Health: Local Healthwatch Organisations

Lord Collins of Highbury Excerpts

Monday 11th June 2012 Lords Chamber

Asked By

[Lord Collins of Highbury]

To ask Her Majesty’s Government what progress is being made on establishing local Healthwatch organisations and what steps they will take to ensure that their commissioning and administrative costs are kept to a minimum.

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

My Lords, 75 local Healthwatch pathfinders have generated learning for all local authorities to use. The Local Government Association is working with all local authorities, including holding a series of master classes, and the Government are undertaking targeted engagement on local Healthwatch regulations until mid-June. The Government have made £3.2 million available for start-up costs and information is being made available on commissioning and procurement options.

[Lord Collins of Highbury]

I thank the Minister for that response. Only one local Healthwatch organisation will be contracted in an individual local authority, but the body itself will be permitted to subcontract most if not all of its activities. What are the department’s estimates for the overall cost of multiple contracts, solicitors’ fees and all the other on-costs of commissioning? Can the Minister also explain how fragmenting local Healthwatch organisations in this way will provide the strong and co-ordinated voice for patients and their carers that we need for real local scrutiny and accountability?

[Earl Howe]

My Lords, the noble Lord is absolutely right to raise the question of the cost-effective commissioning of Healthwatch and I have no doubt, from the Local Government Association, that both the efficient and effective functioning of Healthwatch is something that is well within its sights. The noble Lord has raised a series of hypotheses which I think are somewhat extreme, of local Healthwatch organisations parcelling out their functions all over the place. Our aim is to have as locally inclusive a body as possible in each local Healthwatch area to enable Healthwatch to perform its functions as much by itself as with the aid of others. Indeed, the pathfinder events to which I have referred have been clear that there is a local appetite to do that.

Autism Act 2009

Lord Collins of Highbury Excerpts

Monday 26th March 2012 Grand Committee

[Lord Collins of Highbury]

My Lords, I apologise for being slightly delayed in the voting Lobby earlier and for missing a few of the comments, but I picked up their general gist. I too am grateful to the noble Baroness, Lady Browning, for initiating this debate and, just as importantly, reminding us why the 2009 Act was developed. As she rightly pointed out, it recognised that adults with autism were a particularly socially isolated and excluded group, and it is important to keep reminding our society about that. The Act put two key duties on government: to produce, first, the strategy and, secondly, the statutory guidance which noble Lords have referred to. The Government are now committed to reviewing implementation of the strategy in 2013, and it is vital that this review is as comprehensive as possible. Like many noble Lords, I am also grateful to the National Autistic Society for assisting me with the provision of background information, and for the excellent work that it is doing. I pay it a special tribute.

That society has, of course, not been standing still. It has been looking at monitoring progress towards the full implementation of the strategy. It has particularly been monitoring local authorities about the specific tasks within that strategy: the autism lead; working pathways for diagnosis; established partnership boards, which noble Lords have referred to; including the needs of adults with autism in the joint strategic needs assessment; and developing a local commissioning plan. There is also awareness training, which is vital in all service providers because as the noble Baroness, Lady Browning, pointed out there are still things going on which should not be and which are illegal. We also need to broaden that and have, as she said, awareness training in place for community care assessors.

The results of the national society’s own research are patchy, but it appears that many authorities are starting with the easy bits, as your Lordships would expect. A very high rate—74 per cent—have established an autism lead and 55 per cent have established an autism board. Yet when it comes to more complicated steps, such as producing a commissioning plan, collecting information about adults with autism and having basic training, only about one in three authorities has either taken action or is actively pursuing these goals. The society has advised me that it regularly hears from front-line professionals who say that a key challenge in implementing the strategy is gathering accurate data on the needs of their local population of adults with autism. The strategy sets out that the Department of Health would develop a protocol for information-sharing at local level to help improve local data. This is yet to be published. One of my first questions for the Minister is, therefore: what progress is being made in developing this protocol?

I also understand from the society that the health department is currently undertaking a zero-based review of its data returns. Again, front-line professionals have told the society that adding autism into these returns is essential to help them gather the information they need to plan for cost-effective services. The society is aware that the department has been discussing adding information on autism. What progress is being made to ensuring that data on autism will be collected as a result of the zero-based review?

