Tobacco: Control

Lord Naseby Excerpts

Tuesday 19th June 2012 Lords Chamber

Asked by

[Lord Naseby]

To ask Her Majesty’s Government whether they will meet representatives of non-governmental organisations, the tobacco industry and retailers to discuss tobacco control issues, publishing the minutes of such meetings, in line with both the requirements of Article 5.3 of the World Health Organisation Framework Convention on Tobacco Control and the practice of the European Commission and other member states.

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

My Lords, Health Ministers consider all meeting requests carefully. Article 5.3 of the Framework Convention on Tobacco Control requires the Government to protect the development of public health policies from the vested and commercial interests of the tobacco industry. The tobacco industry is welcome to share its views on tobacco control issues with us in writing at any time.

[Lord Naseby]

My Lords, that is a depressing Answer. How is it possible that in a country that believes in freedom of speech, a highly regulated and legitimate industry employing thousands of people and providing millions of pounds of revenue for Her Majesty's Government can be treated quite so shabbily when the Government are developing new regulations affecting plain packaging, which affects intellectual property, and are involved in consumer safety? I ask my noble friend to think again and to receive representations. The Government may not want to agree with those representations, but surely it is the legitimate right of every elector and every employer in this country to make their representations in person to Her Majesty’s Government.

[Earl Howe]

My Lords, we welcome the views of tobacco companies, retailers and all those with an interest in tobacco-related policy. Ministers in other departments may have legitimate reasons to meet the tobacco industry—I understand that, from time to time, they do—but Health Ministers and Department of Health officials would have a good reason to meet tobacco companies only if a specific matter, as opposed to general issues to do with tobacco control, demanded that. We would have to think carefully whether there was a good reason.

NHS: Risk Register

Lord Naseby Excerpts

Tuesday 15th May 2012 Lords Chamber

[Earl Howe]

My Lords, we do not agree with that. We have, as I have mentioned, published a document setting out a summary of all the risks in the register and the mitigating actions associated with each category, but we resist publishing the risk register itself at present. It is essential that officials are able to formulate sensitive advice to Ministers, making frank assessments and using direct language, without the fear of causing unnecessary embarrassment for the Government or damage to their area of policy. That is the essence of the reason.

[Lord Naseby]

Is my noble friend aware that there is nobody more passionate about the NHS than I am, but that a great many people outside want civil servants and other advisers to Ministers to point out the whole extremity of risks in any policy, whether it is policy A, B or C? At the end of the day, they expect Ministers to look at those risks and take appropriate decisions. Against that background, therefore, the strategy that my noble friend is following is understood outside by the ordinary public. It may not be understood by the lobby groups; nevertheless, it is the public whom we serve.

[Earl Howe]

My Lords, I am very grateful to my noble friend, and he is right. The risk assessment process, carried out by civil servants and detailed in these registers, is an integral part of the formulation and development of government policy. It is in the public interest that this process be as effective as possible. We are clear that where policy is sensitive, that necessitates confidentiality.

NHS: Management Consultants

Lord Naseby Excerpts

Monday 13th February 2012 Lords Chamber

[Earl Howe]

The noble Lord is, I think, insinuating some impropriety on the part of McKinsey and, perhaps, on the part of civil servants. I know of no such impropriety. Indeed, as I said earlier, there are clear and strict rules about transparency and openness. Declaring hospitality received is something that all civil servants and Ministers have to do. The results are published regularly. I will of course ask the question of McKinsey, which I have not yet had time to do. If I discover that there is any substance to the questions that the noble Lord has asked, I shall of course write to him and place a copy in the Library, but I very much doubt that I shall find any substance to them.

