NHS: GP Clinics

Lord Colwyn Excerpts

Thursday 25th June 2015 Lords Chamber

[Lord Prior of Brampton]

The right answer to the noble Baroness is twofold. First, we have to paint a picture that inspires young doctors to go into general practice. There is no doubt in my mind that the solution to the health needs of today’s population depends on a different model of general practice. We can paint that picture, and I hope that leaders of the BMA might wish to help paint it as well. Secondly, on the seven-day week issue, we are living in 2015 and people expect to be able to see GPs at the weekend. People get ill at weekends, and if we want good quality of care, we have to provide that care seven days a week. If we wish people to be treated outside hospitals, we have to provide good access seven days a week in primary care.

[Lord Colwyn (Con)]

Will my noble friend make it easier for GPs who have retired to come back to work in part-time practice? I am told this is extremely difficult at the moment.

Health: Innovative Medicine

Lord Colwyn Excerpts

Tuesday 1st April 2014 Lords Chamber

[Lord Colwyn (Con)]

My Lords, in the late 1970s and early 1980s, I regularly annoyed House of Lords Health Ministers from both sides of the House with what I described as innovative treatments for common diseases which had not completed the necessary trials and approvals, but which were harmless and cheap. Those treatments tended to involve homoeopathy, acupuncture, herbal medicine and traditional Chinese medicine. At the time, I was president of the Natural Medicines Society, and I declare my interest now as president of the All-Party Parliamentary Group for Integrated Health Care.

Recently, there have been many instances of the need to try new drugs which have not completed their normal phase trials and testing but might be able to be used on patients who have few remaining treatment options. My noble friend will forgive me if I resurrect some of those ideas, which were rejected and never used to treat patients in the UK. The Innovative Medicines Initiative will pave the way for new vaccines, medicines and treatments to tackle major health challenges, but many of the challenges have been there for many years. Artherosclerosis is by far the largest health problem affecting the western world. Attitudes to its prevention and to the ability to reverse its effects have ranged from the extremes of those who feel that it is completely preventable and reversible to those who regard it as an inevitable ageing process for which there is no remedy.

Lower limb peripheral arterial disease can affect about 9% of the population, and the incidence increases with age. About 20% of people aged over 60 have some degree of peripheral arterial disease. Incidence is higher in people who smoke, people with diabetes and people with coronary artery disease. Peripheral arterial disease occurs when the vascular system becomes obstructed due to atherosclerosis. The obstruction leads to gradual tissue death in the lower legs because of the lack of blood, which carries vital nutrients and oxygen. Critical limb ischaemia is characterised by severely diminished circulation, ulceration, tissue loss and gangrene. Amputation is a major risk for those patients, particularly those who have diabetes.

I invite my noble friend to revisit the techniques of oxidative therapy, first reported in the Lancet in 1920. There are many theories about the different functions of hydrogen peroxide in the body, and a great deal of scientific material supports almost every one. At one time in my dental career and as president of the Arterial Health Foundation, I tried to persuade the Government to examine the claims of the practitioners of EDTA chelation therapy. I have some personal experience of that technique. Over a period of six months at a clinic in Eindhoven, I followed the treatment plans of several patients who were unable to walk more than a few paces and had all been recommended for amputation. After two months, they were walking and then were able to run. Seeing those patients improve is something that I shall never forget.

Chelation therapy removes heavy metals from the arteries and is able to improve the blood flow to all areas and so preserve health and normal function by re-establishing peripheral circulation—supplying oxygen and essential nutrients. Ethylene diamine tetra acetic acid is introduced into the blood by intravenous drip and binds itself to heavy metals, such as lead, mercury, cadmium and other minerals, including calcium, and is excreted normally via the kidneys.

For many years, physicians in the US and Europe have used the chelating agent EDTA as an anti-atherosclerosis drug. A large anecdotal history has grown up supporting its value. In the 1950s and 1960s, a number of uncontrolled trials reported favourably on its value in cardiovascular disease, ischaemic heart disease and peripheral vascular disease. However, none of the trials was properly controlled by the double-blind procedure and thus the use of EDTA has not gained acceptance among the majority of physicians.

A patient might need 20 infusion visits of three hours. The EDTA solution travels through every blood vessel in the body, treating every vessel from the aorta to the smallest capillary. Chelation therapy was first developed in the US, and has been approved by the FDA as a way to remove toxic metals such as lead and mercury from the bloodstream, but no such approval has been granted for its use in unclogging the arteries of heart patients. Its use in that area remains controversial.

Intravenous EDTA chelation therapy, properly administered, is a safe, economical and effective treatment for the symptoms of atherosclerosis caused by free radical pathology. There is insufficient time to examine the technique in more detail, but I believe that it is a treatment that should be carefully considered before resorting to amputation.

