NHS: Midwives

Lord Harrison Excerpts

Monday 17th March 2014 Lords Chamber

Asked by

[Lord Harrison]

To ask Her Majesty’s Government what steps they are taking to ensure that a sufficient number of midwives are trained, employed and retained by the National Health Service.

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

My Lords, this Government are committed to improving maternity care. That is why we have charged Health Education England with ensuring that training numbers meet service demand. By reducing attrition rates, record numbers of midwives will be available to the NHS. Since May 2010 the number of full-time equivalent midwives increased by around 1,800 to nearly 22,000. A record number of midwives, some 6,000, are currently in training. New midwife training commissions by HEE for 2014-15 number 2,563.

[Lord Harrison (Lab)]

My Lords, given that the Commons Public Accounts Committee believes that there is a shortfall of around 2,300 midwives and that the NSPCC has computed that number at 5,000, does the Minister acknowledge that we are beginning to get anecdotal evidence, certainly in Chester in the north-west, of maternity services under real pressure? With regard to maternity services, does he recognise that three out of four such services lack any trained mental health midwives to deal with perinatal mental illnesses, which I am afraid are associated with as many as 10% of all pregnancies? Will the Minister look in particular at the question of the training of midwives, where all too often the perinatal mental health services are left off the agenda?

[Earl Howe]

My Lords, I agree that in certain parts of the country maternity services are under pressure, but it is encouraging that the ratio of births per midwife has improved nationally. Indeed, since 2010 the number of midwives has increased by 4% and the number of births by 1%. However, the noble Lord is right to attach importance to mental health services. Improving diagnosis and services for women with pregnancy-related mental health problems is one of the Department of Health’s objectives for maternity care. That is why Health Education England has been tasked with working with partners to ensure that pre-registration and post-registration training in perinatal mental health is available to enable specialist staff to be available to every birthing unit by 2017.

Alcohol: Calorie Labelling

Lord Harrison Excerpts

Thursday 13th March 2014 Lords Chamber

[Earl Howe]

My Lords, I would love to receive details but, once again, it is a question of how much my noble friend consumes rather than how much he pays.

[Lord Harrison (Lab)]

My Lords, the Minister may recall that last September I shared with him my concern at the ever-rising alcoholic content of wines that are on sale in supermarkets and the need for greater provision of lower percentage wines so that the consumer can indeed make a choice. What progress has he made in that area?

[Earl Howe]

My Lords, this area is currently under scrutiny by my ministerial colleagues in the Treasury.

Health: Diabetes

Lord Harrison Excerpts

Wednesday 3rd July 2013 Lords Chamber

Asked by

[Lord Harrison]

To ask Her Majesty’s Government what assessment they have made of the quality of healthcare available to diabetics with eye problems.

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

My Lords, we have set clear objectives for the NHS and Public Health England to improve the care and quality of life for people with diabetes. The public health outcomes framework includes an indicator on preventable sight loss, which will track three of the commonest causes of preventable sight loss, including diabetic retinopathy, to drive improvements in quality.

[Lord Harrison]

My Lords, given the decline in the regular and important annual check-up for diabetics, does the Minister acknowledge that the retinopathy screening for diabetics introduced by the previous Government is being undermined and underresourced? On cataract operations, will the Minister explain why, among our European Union colleagues, we are the most demanding regarding the threshold required to have such operations? Given the importance of cataract operations, especially for older people in retaining their vision, will the Minister meet me and other colleagues to discuss these matters and allied subjects?

[Earl Howe]

I would be happy to meet the noble Lord. I am aware that the whole area of the cataract threshold and, perhaps more importantly, the interpretation of that threshold, is one that NHS England is now actively looking at to ensure greater consistency around the country.

I do not agree with the noble Lord’s interpretation of the screening figures. The UK countries, I believe, lead the world in the area of diabetes eye screening. This is the first time that a population-based screening programme has been introduced on such a large scale. The latest figures show that up to March 2013, 99% of people with diabetes who were eligible for screening were offered it in the previous 12 months.

Health: Diabetes

Lord Harrison Excerpts

Tuesday 19th March 2013 Grand Committee

[Lord Harrison]

My Lords, it is a great pleasure to follow the noble and learned Lord, Lord Morris, who is a distinguished member of the All-Party Parliamentary Group for Diabetes, so admirably led by our colleague in the Commons, Adrian Sanders.

