can the Minister explain how the Government will address the growing problem in middle-income countries whereby funding is being pulled out from all directions, including from the Global Fund, while the pharmaceutical industry continues to expect MIC Governments to afford higher prices for ARV treatment?
In England, the Health and Social Care Act changed the commissioning and monitoring of HIV prevention, testing, treatment and care services. Conditions that require specialist expertise and medication are the responsibility of NHS England, including HIV treatment. In its Five Year Forward View, NHS England states that it plans to let local commissioners share responsibility for commissioning specialised services, incentivising them to direct funding towards local priorities.
Naturally, many patient groups are concerned about the impact on service standards leading to a possible postcode lottery. Their concern is heightened by the fact that there are so many outstanding questions about what co-commissioning will look like and no specific announcements related to HIV. What steps will the Minister take to ensure that the overall responsibility for the provision of services is clearly defined? It is also vital that standards of care are maintained across the country.
As we have heard in this debate, particularly from the noble Lord, Lord Fowler, the Government have funded national HIV prevention programmes since 1996. In recent years, funding for these programmes has been progressively reduced. The current English national prevention programme HIV Prevention England—HPE—has been funded for three years until the end of March 2015. Funding for HPE is £2.4 million per year, which is less than the combined funding received by the previous prevention programmes in 2011 and 2012. In December 2014, the Government indicated that they intended to reduce funding for HPE by 50% to £1.2 million for 2015-16.
That decision was criticised by many organisations, who led a public campaign seeking reconsideration, and shortly afterwards it was reversed and a commitment made to fund the programme at current levels for a further year. Will the reallocated budget support a new programme of work or existing activities that are currently paid for with other budgets?
In addition to the national HPE programme, local authorities should be investing in complementary prevention initiatives as part of their public health responsibilities. However, National Aids Trust research shows that less than 0.1% of local funding allocated to public health in high HIV-prevalence areas is being spent on primary HIV prevention. A total of about 1.2 million men have sex with men and black African adults living in England. A budget of £1.2 million means that the national programme has only £l to spend a year for each person in its target audience. Does the Minister believe that that is enough to achieve the programme’s objectives? The estimated lifetime cost of treating someone with HIV is £360,777. That means that even if a £2.4 million programme prevented only seven new transmissions a year, it would save the NHS money. Is there not a strong case for increasing the funding rather than cutting it?
Finally, I raise the issue of pre-exposure prophylaxis—PrEP—to which the noble Lord, Lord Black, referred. Really impressive research from England was released last week. I read it at the international retrovirus conference in Seattle. The study recruited men who have sex with men and trans women who were at elevated risk of acquiring HIV. They had multiple partners; condom use was inconsistent or irregular; rates of sexually transmitted infections were high; many participants had needed post-exposure prophylaxis before and recreational drug use was common. Participants were generally well-educated and in full-time employment. The fact that the study has demonstrated such a high and statistically significant level of efficacy with a few hundred participants tells us both about how effective PrEP is and how high the rate of infection is in some groups of gay men.
What is being done to ensure that this highly effective HIV-prevention intervention is made available to those who need it without delay? What work is being done to ensure that prescribing of PrEP is appropriately targeted to those who are most likely to benefit from it?
HIV
Lord Collins of Highbury Excerpts(9 years, 6 months ago)
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Earl Howe
My noble friend is right. I think that we have come a long way since my noble friend Lord Fowler was Secretary of State, when stigma and discrimination were very apparent in virtually all sections of society. We do not see that so much now, I am glad to say, as evidenced by the fact that we are reporting a continuing reduction in late diagnosis. It was down to 42% last year from 47% in 2012, and that is a key indicator in this context.
Lord Collins of Highbury (Lab)
My Lords, the UK is a leading supporter of research and development into universal prevention methods, including HIV microbiocides and vaccines. With 19 million people globally remaining unaware of their HIV status today, will the noble Earl tell us how the Department of Health is working with the Department for International Development to support this research and development work?