One important area that the noble Baroness, Lady Browning, and my noble friend both referred to is of ensuring access to diagnosis, which is the cornerstone of the autism strategy. This is also an issue which, to date, very few areas have been able to address successfully. This is one of the areas which I want to focus on. As we have heard, NICE is currently drafting a guideline on the most effective way to develop a local diagnosis pathway, as well as the most effective interventions for adults with autism, which would of course help. However, professionals are telling society—I also read about this at the weekend in an excellent article on autism in the Observer—that a key barrier for developing local pathways to diagnosis is trying to engage the local NHS in local implementation plans. In this respect, the blame is being partly laid on the NHS reorganisation.

I would like to repeat the question posed by the noble Baroness, Lady Browning, to the Minister: as NHS reforms are taken forward, will guidance be developed for health and well-being boards and clinical commissioning groups about the Autism Act? As the noble Baroness has already pointed out, there are already failures in understanding the true nature and requirements of that Act, and we need to ensure that it is understood at all levels as a consequence of the reorganisation.

As we have heard, many aspects of the strategy’s objectives also realise the full potential of people—both children and adults—who are autistic. As many, including the National Audit Office, have identified, the implementation of this strategy will save money: it will save the public purse. I would like to once again stress the question posed by the noble Lord, Lord Touhig, to the Minister: what progress is being made by the Department of Health in developing guidance with professionals on the business case for local teams? What action is the Department of Health taking to encourage the development of these teams locally? Will the barriers to developing these teams be considered as part of the 2013 review of the strategy?

Health: Diabetes

Lord Collins of Highbury Excerpts

Wednesday 1st February 2012 Lords Chamber

Asked By

[Lord Collins of Highbury]

To ask Her Majesty’s Government what plans they have to act on the National Diabetes Audit Mortality Analysis 2007–08, published by the NHS Information Centre, which estimated that up to 24,000 deaths from diabetes per year could be avoided by the condition being better managed.

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

My Lords, we are working with the National Diabetes Information Service and National Health Service organisations to ensure that local services have the audit data for their own areas to show how they compare with others and where improvements can be made. NHS Diabetes has a suite of tools that can be used to help drive improvements and reduce avoidable deaths.

[Lord Collins of Highbury]

I thank the Minister for his response. Diabetes UK estimates that about 26 per cent of the 450,000 residents in nursing and care homes in England have diabetes. Care home residents are a highly vulnerable group of people and, without regular screening for diabetes, they are at an increased risk of complications such as heart disease, stroke, kidney failure, blindness and amputation. What are the Government doing to ensure that residents in care homes receive the appropriate screening that they need for diabetes?

[Earl Howe]

My Lords, much will depend on the way in which primary care engages with those in social care to ensure that the residents of care homes, who need diabetes care management, receive it properly. We very much want to see that joined-up commissioning arise from the reforms that we are currently in the process of debating in your Lordships' House. The noble Lord makes a very good point. We have many tools at our disposal. There is no shortage of guidelines in this area. Much will depend on the training of care home staff and a lot of work is going on under the aegis of the National Clinical Director for Diabetes in this area.

Health: Early Diagnosis

Lord Collins of Highbury Excerpts

Monday 21st November 2011 Lords Chamber

[Earl Howe]

My Lords, the noble Lord makes an extremely good point. The answer to his question is, yes, I believe that it will have the capacity to do that. He rightly mentions advances in genomic science, which of course will have a major part to play in the field of diagnostics. As regards rarer diseases, as he will know, we are placing responsibility with the national Commissioning Board for the commissioning of specialised services for rarer conditions.

[Lord Collins of Highbury]

My Lords, as the Minister is aware, the reduction of 10 per cent in weight maintained over a period can reduce the risk of developing type 2 diabetes by 50 per cent. Small improvements in eating and drinking are needed. Will the Minister accept that the country needs a major awareness programme, led by the Government, on what to do to avoid developing type 2 diabetes; and, under the new legislation, will he continue to use his powers?

