NHS: Out of Hours Service

Lord Kennedy of Southwark Excerpts

Tuesday 26th March 2013 Lords Chamber

Asked by

[Lord Kennedy of Southwark]

To ask Her Majesty’s Government what steps they are taking to ensure high-quality out of hours GP medical care is in place.

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

My Lords, people are entitled to expect high-quality health services at any time of day or night. All out-of-hours services must be delivered according to national quality requirements, and local providers have a legal requirement to make sure that high-quality out-of-hours care is in place. If this is not happening, we expect action to be taken immediately to improve services.

[Lord Kennedy of Southwark]

The publication of the Patients Association survey and the comments from the BMA highlight that many GP practices are struggling to cope with a rising workload as resources are falling. Does the Minister agree that, with many other changes taking place across government on 1 April, we are in a dangerous and worrying period for people who find themselves in need of health and related services?

South London Healthcare NHS Trust

Lord Kennedy of Southwark Excerpts

Thursday 31st January 2013 Lords Chamber

[Earl Howe]

My Lords, perhaps I may put on the record my own recognition that Lewisham hospital is an excellent hospital. There is no question about that and there has never been any question about it. The hospital provides good care for local people and it is highly valued. Only this afternoon I had one noble Lord from my own Benches telephoning me to tell me of his personal experience of Lewisham hospital and its excellent maternity care.

The noble Lord asked me two specific questions. He quoted the Statement where at one point it was made clear that a non-admitting urgent care unit at Lewisham would not improve patient care. That is the precise reason why Sir Bruce Keogh recommended something different; namely, an admitting A&E unit with 24/7 cover. He looked at the recommendation and was not satisfied with it in terms of risks to patients. I hope that that is helpful to the noble Lord because I think he misconstrued what I was saying.

On the question of risk, any set of assumptions that relies on hypotheses around patient flows in the future and clinical referral decisions has to be, by its very nature, uncertain. It is the view of the trust special administrator and the review of my right honourable friend that the assumptions underpinning these decisions are reasonable, and that was backed up by Sir Bruce Keogh. But the noble Lord has a point because the implementation of these recommendations is going to be key, and that is why the TSA has recommended a programme board to oversee the implementation of these recommendations over the next few years. It is absolutely essential that commissioners and the providers in that area buy in to these proposals. We believe that they will, but it is important that if the financial risk is to be minimised, we get as close as possible to the forecast and predictions that the TSA has set out.

[Lord Kennedy of Southwark]

My Lords, I want to draw the attention of noble Lords to my declaration of interests in respect of Lewisham hospital. I would like to pay tribute to the staff of the hospital who serve the community so well, and the local residents involved in the save Lewisham A&E campaign for the fantastic campaign they have run. It is supported by local GPs, local businesses and Millwall Football Club. We have a great hospital that is supported and valued locally. In the past two years the ConDem Government have spent £12 million on funding the refurbishment of the Lewisham A&E unit. We have a fantastic children’s A&E unit. That refurbishment was finished only in April last year, yet today they have downgraded our maternity and A&E services to pay for the failings of a neighbouring trust. Will the noble Earl agree to publish all of the legal advice the Government have received in respect of the decision they have taken today? Can he also tell the House if he has ever visited Lewisham Hospital? I am glad he agrees that it is actually a great hospital. If he has not visited it, will he confirm that he is willing to do so at the earliest opportunity, in the light of his responsibilities for quality and urgent care? Further, can he tell the House what he would have spent the £5 million on?

[Earl Howe]

My Lords, the facilities at Lewisham A&E are indeed very good, and a lot of money has been spent on them. I would hope that the noble Lord will therefore welcome the fact that we are keeping an A&E department open. That department will be comparable with many other A&E departments around the country. It will be a fully functioning department other than for those difficult and critical cases which, by common clinical agreement, need more specialist care where clinical resources can be concentrated. That is increasingly the view of senior clinicians in the royal colleges around London.

The other point that the noble Lord may need to factor in is that many of the services in an area of the country, whether it is London or anywhere else, depend on networks. What we envisage for Lewisham and Woolwich, taken together, is that they will be part of an active network, with staff rotating between the two. There will be an understanding of what each hospital is capable or incapable of doing, and an understanding on the part of ambulance trusts as to where best to take patients. We have already seen the results of that policy. This is not idle speculation. There is proof positive from the decision to decrease the number of acute stroke units in London from 32 to eight; the mortality rate has more or less halved since that decision was taken. So there is clear clinical underpinning.

I note the noble Lord’s understandable regret that Lewisham has been caught up in the problems of its neighbour. However, as the Statement made clear, the people of Lewisham also depend on the services of South London Healthcare Trust, so to say that there is somehow an island of patients who simply go to Lewisham would not be fair.