Earl Howe
My Lords, in November 2013 DfID conducted a review of our 2011 HIV position paper. The review paper highlighted three areas of particular focus in the international context. They were to identify the key affected populations—girls and women—and the integration of HIV responses into the wider health system, as well as broader development priorities. That of course includes tackling stigma and the unacceptable things that we see in certain overseas countries, including discriminatory legislation.
Health: Diabetes
Lord Collins of Highbury Excerpts(11 years ago)
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Earl Howe
My Lords, I am aware of the issue that the noble Lord raises. He will know that NHS commissioners are statutorily required to fund clinically appropriate drugs and treatments which have been recommended by NICE. The Centre for Workforce Intelligence has been commissioned to review the ophthalmology medical workforce after discussions were held between the royal college and Health Education England earlier this year. That review is due to report in the summer and the results of it should, I hope, point the way to a resolution of the issue that the noble Lord has raised.
Lord Collins of Highbury
My Lords, as a type 2 diabetic, I benefit from annual retinal check-ups at UCH; it is an excellent service. However, despite there being a national screening programme, there is a large variation in take-up, which in some areas is as low as 65%. What steps are the Government taking to ensure a higher and more consistent take-up?
Earl Howe
In the end, accepting the offer of screening is a matter for each individual. There are some people who, for personal reasons, will choose not to take up the offer. However, as part of the process of continuous improvement, we would expect the gap between the number of people offered and the number of people receiving screening to reduce, and for there to be greater consistency in numbers offered and received across local screening programmes.
Autism
Lord Collins of Highbury Excerpts(11 years, 1 month ago)
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Earl Howe
My Lords, the Children and Families Bill, which was introduced into Parliament this month, will usher in from next year new joint arrangements for assessing and planning commissioning services for children and young people with special educational needs. We realise the difficulties that young people with autism can face in making that transition to adulthood. Under the autism strategy, my department and the Department for Education funded the social policy research unit at the University of York to examine how statutory services are currently supporting young people on the autistic spectrum. Its report, published in February, points the way to some important lessons that we should take on board during the review.
Lord Collins of Highbury
My Lords, despite the strategy, only 63 out of 152 local authorities have a pathway to diagnosis. Will the Minister give an assurance that the department will produce a clear guide for CCGs on how to commission the right diagnosis and support services?
Earl Howe
My Lords, we are indeed currently supporting, along with NHS England, a practical guide for CCGs to support health professionals and others in implementing the adult autism statutory guidance, as well as the NICE guidelines on recognition, referral and diagnosis, and the management of adults on the autism spectrum. This will be published later in the summer through the Joint Commissioning Panel for Mental Health.
Care Bill [HL]
Lord Collins of Highbury Excerpts(11 years, 1 month ago)
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“( ) The HRA shall also have the function of encouraging the translation of research into innovative practice.”
Lord Collins of Highbury
My Lords, in Amendment 58A, in addition to conducting and promoting health and social care research, we are seeking to give the Health Research Authority the ability to encourage this research to be translated into innovative practice.
On Monday, in a debate on amendments to Health Education England, many noble Lords highlighted the need to place research at the centre of what the NHS does. Under the Health and Social Care Act, Labour fully supported placing duties on the Secretary of State, the National Commissioning Board and CCGs to promote research. Indeed, my noble friends Lady Thornton and Lord Hunt supported amendments to the Bill reinforcing the importance of research.
In Monday’s debate, my noble friend Lady Wheeler reminded us of the concerns and frustration at the often painfully slow, complex and bureaucratic process of getting innovation in care and treatment adopted in the NHS. I suspect that the noble Earl shares this concern as in the debate in this House last January he reminded us that it took an estimated 17 years for only 14% of new scientific discoveries to enter day-to-day clinical practice. On Monday, too, my noble friend Lord Turnberg referred to the vision for research in the NHS contained in the recent publication of the Association of Medical Research Charities. In this vision, every patient should be offered the opportunity to be involved in research; all staff should be made aware of the importance of research; and the NHS should conduct high quality research and adopt innovation in healthcare rapidly. The purpose of the amendment is to achieve a joined-up approach in reaching these objectives so that when research is commissioned these principles are absolutely borne in mind. I look forward to hearing the Minister’s response.