[Earl Howe]

My Lords, the Government have no current plans for a specific national campaign to raise awareness of diabetes. On the other hand, as part of Change4Life, which we are continuing with, we aim to raise awareness about diet and physical activity, and to create what we hope will be a mass movement to help to reduce obesity and related conditions, including diabetes. The campaign encourages everyone to,

“eat well, move more and live longer”.

There is also the very important ingredient of the NHS Health Check in this area, which the noble Lord is familiar with, for people in England aged 40 to 74. We think that this has the potential to prevent over 4,000 people a year from developing diabetes.

EU: Economy

Lord Collins of Highbury Excerpts

Wednesday 2nd November 2011 Lords Chamber

[Lord Sassoon]

My Lords, I think that I have already done so. The two-speed Europe that people seek to paint is one between the eurozone and the rest, but thanks to the work of the Prime Minister at the 23 October Council, the very important principle was accepted that those matters which relate to all EU members and the whole of the EU, such as the single market, will of course continue to be the province of the EU 27. That is the critical acceptance which has been made by the Council and the Commission at the prompting of the Prime Minister.

[Lord Collins of Highbury]

NHS: Private HealthcareQuestion3.22 pmAsked By To ask Her Majesty’s Government whether general practitioner practices are permitted to advertise their own private healthcare services using the NHS logo.

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

My Lords, the Department of Health does not permit organisations, including general practitioner practices, to use the NHS logo to promote their non-NHS services, including private healthcare services.

[Lord Collins of Highbury]

I thank the noble Earl for his response, but of course most of us in the Chamber have read in the newspapers recently about the case of a GP practice writing to its patients. I believe that what happened there goes straight to the heart of general practice; that is, the relationship between the doctor and the patient. It is a relationship that I fear the Government show no sign of understanding. Will he give an assurance that the proposed form of commissioning in the health Bill will not result in the nightmare possibility of the doctor changing from the person who decides the best medical treatment for the patient to the person who decides what can be afforded?

[Earl Howe]

My Lords, I can give that broad assurance, but the noble Lord will know that it is already within the GMC code that doctors have to consider the totality of the resources available to them and take account of the needs of all their patients. With that qualification, of course our reforms are designed to ensure that the highest-quality care is delivered to every patient according to his or her needs.

Health: Diabetes

Lord Collins of Highbury Excerpts

Tuesday 1st November 2011 Lords Chamber

Asked By

[Lord Collins of Highbury]

To ask Her Majesty’s Government what plans they have to act on the nearly 50 per cent rise, since 2005, in the number of people diagnosed with diabetes in the United Kingdom.

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

My Lords, the increasing prevalence of diabetes is one of the reasons we remain committed to the NHS health check programme. The programme has the potential to prevent over 4,000 people a year developing type 2 diabetes. We are also continuing to improve treatment and support for diabetes. Earlier this year, NICE published a diabetes quality standard, which provides an authoritative definition of good quality care for use by clinicians and commissioners.

[Lord Collins of Highbury]

I thank the Minister for his response. I agree that the biggest benefit of the NHS programme is the prevention of diabetes. However, despite its being in place for two years, very few people have heard of it or used it. Will the Minister explain what action he will take to ensure that the scheme is properly provided and promoted? Can he guarantee that such schemes will not be the first casualty of the proposed NHS reforms?

[Earl Howe]

My Lords, we are completely committed to the NHS health check programme, so I can reassure the noble Lord that we are clear that it has a major part to play. It is a very cost-effective way of both preventing and detecting early those who are at risk of diabetes or who may have recently contracted it. Health checks are part of the current operating framework. It is true that the figures for the first quarter of this year were a little disappointing, but PCTs are fully engaged in the process.

Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2011

Lord Collins of Highbury Excerpts

Monday 31st October 2011 Grand Committee

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

My Lords, the regulations before the Committee today relate to the registration of providers of NHS primary medical services with the Care Quality Commission. The effect of the regulations is straightforward. It defers the registration of most providers of NHS primary medical services by 12 months, until April 2013. The registration of a small number of out-of-hours providers of such services will still go ahead in April next year, and the commission has started the process of registering these providers.