[Lord Naseby]

My Lords, as the Question refers to consultants and not to any specific consultant, is it not a fact that consultants provide a good interim role of management, suggestion or policy for consideration for Her Majesty's Government rather than their taking on ever more central staff? Is that not particularly appropriate, bearing in mind that the Prime Minister held a consultation on the whole of the Bill, as a result of which, as I understand it from listening to the debates in this House, changes have been made to the Bill which will have to be implemented pretty quickly? One can understand why consultants are brought in at the centre of the National Health Service. Surely on the whole it can only be healthy to have consultants there to speed up the implementation of this very important Bill.

[Earl Howe]

My noble friend is quite right. As I said earlier, the use of consultants—provided that that use is judicious and they are engaged in open competition processes—can be very cost-effective. It is a very flexible way of obtaining high-class advice without incurring long-term costs.

Tobacco

Lord Naseby Excerpts

Monday 6th February 2012 Lords Chamber

[Earl Howe]

My Lords, I wonder too.

[Lord Naseby]

My Lords, the Minister says that the control of illegal importation of tobacco is showing progress. Is it not the reality that the vast majority of illegally imported tobacco and cigarettes is being consumed by young people, and that while the official statistics may show one thing, all the evidence, when I inquired of the tobacco industry on this particular aspect, is that this is still the major problem in terms of young people taking up smoking?

[Earl Howe]

My noble friend is absolutely right that that is where the problem principally lies: 320,000 young people experiment with smoking or take it up every year. That is a very serious rate of incidence and it must be tackled at every possible level. The tobacco control plan sets out a concerted programme of action to try to do just that.

Health and Social Care Bill

Lord Naseby Excerpts

Monday 19th December 2011 Lords Chamber

Debate on whether Clause 240 should stand part of the Bill.

[Lord Naseby]

My Lords, the Deputy Speaker called the amendment and it was agreed, but I did not specifically hear that Clause 240 should stand part. If I may, I will intervene briefly on whether the clause should stand part, particularly the additional functions under subsection (1)(a). It states:

“NICE may do any of the following … acquire, produce, manufacture and supply goods”.

I have a query for my noble friend on the Front Bench. We are well aware that in the past some hospitals have manufactured certain generic medicines and marketed them, which has caused the normal market for medicine and pharmaceuticals to be disrupted. Secondly, we are aware, particularly recently, of certain hospitals that have been selling medicines in another market, which has caused disruption to that market and particular difficulties for parts of the country where there has been a shortage of medicines.

I may be wrong but, as I read it, this clause means that NICE will be in a position to manufacture directly, maybe even under a licence. I see that under paragraph (f) NICE will be able to,

“exploit ideas and exploit intellectual property”.

Can we be quite clear? Is my noble friend really saying that NICE, the adjudicator of value for money and all the other dimensions in the Bill to do with pharmaceuticals, medicines et cetera, will manufacture certain medicines on the side? That does not seem to be part of the role of the regulator. It seems, frankly, to be virtually direct labour within the context of NICE. I would be most grateful if my noble friend would respond. If he is not able to respond today, perhaps he will respond on Report or write to me.

[Earl Howe]

My Lords, I hope I can assist my noble friend. Clause 240 enables NICE to undertake additional functions, such as supplying new services and exploiting intellectual property. These functions must be related to the provision of health and social care. They seek to reproduce the income-generation powers that NICE currently enjoys as a special health authority and do not therefore represent an expansion of its powers. NICE may do this for any number or type of organisations, including the private sector and overseas Governments. This clause allows NICE to charge for carrying out these additional functions on an appropriate commercial basis.

In the White Paper Liberating the NHS: Report of the Arm’s-Length Bodies Review, the Government stated that,

“where appropriate, arm’s-length bodies will be expected to exploit commercial opportunities and maximise commercial discipline across the sector”.

NICE may carry out these additional functions provided that they do not have an impact on its ability to carry out its functions. We do not envisage, and nor does NICE, that the performance of any of these functions will interfere with its normal work programme. I hope that that is helpful to my noble friend. It is certainly not the case that NICE will be manufacturing medicines, as I think he feared.