The noble and learned Lord highlighted the amount of money being spent on type 1 and type 2 diabetes, which is familiarly known as some £10 billion a year, but evidence from a European study that I am going to quote in a minute suggests that it could be nearer £14 billion a year. This illustrates the theme of the noble and learned Lord, Lord Morris, that there is a large degree of uncertainty about the knowledge and facts that we have in this field and it is something we need to repair, which I will turn to shortly.

Having said that, we should have an update on the debates we have had in the past with regard to the treatment of diabetes. It is an odd circumstance that as diabetes becomes an epidemic in this country it has been largely neglected. Much more concentration has been on the repair of cancer or the attack on heart diseases and so on. I do not know whether the Minister has a reply to that but it is something that we need to turn our attention to.

I am very grateful that the Government have reiterated their desire to maintain the same levels of health spending as in the past. Nevertheless, cutbacks are beginning to happen. One of the most worrying themes, which I hope the Minister will address, is the decline in the cover of diabetics. We are beginning to lose the annual check-up, which is typical of what we have had. There is a tilting over to relying on the patient to bring to the attention of the GP a problem for the GP to refer on. The problem with that is that it is the middle-class, knowledgeable patient who understands that—so often at the cost of neglecting those who do need the annual check-ups and the variety of check-ups that were put in place by the previous Labour Government.

I encourage the Government to spend wisely. For instance, I have made this plea before about the DAFNE programme, which provides structured educational courses for type 1 diabetics. It is claimed, and I believe it may be true, that it pays for itself in four to five years, but it is not generally applied throughout the United Kingdom and that is a bad thing.

The general rush to do away with bureaucracy sometimes has a fatal element to it. I saw one of my many health advisers on Monday and at the end of the consultation she looked at the screen and said, “We no longer have the appointments done elsewhere and a paper notification for you”. She has to do it. It took her about six minutes, typing away. Of course, she is taking on administrative duties that take away from her skills at the coal face. I hope that the noble Earl, Lord Howe, will ensure that we leave the bureaucracy to the bureaucrats and that the health specialists have the opportunity to do what they do best.

I want to turn to a study by LSE Health at the London School of Economics, Diabetes Expenditure, Burden of Disease and Management in 5 EU Countries, which was published last year. It makes very informative reading. Noble Lords will know that I am a passionate pro-European. One reason for that is the ability to compare and contrast the practice of the 27 countries of the European Union. This is a study of the five biggest countries, but it offers us insights that we can adopt and adapt here, or which they can adopt and adapt in their countries.

I was surprised to note that the study firmly declared that blood glucose monitoring is a cheap and hugely effective way of ensuring the health of diabetics. The Minister will recall arguments we have had in the past over testing strips, for instance. He will remember that he responded to a debate in which I tried to highlight diabetic foot care, which I have always thought was quite expensive. I am clad in shoes which are appropriate for my very strange feet as they give protection which enables me to continue to do the kind of stuff I am doing, as is the case with thousands of other diabetics throughout the United Kingdom. I know that the noble Earl is familiar with these debates. I sometimes think that he has been answering them since the time of Galen.

The study looks at Germany, the UK, France, Italy and Spain and quantifies evidence and data. It notes:

“There is increasing concern amongst government officials and public health agencies about diabetes care in Europe. Both diabetes prevalence and spending appear to be increasing. … Diabetes prevalence has been increasing steadily over the past two decades, along with an aging European population, increasing, high obesity prevalence and changing ethnic make-up. This study estimates that Germany has the highest diabetes prevalence at 8.9%, followed by Spain (8.1%), France (6.4%), the UK (6.1%) and Italy (4.8%)”.

It is interesting to ask why these differences arise. The study continues:

“Only three countries have national diabetes programmes”.

I am glad to say that that includes the United Kingdom, along with Italy and Spain. The study notes that France’s programme,

“has not been operational since 2005”.

It continues:

“Germany has Diabetes Disease Management Programmes (D-DMP), however, not all patients with diabetes are registered. None of these strategies have hard targets to achieve ideal diabetes management”.

It would be interesting to learn more about that. In 2009, the United Kingdom introduced screening for high-risk patients. We have done well in regard to screening for retinopathy. It is imperative to maintain that momentum.

The study states:

“All countries have care guidelines, the UK’s being the most prolific, but none have guidelines written for patients”.

