Alcohol

Lord Harrison Excerpts

Thursday 2nd February 2012 Lords Chamber

[Lord Taverne]

My Lords—

[Lord Harrison]

My Lords—

[The Chancellor of the Duchy of Lancaster (Lord Strathclyde)]

My Lords, perhaps we can hear from my noble friend Lord Taverne and then from the other Benches.

Health: Diabetes

Lord Harrison Excerpts

Wednesday 1st February 2012 Lords Chamber

[Earl Howe]

The noble Lord is to be congratulated on bringing me back to the very important subject of the labelling of alcoholic drinks. I hope that the House will feel that he was a little unfair in blaming the Government for the line that they have taken on this. As the noble Lord knows, labelling is an area that is very largely a matter of EU competence. However, he is right that type 2 diabetes is closely linked to obesity and insufficient physical activity. We would like to see businesses use a more consistent front-of-pack nutrition labelling approach than has been achieved in the past, particularly with food.

[Lord Harrison]

Will the noble Earl recognise another acronym, the DAFNE programme, and give greater government support to rolling out such a programme, as illustrated by the noble Lord, Lord Rennard? Will be also reply to the Danish Government, who have made diabetes a priority under their presidency for the coming six months? What is being done with our Danish colleagues to promote a better understanding of diabetes and its treatment?

[Earl Howe]

The noble Lord is right to emphasise the role of DAFNE. The 2011-12 NHS operating framework signals the need to commission patient-structured education for people newly diagnosed with diabetes, and at appropriate points in their life as their condition progresses. I do not have a briefing on the dialogue with our Danish colleagues on their programme of action, but I will write to the noble Lord on that.

Health: Diabetes

Lord Harrison Excerpts

Thursday 14th July 2011 Lords Chamber

[Earl Howe]

My Lords, I am grateful to my noble friend. I have an astonishing figure in my brief. On average, 73 amputations of lower limbs occur every week in England because of complications to do with diabetes. It is estimated that, with the right care, 80 per cent of amputations carried out on patients suffering from diabetes would be preventable. That is the scale of the challenge. We are clear that this is a major issue for diabetes. NICE has published guidelines on in-patient management of people with diabetic foot ulcers and infection. That is vital because amputations are often preceded by ulceration. That is also why the national clinical director for diabetes considers diabetic foot care and prevention to be a major priority.

[Lord Harrison]

My Lords, will the Minister give an assurance that the retinopathy screening that was introduced by the previous Labour Government, and which has been so successful, will continue apace to match his own ambition of ensuring prevention by identifying diabetic disease of the eye at an early stage?

[Earl Howe]

The noble Lord, Lord Harrison, is quite right. England, along with the devolved Administrations, leads the world in this area. It is the first time that a population-based screening programme has been introduced on such a large scale. We are committed to continuing it. More people with diabetes are now being offered retinopathy screening than ever before and to higher standards, despite the increasing number of people with diabetes. The latest data that I have show that 98 per cent of people with diabetes have been offered screening for diabetic retinopathy during the past 12 months.

NHS: Chiropody and Podiatry Services

Lord Harrison Excerpts

Tuesday 26th April 2011 Lords Chamber

[Earl Howe]

My Lords, let me first make it clear to my noble friend that GP consortia will not be responsible for commissioning training—at a local level that will be the responsibility of the skills networks, made up of healthcare providers. Health Education England will be a new organisation with new executive powers. It will provide national leadership on planning and developing the healthcare workforce and promoting high-quality education and training that is responsive to the changing needs of patients and local communities.

[Lord Harrison]

Is the noble Earl aware of the recent study by the American Podiatric Medical Association which demonstrates that early recognition of foot ulcers or foot problems in diabetics can prevent hospitalisation, or indeed amputation, if action is taken early and resources are commanded to deal with potential problems?

[Earl Howe]

My Lords, I am aware of that study. If we apply the lessons learnt to the UK, the noble Lord may already know that approximately 100 people have an amputation due to foot ulceration, as a complication of diabetes, every week. The International Diabetes Federation has estimated that 85 per cent of these amputations could be prevented through early intervention by a diabetic foot team that includes a specialist podiatrist. Indeed, the diabetes foot protection team in Southampton, to take one area, reduced in-patient stays from 50 to 18 bed days and saved £1.2 million in the first three years.

Health: Parkinson’s Disease

Lord Harrison Excerpts

Monday 10th January 2011 Lords Chamber

[Lord Harrison]

My Lords, I, too, congratulate my noble friend Lady Gale and all her colleagues on Minding the Gap and on producing a groundbreaking contribution to the understanding of Parkinson’s and its effects on people affected by it and on carers. I hope that the noble Earl will spare some of his time to talk about the carers, who have a particularly difficult time in caring for people with such a difficult disease as Parkinson’s. I look forward to the Government’s response and I hope that the fate that befell the multiple sclerosis review will not befall the NICE guidelines for Parkinson’s this year, when the review is taking place. It would be very helpful to have an assurance that will not happen.