--- Later in debate ---

[Earl Howe]

The noble Lord is exactly right. He will know from his time as a Minister with responsibility in this area that NICE has steadily grown its reputation overseas, and that with that have come opportunities to sell its services in a number of quarters. We simply want to see that continue.

[Lord Naseby]

I understand that and I understand the point made by the noble Lord, Lord Hunt. Nevertheless, to the best of my knowledge, NICE has never manufactured, and presumably from what my noble friend has said is not going to manufacture, in which case perhaps “manufacture” can be deleted from the Bill when it returns on Report.

[Earl Howe]

I will take advice on why “manufacture” is in the Bill and come back to my noble friend.

National Institute for Health and Clinical Excellence

Lord Naseby Excerpts

Wednesday 14th December 2011 Lords Chamber

Asked By

[Lord Naseby]

To ask Her Majesty’s Government what, if any, changes there will be in the procedures of the National Institute for Health and Clinical Excellence as a result of the recent life sciences Statement.

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

My Lords, the Government’s Statement on the life sciences set out a range of actions to support the adoption and diffusion of innovation in the NHS. This includes a commitment to establish, through the National Institute for Health and Clinical Excellence, an advice service to support medical technology companies in demonstrating the value of their products, and measures to improve NHS compliance with NICE guidance. It is for NICE to consider any changes to its procedures as a result.

[Lord Naseby]

Is my noble friend aware how welcome the Statement on life sciences was both to patients who suffer from chronic diseases and indeed to the pharmaceutical industry? However, that welcome is tempered by the statement that my noble friend has just made, because, quite frankly, NICE is and has been a dead hand on development for many medicines. I note that the current chairman has been in position for 12 years, and is scheduled to stay for another two, while the chief executive has been there for 12 years, and is scheduled for an unlimited term beyond that. Many charities have commented on NICE, and I will quote briefly from Sarcoma UK: “In the UK the delays caused by NICE can add years to introduction and mean patients die waiting”. Against that background, will my noble friend ensure that NICE has a new, younger and more modern management?

[Earl Howe]

My Lords, I need to put on record that I have every confidence in the senior leadership of NICE. The current chair and chief executive have overseen NICE’s development into an organisation of global repute that provides robust, independent guidance on a range of issues. Continuity of leadership can be a very good thing, and I believe that it is in this case, where the leadership is of the highest calibre. I would also say that significant improvements have been made to the timeliness of NICE appraisal guidance on new drugs. NICE is now able to issue draft or final guidance for a significant majority of the drugs that it appraises within six months of a drug being licensed. That is extremely good, considering the complexity of some of these assessments.

NHS: Waiting Times

Lord Naseby Excerpts

Tuesday 22nd November 2011 Lords Chamber

[Earl Howe]

My Lords, in the first quarter of the current financial year, 0.4 per cent of occupied bed days were taken by patients who were delayed while waiting for a care package. That picture has deteriorated over the past year but that deterioration masks some variations. Some hospitals have improved dramatically and others have started reporting for the first time. It is not possible to compare this year’s figures with the previous year, although these are very important figures which we do monitor.

[Lord Naseby]

My Lords—

[Baroness Jolly]

My Lords—

[Lord Naseby]

My Lords, is it not strange that the figures show that certain hospitals consistently get nowhere near meeting the 18-week target? What action are the Government going to take to help those hospitals ensure that they perform like the average?

[Earl Howe]

Yes, my Lords, my noble friend is right. Five hospitals account for a very significant proportion of the number of patients waiting for longer than 18 weeks. We are working with those hospitals to look at ways in which that performance can be improved. We know that it can be because many hospitals are more than achieving the desired standard.