As the independent regulator, the Care Quality Commission has a key role in assuring the public and people who use services that health and social care providers of “regulated activities” meet certain requirements. In order to be registered, providers must meet a series of essential safety and quality requirements on an ongoing basis. Where a registered provider fails to meet these requirements, the CQC has a range of enforcement powers that it can use to bring a provider back into compliance. In the case of the most serious failings, the CQC is able to cancel a provider's registration, which would result in the provider's closure.

The Committee will be familiar with some of the criticisms that have been levelled recently at the CQC, in particular that the number of inspections of providers that it carries out has fallen to unacceptably low levels and that it failed to respond appropriately to serious service failings, most notably in the case of the appalling abuse of residents at Winterbourne View, a hospital for people with learning disabilities.

The Government attach the highest importance to the role of the regulator in carrying out its statutory functions in an efficient and effective manner. The regulations before us are part of the process of how we and the CQC respond to these issues. Deferring the registration of around 9,000 providers of NHS primary medical services will give CQC additional time both to improve the registration process for this tranche of registrants and to increase the compliance activity of providers that are already registered with it.

Implementing the new registration system has required the Care Quality Commission to register around 21,000 providers already, bringing in, first, NHS providers; then independent sector healthcare providers and adult social care providers; and then independent ambulance and primary dental care providers. This has been a major programme of work for the CQC, which it has carried out well. However, given the scale of the task, it is perhaps not surprising that the number of compliance inspections carried out by the regulator fell. The current timetable set in regulations brings providers of NHS primary medical services into the registration system in April 2012. This would bring in around 9,000 additional providers and includes GP practices, out-of-hours primary medical care providers and some NHS walk-in centres.

Although we remain committed to the registration of providers with the CQC and are confident that this will provide effective levers to tackle providers who deliver sub-standard care to patients, we have reconsidered the timing of registering the majority of these providers in the light of the challenges that the CQC has faced. Following a consultation that came to an end in July, and engagement with key stakeholder representatives, we have decided that providers of NHS primary medical services who provide out-of-hours care to patients who are not registered at their practice will be required to register with the CQC as planned from April 2012.

Out-of-hours services tend to treat unfamiliar patients in unfamiliar surroundings and see a higher proportion of vulnerable patients with urgent care needs that are often more complex than those generally found in daytime general practice. As such, there is a more pressing need to register these services than other NHS primary medical services, which is why we are forging ahead with the registration of this group of providers. All other providers of NHS primary medical services will now be required to register in April 2013. The regulations before us amend the regulated activities regulations in order to achieve this delay.

In parallel with our consultation on the proposed changes, the CQC has reviewed its registration process, looked at streamlining its registration systems, and is increasing its scrutiny of providers that it already registers. Consultation responses made clear that a streamlined process would be welcomed. I am pleased to assure the Committee that the commission is taking steps in this direction. On the registration process for primary medical services, I am informed that the CQC is overhauling its online application process so that providers will be able to start completing the application sooner than in previous application rounds. The website will contain full information on the registration process and will provide updates on the progress of an application and how long it is anticipated that it will take for key decisions to be made. The CQC will also put in place a central team to handle applications, avoiding the risk of the registration of NHS primary medical care providers impacting on the CQC’s ability to monitor the compliance of other registered providers. Noble Lords may recall that there were delays in registering dental practices earlier this year due to the volume of Criminal Records Bureau checks required. The CQC is considering a different approach, which I am assured will go a long way to resolving these problems.

The CQC will engage with providers of medical services over the coming months to ensure that they have a clear understanding of what registration will entail and how compliance with the registration requirements will be assessed. The CQC’s compliance inspections have been increasing steadily since the spring. and I am confident that the delays proposed and the arrangements the commission is putting in to handle registration in April 2013 will allow this to continue and be sustained.

Looking beyond initial registration, the CQC is also proposing changes to strengthen and simplify its regulatory model. Importantly, the commission is planning to increase the number of inspections that it carries out. These proposals would see all registered providers of hospitals, social care providers and independent healthcare providers being inspected at least once a year, with primary dental care providers inspected at least once every two years.

