NHS: Accident and Emergency Units

Lord Kennedy of Southwark Excerpts

Tuesday 26th November 2013 Lords Chamber

[Lord Kennedy of Southwark (Lab)]

My Lords, I am most grateful to my noble friend Lady McDonagh for securing this debate on the future of NHS accident and emergency units. At the start I declare an interest: I chair, on an entirely voluntary basis, a small committee at Lewisham hospital. It is impossible in just three minutes to get across the scale of the problems and the anxiety and concern of local communities about the A&E crisis that is unfolding before us as the winter sets in.

What did the Government do as soon as they came into office? They had a top-down reorganisation of the NHS, after pledging not to do that, which only made matters worse. What is clear is that this is the Government’s problem. It has happened on their watch, with poor implementation of their already flawed policies, and the cuts they have made to the NHS, to social services and other budgets. There has also been the running down of NHS Direct and the ramshackle way in which the NHS 111 service has been introduced.

I hope the Minister will be able to tell the House how the Department of Health and the NHS are going to respond to the challenges they face, and how they propose to do that with thousands and thousands fewer staff than we had only a few years ago. I fear that things could be even worse than last winter, and we will be back with rising numbers of patients waiting on trolleys at A&E.

We have already had an A&E summer crisis, with more than 1 million people waiting more than four hours to be seen, all on the Minister’s watch. The problem is all of this Government’s own making, and they are not going to get away with trying to wriggle out of it. The Minister and the rest of his team would have us believe that it is everyone else’s problem—it is the doctors’ fault, and the fault of the nurses, the GPs, the porters, the radiographers, the support staff, the patients, or even the weather. It is too cold, or it is too warm, or it is the wrong time of the year. But it is this Government’s problem; it is down to mismanagement by this Conservative and Lib Dem coalition.

If the Minister is going to tell us the problem is caused by too many people going to A&E when they should go somewhere else, can he tell the House why the Government cut Labour’s extended opening hours for doctors’ surgeries and why they are closing NHS walk-in centres up and down the country? Can he confirm how many walk-in centres have closed since the Government came into office? Why did they close NHS Direct, and why did they introduce NHS 111?

My noble friend Lady McDonagh has got it right. We have a dangerous mix of incompetence and ideology. They want to get rid of the NHS, but they realise how unpopular that would be, so instead they pare down to the bone, to the minimum that they can get away with.

--- Later in debate ---

[Earl Howe]

I shall say more on Lewisham in a moment. This is a time-limited debate, and I hope that I may be allowed to conclude my speech.

The principles that I have just enunciated are further enshrined in the four reconfiguration tests first set down to the NHS in 2010, which all local reconfiguration plans should demonstrate. These are support from GP commissioners, strengthened public and patient engagements, clarity on the clinical evidence base, and support for patient choice.

Our reforms allow strategic decisions to be taken at the appropriate level. We are enabling clinical commissioners to make the changes that will deliver real improvements in health outcomes. That is the purpose of reconfiguration. Furthermore, local commissioners proposing significant service change should engage with NHS England throughout the process to ensure that any changes are well managed strategically and, crucially, that they will meet the four tests that I have just referred to.

Given the scale of change across the health system, it is important that local NHS organisations are now supported when redesigning their health services. We are working with our national partners, NHS England, the Trust Development Authority and Monitor, on the continuing design of the interfaces, roles and responsibilities of organisations in the new system. For example, stroke care in London, which has been centralised into eight hyper-acute stroke units, now provides 24 hours a day, seven days a week acute stroke care to patients regardless of where they live. Stroke mortality is now 20% lower in London than in the rest of the UK, and survivors, with lower levels of long-term disability, are experiencing a better quality of life. That is why we must allow the local NHS to continually challenge the status quo and look for the best way of serving its patients.