That is interesting. I wonder whether we can elaborate on that as I am not sure that that has been adequately dealt with. I have mentioned the DAFNE and DESMOND training protocols. The study continues:

“None of the governments collect diabetes spending accurately”.

There is no doubt about the difficulty of doing that because it is such a complicated matter. The study estimates that,

“in 2010, the direct cost burden of people with diabetes was highest in Germany … at €43.2 billion, followed by the UK (€20.2 [£13.8] billion), France (€12.9 billion), Italy (€7.9 billion) and Spain (€5.4 billion)”.

There are some strange discrepancies there which might be worth looking at.

I would like to draw your Lordships’ attention to other facts and figures but we need improved diabetes data so that we can construct more useful policy initiatives. The study has very little information on the indirect costs of diabetes. Can the Minister provide information on that?

I am coming to a close and should say that only France, Italy and the UK regularly collect and publish monitoring data. France did so intermittently, in 2001 and 2007. Thankfully, Italy and the UK do so annually but that is apparently not the case in Germany. Other elements in the collection of data are missing or overlooked and ought to be repaired. My general plea is—to embellish what the noble and learned Lord, Lord Morris, has said about spending—let us look and learn from our neighbours and improve what we can, but there has to be a fundamental drive towards better knowledge and data on type 1 and type 2 diabetes; otherwise, we will fail and misdirect the funds available to us in battling a disease that has become of epidemic proportions.

NHS: Healthcare UK

Lord Harrison Excerpts

Thursday 14th February 2013 Lords Chamber

[Earl Howe]

It is a little too early to say because the business plan for Healthcare UK has yet to be drawn up. We have appointed a managing director in the shape of Howard Lyons who I think will do an excellent job. It remains to be seen what requirements are needed. We are looking at certain target markets at the moment—in particular, the Middle East, the United Arab Emirates, Saudi Arabia, Libya, China and India. But it depends on the requests that we get from those countries as to what skills set might be needed.

[Lord Harrison]

Given that the National Health Service has much to learn from other health services and best practice elsewhere in Europe and the wider world, what methods will the Government adopt to promote that interchange? Will the noble Lord give an example of such an exchange which has benefited medical practice in this country?

[Earl Howe]

The noble Lord makes an extremely important point. This is not only a one-way street in terms of exporting British expertise. I know one very good example in which some of our trauma clinicians have been seconded to hospitals in South Africa where there is tremendous expertise on gunshot wounds, for example. That has been of direct benefit to clinicians in this country.

Diabetes

Lord Harrison Excerpts

Thursday 10th January 2013 Lords Chamber

[Earl Howe]

My Lords, yes, I certainly do. There are a number of positive ways in which we can do that. One is the NHS health check, which should, if it is performed correctly, pick up those with undiagnosed diabetes. Early identification of diabetics is key in this area, particularly for those who are at risk of ulceration. Other ways are targeting preventive services at those most at risk, including those with learning disabilities; early management of foot infection and rapid access to multidisciplinary teams; and having good diabetic foot prevention and ulcer management services in local areas.

[Lord Harrison]

My Lords, the point at issue is surely this: that to prevent the four out of five needless amputations that currently take place, Her Majesty’s Government need to respond to the Question of my noble friend Lord Kennedy by saying how they will ensure that there are those multidisciplinary groups with specialist knowledge of feet and the ability to make sure that there is not a postcode lottery as there is now. They should be properly monitored by the Government to ensure that a proper service is offered to diabetics at a time of decline in the amount of money going into the National Health Service.

[Earl Howe]

My Lords, there is no single magic bullet that will solve this problem, but undoubtedly better monitoring in general practice is one answer; the QOF incentivises that. The NHS outcomes framework will also incentivise clinical commissioning groups to ensure that those with long-term conditions—particularly diabetes—are properly looked after. The benefits of multidisciplinary teams are now proven. The evidence is there and, if we can shine a spotlight on the statistics—and there is, as the noble Lord knows, a wide variation in success rates across the country—that will be the key to driving better performance throughout the health service.

NHS: Diabetic Services

Lord Harrison Excerpts

Thursday 29th November 2012 Lords Chamber

Moved By

[Lord Harrison]

That this House takes note of the management of diabetic services in the National Health Service.

