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.

Tobacco Advertising and Promotion (Display and Specialist Tobacconists) (England) (Amendment) Regulations 2011

Lord Naseby Excerpts

Monday 11th July 2011 Lords Chamber

[Lord Borrie]

My Lords, three years ago the Chief Medical Officer, Sir Liam Donaldson, said that the ban on smoking in enclosed public spaces, which began in 2007, had been a great success in terms of both compliance and improved health. There had been a considerable drop in the number of smokers. I believe that the enclosed spaces ban has indeed been a great success, and for our social environment—a benefit to the whole population.

But in the Health Act 2009 the Labour Government sought to go further and ban the display of cigarettes in shops in order particularly to give even further discouragement to underage smokers. I thought the case for such a ban on display was a thin one. It ignored the fact that in recent years the display has had to be festooned with off-putting words such as “Smoking kills”, plus hard hitting pictorial warnings. Moreover, evidence from the likes of Iceland and the Canadian provinces where displays are banned was somewhat speculative as to the effect on smoking among the young.

In the UK we seem to have given up trying to keep a balance between the rights of individuals to do something which is legal—to sell and consume tobacco and cigarettes—and society’s desire to help people give up smoking and stop children purchasing cigarettes. The Labour Government ruled that a display ban should come into effect in 2011 for large outlets, but to protect small and medium-sized enterprises to some extent from the costs of the new regulations they should be subject to a ban only from 2013. I leave aside the arguments that this distorts competition between one group of retailers and another, and it may have been justified. Now, because of the recession, the present coalition Government seek to delay the imposition of the ban a further six months for large retailers, and a further 18 months for small retailers. My noble friend Lady Thornton from the opposition Front Bench regrets these delays. I regret I cannot join her in grumbling about the modest delays that have been proposed. There are more restrictions in the offing: from campaigning groups, particularly ASH; a ban on open-air smoking—in parks and beaches, such as applies in parts of Australia—bans on smoking in cars, which would be very difficult to enforce; and, of course, banning the use of brand names, which cropped up during the discussions on the Health Act a few years ago.

There is one country in the world to which I draw the attention of the Government: Bhutan, known perhaps to many walkers on the lower levels of the Himalayas as an interesting country somewhere between India and China. I mention Bhutan because all smoking is banned there, as are all displays of cigarettes and tobacco. How far do the Government want to go in their efforts to discourage the young from smoking? It is a splendid objective, but one which sometimes ignores the other aim of allowing people their own individual choices.

[Lord Naseby]

My Lords, I am not going to repeat what the noble Lord, Lord Borrie, has said, other than to say that I agree 100 per cent with what he has put before your Lordships’ House. I will add a couple of points.

It has to be the right of any manufacturer in this country who is trading a lawful product to consult the Government of the day, the Ministers responsible for their industry, and equally members of the Opposition and all Members of Parliament and of the House of Lords, MEPs, et cetera. That has to be its legitimate right, and I hope nobody is suggesting that some civil servant is going to refuse to communicate with this particular industry. It is a legitimate industry at this point; it has the right to trade. These proposals, albeit at a short delay, are still a restraint to trade for our retail businesses.

I had nearly 30 years in advertising and marketing, and one of the things your Lordships’ House recognises is skill and experience across whole walks of life. I dealt with a great number of branded goods in all sorts of different fields, some of which were sensitive areas. There is no evidence that having a ban on displays does anything for consumption. What it does do is prevent the consumer from deciding to change brands if they so wish. There is no firm evidence, and it is no good anybody shaking their heads—as the noble Lord, Lord Borrie, has said, the work that has been done in Canada, Iceland and the other places is all peripheral: it would not stand up to the slightest bit of analysis in any other scientific area.

I say to my noble friend that while I am pleased there is a short delay, I hope very much that the Government will think again in this period and certainly not think about plain packaging, which frankly would bring the whole of the package industry down on the neck of the Government and quite rightly so.

--- Later in debate ---

[Earl Howe]

My Lords, I had planned to carry on and cover that point. In broad terms, the impact of this is being recalibrated, and we will publish further figures in due course.

Experience across the world shows that success in reducing smoking prevalence requires a comprehensive approach; the tobacco control plan for England sets out our strategy for the next five years, and it therefore includes a range of initiatives that will help to reduce smoking uptake and in particular help us to achieve our national ambition to reduce rates of regular smoking among 15 year-olds in England to 12 per cent or less by the end of 2015, from 15 per cent in 2009.

The Government are taking the following actions to reduce smoking by young people. We will end tobacco sales from vending machines on 1 October this year. This will remove an easily accessible, and often unsupervised, source of cigarettes for under-age young people. The Government will review sources of tobacco for young people. The Department of Health has commissioned an academic review of the evidence about this. The report will be completed late this year and we will then be able to determine what further action might be needed to reduce under-age access to tobacco. We will encourage and support the effective enforcement of the law on under-age tobacco sales by local authorities, and encourage local authorities and their partners to play an active part in helping to change social norms around smoking, particularly through using behavioural insights. We will also explore whether the internet is being used to promote tobacco use to young people and, if so, to consider what more can be done on a global level. In addition, as part of a new tobacco marketing communication plan to be published later this year, we will explore ways in which to provide young people with information about risky behaviours that can affect their health, including tobacco use, and to help them to resist pressures to take up smoking. This work is likely to involve digital media, because of their popularity, and reach among young people.