About 20 years ago, I had a course of treatment myself, partially to eliminate small deposits of mercury, which tended to build up in dental practitioners, and partially to demonstrate to the Secretary of State for Health at the time—my noble friend Lady Bottomley—that the treatment was harmless. The heavy metals were removed and I survived the treatment. If I was told that I needed to have a leg removed, I think that I would seriously consider chelation as a first line of defence.

NHS Property Services Ltd

Lord Colwyn Excerpts

Thursday 30th January 2014 Lords Chamber

[Earl Howe]

My Lords, the noble Lord has painted rather a black picture of the company, which we believe has got off to an extremely good start, contrary to his impression. The company’s former chair asked to step down six months earlier than planned because the company had completed the transition phase early, and it was agreed that a chair with a different skill set was needed to oversee the rationalisation of the company.

As regards the company’s cash needs, we made £350 million available to the company as a working capital loan. That was planned some six months ago and was needed in large part due to the slow payment of invoices by the company’s customers, many of whom were themselves new organisations set up as part of the reforms, so it is not altogether surprising that cash flow initially was slow, but the situation is improving.

[Lord Colwyn (Con)]

My Lords, can my noble friend tell us what efficiencies and successes NHS Property Services has actually made?

[Earl Howe]

My Lords, it has been a good start for the company. It has generated £22 million from sales of surplus assets and savings of £2 million a year on the running costs of those disposed properties. The company is also harnessing economies of scale—for example, savings to date of £1.2 million by standardising the procurement of electricity across the whole estate. The company is now exploring how to make savings across other utilities and services, such as legal services.

Professional Standards Authority

Lord Colwyn Excerpts

Thursday 7th November 2013 Lords Chamber

[Earl Howe]

My Lords, as the noble Lord knows, it is the responsibility of local NHS organisations to make decisions on the commissioning and funding of any healthcare treatments for patients, taking account of issues to do with safety, clinical and cost effectiveness and the availability of appropriate practitioners. However, it is interesting to note that there are a number of complementary and alternative therapies referenced in NICE guidance, and I would expect any self-respecting doctor to take account of those.

[Lord Colwyn (Con)]

My Lords, can the Minister give us any news about the proposed accreditation of herbal practitioners?

[Earl Howe]

My Lords, as my noble friend knows, this is a complex policy area. There have been delays to the Government’s original proposals around the regulation of herbal medicine practitioners. One of our main concerns here is to ensure safety for those who wish to use the products. Given that complexity, my honourable friend Dr Poulter announced his intention to set up a working group to consider matters relating to patient protection when using unlicensed manufactured herbal products. Officials are currently working through the details of that group, including its terms of reference.

Care Bill [HL]

Lord Colwyn Excerpts

Monday 14th October 2013 Lords Chamber

[Lord Warner]

I thought I had a right to respond to the noble Earl on Amendment 137.

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

It was the noble Earl’s amendment. Can we go back to it? We cannot.

Clause 20: Duty and power to meet a carer’s needs for support

Amendment 58 not moved.

Emergency Services: Paramedics

Lord Colwyn Excerpts

Wednesday 15th May 2013 Lords Chamber

[Lord Colwyn]

My Lords, how often are fully trained paramedics and those in the training process evaluated as being fit to practise?

[Earl Howe]

My Lords, it is up to the employer—in this case, the ambulance trust—to ensure that it has a body of suitably trained and experienced staff. That depends on regular monitoring and ensuring that training is kept up to date. Equally, it is up to commissioners to ensure that the service that they are receiving is delivered by suitably experienced and qualified people. The CQC will also have a role in this regard.

Health: Cardiology

Lord Colwyn Excerpts

Wednesday 6th March 2013 Lords Chamber

[Earl Howe]

The noble Baroness makes a very important point. My department supported the formation of the UK Cardiac Pathology Network in 2006 to provide local coroners with an expert cardiac pathology service and to promote best pathological practice in sudden death cases. A national database on sudden arrhythmic death was launched in November 2008, allowing pathologists to record information on cases referred to them. In the longer term this could be very helpful in building a deeper understanding of the problem.

[Lord Colwyn]

My Lords, during 2011, 56 deaths were caused by fire in London. Legislation requires all public buildings to have fire extinguishers. In that same period in London, there were 9,657 out-of-hospital cardiac arrests. Why is there no similar legislation for public-access defibrillators?

[Earl Howe]

My Lords, as a general point, ambulance trusts are by far the best placed to understand the requirements of their local populations in terms of defibrillator distribution. However, I understand that the British Heart Foundation is looking into the need for more defibrillators in the community, so we will await that work with great interest.