[Lord Harrison]

My Lords, as a type 1 diabetic of 43 years’ standing, I have received unparalleled support from the NHS and, in recent decades, from health professionals in Chester and Liverpool. I am ever grateful for their continuing expertise and engagement. However, recently I have witnessed a worrying decline in the care offered to me and other diabetics. First, my excellent local hospital no longer invites me for my annual diabetic check-up. Similarly, the regular check on my eyes at the hospital is being curtailed, blindness being a not infrequent complication of diabetes for one in seven of us.

My big concern here is that the onus is falling on the individual diabetic to repair to the GP at the first signs of disquieting changes in his or her health for referral to the relevant specialist. That is all well and good if you are alert and dedicated to preserving your health, as am I, but that is not true of all of us. I have sat in the waiting rooms of diabetic clinics next to other, less articulate and perhaps less personally organised patients, who have turned up at the wrong hospital, never mind getting the date and time of their appointment wrong. In a hospital that I know, missing an appointment means instant dismissal from the clinic, with all the morbid consequences for the diabetic involved. Moreover, the regular diabetic check-up uncovers trends and problems that patients may not have recognised themselves. Action can be taken. Potential blindness, the amputation of a septic foot or the continuation of an unhealthy lifestyle can be diverted by action, and a life or a limb can be saved.

Therefore, my first question to the Minister is this: does he recognise that there is folly in short-termism, such as the cutting of annual clinics, which brings in its wake long-term deleterious consequences for the individual and, in the end, greater NHS expenditure in administering to the diabetic at peril?

A very recent example of a laudable NHS innovation is the potential treatment and advice to be given to patients online to save GP surgery time. However, that may lead to a greater exposure to danger for diabetics. All such worthy changes and innovations in the treatment of diabetics must be tempered by acknowledging that penumbra of citizens afflicted with diabetes who are less accustomed to the computer cursor. How will the Minister ensure that the computer-averse are not left behind? Perhaps, too, the Minister, who is admired on all sides of the House for his deep knowledge of his brief, could roundly repudiate the Tory GP Back-Bencher who foolishly opined last week that type 2 diabetics were to blame for their condition and should be deprived of NHS services as a punishment. That kind of response to the diabetes epidemic is unworthy and unrealistic. Nevertheless, diabetes is the UK’s number one health threat. Some 3.7 million of us live with the condition and a further 7 million are at high risk of type 2 diabetes. Half of those diagnosed with type 2 already have serious complications, thereby incurring increasing costs for the NHS budget, which currently stands at £10 billion a year and is rising. Action now on this killer disease is imperative. There is a need for a matching application of enthusiasm, expertise and expenditure to be granted to defeating diabetes that have rightly been developed for heart disease and cancer treatment in recent decades.

The National Audit Office found that diabetic care in the NHS is poor, with low achievements of treatment standards and high numbers of avoidable deaths. Indeed, 80% of the NHS costs are spent on the complications stemming from the condition, which are largely avoidable. Can we tolerate the fact that 24,000 people die each year from the condition needlessly, avoidably and with attendant unsung misery to their families and friends? The excoriating report of the Commons Public Accounts Committee rightly demands, in the words of its chair, Margaret Hodge, “straightforward care and support” for diabetics. Can the Minister be equally straightforward and respond to the detailed shortcomings exposed in the PAC report on diabetes care?

The noble Baroness, Lady Young, the chief executive of Diabetes UK, who is on duty in New York today, notes the postcode-lottery nature of diabetes cover across the UK. Can the Minister guarantee the maintenance of high standards, as in the established “15 healthcare essentials” for diabetics, so woefully underpowered in application at the moment? As the PAC report shows, these essential desiderata are simply not being met. Tailored education about their condition is essential for individual diabetics but this ambition fails to be fulfilled. Can the Minister comment on the important work done by the DAFNE programme? This is already being delivered in 70 centres around Britain and helps to provide proper cholesterol control among other tasks, such as promoting healthy eating among diabetics. Given the imprimatur that it has received from NICE, can this programme not have wider reach and support within the NHS?

April is the cruellest month, for in April next year we are to come under the reformed regime of local commissioning in the NHS. Some of us quake in our boots at this prospect. The PAC report tells us that the current NHS accountability structures have palpably failed to hold commissioners of diabetic services to account for poor performance. Indeed, it details other failings. Only one in two patients receives all the basic tests to monitor their condition, and only one in five achieves recommended levels for blood glucose and blood pressure, as well as the vital cholesterol norms. Will the Minister respond to the charge that the department is failing to incentivise delivery of all these aspects of its recommended standards of care through the medium of the payments system and that it neglects to gather the cost information and to carry out general monitoring? These responsibilities of the department are vital for proper reform.