With regard to Clause 97 standing part of the Bill, I should like to refer the noble Earl to paragraph 8 of the first report this Session of the Delegated Powers and Regulatory Reform Committee. The committee expressed concern over the Secretary of State’s powers to amend the main functions of the Health Research Authority. If, as suggested, they were needed to meet the obligations of an EU directive, an appropriate amendment could be made by exercising powers under Section 2(2) of the European Communities Act 1972. If that is the case, perhaps the noble Earl could explain why the Secretary of State needs these extra powers.
It is a long time since I completed my British Government A-level. I recall how Henry VIII clauses can give powers to delegated legislation to amend or repeal Acts of Parliament. However, I did a little more recent research and found reference to the 1932 Committee on Ministers’ Powers. One quote from its report is particularly relevant. A member said that, whether good or bad, delegated legislation is inevitable. It is,
“a necessary evil, inevitable … But nevertheless a tendency to be watched with misgiving”.
I look forward to the noble Earl’s further explanation as to why the Department of Health believes that these powers are necessary.
Lord Walton of Detchant
My Lords, I rise briefly to express my strong support for Amendment 58A. I used to teach my medical students and my postgraduates by telling them that today’s discoveries in basic medical science bring about tomorrow’s practical developments in patient care. Surely this is what the amendment is about. If I were to be pedantic, I would prefer a change in the wording to:
“The HRA shall also have the function of,”
promoting
“the translation of research into innovative practice”.
That is preferable to simply “encouraging” it. Again, I am happy to support the amendment.
Lord Collins of Highbury
I thank the Minister for that response. I agree with him that we have to see this in the round. We were trying to pick this up as an objective rather than as a specific function so that in its work the HRA could see the benefits of ensuring that research was implemented in a way so as to change practice. In relation to Clause 97 standing part of the Bill, I again hear what the Minister has said. I was rather hoping for a detailed reference to Henry VIII in his response but that was not forthcoming. We will need to watch this matter carefully. I look forward to seeing the Government’s response to the committee’s report. In the light of that, I beg leave to withdraw the amendment.
Health: Tuberculosis
Lord Collins of Highbury Excerpts(11 years, 3 months ago)
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Earl Howe
My Lords, we are now introducing a system of pre-entry screening. We recognise the contribution that latent TB makes to the overall TB disease burden and that is why we have commissioned NICE to produce a clinical guideline on this. In the countries where TB presents the most significant risk, we shall in future insist that people are screened before they enter the United Kingdom.
Lord Collins of Highbury
My Lords, drug-resistant TB will not subside until the problem is controlled globally. That requires not only intergovernmental co-operation but cross-departmental working. Will the Minister update the House on the Government’s position on the replenishment of the global fund, which will be useful in tackling this problem globally?
Earl Howe
My Lords, the Government fully support the need to scale up efforts to deliver universal access to TB prevention and treatment, and care and support services. Our target date for that is 2015. We have made a long-term commitment of £1 billion between 2007 and 2015 to the Global Fund to Fight AIDS, Tuberculosis and Malaria, and a 20-year commitment to the international drugs purchase facility, UNITAID, which is helping to increase access to and the affordability of TB drugs.
Food: Fast Food
Lord Collins of Highbury Excerpts(11 years, 4 months ago)
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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.
Lord Collins of Highbury
My Lords, helping people to make informed choices on what they eat is really important. However, we have learnt in recent times that what is on the label is not always what is inside. I have stated previously that so-called healthy products such as low-fat yoghurts and cereals are jam-packed with sugar, which has huge implications for the threat of diabetes. Will the Minister consider statutory food labelling which is easy to understand?
Earl Howe
My Lords, we certainly have not ruled out regulation in this area, but we can be encouraged by the progress that we have made to date through the responsibility deal in terms of calorie labelling. Some 47 businesses signed up to labelling calories at the end of 2012, while 5,000 fast food and takeaway outlets and around 9,000 high street outlets, including pubs, restaurants and coffee shops, will display calories.
