Children and Families Bill

Lord Colwyn Excerpts

Wednesday 16th October 2013 Grand Committee

Relevant document: 7th and 9th Reports from the Delegated Powers Committee, 3rd Report from the Joint Committee on Human Rights.

[The Deputy Chairman of Committees (Lord Colwyn) (Con)]

My Lords, if there is a Division in the Chamber while we are sitting, the Committee will adjourn as soon as the Division Bells are rung and resume after 10 minutes.

Amendment 40

Moved by

Herbal Medicines

Lord Colwyn Excerpts

Wednesday 24th April 2013 Grand Committee

[Lord Colwyn]

My Lords, I am grateful to the Committee for the opportunity to say a few words in the gap. I declare an interest as a patron of the Foundation for Research into Traditional Chinese Medicine. I am also president of the All-Party Parliamentary Group on Alternative and Complementary Medicine.

It is always a pleasure to follow the noble Lord, Lord Taverne. His claim that there is no evidence of homeopathy’s efficacy and that herbal remedies are useless is not new to me or to the Committee. When compared with the risk of taking food supplements, an individual is about 900 times more likely to die from food poisoning and 300,000 times more likely to die from a preventable medical injury during a spell in a UK hospital. Adverse reactions to pharmaceutical drugs are 62,000 times more likely to kill a UK citizen than taking a food supplement and 7,750 times more likely to kill than taking herbal remedies.

In February 2011, following a series of meetings with Ministers from the Labour Party and with the new coalition Government, the Department of Health announced that it would introduce a statutory register of herbalists by the end of 2012. Statutory regulation is absolutely essential because it is the only way that herbalists can continue to have access to a full range of manufactured herbal medicinal products. It is unreasonable that interference from the European Commission should hold up the establishment of this register.

My noble friend Lord Howe said recently:

“The legislation around this policy is complex and there are a number of issues that have arisen which we need to work through. We appreciate that the delay in going out to consult on this matter is causing concern; however, it is important that any new legislation is proportionate and fit for purpose”.—[Official Report, 19/3/13; col. WA135.]

Can my noble friend explain what,

“going out to consult on this matter”

means? I hope that it refers to consultation with representatives of the practitioners, their suppliers and relevant departments in the administration of this area. If it means more delay and uncertain outcomes for a sector already plagued with uncertainty, it is unacceptable.

However, the situation is not that straightforward. This afternoon in Central Lobby, I heard a rumour that the Government have changed their mind. Apparently, they have decided to drop all plans for statutory registration and will rely on licensing mechanisms to ensure patient safety. I do hope that my noble friend can give the Committee an assurance that this is not true. Should there be any substance to that rumour, further discussion and negotiation must be an absolute priority.

--- Later in debate ---

[Lord Colwyn]

My Lords, my recollection was, in February 2011, that it had been settled. We shook hands and congratulated each other on the fact that strategy regulation had been promised by the Government.

[Baroness Northover]

As I say, my noble friend Lord Howe is happy to meet people and no doubt this will be discussed further. Maybe I had better hurry up and conclude because I think I am about to go beyond time. Unless I hurry up, nobody will have a chance to say anything else.

Health and Social Care Bill

Lord Colwyn Excerpts

Monday 5th December 2011 Lords Chamber

[Lord Colwyn]

My Lords, my noble friend Lady Gardner reminds me of how I used to practise. It is not a lot of fun to pull a load of teeth out for a child under general anaesthetic. We are in great danger of getting into a pro and anti-fluoride debate, which I do not want to do. However, I want to support the noble Lord, Lord Hunt, who is a patron, or vice-president, of the British Fluoridation Society, as am I.

As it stands, Clause 32 will mean that after 1 April 2013 the money currently spent on the existing NHS schemes will pass to local authorities, which do not have a dental budget. They would have to pass it on to the Secretary of State via Public Health England to pay the continuing bills. Would it not be more efficient and quicker if the current NHS spend on fluoridation went directly to the Secretary of State—that is, Public Health England? It would mean that the organisation that pays the bills has the money in its account and is not reliant on transfers from local authorities.