I do indeed stand in the Chamber before your Lordships today because of the excellent care that has been accorded to my feet. I suffer from severe neuropathy, where one has no feeling at all in the feet, and I have a minor debriding of part of one foot. My wife and I have become foot fetishists in constantly visually examining my feet for any minor changes that might presage drastic and draconian complications. Indeed, at the recent Putting Feet First reception, Diabetes UK and the College of Podiatry noted that 125 amputations are carried out each week, of which 80% are preventable, costing the NHS some £700 million each year. Can the Minister ensure that all diabetics become foot fetishists in assiduously committing to look at their feet twice daily? Can he also ensure that health professionals are aware of the imperative to so monitor feet and that the integrated pathway approach to the diabetic foot, which characterised the approach of the care I received from Broadgreen in Liverpool, is applied universally? Incidentally, that is where my shoes are made at a cost to the NHS, but it means that I can become economically productive, as can many other diabetics, because they can get on their feet and do a job.

I await with interest the speech of the noble Lord, Lord Kakkar, on the imperative of an integrated approach to the treatment of diabetes as a whole. I hope that the noble Lord might also offer us some insights into Britain’s ethnic groups, who suffer disproportionately from diabetes. Indeed, he and the Minister may know of the recent research findings from Imperial College London detailing the worryingly high incidence of type 2 diabetes among our Asian, black African and African Caribbean communities. At November’s south Asian health education reception in the Lords, we learnt of the courses run in temples, mosques, gurdwaras and community centres assessing diabetic risk among these populations. Perhaps our Christian church-based communities might take up that useful contribution. I note the presence of the right reverend Prelate the Bishop of Liverpool, who might communicate that to colleagues.

Beyond that, I ask the Minister what is being done at the European Union level to share best practice among health professionals and health Ministers on the treatment of diabetes—I sense that the desirable exchange of knowledge is piecemeal at best—and also about our engagement internationally on reducing the terrible toll of 4 million deaths each year round the world. Tragically the notion that diabetes is the rich world’s disease is sorely mistaken. I ask the Minister, if I may, when he last had a conversation with another Minister from the European Union on the question of diabetes. It would be intriguing to know.

Let us return home. In-patient care studies, according to the 2011 in-patient audit, reveal: stark problems in the referral processes; a decline in diabetic consultant availability; no fewer than one in three entities lacking diabetic in-patient specialist nurses and, more specifically, no essential podiatric provision; and diet advice to diabetics deteriorating. A diabetic nurse at the Countess of Chester replied to my inquiry, “How can we do things better in the NHS?”, by volunteering that she would like to visit all the wards in the hospital and peek under the bedclothes to see the feet of new patients. No, she is not another foot fetishist. The purpose of such inspections is to identify potential problems by scrutinising feet when there is a captive audience within the hospital.

The national Health Check programme which was introduced four years ago to promote early diagnosis has been patchily implemented. Many PCTs fail to offer such checks. Next year this responsibility falls to local authorities whose budgets are being negligently cut by the Government, who continue to pile responsibility on responsibility on local authorities with no additional compensating funding. Can the Minister give us some hope and allay this fear?

Recently the Minister kindly replied to some Written Questions that I posed on the incidence of the very frightening and life-threatening condition for children of diabetic ketoacidosis. Some one in five children is diagnosed with type 1 diabetes through a DKA episode. What improvements are being made in the early diagnosis of children’s typically type 1 diabetes, and also in the auxiliary help given to parents and carers who, untutored, have to face the heart-rending job of explaining to their child the necessity of insulin injections and renouncing chocolates? I celebrate all those parents and carers who so dedicatedly help bring their children to maturity by their love and unstinting work. I know that others will highlight the needs of the diabetic child but it is imperative that paediatric and adult services combine to offer effective, tailored care for the individual child. Does HMG support the so-called transition clinic to help the child come to terms with their diabetes? Transition clinics are characterised by their multidisciplinary approach.

Could the Minister also report on the work done by his department and the education services on the diabetic child’s exclusion in so many ways from PE, school trips and so on? They are denied access to necessary medicines for the lack of a nurse or private space to inject insulin or take a blood reading. They can experience bullying as a result of being the child excluded by a diabetic condition. These are all examples of plain discrimination that must be tackled head-on in the classroom. Sometimes there is also a need for children and adults to have access to appropriate psychological and emotional support services. To many diabetics their condition is inexplicable, frightening and paralysing socially. Given that some two in five diabetics suffer poor psychological well-being, can HMG assure us that resources will be found?