I hope that the Committee will be reassured by the progress that the CQC is already making to improve its registration processes and to increase its focus on compliance and inspection. The delay to the registration of providers of NHS primary medical services that we are considering today will allow the commission the space and time that it needs to move further in this direction more quickly. I commend the regulations to the Committee.

[Lord Collins of Highbury]

I thank the Minister for his remarks about the regulations. I must admit that when I read the words:

“These Regulations may be cited as the … Regulated Activities … Regulations”,

I felt as if I was participating in a Marx brothers’ movie, as you wonder which part relates to which. However, behind the regulations lies a very important human story. I want to focus my comments and questions on some of those issues. The Minister referred to the fact that in respect of NHS primary care services there is clearly a risk that the problems which the Care Quality Commission faces now could still apply in 2013. Apart from simply delaying the requirement to register again, has the Minister any other contingency plans to deal with the capacity problems in the CQC?

A human-issue story concerning out-of-hours services relates to the report that the CQC wrote arising out of the Daniel Ubani case, where the real risk posed to patient care from out-of-hours services was apparent. I would like the Minister to spell out how the small number of—

[The Deputy Chairman of Committees]

My Lords, there is a Division in the Chamber. The Committee will adjourn until 4.29 pm, taking note that the Clocks in the Room are an hour fast.

--- Later in debate ---

[Lord Collins of Highbury]

I have received a warning that I must not repeat myself, so I shall try to start from where I left off, which was highlighting the CQC report on out-of-hours services arising from the Daniel Ubani case, which highlighted that we have a nationwide problem. Delaying the requirement to register for a further year means that a lot of the issues that need to be addressed by proper monitoring of compliance will not be.

My other questions relate to which organisations are covered by the regulation. The estimate was about 230 organisations. Does that include the co-operatives such as SELDOC, established in south-east London? Is it simply those organisations separate from GPs? There is an issue about high-risk out-of-hours services stemming from provision within GP services by the use of locums employed directly. I would appreciate clarity about the risk assessments. What concerns me most is that within a 12-month period, the Care Quality Commission will be required to get in to 9,000 organisations, but the Government have given it 12 months to deal with about 230. Having been on the commission’s website and seen the processes and procedures, and the advice being given to primary health services, I think we have a difficult job ahead of us.

I leave my remarks to those few specific points. On the extension of out-of-hours—I must not say out-of-office services, that is my trade union background coming out—the flexibility of the provision of services by primary health services is most important. People are reverting to organisations that do not have their medical records or knowledge of their conditions because they have to work and cannot get to a surgery within its opening times. I know from personal experience that even booking a medical appointment can be extremely difficult. You have to do it within a particular time frame. With those concerns, I leave my remarks.

[Baroness Jolly]

I should like the Minister to clarify one point. Out-of-hours services providers need to register a year early if they are not in the practice of treating patients from outside their area. Can the Minister clarify the situation regarding itinerant or travelling workers? Where I come from, huge swathes of people come in to pick strawberries, daffodils or whatever. They certainly do not register. I am not clear whether the out-of-hours providers would treat them as temporary residents. What is the case in those circumstances? Would GPs who currently provide services in Cornwall in a co-operative be required to register a year early?

Medicines Act 1968 (Pharmacy) Order 2011

Lord Collins of Highbury Excerpts

Monday 17th October 2011 Grand Committee

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

My Lords, the Medicines Act 1968 (Pharmacy) Order, being debated today, will remove the restriction placed upon pharmacists registered in Britain by virtue of a pharmacy qualification awarded by a relevant European state that prevents them being in charge of a newly established pharmacy. This refers to any pharmacy that has been registered for less than three years and is commonly known as “the three-year rule”.

The relevant European states referred to are Iceland, Norway, Liechtenstein, Switzerland and the European Union (EU) member states. It is not relevant to pharmacists who qualified in the United Kingdom.

I should first give the Grand Committee some background. All pharmacists practising in Britain must be registered by the General Pharmaceutical Council, as must all pharmacy premises. Some pharmacists are registered to practise in Britain under arrangements for the mutual recognition of pharmacist qualifications awarded by EU member states or other relevant European states.