The 2011 review, indeed, offers a real opportunity not only to examine the recent evidence on the new drugs and treatments for managing symptoms but to scan the full multidisciplinary range of services provided to Parkinson's people for their present effectiveness. It would be helpful if NICE could include Parkinson's in the list of conditions for which it develops quality standards, because that will help avoid any postcode lottery approach to Parkinson's which undermines the proper national and comprehensive service which my noble friend Lady Gale has already mentioned. Again, I ask: is that possible?

Also, at a time of impending NHS reorganisation, it is imperative that GP consortia, which will be at the centre of change, should also commission services once they have sought expert advice and support from Parkinson’s experts. Third sector organisations such as the Neurological Commissioning Support service, or NCS, should also be fully consulted, especially as they represent a joint initiative of the Mind, the MS Society and Parkinson’s UK. The NCS is best placed to advise GP consortia about people with long-term neurological conditions. I wonder whether we can have an assurance there.

I should, perhaps, mention a local initiative in Chester and North Wales that may qualify as a contribution to the big society espoused by the Government. Last year, with the noble Lords, Lord Wade of Chorlton and Lord Jones, I was present at the launch of a co-operative arrangement between the local MS support centre and the local Parkinson’s branch, of which I am very honoured to be the president. Indeed, we are having our Parkinson’s branch AGM in the MS support centre later on in January. Such collaboration between natural allies should be encouraged as providing added value and not just as a cover for cost-cutting.

However, the more that I have come to understand Parkinson's, the more I have come to understand the central role of the Parkinson’s specialist nurses, on which the two previous speakers commented. Those nurses stand as advisers, advocates and allies of Parkinson’s people between the GP, who seldom has the detailed knowledge, and the consultant, who seldom has sufficient time within the very busy days that occupy them. The importance of the specialist nurse is that Parkinson’s is a shape-shifter of a disease, which requires the prompt attention of expert nurses to match its every deleterious move. Some years ago in Chester our specialist nurse was axed by the local PCT, which was then experiencing financial difficulties. We fear that the new NHS commissioning changes will again imperil our specialist nurse post, which was re-established after the community worked long and hard to finance its future. Indeed, I fear for all 300 of the national team of specialist nurses for Parkinson’s, who are in place and funded by local groups, Parkinson’s UK and local PCTs. Can the noble Earl give us an assurance on maintaining the efficacy of that team?

For people with Parkinson's, maintaining personal mobility is key to leading a normal lifestyle. My local branch, for instance, has just supplied its specialist physiotherapy team with the latest laser-enhanced walking aids for their diagnostic programmes. They cost £150 but work wonders. Any move from specialist nursing to a more generalised provision of nursing will turn off the tap of such innovative approaches. Nurses are crucial advisers when it comes to mobility and passing on best practice. Indeed, one such best practice is the use of Nintendo Wii programmes that now help those who want to maintain their balance by, for instance, using a ski programme that allows you to go down ski slopes. That helps people with Parkinson’s to maintain balance. We should be encouraging all these items.

I shall end on a more amusing note. It is good that Michael J Fox, who is himself a sufferer, continues to pour money into research into Parkinson’s, but I was struck the other day that there is a new romantic comedy doing the rounds called “Love and Other Drugs”. The feature of the film is that Anne Hathaway plays the part of an early Parkinson’s sufferer. She tells us that she has enormous respect for Parkinson’s, which she has learnt about as a result of doing this romantic comedy, and she says that in the throes of a passionate embrace on one occasion she had to simulate a Parkinson’s tremor at the same time. It is interesting that something that is a reality for so many people outside is now beginning to filter in and be represented in films like this romantic comedy.

I commend again the work of the all-party group headed by my noble friend Lady Gale, and I hope that the Minister, who has always had a strong interest in all these issues, is able to give us some promising responses today.

Health: Diabetes

Lord Harrison Excerpts

Thursday 4th November 2010 Lords Chamber

Tabled By

[Lord Harrison]

To ask Her Majesty’s Government what is their response to the Diabetes UK report Putting Feet First and its implications for the treatment of diabetes.