Health: Diabetes
Lord Collins of Highbury Excerpts(11 years, 4 months ago)
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Lord Collins of Highbury
My Lords, I have no doubt that my contribution will be interrupted very shortly. I, too, thank my noble and learned friend Lord Morris for initiating this important debate. As a type 2 diabetic, I am acutely aware of the possible causes of my condition and how lifestyle changes can improve matters. That is not the case with type 1 diabetes, which is a chronic, life-threatening condition with a lifelong impact on those diagnosed and their families. It cannot be prevented and there is no cure. No one is quite sure what causes it; possibly it is triggered by an auto-immune disease. It does not involve lifestyle factors such as poor diet or lack of exercise, as my noble and learned friend has said.
Although the major increase is in type 2 diabetes, type 1 is also rising. As my noble and learned friend said, estimates suggest that between 300,000 and 400,000 people living with type 1 diabetes in the UK, which accounts for around 10% of all people with diabetes. People with type 1 diabetes are at greater risk of dying younger. The first ever report into mortality from the National Diabetes Audit was published just over 18 months ago, and I referred to it in the previous debate. It found that up to 24,000 people with diabetes are dying in England each year from causes that could be avoided through better management of their condition. About three-quarters of those are aged 65 and over. However, the gap in the death rate between those who have and who do not have diabetes becomes more extreme when comparing younger people. It is truly shocking to learn that so many young people are dying from diabetes. Type 1 is a particularly difficult condition to live with, as my noble and learned friend pointed out. We need to raise awareness and campaign to help to prevent and detect diabetes, as my noble friend Lord Hoyle said. I am therefore sorry that the Government decided not to accept the Public Accounts Committee recommendation on this particular aspect of its report about mounting public campaigns.
According to the 2012 Impact Diabetes report, the current cost of direct patient care for those living with type 1 diabetes is estimated at £1 billion, along with indirect costs of just under £1 billion related to increased death rates and illness, work loss and the need for informal care. Last year’s Public Accounts Committee report also recognised that while the department had improved information on diabetes, it was not being used effectively by the NHS to assess quality and improve care. It recommended that the department should work with the NHS to ensure that the costs of diabetes are fully captured and understood in order to promote appropriate services and better outcomes for patients. In their recent response, the Government agreed with the committee’s recommendation. I would therefore like to ask the noble Earl what progress has been made in implementing it, especially on the further work required to improve the underlying financial information collected at both the local and national level, and how quickly this will be made available to commissioners.
As we have heard, people with type 1 diabetes can live long, healthy lives if their condition is well managed. However, too many are not getting the help and care they need, leading to devastating complications, avoidable deaths and greater costs to the NHS. Everyone with diabetes should receive the nine agreed care processes recommended by NICE as part of their annual review. However, two-thirds of those with type 1 diabetes do not receive all nine. Can the noble Earl give more detail on how the target of 80% coverage by 2018 given by the department in the PAC response will be met? The concern is that the disbanding of NHS Diabetes may result in a number of established work programmes either not continuing or being suspended. It is really important that these programmes continue. They include integrated care supporting self-management, clinical safety, paediatric care and education, specialist foot care, older person’s care, inpatient care and, as we have heard from my noble and learned friend, insulin pump networks. Will the noble Earl support further development of these work programmes with the input of clinicians and patients to drive quality improvement?
Data from the National Paediatric Diabetes Audit show that only 6% of children and young people whose checks are being recorded are getting all of the recommended diabetes care, services and support that they are entitled to. Over 85% of children and young people over the age of 12 have blood glucose levels higher than the recommended targets. As many noble Lords here will know, on 13 March, Diabetes UK launched its type 1 essentials for children and young people campaign. In seeking to help end the variation in levels of diabetes care, the organisation wants to see specific diabetes leadership and a diabetes service improvement function in the new NHS improvement body. Assuring the effective commissioning of integrated models of diabetes care across primary and specialist services by working closely with clinicians and patients is vital.