I turn specifically to accident and emergency departments and points raised by a number of noble Lords. The NHS is seeing more than 1 million additional patients in A&E compared to three years ago and, despite this additional workload, it is generally coping well. I can say to the noble Lord, Lord Kennedy, that we are meeting our four-hour A&E standard and have done since the end of April. The latest figures show that around 96% of patients were admitted, transferred or discharged within four hours of arrival. There are now 500 more A&E doctors in the NHS than there were under the previous Government. Trusts expect to hire 4,000 more nurses, due to the Francis effect, as a result of the public inquiry that the party opposite decided not to pursue.

I have heard many noble Lords describe the current situation as a crisis. I do not share that perception. The NHS is performing well under pressure. Dealing with an extra 1 million patients in A&E does, however, mean that we must look at the underlying causes. Providing urgent and emergency care for people is not just about A&E. It is about how the NHS works as a whole and how it works with other areas such as social care, and how it faces up to the challenge of an ageing population of more people with long-term conditions. Therefore, the Government are taking action to respond to the immediate winter pressures and, looking longer term, we will tackle the unsustainable increasing demand on the system.

NHS England, Monitor and the Trust Development Authority, working with ADASS, have been working together on the A&E improvement and winter planning since May. Staff across the service have worked extremely hard to prepare this year and are committed to making sure that their plans are robust and that patients will receive the services they should expect and deserve. This process was started earlier and is more comprehensive than in previous years. We are determined to do everything we can for the NHS to continue providing high-quality care to patients throughout the winter, which is why we are backing the system with additional funds in the short term to help local areas prepare for and manage additional pressure during the winter.

We have allocated £250 million of funding to NHS England to help cope with winter pressures, with another £250 million for 2014-15. There will also be an extra £150 million from within the NHS England existing budget this year to ensure that everywhere receives a fair share of the funding.

It is, however, clear that the current situation is unsustainable in the long term. That is why we asked Sir Bruce Keogh to lead a review of urgent and emergency care with the first phase published on 13 November, which was also roundly welcomed by the system, including, as noble Lords will be aware, by the NHS Confederation and the Royal College of Surgeons. There will be a further update in spring 2014.

The review is aimed at delivering system-wide change, not just in A&E but across all health and care services in England by concentrating specialist expertise where appropriate to ensure that patients with the most serious illnesses and injuries get the best possible care and ensuring that other services, such as primary and community care, are more responsive and delivered locally. This will mean that people will understand how to access the most appropriate treatment in the right place as close to home as possible.

The noble Baroness, Lady McDonagh, the noble Lord, Lord Patel, and others referred to NHS 111. The introduction of the NHS 111 service is part of the wider revisions to the urgent care system to deliver a 24/7 urgent care service that ensures people receive the best care from the best person in the right place at the right time. This is not only government policy; it was a policy fully signed up to by the previous Government and initiated by them. Although NHS 111 has had a difficult start, we have backed the service with a £15 million fund to support it over the winter. NHS 111 now deals with more than half a million calls a month, and 97% of them are answered in under a minute. The first phase of the urgent and emergency care review sets out a significant expansion and enhancement of the NHS 111 service so that patients know to use the 111 number first time, every time, for the right advice or treatment.

NHS Direct, which was referred to by the noble Baroness, Lady McDonagh, and the noble Lord, Lord Patel, will continue to provide 111 services to patients until alternative arrangements can be made by commissioners. The transfer of NHS Direct’s 111 services is progressing well.

Together with NHS England, we are putting together a strategy focusing on the people who are the heaviest users of the NHS, vulnerable older people and those with multiple long-term conditions. Here I am addressing particularly the points raised by the noble Lords, Lord Patel and Lord Kakkar, and my noble friend Lord Selsdon. The vulnerable older people’s plan will focus on improving out-of-hospital care services centred on the role of general practice in leading proactive, person-centred care within a broader team and is due to be published later this year. A key element of the plan is the provision of joined-up care for vulnerable older people, spanning GPs, social services, and A&E departments themselves, which is overseen by an accountable GP. The aim of proactive care management is to help keep people healthy and independent longer.