[Lord Harrison]

My Lords, as a serial killer, diabetes is getting bolder, accounting over the past year for some 150,000 newly diagnosed diabetics, adding to the 2.8 million known diabetics in the country, with perhaps another half a million undiagnosed. It also absorbs 10 per cent of the NHS budget—that is, some £9 billion a year—as well as immiserating the lives of many of our fellow citizens, often needlessly, for with speedy diagnosis and treatment, the sickening complications of blindness, renal failure and amputation can be forestalled. Diabetics can lead long, healthy and productive lives. Dynamic public health programmes concerned with diet, obesity and exercise are crucial in preventing or staunching the rising incidence of diabetes. More recently, type 2 diabetes among schoolchildren, allied to the rising tide of obesity, places yet another challenge on the scarce resources provided in this direction. Indeed, these are desperate times of pressure on the NHS and of financial retrenchment and cuts.

Some additional spending now on upgrading diabetes therapy will save lives later and money and resources for the NHS in the long run. An example of the success of the long decade of Labour’s investment in the NHS and diabetes care is the increased incidence of retinopathy screening, saving the eyesight of many a diabetic. I hope that that is retained. The recent reform and investment in diabetes management, principally designed to help us to manage our condition, has transformed the lives of diabetics.

I come to some questions for the Minister. There are two discretionary areas at the moment with respect to diabetes care. One area is that of insulin pumps and the allied use of insulin inhalation, which is currently not paid for. I wonder whether he has any comments to make on those points. Something that I have raised in this House before is the essential need for the availability of blood glucose testing strips for diabetics as part of caring for themselves, to ensure that they have good blood sugar levels. Does the Minister recognise that there can be a postcode lottery in the distribution of blood glucose testing strips, with four different health services and different practices throughout the nations and authorities dealing with diabetes?

I ask the Minister, too, about NICE, which recently concluded a consultation on diabetic foot care. I do not know whether he can give us any indication there. He was rather unclear, and I hope he can clear it up today, about the role of NICE, especially as diabetic drugs now form the second largest call on the NHS budget. Good innovations that are cost-benefit assessed must be made available. Would he comment, too, on the flanking policies of the Government? I give the example of sport for young people, which will help to set back the rise in obesity and type 2 diabetes. We need more of the self-management programmes that I referred to and more education of diabetics and diabetic professionals to ensure that they are helpful. Would he say more, too, about whether the focus of the previous Government will be retained on children, obesity in women—typically in pregnancy, when they are diabetic—but also the immigrant population, where there is a higher incidence?

Can the Minister reflect on our colleagues in the European Union? The Federation of European Nurses tells us that the incidence of diabetes in the United Kingdom is, surprisingly, recorded at 4 per cent, while in Germany it is 13 per cent and in most other countries typically 9 per cent. I do not know whether the data are collected inaccurately, and perhaps he would look into that, but we need better information in that area. Would he also note that we have had no pan-European research since 1999 on the cost of diabetes? There is so much that we should be doing with our European colleagues to do something about that.

My superb NHS diabetes care by outstanding healthcare professionals in Chester and Liverpool has kept me active and on my feet as a type 1 diabetic of some 41 years’ standing, and it is to that I now return. Diabetic foot care deserves the same focus as actions on diabetic retinopathy. It may not be very sexy but we need health professionals to come into this area. The 2010 DoH review, Six Years On: Delivering the Diabetes National Service Framework, says that in the key area of feet we still have poor clinical outcomes, resulting in amputations, extended lengths of stay in hospitals and concludes that we need effective management of diabetic foot care to reduce expenditure and amputations.

Last year, Diabetes UK published an excellent document, Putting feet first, summarising the optimal management of available resources to minimise the manifold complications associated with the diabetic foot. Diabetic foot problems are the most common cause of non-traumatic limb amputation in the United Kingdom. Some 100 are performed each week. Neuropathy, peripheral arterial disease, foot deformity, infections, ulcers and gangrene are just some of the nasty complications of diabetes.

In addition to the financial implications of the NHS—out-patient costs, increased bed occupancy and prolonged stays in hospital—diabetic foot problems adversely affect patients’ quality of life, reduce mobility which in turn leads to loss of employment and depression among other social and health consequences.

As outlined in Putting feet first, pivotal to diabetic foot care is, first, fast action within four hours of diagnosis. Then the second period, the following four to 48 hours, is crucial to saving the threatened foot. Delay in diagnosis and management increases the risk of amputation, morbidity and mortality. The third period is the continuing foot surveillance which is so vital for keeping us on our feet.

However, catastrophic trauma need not happen. Let us take peripheral arterial disease where some 100,000 people are diagnosed each year. Vascular specialists need to be swiftly available and treatment by appropriate technologies—the use of balloons or stents to widen or relieve arteries—can prevent the devastation of foot amputation. Unfortunately, the UK has one of the poorest rates of lower limb revascularisation in Europe. To avoid this, we need to encourage the proliferation of local vascular networks and I ask the Minister whether he has anything to say on that. Will the Government implement Putting feet first, emphasising the vital need to create active local networks of key health specialists working with others to ensure speed of response and quality follow-up?