As the Bill stands, when any new schemes are agreed by local authorities after they take charge of consultations on fluoridation, the Secretary of State will look to them to pay for those schemes. However, local authorities are not responsible for dentistry and have no dental health budget. The amendment of the noble Lord, Lord Hunt, means that although local authorities will be the decision-making bodies in future, the money for any fluoridation schemes that they support will come from the dental health services budget of the NHS Commissioning Board—the body that stands to benefit from the reduced treatment costs that would inevitably follow. The NHS Commissioning Board would transfer funds to the Secretary of State, who would pay the bills submitted by the water companies. Does the amendment of the noble Lord, Lord Hunt, not simplify the process?

[Baroness Northover]

My Lords, let me first set out the Government’s position on fluoridation. The Government’s policy is that decisions on fluoridation should be taken locally. That is why we have transferred the responsibility for conducting consultations and determining their outcome to local authorities. More than 5 million people, mainly in the West Midlands and the north-east of England, receive a water supply in which the fluoride content has been topped up to a level of one part per million. Worldwide, some 200 million people now receive fluoridated water in the United States and 11 million more in Australia. There are also fluoridation schemes in Ireland, Canada and Hong Kong.

I hear what the noble Earl, Lord Baldwin, said about evidence. A report, A Systematic Review of Public Water Fluoridation, commissioned by the department of health at the University of York, was published in September 2000. It concluded that water fluoridation increased the proportion of children without tooth decay by 15 per cent and that children in fluoridated areas had, on average, 2.25 fewer teeth affected by decay than children in non-fluoridated areas. However, as the debate has shown, there is a great range of views on this matter. That is why we feel that decisions must be taken at a local level following extensive consultation.

Our view is that the responsibility for proposing fluoridation schemes and for conducting consultations on such schemes should transfer to local authorities, while the responsibility for contracting for fluoridation schemes should transfer to the Secretary of State. In practice, the Secretary of State’s functions would be carried out by Public Health England. Making local authorities responsible for consultations on fluoridation schemes fits well with their responsibilities for public health. We anticipate that proposals for fluoridation schemes will derive from the joint strategic needs assessments that local authorities and health bodies will make of their populations.

The noble Lord, Lord Hunt, raised the question of whether local authorities would neglect dental health. Dental ill-health would seem to have wider repercussions. The great difficulty, particularly among older people whose teeth have decayed, certainly bears out the necessity of preserving teeth in younger life. It is not simply a matter of looking at children’s teeth and the impact on them but of seeing dental health as lifelong. Health and well-being boards would therefore have a responsibility to consider dental health because of that significance.

More than one authority might be involved in any scheme that is put forward because water distribution systems are generally larger than the area of an individual local authority. The Bill sets out a number of initial steps that the lead or proposing local authority must take, including consulting relevant water undertakers and the Secretary of State to ensure that a proposed scheme is operable and efficient. Unless only a single authority is affected, or the other affected authorities do not wish to participate in the process, the Bill requires local authorities to arrange for a joint committee to carry out the consultation process and make subsequent decisions in relation to the proposal. From 2013-14, the department intends to allocate a ring-fenced public health grant to local authorities. The ongoing costs of fluoridation schemes will be reflected within the grant to those local authorities.

The noble Earl, Lord Baldwin, asked about neutral information. This is an area where we should proceed on the basis of evidence. Public Health England might well be the right body to assess such evidence. The noble Earl also asked about schemes going ahead only with the support of the local population. The provisions in the Bill transfer responsibility for consultations to local authorities and include powers for the Secretary of State to specify the steps that local authorities must take in relation to consultation. We expect that the evidence base will still determine a decision to consult. However, putting local authorities in charge of consultations would make decisions on fluoridation more democratically accountable. We intend to consult on the detail of the regulations, including the process that local authorities must follow when ascertaining public opinion.