EU Directive 85/433—now 2005/36/EC—includes provision for member states to place restrictions on the recognition of the qualifications of such pharmacists in the case of pharmacy premises registered for a period of less than three years. In Britain, the restriction applies to the pharmacist in charge of such pharmacies, known as the “responsible pharmacist”. In other words, while all pharmacists registered in Britain under the mutual recognition arrangements may work in any British pharmacy, however long it has been registered, such pharmacists cannot hold the position of responsible pharmacist in a pharmacy that has been registered for less than three years. The current restrictions on visiting pharmacists owning pharmacy businesses or acting as superintendents are not affected by this order.

The derogation in the directive was originally put in place in the mid-1980s for economic reasons, following concerns by UK MEPs. They believed that, given the UK’s comparatively open arrangements in relation to pharmacy ownership, there was a risk that the mutual recognition arrangements would put existing UK pharmacies at a disadvantage. Since then, however, much has changed both in terms of pharmacy arrangements in other EU member states and the evolution of domestic policy in Britain.

We have conducted a full public consultation on removing the restriction, both for established pharmacists—those fully registered with the General Pharmaceutical Council in part 1 of the register—and for visiting pharmacists—those temporarily practising in the UK and registered in part 4 of the register. However, the restriction has not affected any visiting pharmacists as, to date, none has been registered.

The response to the public consultation has been very much in favour of removing the restriction. The proposal has support from the General Pharmaceutical Council, the pharmacy regulator, the Royal Pharmaceutical Society, the professional body for pharmacists, as well as all the main pharmacy representative organisations, including the Pharmaceutical Services Negotiating Committee, Community Pharmacy Scotland, the Company Chemists Association and the devolved Administrations.

The proposal will encourage flexibility, efficiency and continuity of care within pharmacy. It will end the situation where a responsible pharmacist, registered here by virtue of the mutual recognition arrangements, can no longer continue in that role if their pharmacy relocates, even if it only moves next door, and therefore becomes a newly registered pharmacy. Removing this restriction will mean that patients can enjoy greater continuity of care in such circumstances; that all registered pharmacists will be placed on a level footing in terms of their employment prospects; and that employers will have a deeper pool of potential employees to draw upon and less bureaucracy to deal with when filling vacancies.

I should now explain the revision of the draft Explanatory Memorandum laid before your Lordships today and the change required to the final version of the Explanatory Note on the order. In undertaking preparatory work for this debate on the draft order, officials in the Department of Health realised that, contrary to previous understanding, “visiting pharmacists”, a sub-category of registrants from relevant European states who do not go through the full registration procedure, are covered by the removal of restrictions that the draft order would achieve. It will not, therefore, require a separate legal instrument to remove the restriction upon their acting as “responsible pharmacist” at new pharmacies. Up to this point, it had been thought that a separate legislative instrument would be required to achieve this. The confusion appears to have arisen in the understanding of the differences between the restrictions applying to those who either may own, or carry on, a pharmacy business or act as superintendent, on the one hand, and the provisions relating to the responsible pharmacist on the other. A superintendent manages a pharmacy on behalf of a company. A responsible pharmacist is in charge of a pharmacy at a given time, and takes on responsibility for the effective management of pharmacy law and practice within a single branch at a particular time. If the draft order is approved, it will still not be possible for a visiting pharmacist to carry on—that is, to own a new pharmacy—or act as a superintendent in relation to a new pharmacy.

However, a visiting pharmacist, and any other pharmacist registered by virtue of the mutual recognition arrangements, would, upon the coming into force of the order, be entitled to be the responsible pharmacist in charge of a newly registered pharmacy in Britain. It is the similarity between the different concepts of control that appears to have led to the confusion. The intention has always been to remove the restriction on responsible pharmacists for all those registered to practise in Great Britain under the EU mutual recognition arrangements, whether visiting or not. The consultation reflected this and the order as currently drafted would achieve this.