Finally, when he replies, will the Minister tackle the vexed question of giving appropriate help to diabetics in hospitals? Sometimes appalling food is served up. I well remember the very sweet puddings that I was offered in the two periods that I stayed in hospital. I am most grateful to colleagues here today and hope to hear a report from the Minister that will perhaps give us some hope of ensuring that diabetic services are maintained at a level that is appropriate for the population.

--- Later in debate ---

[Lord Harrison]

My Lords, I thank the noble Earl for his repudiation of the intemperate remarks made at the other end about type 2 diabetes. I share his acknowledgement of the width and the depth of this debate, in which so many interesting individual contributions were made. I thank colleagues who have joined us in the Chamber to hear my last words on this important day. As the warm-up act for the Leveson inquiry, perhaps I may just identify the point made by the noble Lord, Lord Roberts of Llandudno, that diabetes is not properly represented on radio and TV. If the press have nothing better to do in the future after Leveson, perhaps they could explore and investigate some of the problems that we have identified today in the care given to diabetics, and many of the exhilarating stories of diabetics who have resisted their disease and who should be celebrated in the press and the highest organs of the state.

Motion agreed.

NHS: Walk-in Centres

Lord Harrison Excerpts

Thursday 11th October 2012 Lords Chamber

[Earl Howe]

Many GP surgeries have extended opening hours. Some have walk-in centres attached to them but there is no general rule about that. The decision to open on an extended-hours basis is voluntary for GPs.

[Lord Harrison]

Does the Minister share my surprise that data are not available for the number of closures of such walk-in centres in the past two years?

[Earl Howe]

My Lords, no. The previous Government did not collect the figures and we have chosen not to either. This is a decision for local commissioners and there is a limit to the extent that we can require the NHS to fill in forms and send them to Richmond House.

Health: Diabetes

Lord Harrison Excerpts

Wednesday 25th July 2012 Lords Chamber

Asked By

[Lord Harrison]

To ask Her Majesty’s Government what actions they are taking to ensure effective treatment of diabetes in minority-ethnic communities.

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

My Lords, the Government are aware of the growing issue of diabetes in minority-ethnic groups. The NHS is taking a range of actions to ensure effective treatment. The recent publication of clinical guidance on type 2 diabetes by the National Institute for Health and Clinical Excellence identifies those at high risk and how best to manage the risk. It specifically mentions ethnic minorities and identifies pathways to ensure effective management.

[Lord Harrison]

My Lords, given that the worrying rise of type 2 diabetes among our ethnic communities is absorbing an ever increasing share of 10% of the NHS budget, which itself is shrinking for diabetes care, will the noble Earl institute an increase in the number of diabetes nurses, who are at the heart of communities, support the Diabetes UK campaign for ethnic-community champions and, finally, heed the advice coming from the dedicated research team at the University of Warwick that matching health professionals tutored in the cultural knowledge and understanding of our ethnic communities can give enormous benefits?

[Earl Howe]

My Lords, I agree wholeheartedly with the thrust of the noble Lord’s question. As he will know, Diabetes UK has pioneered a programme of diabetes community champions from ethnic-minority communities to raise awareness of the condition in their communities. The Department of Health has awarded Diabetes UK a grant through the volunteering fund national awards for the programme to be rolled out across 12 English cities over the next two years. I gather that 111 community champions have already been recruited in London. This is exactly the sort of initiative that we need if we are to reach those who are most at risk of developing or, indeed, being diagnosed with diabetes.

NHS: General Practitioners

Lord Harrison Excerpts

Wednesday 23rd May 2012 Lords Chamber

[Earl Howe]

My noble friend is extremely familiar with this area. I have also come across some extremely effective practice-based patient groups that are enormously valuable, and are valued by the GPs and other primary care staff with whom they interact. It is very much part of the world of the NHS today and we wish to see it continue.

[Lord Harrison]

My Lords—

[Baroness Wheeler]

My Lords, at the conference this week we heard the growing concern of GP leaders and delegates that grass-roots GPs were being excluded from involvement in clinical commissioning groups. How will the Minister address this, and will he ensure that CCG guidance includes best practice on how their involvement can be ensured?