The noble Lord asked me about publication of the legal advice. I can confirm that the decision of my right honourable friend has been taken in the light of consideration of the legal issues and advice to him that it is lawful. The normal position is that the Government do not publish legal advice; there is a long-standing precedent. However, I can tell him that the legal advice backs up his decision.

Diabetes

Lord Kennedy of Southwark Excerpts

Thursday 10th January 2013 Lords Chamber

Asked By

[Lord Kennedy of Southwark]

To ask Her Majesty’s Government what action they are taking to reduce the number of amputations due to diabetes.

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

My Lords, foot complications of diabetes are usually preventable. Early identification and prompt treatment prevent amputations. NICE guidelines recommend annual foot checks, which are included in the quality and outcomes framework for general practitioners. NHS Diabetes has established regional diabetes footcare networks. People with vulnerable feet require expert protection, while those with problems need urgent specialist care. Local national health services are responsible for commissioning podiatry services and multidisciplinary specialist footcare teams for people with diabetes according to local needs.

[Lord Kennedy of Southwark]

I draw the attention of the House to my declaration of interests in respect of Diabetes UK. One hundred and twenty-five amputations take place each and every week in England alone, and 80% of those are preventable. The record of the Department of Health is not good; the figures are going up, not down. If I asked this question in a year’s time, what progress does the Minister expect that his department would have made to reverse that trend?

[Earl Howe]

The noble Lord is absolutely right that this is a major public health issue and one that impacts very seriously on the health and well-being of individuals, so it is a priority for us. We are committed to reducing the number of avoidable amputations among people with diabetes. In fact, progress is being made: although the number of amputations is going up, the rate is falling. However, we are under no illusion that this will be a growing problem because of the growing number of people with diabetes. All our work on improving completion of the NICE nine care processes for people with diabetes and improving timely access to specialist diabetic footcare multidisciplinary teams will support that aim, and the Diabetes UK Putting Feet First campaign has real potential to improve awareness of foot complications in diabetes.

Health: Non-communicable Diseases

Lord Kennedy of Southwark Excerpts

Thursday 6th October 2011 Lords Chamber

[Lord Kennedy of Southwark]

My Lords, I congratulate the noble Lord, Lord Crisp, on putting down this Motion for debate today. He has had a distinguished career in health and related fields, culminating in serving as the chief executive of the NHS and Permanent Secretary at the Department of Health. It is a timely Motion that allows us to reflect on the four major chronic non-communicable diseases and the enormous problems and suffering that they cause. I agree wholeheartedly with the thrust of the points that the noble Lord has made.

The four major non-communicable diseases are, of course, cardiovascular disease, type 2 diabetes, cancers and chronic lung disease. As the noble Lord, Lord Crisp, said, 6 per cent of deaths in the world is a truly shocking statistic. I will speak briefly today about type 2 diabetes.

For many years I felt stressed, agitated, tired and run down at work. You could say that if you work for the Labour Party for 20 years, what do you expect? But in reality, I was an undiagnosed diabetic, having symptoms and developing complications but not getting the treatment that my body desperately needed. The point made by the noble Lord, Lord Crisp, about how we have an about-face, with more money going into dealing with the complications than the prevention, is absolutely right. I hope the noble Earl can address that in particular in his response.

Undiagnosed diabetics are an even more at-risk group. Enabling people to spot the signs, have a proper test, and seek medical care at as early a stage as possible, thereby offsetting some of the complications that can develop, is important for us all. Annual eye screening, regular checks on feet, and regular visits to a diabetes nurse are all welcome measures to deal with complications and enable sufferers to deal with the problems. They enable people with the condition to have a better quality of life and save the NHS considerable sums of money in treating otherwise preventable complications.

Complications such as heart problems, strokes, amputations and blindness are all things that we can work together to eliminate and to improve people’s quality of life. I am sure the noble Earl, in his response, will tell the House how much better prevention is than cure for sufferers of type 2 diabetes. Bearing in mind the huge number of preventable amputations that are still taking place today, something must be done to improve on this situation.

I am delighted that my noble friend Lord Collins will respond to the debate for the Opposition. Like me he has type 2 diabetes. In our previous lives, mine as the director of finance for the Labour Party, and that of the noble Lord, Lord Collins, as general-secretary, we worked and sat closely together. Having been diagnosed some time earlier, I saw the signs in my noble friend and was not surprised when he told me the diagnosis from his GP. Getting the diagnosis, advice and treatment has certainly considerably improved how I feel and enabled me to take positive steps to control the condition.