I highlight one of the many useful suggestions in the pamphlet which has been put to me by my own hospital orthotist expert. She tells me that huge benefits are to be derived from examining all new in-patients’ feet. Such inspections typically uncover hidden foot problems, as well as undiagnosed diabetics whose problems may thereby be quickly treated. Helpful, too, are the regular ankle/brachial pressure index tests as a predictor of future PAD. Resources are of course the nub of the problem. I ask the Minister whether he will provide the resources and trained staff to enact the strategy outlined in Putting feet first. How many practice nurses are trained in diabetes management—the orthotists, chiropodists, specialist shoemakers, diabetologists and vascular cardiologists as well as specialist lower limb surgeons?

I want to say a final word on the continuing care of diabetics with foot problems. As I speak to you, I am wearing fashionable orthopaedic shoes made for me by experts who form part of the clinical team at Liverpool’s Broad Green Hospital foot unit. These shoes offer vital protection for my feet, moulded as they are to the ever-changing shape of my feet to preclude the onset of ulcers as a result of my diabetes-associated neuropathy—that is, I have no feeling in the nerves of my feet which warn me of a loose stone doing untold damage to my foot tissue. However, these shoes are expensive—perhaps £500 a pair—and unsurprisingly rationed on the NHS. But these shoes keep me and thousands of other diabetics protected and active in the community. They are an economic investment of the kind with which the Government must wrestle. The Government should heed George Bernard Shaw’s wise aphorism and great foresight:

“I marvel that society would pay a surgeon a large sum of money to remove a person’s leg—but nothing to save it”.

Finally, I welcome to the debate not only the noble Baroness, Lady Young, who has recently taken over as chief executive of Diabetes UK, but also the Minister, who I know will give us a sympathetic reply.

Health: Spending Cuts

Lord Harrison Excerpts

Wednesday 30th June 2010 Lords Chamber

Asked By

[Lord Harrison]

To ask Her Majesty’s Government what is their response to the report in the British Medical Journal on the effect of spending cuts on public health.

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

The Government are committed to improving the prevention of ill-health and will publish detailed proposals later this year. The determinants of public health are complex and we welcome this research. The spending review will set budgets for the years ahead and, in making savings, we will ensure that services work collaboratively and that the wider impacts of spending cuts are considered to avoid false economies.

[Lord Harrison]

Does the Minister acknowledge that it is impossible to ring-fence NHS spending from the surrounding cutpurse policies of this increasingly cut-price Government, as illustrated in the recent report? Will he tell his friends in the Treasury that decent jobs, decent housing, proper programmes for family welfare and protection of pensioners are integral to a proper and comprehensive health policy in this country? Will he slam the back door on these insidious back-door cuts?

[Earl Howe]

My Lords, the Government are conscious that the health and well-being of the population are affected by a number of factors outside the strict confines of the healthcare system. At the same time, we should not underplay the role of the NHS in tackling health inequalities, and not least the role of primary care. In that context, my department is privileged in being able to look forward to a budget that is not going to be cut over the course of this Parliament.

First Aid

Lord Harrison Excerpts

Thursday 17th June 2010 Lords Chamber

Asked By

[Lord Harrison]

To ask Her Majesty’s Government what is their response to the St John Ambulance campaign, entitled “The Difference”, promoting better public understanding and practice of first aid.

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

My Lords, the Government admire the work undertaken by health organisations such as St John Ambulance and the Red Cross, and warmly welcome the contribution that “The Difference” can make to the treatment of the ill and injured.

[Lord Harrison]

Given that the St John Ambulance report suggests that some 150,000 lives could be saved if there was a rudimentary understanding of first aid, and given the paucity of understanding in this country—where only seven out of 100 of us have such knowledge, compared to four out of five of our German colleagues—will the Government redouble their efforts and consider including first aid in the PSHE part of the national curriculum? Will the Minister also study the work being done in the north-west, in a crucial project in Greater Manchester, where ambulancemen and paramedics teach primary schoolchildren about the work of providing and administering first aid? That has gone down very well indeed.

[Earl Howe]

My Lords, the noble Lord asks several questions there. As I have indicated, we are extremely grateful to organisations such as St John Ambulance, the Red Cross and the British Heart Foundation for the extensive and excellent work that they do. As a general approach, we are clear that the NHS locally is best placed to assess and address what is needed in its areas, as indeed in other areas of healthcare. However, we encourage NHS providers to consider the kind of partnerships that work so well.

As regards schools and PSHE, as the noble Lord will know, first aid is included in the PSHE part of the school curriculum. It is not a mandatory module, though it is often included in key stages 3 and 4. What I can do is convey the noble Lord’s concerns to my colleagues in the Department for Education.