Despite the fact that type 1 diabetes is a condition which people have to live with every day of their lives, my noble friend Lord Hoyle pointed out that education for people with diabetes is not universal or guaranteed. NICE guidance recommends that people with type 1 and type 2 diabetes should be offered patient education programmes to help them understand more about their condition and develop the skills needed effectively to self-manage their diabetes. An economic analysis performed by the York Health Economics Consortium, referred to by my noble friend Lord Harrison, revealed that DAFNE, a structured education course for people with type 1 diabetes, would pay for itself within four to five years due to the reduced complication rate expected from improved management of an individual’s diabetes.
As my noble friend Lord Hoyle said, the National Diabetes Audit has been collecting data on structured education in England and Wales since 2005. However, the completeness of the data is limited and therefore has not previously been reported nationally. The 2009 data show that of the 6,444 people who were diagnosed with type 1 diabetes during that year, just 180 recorded offers of education. In Diabetes UK’s 2009 membership survey, only 36% of people had attended a course to help them manage their diabetes since diagnosis. All people with diabetes, whether recently diagnosed or those with pre-existing diabetes, should receive access to the education and support they need to enable them to manage their condition. It should be available in their local area and be accessible and flexible enough to meet their individual needs. Like other noble Lords today, and like Diabetes UK, I welcome the appointment of Dr Jonathan Valabhji as the National Clinical Director for obesity and diabetes for England. However, I would seek from the Minister an assurance that type 1 diabetes will not be forgotten and that it will remain a core part of the new director’s responsibilities. I have completed my speech without interruption.
Health: Anorexia
Lord Collins of Highbury Excerpts(11 years, 4 months ago)
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Lord Collins of Highbury
My Lords, I, too, thank my noble friend Lord Giddens for initiating this debate. As we have heard, the causes of eating disorders are both complex and multifaceted. At times of stress many of us resort to what is euphemistically called comfort eating, and the consequential results impact on self-esteem that can cause a very negative spiral.
Whatever the physical or psychological factors are it does not help that in our modern society we are constantly urged on the one hand to look sleek yet on the other to consume fattening foods. More often than not the food industry through its advertising campaigns manages both in one ad. Why is it that only on television does the person stuffing a bar of chocolate down their mouths appear to be so thin?
The excellent work of the All-Party Parliamentary Group on Body Image has shown that the constant portrayal of the man with the perfect six-pack or a young woman in a bikini does have an impact. It has highlighted the growing evidence that body image dissatisfaction is high, and on the increase. It is associated with a number of damaging consequences for health and well-being. We should contrast this with the way we are encouraged to eat foods packed with calories and made up of saturated fat and simple carbohydrates, the two food types most likely to make us put on weight. I remain concerned that so many so-called low-fat products are packed with sugar and calories.
Eating disorders can stem from a combination of issues, including distorted body image and low self-esteem. As I know from personal experience, someone with an eating disorder is very good at hiding the fact, often using a great deal of deception to fool the person or people to whom they are closest. This partly explains why there is a lack of data on the number of people who suffer from eating disorders. However, as we heard tonight, the numbers are great and the costs to the individual, their family and society can be devastating. Although eating disorders are considered to be a young girl’s disease, they can affect anyone at any stage in life, and up to 20% of sufferers are male.
It is clear that early intervention is vital. However, that relies on greater openness and understanding of the issues on the part of all of us. The excellent campaign launched by the eating disorder charity Beat just two weeks ago used as its theme, “Everybody Knows Somebody”, to flag up the fact that these illnesses are far more common than most people think. The Minister for Women and Equalities, Jo Swinson, in supporting the campaign, highlighted the fact that we are bombarded with all kinds of images, and that we need to equip young girls and boys to be more resilient to these pressures.
The Government’s Body Confidence campaign has worked for the past 18 months to identify non-legislative solutions to tackle the causes of low levels of body confidence. It is a great initiative that includes representatives from the health and fitness, fashion and retail, youth and education, media and advertising, and beauty sectors. That is to be welcomed, but we still have a fashion industry that portrays extremely thin women and girls, and we have also heard that we face a proliferation of websites promoting images of anorexic girls. What assessment has been made of the impact of the Body Confidence campaign? What action will the noble Earl’s Government take against these appalling websites? What action are they taking about the growing number of eating disorders among men?