Soon after I was diagnosed, I joined Diabetes UK. I am sorry that my noble friend Baroness Young of Old Scone, who is the chief executive of Diabetes UK, cannot be with us today. She is at a board meeting, or otherwise would be taking part in this debate in your Lordships’ House. Diabetes UK is a great charity and has given me great advice, help and support.

I want to say congratulations and well done to Diabetes UK for winning the healthcare and medical research award at the charity awards this year for its diabetes roadshow, which goes out into communities to make people aware of the risk they are at. Through its campaigning and briefings, the research that it is funding, and the awareness and support that it gives, working with the Health Department, it is leading the way in ensuring that people can live fulfilling lives and avoid the problems and complications that diabetes can bring. Diabetes UK also has a fantastic care line, the only dedicated helpline in the UK, which enables sufferers to get advice and guidance when they need it.

I also pay tribute to another diabetes charity, Silver Star, which my right honourable friend, Keith Vaz, the Member for Leicester East, was instrumental in setting up. It raises awareness of diabetes and its complications, particularly in the Asian community, both in this country and on the Indian subcontinent. Diabetes is one of the conditions where prevention is the key. Proper information is needed to allow people to make informed choices about their lifestyle. Better diet, losing weight, and more exercise all contribute to dealing with what has become an epidemic across the globe but that can be avoided.

Again, I thank the noble Lord, Lord Crisp, for initiating the debate and look forward to the response by the noble Earl.

NHS: Reform

Lord Kennedy of Southwark Excerpts

Monday 6th June 2011 Lords Chamber

Asked By

[Lord Kennedy of Southwark]

To ask Her Majesty’s Government how they will ensure that their proposals for the reform of the National Health Service do not lead to a break up of the service.

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

My Lords, the Government are currently pausing to consider possible improvements to the Health and Social Care Bill. However, our proposals will reinforce the NHS as an integrated system, joining up working between the NHS, public health and social care locally. A new NHS commissioning board will set national commissioning guidelines promoting greater consistency. All NHS bodies and providers of NHS services will remain bound by the NHS constitution, and the Secretary of State will remain accountable overall.

[Lord Kennedy of Southwark]

My Lords, I thank the Minister for his reply. Does he understand the issue of low morale within the NHS that is being caused by these proposals, as well as the concern and worry among patients? Let us be clear that the record of the Conservative Party on the NHS, now supported by the Liberal Democrats, is a great worry to citizens and to anyone who values and cherishes this House.

[Earl Howe]

My Lords, I accept that a number of aspects of the Government’s proposals have caused concern in many quarters, and that is why we have chosen to pause in order to listen and reflect on those concerns. As I have said, we will be bringing forward proposals shortly to improve the Bill. I hope that those proposals will meet with widespread acceptance. I think that it is fair to say that it is not the main principles which the Government have laid out that have been the subject of controversy but rather the detail and the implementation, which we are looking at most closely.

Health: Preventable Sight Loss

Lord Kennedy of Southwark Excerpts

Tuesday 29th March 2011 Lords Chamber

[Earl Howe]

My Lords, I quite agree with the noble Lord that sight tests allow an invaluable opportunity to review all aspects of eye health, including investigations for signs of disease. The uptake of NHS sight tests is, I am glad to say, increasing. As regards messaging, the department has worked, and continues to work, with NHS Choices on the development of articles and videos to raise the profile of visual health and promote the importance of regular sight tests. Looking ahead, and as part of their new public health responsibilities, we propose that local authorities will have primary responsibility for the health improvement of their local populations. They could well choose, if they wished, to promote eye health and work to improve the wider aspects of health and lifestyle that contribute to improved eye health. We are currently consulting on the public health outcomes framework, as I am sure the noble Lord is aware. We are also consulting on the scope of the evidence base for public health and the interventions that will work best.

[Lord Kennedy of Southwark]

Does the noble Earl agree that one of the groups of people at risk of developing eyesight loss is people with diabetes? As part of the increased work to deal with diabetic retinopathy, should not everyone at risk have, in addition to their normal eyesight tests, annual eye screening? This service must not be cut but be expanded, as early detection and prevention is right for the patient, their family and ultimately the taxpayer, as thousands of pounds that would otherwise have to be spent on dealing with preventable complications will be saved.

[Earl Howe]

My Lords, the noble Lord makes some extremely important points. This is a good news story and very good progress has been made; more people with diabetes are being offered screening for retinopathy than ever before, and to higher standards. More people are being offered screening now than when the screening programme was announced in January 2003. At that time, 1.3 million people with diagnosed diabetes in England were being screened. The latest figures, for December 2010, show that 2.21 million people were offered screening.

Health: Influenza Vaccination

Lord Kennedy of Southwark Excerpts

Thursday 20th January 2011 Lords Chamber

Asked by

[Lord Kennedy of Southwark]

To ask Her Majesty’s Government what plans they have to review the advice on the availability of the flu vaccination.