A number of noble Lords referred to the workforce challenge. Health Education England is working with stakeholders on a number of innovations to help alleviate the workforce problems in emergency medicine. Through the Emergency Medicine Workforce Implementation Group, Health Education England will work to develop alternative training routes for emergency medicine and a range of mid-level non-doctor clinician posts. They will work with NHS England on potential workforce and training requirements.

I would like to address the point made by the noble Lord, Lord Kennedy, about Lewisham. Lewisham’s A&E is not closing. The TSA proposals were a response, as he is well aware, to a very difficult, long-standing challenge facing south London. The new Lewisham and Greenwich NHS Trust must now work with its commissioners and community to deliver a clinically and financially sustainable future. As regards north- west London, which the noble Lord, Lord Dubs, referred to, the Secretary of State has endorsed the recommendations of the Independent Review Panel, and it is now for CCGs in north-west London, working with NHS England, to take this forward. The decisions here were supported by all the commissioners in the area and all the medical directors in the trusts and all but one of the relevant local authorities.

My noble friend Lady Manzoor spoke about public awareness and engagement. I agreed with a lot of what she said. Through our reforms we have strengthened local partnership arrangements through health and well-being boards. These will provide a forum where commissioners of services, local authorities and providers can discuss the future shape of health services. As I have said, local cases for clinical change should be driven from a local level. We know that these reconfigurations work best when a partnership approach underlies them.

The NHS is one of the greatest institutions in the world. Ensuring that it is sustainable and that it serves the best interests of patients sometimes means taking tough decisions, including on the provision of urgent and emergency care. However—and this is the thought which I leave with your Lordships—those decisions are made only when the local NHS, working with local people and local authorities, is convinced that what it proposes is absolutely in the best interests of its patients.

[Lord Kennedy of Southwark]

My Lords, before the Minister sits down—

[The Countess of Mar (CB)]

Order! It is a time-limited debate.

NHS: London

Lord Kennedy of Southwark Excerpts

Wednesday 30th October 2013 Lords Chamber

[Earl Howe]

Largely, the judgment by NHS England will be made by local area teams—but not in isolation. It has to be a collaborative exercise, which is my overall answer to my noble friend’s second question. The successful integration of services must depend on close collaboration between the different constituent parts of the NHS but also with adult social care and local authorities. It is striking that already we are seeing this happening in north-west London, as we are in many other parts of the country. For the system to work as we want it to, all the constituent parts need to be effective and efficient. The integration of services, which is one example of how the NHS can become more productive in the future, as well as more clinically effective for patients, is an essential way of ensuring that we have a sustainable NHS in the future.

[Lord Kennedy of Southwark (Lab)]

Will the noble Earl confirm, first, that there will be no further appeal in respect of Lewisham hospital after the decisions of two courts; and, secondly, that there will be no attempt to change the law in respect of Lewisham hospital? What lessons have been learnt by the noble Earl and his ministerial team that they can apply to what is going on in north-west London? We are all aware that the Minister has never visited Lewisham hospital; the last ministerial visit was in May 2010. Will he tell the House—if not from the Dispatch Box, then by writing and placing a copy in the Library—when Ministers last visited the hospitals in north-west London that have been mentioned?

[Earl Howe]

I can certainly find out the answer to that last question. As regards the appeal, we have only just received the judgment, as the noble Lord will know. But that is only the outline judgment. We have not received the full text. It is important that we read that and inwardly digest it before we finally decide on the way forward. The lessons of Lewisham are very clear. I confirm that we shall not be legislating around Lewisham and the recent provisions in the Care Bill were not retrospective, as the noble Lord is aware. I have not personally visited Lewisham, which is clearly an omission that I should at some point rectify, but it is important for me to put on the record that the concerns expressed by the people of Lewisham are, and have always been, entirely understandable. Ministers greatly respect the wish of local residents to see their hospital thriving, as it always has in the past. Nevertheless, as I said earlier, Lewisham and Greenwich now have a challenge. There is a financial issue that needs to be addressed and I hope that commissioners and providers, acting together, can do that successfully over the months ahead.