The NICE guidelines on the treatment of eating disorders, published in 2004, are due for review in 2014. Many excellent services exist—we have heard about them tonight—but what impact will the new commissioning arrangements have on the fragmentation of these services? In my own area there is now a six-month waiting period for the first appointment for someone referred by a GP. Will the Minister ensure that best practice is maintained and that the gap between youth and adult services is addressed? Is it not time for a more coherent government strategy that encourages us all to understand better that what, when and how we eat really matters?
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, perhaps I may begin by thanking the noble Lord, Lord Giddens, for securing this short debate on eating disorders, not least because it affords us a twofold opportunity: first, to let sufferers and their families know that their voices and experience are influencing what we do at the highest levels of government; and, secondly but no less importantly, to give prominence to a range of disorders that so often are hidden.
The noble Baroness, Lady Crawley, described eating disorders as desperately sad. I agree with her. The statistics are grim. Anorexia nervosa has the highest mortality rate of all psychiatric conditions. It disrupts education and quality of life, and in 20% of cases continues to create difficulties in independent living for up to 10 to 20 years after the onset of illness, as a number of speakers said.
Although relatively little research has been done into long-term outcomes for bulimia nervosa, binge-eating disorders and other less well known conditions, anecdotal evidence suggests that these disorders can, for a significant cohort of patients, have equally life-limiting, long-term consequences. These disorders can affect anyone at any time, regardless of gender, but most cruelly the peak age at onset for the majority of sufferers is the mid-teens.
The noble Lord, Lord Giddens, asked what the Government’s policy is in this area. The answer to that has several strands to it. Early intervention is vital, and that is why it is a key national priority for the Government. Our cross-government mental health outcome strategy, No Health Without Mental Health, takes a life course approach, recognising that the foundations for lifelong well-being are already being laid down before birth and that there is much we can do to protect and promote well-being and resilience through the early years, into adulthood and on to a healthy old age.
The strategy’s implementation framework, published last July, sets out that public services intervening early is one of the 10 key changes that will be needed to turn the mental health strategy into reality and the specific actions which local organisations can take to achieve this, including: children and their parents receiving evidence-based health promotion from birth; public services, including GPs, recognising people at risk of mental health problems and taking appropriate timely action; and schools taking a whole school approach to supporting all pupils health and well-being, including both universal approaches and targeted services for those at risk of developing mental health problems.
We are investing £54 million over the four-year period 2011-15 in the Children and Young People’s Improving Access to Psychological Therapies programme to drive service transformation, giving children and young people improved access to the best mental health care by embedding evidence-based practice and making sure that whole services use session-by-session outcome monitoring. In February 2012 the Government announced a further £22 million over three years to the CYP IAPT programme. Some of this money will be used to extend the training offered by CYP IAPT to two further therapies—systemic family therapy and interpersonal psycho therapy. These therapies are invaluable in addressing some of the major mental health problems of adolescence, including eating disorders, as well as providing much needed support for the families of those affected.
The noble Lord, Lord Giddens, mentioned the tragic case of Laura Willmott. I, too, saw that coverage. I know that transition can be a huge issue, often pitching sufferers and their families into crisis at a critical time. Sudden changes in treatment and services can be bewildering and dangerous for patients and their families, and parents can find themselves excluded from decisions about care. I was very struck by the powerful remarks of the noble Countess, Lady Mar, on this theme. Charities such as Beat and Anorexia & Bulimia Care, which do so much to raise awareness as well as provide support and advocacy in action, are working with experts in the field on the feasibility of improvements to the care system, with a specific focus on introducing the option for students to receive care wherever they are.
It is this kind of grass-roots action that will make the difference the Government envisage when we have freed up health and social care services from micromanagement, empowering localities to make vital decisions that are tailored to meet the needs of their communities.