Hospitals and Care Homes: Hydration

Lord Naseby Excerpts

Monday 7th November 2011 Lords Chamber

[Earl Howe]

My Lords, I think that mandating a blanket approach to hydration from the centre, as it were, will not have the effect that we want, which is to deliver the person-centred improvements that we all want to see. Having said that, I know that there have been some important developments. As I have just said, providers are now required by law to have policies in place that protect people in hospital, and the regulatory body charged with overseeing compliance—the CQC—has been equipped with tough powers of enforcement. My right honourable friend the Secretary of State instigated a whole succession of unannounced inspections of NHS trusts, and there are further ones on the way. We are also looking at changing the NHS constitution in relation to the issue of whistleblowing. So a lot is going on, but there is a limit to what central government can do. It is in the end up to staff and managers on the ground.

[Lord Naseby]

Is my noble friend confident that today’s nursing training understands and re-emphasises the great importance of having a hydration policy?

[Earl Howe]

My Lords, I asked my officials that very same question. I thank my noble friend. My advice is that all preregistration training for nurses contains instruction and information about hydration and how to make sure that people have enough to eat and drink while in a care setting.

Health and Social Care Bill

Lord Naseby Excerpts

Tuesday 11th October 2011 Lords Chamber

[Lord Naseby]

My Lords, all my political life of some 40 years plus, I have been involved in debating the National Health Service. Reflecting on that time, this Bill is probably the most important debate on it over those years. I want to make it clear that I support the Bill. More importantly, I support the need for the Bill. The need is clear because we do not today have an NHS that is the envy of the world, which is something to which all of us in this Chamber would aspire.

Numerous problems need to be tackled, many of which were not tackled by the previous Government. Unless they are tackled in the near future, the outcomes for NHS patients will deteriorate. I compliment the previous Government on what they did as regards funding; namely, to increase the NHS budget, bringing it up as a percentage of GDP that is fairly comparable to France and Germany. But, sadly, whatever the noble Lord, Lord Rea, may think, read or say, we do not have a health service comparable to either of those countries.

However, the crying shame and legacy of that increased expenditure is that it was not achieved with productivity at the same time. The result is that the service is not able today to handle the demand, nor is it able to properly control its budgets and expenditure. We know therefore that, as a result, there is the problem of £20 million of efficiency savings left by the previous Government for the coalition to deal with.

The first challenge is how to get a real grip on expenditure to ensure that money is spent on patient care and not on bureaucracy. That is at the heart of the strategy of why my ministerial friends have produced this Bill. I personally welcome the end of PCTs, the removal of the other layers of bureaucracy and their replacement by GP commissioning. After all, we previously had GP fundholding, which worked really well for those who took part, particularly for patients as waiting times were driven down and minor surgery blossomed. But the problem was that it was not compulsory.

I recognise that this is a Second Reading debate. Therefore, we need to look at all the many representations that I and others in your Lordships’ House have had in Committee, but not today. But I want to highlight some of the key issues that are sitting there writ large. Nursing standards in the NHS have fallen. The evidence is there for all to see. Somehow, the NHS and the Royal College of Nursing have to get a grip on this issue and have a total review of the training, the responsibilities, the supply for general nursing and for specialists, and, above all, the attitude of those nursing patients.

On the speaking of English, for too long the NHS has gone out and recruited doctors and nurses in huge numbers overseas and, allegedly, someone has checked their English. But we all know that that has not happened properly. There now needs to be a rigorous system of the checking of qualifications and the ability to speak English, particularly the ability to understand English in a medical context.

Perhaps more controversially, we need to have a long look at medical students. There is a clear need to review the number in training of doctors, nurses, physios et cetera. I have to say that, for one reason or another, today’s medical school intake—the majority of whom are now women—is not working. I do not know why women do not stay in medicine but the majority of them do not. Medical schools need to look at this. The net result is that we have too few senior doctors because the female medical students have not stayed for too long in the service.

Why do we still have mixed wards in this country? We must be the only leading country in the world that still has mixed wards. I say to my noble friend on the Front Bench that I hope he will have a mission—for as long as he is on the Front Bench—to get rid of all mixed wards.