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

My Lords, the Government’s policy on flu vaccination is informed by the expert advice of the Joint Committee on Vaccination and Immunisation. The JCVI last met on 30 December to review the latest evidence. The committee decided that there were no grounds to change the risk groups that are offered vaccination and recommended that efforts be focused on maximising vaccine uptake among all those in the risk groups. As with all vaccination programmes, the JCVI will keep this matter under review.

[Lord Kennedy of Southwark]

I thank the noble Earl for his response. The latest figures show that approximately 780 people are in critical care, and there is still a long winter ahead of us. What steps are the Government taking in case the numbers continue to rise? Secondly, what steps have been taken to address the reported shortages of flu vaccines in some areas, with GPs and pharmacies running out of stocks?

[Earl Howe]

My Lords, the noble Lord’s figures are slightly historic. Figures due to be published today will give a better picture. I spoke yesterday to the Chief Medical Officer, who told me that the rates to be published at 2 pm today will show a decrease from the figure that he mentioned. There has also been a further decrease since the new figure and it appears that the worst is over as regards the incidence of flu. On the second question, there have been reports of vaccine shortages. We have taken steps to address that by releasing stocks of the monovalent H1N1 vaccine from our national stock. That system is working well. There is an online ordering system, which GPs are using. They are also ordering stock directly from the manufacturers and we understand that that system is working well, too. The reports of shortages are, I hope, a matter of history.

Health: Diabetes

Lord Kennedy of Southwark Excerpts

Thursday 4th November 2010 Lords Chamber

[Lord Kennedy of Southwark]

My Lords, I thank my noble friend Lord Harrison for putting down this Question for debate today. He is well known in this House and elsewhere for his campaigning for greater understanding of and improved care for people with diabetes. I congratulate the noble Baroness, Lady Young, on her appointment as chief executive of Diabetes UK and I look forward to her contribution later today. I should like to declare an interest: I have type 2 diabetes. I am a member of the charity Diabetes UK. I support its activities and the campaigns it undertakes.

As my noble friend Lord Harrison said, more than 2.8 million people in the UK have diabetes, of whom 300,000 have type 1 diabetes and 2.5 million have type 2 diabetes. That equates to almost one in 20 of the UK population being diagnosed with this condition. Add to that the estimated 500,000 people who have undiagnosed diabetes and you see the truly worrying numbers we have to deal with.

The report that my noble friend Lord Harrison refers to specifically looks at the commissioning of specialist services for the management and prevention of diabetic foot disease in hospital. It is an excellent piece of work and the authors and the working group are to be congratulated on its production. Diabetic foot complications leading to nerve damage, foot ulcers and amputations are, in the majority of cases, avoidable with good care and proper management. That is obviously better for the patient and for the NHS. Amputations clearly have a major impact on a person's quality of life, and there is also the cost to the NHS of the amputation and the ongoing aftercare. Noble Lords who have read the report will have seen in the appendix the poster setting out best practice in integrated healthcare in hospital and the information card for people with the condition.

Noble Lords will also be aware that foot disease is not the only complication that people with diabetes have to tackle. Other long-term complications include how diabetes affects your eyes, heart, kidneys and nerves. I am very lucky. My care at the Morden Hill surgery in Lewisham, led by my GP, Dr Gostling, is excellent. But all too often the reports are that it is a bit of a lottery out there and care varies tremendously from place to place. This is a truly serious condition for patients, the NHS and the country. Parliament and government working with health professionals and patients have to make significant strides in the coming years to deal with this growing problem. The cost to the patients and their families, the NHS and the whole country is far too great.

As I said before, with good care, this is a wholly manageable and controllable condition. People with the condition of course have to take responsibility for their own diabetes control. Noble Lords may find it hard to believe, but I like the odd chocolate bar or Jaffa Cake at home watching the TV, and that is fine, but I am working to bring my condition under control and to improve my own health. Patients need ongoing support to help them to take control of the condition, as well as access to cutting-edge treatments, as they are developed, to deal with the many complications that they have to face: the regular visits to the practice nurse, the annual eye screening, and the advice from the dietician about what to eat and what to eat a little bit less of.

In his response, I hope the Minister can give the House a commitment to continuing a regular series of meetings and regular dialogue with Diabetes UK and other diabetes charities such as Silver Star, of which my right honourable friend Mr Keith Vaz, the Member of Parliament for Leicester East, is the founding patron. Such a commitment cannot just be between the department and professionals, however; it must include Ministers engaging in the discussion and the full involvement of people with diabetes.

In conclusion, I again thank my noble friend Lord Harrison for tabling this Question for debate.