My noble friend Lord Carlile referred to the variation in services. I recognise his concern. New arrangements for the commissioning of services for eating disorders should also result in better planning and co-ordination of specialised services, greater equity of access, care and outcomes for patients, and a more proactive and systemic approach to service development, research and innovation. The child and adult specialised eating disorder services will be commissioned by the NHS Commissioning Board from April this year.
Within the board there will be a central team that will have a clear focus on specialised services organised around programmes of care. The team will develop a national service specification for each service while at the same time ensuring that it is sensitive to local needs. Work on eating disorders services has been underpinned by expert clinical reference groups on eating disorders and child and adolescent mental health services. The groups have explicitly recognised that targeted work is needed on the issue of transition.
However good our intentions, beneficial change does not always keep pace with the urgent desire of patients and families to feel the impact of those changes, but there are areas where direct action can yield swift dividends. The Time to Change programme, England’s most ambitious programme to end mental health stigma and discrimination, now has the potential, with funding from the Department of Health and the Comic Relief fund, to reach 29 million members of the public with its vital messages on mental health. As is so often the case, it is the courage of individuals as evidenced recently in a debate in Westminster Hall in which Mr Brooks Newmark spoke. Events like that do much to challenge stigma and secrecy, and I think the honourable Member is to be commended for shining the light on an underreported aspect of eating disorders. The fact is that they are not simply the preserve of teenage girls. Male sufferers are growing in number, and I shall have something more to say about that in a moment.
The noble Baroness, Lady Gale, asked what we are doing to work with the fashion industry, a question echoed by the noble Lord, Lord Collins, and the noble Baroness, Lady Crawley. I commend the assiduous work of the All-Party Parliamentary Group on Body Image under the expert chairmanship of Caroline Nokes. The Government’s own Body Confidence campaign has made great strides over the past two years in encouraging a more open and public conversation about body image. Working with a range of representatives from health and fitness, fashion and retail, youth and education, media and advertising, and the beauty sectors, we have been active in a number of areas: research, parent education, resources for teachers, industry awards and promoting public debate.
The noble Lord, Lord Giddens, my noble friend Lord Carlile and the noble Baroness, Lady Gale, spoke powerfully on the theme of websites. I am aware of the growing evidence of pro-eating disorder websites. They attract impressionable young people and intensify weight/shape anxiety as well as, disturbingly, introducing users to new methods of losing weight, as the noble Baroness, Lady Gale, told us so graphically. What can the Government do about this? Legislation is not the answer. Many of these websites are set up by young people with an eating disorder and we would not want to criminalise an already vulnerable group, while other websites are hosted overseas. However, we are committed to joint working with charities and the internet industry to speed up the reporting of damaging web-based content and the blocking of harmful websites. In January, my honourable friend Norman Lamb hosted a round table with key stakeholders on this very issue where, encouragingly, the development of a concordat was discussed. The Government will support this joint endeavour in whatever way we can.
The noble Lord, Lord Giddens, asked whether we recognise the link between these disorders and obesity, while the noble Lord, Lord Brooke, also spoke on that theme. The answer is that we do recognise it and we are doing a whole host of things to combat obesity, some of which I have referred to in your Lordships’ House before. Weight management funding will in future be addressed through the new public health system, but most data on eating disorders come from charities such as Beat, particularly in its report on the costs of eating disorders in England, as well as surveys and reports from the royal colleges and other professional bodies. The Health and Social Care Information Centre published its annual mental health bulletin last Tuesday. It provides information on eating disorders for the first time, and I commend it to noble Lords as a reference point.
The mandate to the commissioning board makes it clear that the NHS should measure and publish outcome data for all major services by 2015, broken down by local clinical commissioning groups. To support that, the Government will strengthen quality accounts, which all providers are legally required to publish.
I have a great deal more material, but signals are being sent to me that my time is running out. I would like to address all these issues in letters to noble Lords, particularly those concerning men with eating disorders; my noble friend Lord Alderdice’s question on research that we are helping to fund; and the role of schools, which my noble friend Lord Carlile and the noble Baroness, Lady Gale, asked me about.