My noble friend Lady Eaton asked whether people would be able to reject local fluoridation. Of course, consultation needs to be meaningful. The decision to consult and whether to fluoridate will be for local authorities, not the Secretary of State, to take. We expect them to take account of the scientific evidence as well as public opinion.

I acknowledge that these provisions and the whole area are complex. Much of the technical detail will be included in regulations. No doubt we will have further profound discussions of this. We intend to consult on the policy proposals for the regulations that we will make under the powers in this clause in a consultation document that we will publish in due course. In the light of this, I hope that noble Lords will be content not to move their amendments, and that the noble Lord, Lord Hunt, will be happy for the clause to stand part of the Bill.

Health Professionals: EEA and Non-EEA Citizens

Lord Colwyn Excerpts

Thursday 8th September 2011 Lords Chamber

[Lord Colwyn]

My Lords, I am delighted to follow the noble Baroness, Lady Young. I spent many years on Sub-Committee G and I regret not being there while she was chairman.

Professionals holding specific qualifications and currently registered with a competent authority in one member state can register to practise in any other member state without having to satisfy further tests or formalities. Automatic recognition of qualifications under the directive 2005/36/EC is about granting access to professional registration, not about suitability to undertake a particular job. It is up to employers to ensure that the applicant has the necessary skills and competencies to perform the role for which they are applying. In the limited time available I will make some general remarks about issues that affect the dental profession. I declare an interest as a former dental practitioner.

Registration of non-UK dentists with the GDC is dependent both on the individual's nationality and the country in which they qualified. Dentists who are EU citizens with degrees obtained within the EU benefit from automatic registration based on the rules of free movement of EU citizens. Subject to proof of identity, degree and good standing in the home country, dentists are able to register with the GDC without further exams. A directive defines the minimum training standards required within the EU. All degrees of current EU countries comply with these requirements, although some member states require their dentists to undertake a period of clinical work experience in addition to the degree before they can work independently. In these cases, the requirement may apply also to registration with the GDC.

There are regulations for dentists who are EU citizens with degrees obtained outside the EU; regulations for dentists with a qualification gained before and after 01/01/01 from Hong Kong, Singapore, Malaysia, South Africa, New Zealand and Australia; and regulations for dentists who are not EU citizens but who have obtained degrees within the EU. I would like to have had the time to explain this more fully. The regulations are considered to work well, both with regard to the minimum training standards and the compensation measures for those countries that joined the EU more recently and did not at the beginning comply with the directive. A consultation is currently taking place with a view to modernising the directive.

The main concerns for dentistry have been the lack of language testing at registration points and the lack in some countries of practical training involving seeing patients. In the current review there is a welcome option for more formal language testing. I suggest that there is also a need to update the minimum training standards in accordance with the latest science.

Another concern that is not directly related to registration with the GDC is the fact that dentists from Europe are exempt from the requirement to undertake vocational training. UK-qualified dentists as well as non-EU dentists are required to undertake this training, while EU dentists are able to register without further training on a local performer list. All dentists should be required to undertake such training. However, to ensure fairness of the system all places would have to be funded. EU dentists are eligible to apply for foundation training but, if allocated a place, take it away from a UK graduate. There is high competition for these training places across the UK.

The overseas registration exam for non-UK dentists is designed as a competency test set at the level of a UK undergraduate. The pass rate is not high. Concerns over the exam remain with regard to appropriate provision of exam places, as there continues to be a waiting list. Dentists who are not EU citizens are required to undertake vocational training or foundation training through an equivalence route before they can become independent performers. My time is up: I look forward to hearing from the Minister.

Health: Cancer

Lord Colwyn Excerpts

Thursday 11th November 2010 Lords Chamber

[Lord Colwyn]

My Lords, despite the fact that successive Governments have generally maintained funding, modern medicine is, I believe, experiencing an economic crisis that has brought changes that have alienated patients and eroded the job satisfaction of physicians. It has become too expensive. The resultant managed care system is making the lives of both patients and doctors difficult. One of the attractions of medicine as a profession was the promise of autonomy. Today, few doctors can succeed in solo practice and most must work in group practices or corporate settings, where they are told how many patients to see in an hour, which treatments are authorised and which are not.