Because of the misunderstanding, the earlier version of the accompanying draft Explanatory Memorandum, and the Explanatory Note on the order itself, suggested that the order did not remove the restriction in relation to visiting pharmacists. In fact, the substantive provisions of the order achieve the intention and a further instrument is not, therefore, required. However, the text in the Explanatory Note that refers to the register was incorrect, and the reference to part 1 of the register will not appear in the final version. I apologise for any confusion caused by this late change. I commend this order to the Committee.

[Lord Collins of Highbury]

As the noble Earl stated, a lot has changed since the derogation in the directive was put in place. Much has changed in pharmacy arrangements in other EU member states and in the evolution of domestic policy. The reasons, as the Minister stated, were commercial.

In England, for example, there has been a welcome change over the past few years making it easier for people to get to a chemist, given that there are new pharmacies with longer opening hours. Clearly, such market restrictions are not appropriate today, and their removal will assist by increasing the pool of available pharmacists and ensure improved continuity of service delivery. I note that the change has also been welcomed by the key representative bodies of pharmacies.

I of course recognise that the restriction affects a relatively small number of pharmacies—just over 10 per cent, and just over 5 per cent of all pharmacists registered to practise in Great Britain. I also understand and accept the reasons for the change in the Explanatory Memorandum. However, these changes in the legislation raise broader issues relating to the competencies of the pharmacist and the person’s ability to manage a pharmacy. For example, the report on the consultation noted that concerns were expressed by respondents on competency in English. The Department of Health in its response stated that in the UK a check on the language knowledge of a pharmacist from outside the UK who is seeking work within the NHS is applied by the prospective employer, but that there is no check made at the point of registration.

This leads to three specific questions to the Minister. First, are there plans to introduce a standardised competency test to ensure that any pharmacists from the countries mentioned in the order who are in charge of a new pharmacy have all the required skills and competences? Secondly, are there plans to ensure that those in charge of a pharmacy will have a sufficiently high standard of English to avoid all risk of a patient misunderstanding any advice given? Thirdly, how can an employer determine whether the pharmacist in question is qualified in their own country and has no pending fitness-to-practise cases to answer?

[Lord Clement-Jones]

My Lords, I declare an interest as chairman of the council of the School of Pharmacy of the University of London. I thank the noble Earl, Lord Howe, for a crystal clear explanation. I suppose, perforce, it had to be crystal clear to clear up some confusion arising from the Explanatory Memorandum. This is precisely the kind of uncontroversial deregulation that is important in the context. From both professional and consumer perspectives one could say that it is a perfectly formed small regulation. It affects a limited number of people who could not be responsible pharmacists in certain circumstances, but will now be able to be so where there are no significant safety implications from deregulating in the way that this order does.

I want to raise the issue of reciprocity. The noble Earl mentioned that the reason for deregulation is that circumstances have changed. The noble Lord, Lord Collins, also referred to that. I am sure that in broad terms that is the case, but I should be extremely grateful to hear what the noble Earl believes the level of that deregulation would be. I remember doing a study of several EU countries, looking into what was permissible in pharmacy ownership and the level of regulation. That was about five years ago, when the level of regulation was extremely high—not just pharmacy regulation but the kind of licensing required to run a retail outlet, and so on. We have some extremely well run chains in this country, which would like to expand their offer in the EU more broadly. They have been largely frustrated from doing so by some of the regulation that applies. Therefore, reciprocity in these circumstances is extremely important. I am interested to hear just what the Minister believes to be the level of significant deregulation that has taken place.

Health: Non-communicable Diseases

Lord Collins of Highbury Excerpts

Thursday 6th October 2011 Lords Chamber

[Lord Collins of Highbury]

My Lords, I, too, congratulate the noble Lord, Lord Crisp, on initiating this debate. I have huge respect for the work that he has done and continues to do in promoting better health here, and globally, through his experience of the National Health Service, his involvement as a fellow of the Institute for Healthcare Improvement and, above all, his leadership on global health. In his book, Turning the World Upside Down, the noble Lord highlights the most striking thing about health in the 21st century which is, he says, the way the world,

“is now so interconnected and so interdependent. This interdependence is changing the way we see health, creating a new global perspective and will affect the way we need to act”.