I have spoken previously on medicine, which I know something about in detail. GPs are one of the key gatekeepers and they are assisted by modern medicines, thus reducing the problems for hospital care. It is interesting that the money spent on medicines as a percentage of total healthcare spending has not changed very much over the decades. The NHS has to resist buying always at the cheapest level. It also needs to stop making its own medicines, as it does in certain hospitals. I am very sorry to say that an increasing problem is one of false and counterfeit medicines, to which somehow we need to find an answer.

There needs to be a better understanding of the appropriate relationship between the pharmaceutical industry and the NHS. There needs to be an understanding that incremental improvements in drugs are to be valued and not rejected. If we are not careful and do not get that relationship right, we shall end up with more problems similar to Pfizer’s withdrawal from Sandwich.

Frankly, I think that there is something wrong with NICE. Why does it take longer than any other comparable body? Why does it refuse medicines that are accepted in Europe and even accepted in Scotland? I will not comment on community care, other than to say that it is a key issue in the Bill, which we all know needs to be looked at in huge depth.

Finally, competition is good for any industry. It makes it possible for new innovations, for better value for money and for solutions to be found. Competition gives people pride and responsibility. Even within the NHS there are numerous examples. To highlight eye care, what a transformation there has been from 20 or 30 years ago. The state does not have to undertake everything. It has to be a demanding purchaser, an experienced demanding purchaser, and vigorously assess outcomes.

I welcome this Bill and the Government’s attempt to carry out change in a single, coherent programme, rather than a series of piecemeal initiatives, which is what we have had recently. The idea of having a Select Committee is totally inappropriate. I hope that the noble Lord, Lord Owen, will recognise what the noble Lord, Lord Darzi, said. We need to move forward. The NHS needs to know where it is going. Yes, the issue is important but it does not need a separate Select Committee to find an answer.

[Lord Owen]

The noble Lord must accept that this will not delay the Bill in any stages. The recommendations will be made by 19 December and the House will be considering this Bill into January at the very least.

[Lord Naseby]

I am sure that the House will be debating the Bill but the noble Lord cannot guarantee exactly when he will come back. He has already said that he could not. I am very sorry, but that would be a further delay, which would stir things up and provide some means of making it more difficult for the Bill to go through. This Bill needs to make progress to improve patient care and it does not need to be thwarted by delay. It is a unique opportunity, which we should grab with both hands, to give the NHS some real leadership. Above all, we should remember that the patient has to come first.

NHS: Medical Records

Lord Naseby Excerpts

Wednesday 7th September 2011 Lords Chamber

Asked by

[Lord Naseby]

To ask Her Majesty’s Government whether they intend to continue to computerise all NHS medical records.

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

My Lords, the Government aim to continue to computerise NHS medical records so that patient experience is enhanced, patient care is made more efficient, and patient safety is improved. However, we recognise the weakness of top-down, centrally imposed IT systems. Although elements of the programme have been successful, the policy approach taken has failed to engage the NHS sufficiently. The findings of recent reviews will contribute to planning currently under way for future informatics support to the modernised NHS.

[Lord Naseby]

Is my noble friend aware that the current programme for the NHS database has cost over £6.2 billion, has taken 10 years and is currently totally unworkable? Is he aware of any other country in the world that has attempted such a project and succeeded? As far as I can see, no other country has even attempted it. Would it not be far better if Her Majesty’s Government bit the bullet and scrapped the whole scheme, as they did with the RAF’s Nimrod programme, which was itself a brave decision?

[Earl Howe]

My Lords, I can well understand my noble friend’s acute disquiet over this matter, particularly in light of the recent report from the Public Accounts Committee. The view we have taken is that some very good things have been achieved so far, particularly from the national elements of the programme, but it is equally clear that the top-down policy approach taken to the computerisation of the NHS has not delivered the benefits at local level that everybody was hoping for and has failed to engage the NHS sufficiently. Those are the things we are now concentrating on: making sure that the governance of the programme is sound; learning lessons from what has happened; and achieving value for money.