Care Bill [HL]

Lord Kennedy of Southwark Excerpts

Monday 21st October 2013 Lords Chamber

[Baroness Meacher (CB)]

My Lords, in part, I support the Minister because, as the noble Lord, Lord Warner, said, the Government have a problem. We know that for many years there have been attempts to close hospitals that need to be closed and it can take 15 years for that to happen. If the Government can come forward with a sensible, reasonable way of making those decisions, I will back it all the way. However, I find myself agreeing with the idea that a rather quick fix designed to achieve some solution to the Lewisham problem is not the way to do it. This is a national problem of considerable significance. I ask the Minister to take this away, think hard about it and come back with a good set of proposals to help this country close hospitals when they need to be closed. I would certainly be there behind him.

[Lord Kennedy of Southwark (Lab)]

My Lords, although I sit in this House as Lord Kennedy of Southwark, I actually live in Lewisham, very close to the hospital. I agree with the comments made by my noble friend Lord Hunt of Kings Heath. This is a major change of policy being sneaked through the door by the Government. I am amazed that the Minister has brought his amendment today when we are just a few days away from the case being heard in the Court of Appeal—it will be heard next week, I believe.

I live close to the hospital and I refer noble Lords to my declaration of interest that on a voluntary basis I chair a small committee in the hospital. Whatever the problems of the South London Healthcare NHS Trust, I cannot adequately describe to noble Lords the sense of injustice, unfairness and hurt about what is being imposed by the administrator. We have a good local hospital, which is supported by the local community, delivers on its targets and objectives and is financially solvent, but the administrator came along and ripped the heart out of the hospital.

I contend that the purpose of this amendment is to try to stop the campaign that we have seen in Lewisham over the past few months. The campaign has united the community like never before. We had more than 25,000 people on our march. Streets are plastered with posters to save the hospital. Any political party would be envious of the posters up in people’s windows about this campaign. Our local campaign is chaired by a local GP and has brought together health professionals and the local community.

Will the Minister tell the House whether he has visited Lewisham hospital? I asked him that question earlier this year; I know that he had not been then and hope that he has been there since to see the amount of local support and what a good local hospital it is. More important, there is no support at all for what the Government propose today. I hope that the House will support the amendment of my noble friend Lord Hunt of Kings Heath and reject the amendment of the noble Earl.

[Lord Patel (CB)]

My Lords, I find myself in a strange position, because I agree in part with the amendment moved by the noble Earl and in part with the amendment moved by the noble Lord, Lord Hunt, although that is not a solution.

I agree with the noble Earl that we need to find a way of reconfiguring NHS services. That reconfiguration cannot just be done through dealing with failing hospitals. It must include other hospitals which currently seem to be delivering good-quality services. We have to find a way out of that. The question is therefore whether the amendment allows us to move forward with reconfiguring NHS services. This is where I find myself more in tune with the suggestion of the noble Lord, Lord Warner, that it may not and that more is required.

Another concern I have is that the commissioners may express views. I would like some explanation of why the commissioners of the NHS foundation trust are to be treated separately from those who commission services from other hospitals. Another issue is that, if the commissioners disagree, NHS England would make the decision. That means that, ipso facto, they will agree with a special administrator—or they will not. In that case, what happens?

Another issue is consultation. Clearly, none of the configuration can occur smoothly unless the public are consulted. At what point will the special administrator consult both the public served by the failing hospital and the public served by the hospital that is not failing but whose services may require reconfiguration?

In summary, therefore, there is a need for amendments that will allow us to move forward with the reconfiguration of services throughout England. In that respect, I am with the noble Earl, but I wonder if he needs to go a bit further. He might consider looking at this further and tabling more amendments at a later stage.

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.