The very success of modern scientific medicine has been partly responsible for this situation. Eliminating infectious disease—the major killer of the early 20th century—has left us to deal with chronic degenerative illness. The success of medicine has also contributed to the ageing of the population. Of course, medical expenses increase the more elderly people that there are.

Another reason for the expense of conventional medicine is its extreme dependence on technology. Medical technology is inherently costly, and unless we change that dependence, there is little hope of cutting costs. Another powerful economic force impacting on medicine is the still-growing consumer movement that is demanding low-tech options for preventing and treating illness. Consumers are very clear about their desire for natural, complementary and alternative therapies. This is not a passing fad but, rather, a sociological trend with deep roots and a great economic significance.

Patients want greater empowerment in medical intervention and they want doctors who share their views about health and healing. They want doctors and specialists who have time to sit down with them and help them understand the nature of their problems rather than just promote drugs and surgery as the only possible treatment. They want doctors who are aware of nutritional influences on health and who can answer questions about the complex array of dietary supplements and natural therapeutic agents in health food stores. They want doctors who are sensitive to mind-body interactions, who are willing to look at patients as mental-emotional beings as well as physical bodies and who will not laugh at them for inquiring about Chinese medicine or therapeutic touch.

Those are all reasonable demands. A problem is that medical schools are not training doctors in the ways that consumers want and many patients are turning elsewhere. At a time when healthcare institutions are economically pressed, medicine cannot afford to ignore where the market is moving.

It is possible to teach both patients and practitioners about the strengths and indications of standard medicine without in any way rejecting its real achievements. Alternative, complementary medicine is a rich mixture of wisdom and folly. A few alternative therapies are dangerous, more are ineffective and still more are unproven, but many conventional practices are also unproven and many are dangerous as well as ineffective and costly. The use of complementary medicine in the treatment of cancer has attracted particular attention because of the fear among oncologists, radiologists and cancer surgeons that patients may be denied effective and potentially life-saving treatment because of a reliance on unproven fringe techniques. This issue arouses strong feelings among orthodox and complementary practitioners and their patients.

A 1984 study by Cassileth et al found that, in their beliefs about illness and treatment, cancer patients using complementary medicine differed substantially from patients using only conventional therapy. Patients using complementary medicine were more likely to believe that their cancer was preventable, primarily through diet, stress reduction and environmental changes. They were also more likely to believe that disease in general is caused mainly by poor nutrition, stress and worry. Almost 100 per cent of the patients interviewed believed that they should take an active role in their own health as compared with 74 per cent of patients having conventional therapy only.

The challenge is to sort through all the evidence about all healing systems to extract those ideas and practices that are useful, safe and cost-effective. Then we must try to merge them into a new comprehensive system of practice that has an evidence base and addresses consumer demands. The most appropriate term for this system is “integrative medicine”. That term is neutral, accurate and acceptable in academic discussion and it avoids the misleading connotations of “alternative medicine”, which suggests a replacement of the standard system, and of “complementary medicine”, which suggests retention of standard therapies as central and primary.

Integrative medicine is not simply concerned with giving physicians new tools such as herbs in addition to, or instead of, pharmaceutical drugs; rather, integrative medicine aims to shift some of the basic orientations of medicine towards healing rather than symptomatic treatment, towards a closer relationship with nature, towards a strengthened doctor-patient relationship and towards an emphasis on mind and spirit in addition to body. These shifts should make for better medicine in addition to greater satisfaction for patients. I should declare that I am president of the All-Party Parliamentary Group for Integrated and Complementary Healthcare.

Integrative medicine offers the promise of restoring values that were prominent in medicine of the recent past, cutting healthcare costs, improving health and renewing consumer confidence and satisfaction. I hope that my noble friend will confirm that the White Paper will enable and promote patient choice, and that cancer patients and those patients who wish to access complementary therapies will have that access and will not be discriminated against in any way.