As we have heard, the UN conference has set out plans to tackle non-communicable diseases such as diabetes and heart disease, which now pose a greater global burden than infectious diseases. As has been said in this debate, lifestyle-related diseases are now the leading cause of death worldwide, killing 36 million people a year. Much of that toll, as we have heard, is in low and middle-income countries and that is where efforts must be focused.

However, as we have also heard, Europe today has a high prevalence of non-communicable diseases, such as cancer, diabetes, cardiovascular diseases, obesity disorders and musculoskeletal disorders, which together cause 86 per cent of deaths in the EU. According to the EU, the causes of these diseases can be attributed to the interaction of various genetic, environmental and, especially, lifestyle factors—including smoking, alcohol abuse, unhealthy diets and physical inactivity. Linked by these common risk factors, many of these diseases are, as we have heard, preventable. Spreading access to effective treatment more evenly across the EU would bring significant health and economic benefits to all EU countries.

At this point in my contribution, I feel I must declare an interest; in fact, I should say interests. When I read the WHO report on this subject, I realised that I was very much a victim of my own bad lifestyle. Five years ago, I stopped smoking and subsequently put on weight. As the noble Lord, Lord McColl, has said, I think that I ate too much. I then took on a very stressful job, as my noble friend Lord Kennedy said, as general secretary of the Labour Party. I discovered soon after taking that job that I had high blood pressure. As a result of further tests, I was told that I had very high cholesterol levels and to cap it all—my noble friend Lord Kennedy has already outed me in this respect—I was formally diagnosed as a type 2 diabetic. Early diagnosis and the excellent response of the NHS means that I have a chance of avoiding the worst consequences of these diseases, but would it not have been better if I could have avoided them in the first place? Early preventive action not only saves lives, it also saves money.

This is where I also want to amplify the conclusions we have heard from the WHO report, which focused on affordable actions that all Governments should take. First, as we have heard, there should be measures that target the population as a whole such as high taxes on tobacco and alcohol, and smoke-free indoor workplaces and public places, as well as campaigns, more importantly, to reduce salt and dangerous fats. I very much understood some of the comments about some agencies that are trying to stop us making progress in this area. Secondly, there should be other actions focusing on individuals such as screening and early treatment, which I have already mentioned in my own case. As I said in my maiden speech to this House, the personal is the political. It was the smoking ban that prompted me to stop smoking, while my local swimming pool provides an excellent service enabling me to deal with some of the stressful elements of my life—I go swimming every morning—and that screening led to my early treatment for diabetes. These are the factors that influenced my health. Unfortunately, no one yet has found a cure for my addiction to chocolate but maybe that will come.

A telling fact for me in the WHO report, as the noble Lord, Lord Crisp, said, is that the total cost for adopting these strategies in all low and middle-income countries would be £7.2 billion a year. In comparison, the cumulative costs of heart disease, chronic respiratory diseases, cancer and diabetes in poorer countries are expected to top £4.4 trillion between 2011 and 2025—an average of nearly £316 billion a year—according to the World Economic Forum. Many countries have already adopted the public health interventions that have seen marked reductions in disease incidence and mortality. The WHO monitored the progress of 38 countries taking steps to address cardiovascular disease at both population and individual levels over the space of a decade. All recorded substantial decreases in exposure to the risk incidence of disease and death toll; proof, if we ever needed it, that there are affordable steps which all Governments can take to address non-communicable diseases.

It is also a fact, as we have heard, that men and women in low-income countries are around three times more likely to die of non-communicable diseases before the age of 60 than they are in high-income countries. In the 2008-2013 EU health programme, the main activities focus on raising public awareness, improving knowledge and reinforcing preventive measures. To support these actions, it proposes networks and information systems across member states to generate a flow of information along with analysis and exchange of best practice in the public health field. As the noble Lord, Lord Crisp, has said, we need to promote a strong global approach involving integrated action on risk factors combined with the efforts to strengthen health systems towards improved prevention and control. I therefore urge the Minister to support positive intervention on this important global health issue and, as the noble Lord, Lord May, said, to have action—not just words.