In my own researches in this area, I have been much struck how many of those affected talk about how worthless and disempowered they feel. I think it is appropriate for me to use this opportunity to send a clear message to them: you are valued, you are not invisible, and with the right, targeted support, recovery is not only possible but probable.
Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) Regulations 2012
Lord Collins of Highbury Excerpts(11 years, 5 months ago)
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Lord Collins of Highbury
I express my thanks to the noble Lord, Lord Willis, for his comprehensive contribution this afternoon. He has covered quite a lot of the questions that I would have asked and there is no point in repeating them. However, I should like to pick up some specific points.
First, in relation to sexual health, like the noble Lord, Lord Willis, we welcome these regulations, particularly the very important principle of the maintenance of open access. HIV has never respected local authority boundaries, nor have other sexually transmitted infections. I have spoken in the Chamber of my concerns about how the new system of commissioning and fragmentation can put at risk regional and sub-regional co-ordination of HIV prevention work. This morning, I visited Positive East, a community facility based in the East End, which does excellent work in a number of boroughs in the east of London. It also participates in outreach and preventive programmes across London and it remains particularly concerned about the future. I appreciate that, while HIV Prevention England is commissioned by Public Health England to run a national HIV programme and local authorities will commission local HIV prevention and testing services, there remains a gap in regional co-ordination. This was highlighted in a health Question in the other place on 15 January, when the Minister assured Members of Parliament that this regional work would continue, but the detail on whether there would be national leadership remains unclear.
What steps will the Government take to encourage co-ordination of sexual health services across boroughs and localities? For example—this was raised by the noble Lord, Lord Willis—25% of HIV prevalence in the UK is in London, which previously had an integrated pan-London programme for HIV prevention. What measures have been put in place, as the noble Lord has already said, to facilitate cross-charging between sexual health clinics for out-of-area residents?
An issue which arises from these regulations is the concern that has been expressed about the pressure on budgets and, certainly, consistency across the country. I am acutely aware that, come the local elections, there will be not so much prioritising of these important issues. This could be a concern. I do not think that sexually transmitted infections have been the highlight of many party manifestos, but they are important issues in public health.
There is no mention in the regulations about the quality of open access health services and the minimum expectation that the Government have of locally commissioned sexual health services. The Minister has repeatedly said that the answer lies in localism—in local circumstances—and that these issues are best addressed locally. However, there is a requirement to ensure that there is proper maintenance of standards on these issues.
Will there be any obligations or duties on local authorities to promote HIV prevention? Currently there are no known incentives on prevention, only on tackling late diagnosis, in the new public health outcome framework.
The other issue which I am particularly concerned about and which I have raised in the House is the question of HIV testing. This is highly fragmented under the new NHS arrangements. I have asked the noble Earl before, and I repeat: how will the Government ensure that HIV testing recommendations from NICE and the British HIV Association are consistently implemented across the country? In some areas of high prevalence it is recommended by NICE that HIV testing should be routinely offered in primary care settings. Will this be implemented? How will this work be funded and provided?
The noble Lord, Lord Willis, also touched on the issue of the treatment of people living with HIV and the treatment of other sexually transmitted infections they may have. I am not sure how that will be covered.
I am also concerned about the question of offering services and treatment through self-management, if you like, for people living with HIV. That is one of the key things I saw at Positive East today. This is not only about the supply of drugs and treatment but about employment advice, general housing conditions and other issues that we have already covered in debates in the Chamber. The funding and support of those activities concerns me. Where is it going to fall? Who is going to take responsibility? Fragmentation is a real worry.
I shall not cover specific local government issues around public health because the noble Lord, Lord Willis, has covered them excellently. However, I wish to pick up on some of the points that the Minister raised in relation to local Healthwatch and its access. We had a major debate on Healthwatch this week, which preceded the Statement on the Francis report on Mid-Staffs. Given the measures outlined in these regulations, will the department review them in the light of the recommendations made by Francis? Issues were raised by Francis which, I suspect, are not adequately covered by the regulations, particularly with regard to access.