Health: Cancer

Lord Colwyn Excerpts

Wednesday 7th November 2012 Lords Chamber

[Earl Howe]

I agree with the noble Baroness, and it is part of the reason why we felt that the recent health service reforms to align clinical decision-making with financial decision-making were so important. The reason why this country lags behind has been clearly set out in a number of documents and, broadly speaking, it is because patients do not present early enough with their symptoms and doctors do not refer early enough to specialist consultants for treatment. There is a lot of work to do there, and I am sure that the noble Baroness will be reassured to know that there will be no let-up in that area.

[Lord Colwyn]

My Lords, we are five, six or seven minutes into this Question, but I am not sure I understand what a cancer network is.

NHS: Dental Care

Lord Colwyn Excerpts

Tuesday 26th June 2012 Lords Chamber

[Earl Howe]

My Lords, the OFT report on the dental market was published last month and we very much welcome that study. We note that it found that the vast majority of patients were happy with their dental treatment and that the vast majority of dentists behave ethically. There should be, and are, clear penalties for the small minority who mislead patients, but the noble Lord is right to draw attention to that aspect of the OFT report. It is an area that we are taking extremely seriously and we are looking at what more we can do.

[Lord Colwyn]

In view of the Minister’s comments on patient charge revenues and the fact that NHS dentists are not allowed to do competitive pricing, has he any idea why the recent OFT report to which he has just referred revealed that 1% of regular NHS patients chose their dentist because, they said, the practice had competitive prices? Why do his colleagues at the department still refer to the NHS as being free at the point of delivery?

[Earl Howe]

My Lords, my noble friend is correct. Treatment provided on the NHS carries only one pricing tariff, which cannot be varied. The OFT report found that only 1% of NHS patients and 2% of private patients chose a dentist on the basis of price. I stand to be corrected, but I do not believe that it made any suggestion that NHS charges were uncompetitive; they are, and always have been, a subsidised contribution to NHS costs—they are not a market price. Therefore, I imagine that the OFT report reflected the fact that patients were comparing private charges with NHS charges. Of course, the NHS is in general free at the point of use, but my noble friend is right. It is important that we are clear that some charges exist, as they have in dentistry for 60 years.

Health and Social Care Bill

Lord Colwyn Excerpts

Wednesday 29th February 2012 Lords Chamber

[Lord Hunt of Kings Heath]

My Lords, I shall be brief. I was very grateful to the Minister for a meeting with her and her officials a week ago. I have two concerns about fluoridation schemes. The first is to make sure that where there are current fluoridation schemes, the amount of money being spent on their running costs will transfer to local authorities and that it will be recognised in terms of the allocation that is given. I think the noble Baroness will be able to reassure me on that.

The other question I want to put relates to where new schemes come into being. The proposed system seems rather convoluted, with various bodies involved, including Public Health England at a national level but also many local authorities. I just want some assurance that if a local authority or a combination of local authorities decide to go for a fluoridation scheme, the system of financing will be as smooth and easy as possible and that resources will be available to enable those schemes to go ahead. I beg to move.

[Lord Colwyn]

My Lords, I support everything that the noble Lord, Lord Hunt, has said and declare an interest as vice-president of the British Fluoridation Society. I believe in the efficacy of the fluoride ion, and during my own dental career have seen the beneficial results of this public health measure.

I do not want to repeat what the noble Lord, Lord Hunt, has said, but the Government envisage that, in future, local authorities will be the bodies that consult on fluoridation and decide whether to introduce and maintain a scheme. The issue is about funding for existing schemes and for possible future schemes. The Bill as it stands would mean that on 1 April 2013 the money currently spent by the NHS on existing schemes would pass to local authorities, which would then have to pass it on to the Secretary of State via the new organisation, Public Health England, to pay the bills presented by water companies. This would be a complex, bureaucratic process. If, for example, the money got stuck somewhere, the water company affected would quickly get fed up and stop fluoridating. How much smoother and quicker it would be if the money that the NHS is currently spending went directly on 1 April 2013 to the Secretary of State and Public Health England. This would mean that the organisation that will actually pay the bills will have the money in its account and not be reliant on local authorities transferring it.

The Bill as it stands also means that if any of the new schemes are ever voted for by local authorities when they take charge of consultations on fluoridation, the Secretary of State will look to them to pay for those schemes. Yet local authorities are not responsible for dentistry and have no dental budget. So where would they get the money from? In all probability they would not get it and, as a result, no new schemes would ever be implemented. This amendment means that, although the 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 follow. The NHS Commissioning Board would transfer funds to the Secretary of State, who would pay the bills submitted by the water companies. I may have got this wrong, but I would be delighted to hear what my noble friend the Minister has to say.

[Baroness Gardner of Parkes]

Everything that needs to be said has been said; I thoroughly approve of this amendment and ask the Minister to note my support as a former dentist.