I impress on the House that the regulations that we are debating tonight are only one part of a concerted effort to reduce smoking prevalence among young people. My Written Statement set out how the regulations will be further amended, and I want to reassure the House and other interested parties, in particular retailers with large stores, that the Government will publish draft amending regulations as soon as possible. These will set out how the legislation will work in detail. By moving forward in this way, we believe we have struck the right balance between improving public health and supporting businesses during these difficult economic times. This is in keeping with our deregulation agenda, while continuing to make long-term progress to protect public health.

The noble Baroness, Lady Morgan of Drefelin, asked me specifically who would benefit from the delay in implementation. Our decision to delay implementation will most benefit the micro and small businesses that are so vital to communities across this country, and the delay is entirely in line with the principle set out in the Government’s growth review.

We have also heard about how the tobacco industry has been involved, and has involved others, in lobbying against tobacco control legislation. While we want to be sure that all voices are heard in debates on new legislation and policies, there is an inevitable tension between policies that are intended to reduce smoking prevalence and the interests of those who profit from the promotion and sale of tobacco, including tobacco companies and, to a lesser extent, retailers that sell tobacco products. I am sure noble Lords will agree that we need transparency in lobbying.

The Department of Health works hard to develop workable, balanced tobacco control policies and invites views, not least through formal consultation exercises, from all those with an interest in, or who may be affected by, proposed policies, including retailers. However, as set out in the tobacco control plan, the Government take very seriously their obligations as a party to the World Health Organisation’s Framework Convention on Tobacco Control. The FCTC places treaty obligations on parties to protect the development of public health policy from the vested interests of the tobacco industry. To ensure transparency, in future all organisations with which the Department of Health liaises on tobacco control, including through responding to consultation exercises, will be asked to disclose any links with, or funding received from, the tobacco industry. We want all parties that engage with the Government to be honest and transparent when it comes to vested interests.

[Lord Naseby]

Can the Minister clarify why whoever is lobbying should not disclose where their funding is coming from. Why is it specific to the tobacco industry? There are all sorts of bodies out there with views which may not seem obvious to the Government but underneath there is some objective. Why not have total transparency so that anybody who lobbies discloses where the money has come from?

[Earl Howe]

My Lords, the principle behind my noble friend’s question is certainly unarguable. He makes a very good point that if somebody is concealing the true basis on which they are making representations then that is clearly undesirable. I will take his point back to my colleagues in the department. Nevertheless, in this particular case the mischief lies in the obfuscation that we have seen on the part of the tobacco industry; I am not aware of any other obfuscation that has been at play in this context.

NHS Reform

Lord Naseby Excerpts

Monday 4th April 2011 Lords Chamber

[Earl Howe]

My Lords, we are clear that the essential functions of the primary care trusts should continue. That includes monitoring clinical governance within primary care. Having said that, I am sure that the noble Baroness will agree that clinical governance in the primary care context has not been all that it might be, which is why we believe that the new arrangements will considerably strengthen that governance.

[Lord Naseby]

My Lords, does my noble friend agree that it was common knowledge that PCTs needed reorganising because they were not meeting patient needs? Furthermore, doctors themselves found that the PCTs were getting in the way of treating their patients properly. Frankly, had not PCTs also created a huge bureaucracy, so that money was being soaked up in bureaucracy rather than being used for patient care?

[Earl Howe]

I agree with every word my noble friend said. It is illustrative of the truth of his remarks that, in the final year of the Labour Government, the administrative costs of the NHS rose by no less than £220 million. The rise in administrative costs was exponential. My noble friend is right: at the moment we largely have an NHS that is managerially and administratively led, rather than clinically led. We want to reverse that balance.

Health: Preventable Sight Loss

Lord Naseby Excerpts

Tuesday 29th March 2011 Lords Chamber

[Earl Howe]

My Lords, I join the noble Baroness in welcoming the formation of the Macular Disease Society, and I can assure her that my department will wish to engage closely with it; I think that it is a very positive development. Reducing avoidable sight loss is clearly an issue that we have to take seriously. The prevention of sight loss will be an aim of work undertaken across the new public health system, as I have indicated. At national level we are proposing that Public Health England will design some specific public health services including screening, as has been mentioned, and locally we propose new responsibilities for local authorities.

[Lord Naseby]

As financial resources are limited, is not avoidable sight loss an absolute public health priority? Is it not better to spend money on that than restricting small and large retailers further in terms of their display of tobacco in a market that is declining in any case?

[Earl Howe]

My Lords, I will simply say to my noble friend that public health clearly has an important contribution to make to reducing avoidable sight loss by addressing the obvious risk factors for sight loss, but also by delivering on our general public health outcomes, such as reducing smoking and obesity and diabetes, all of which are associated with the development of eye disease. The tobacco strategy has a direct bearing on this question.

Health: Passive Smoking

Lord Naseby Excerpts

Tuesday 30th November 2010 Lords Chamber

[Earl Howe]

My Lords, that is the very question that we want to look at. Of course, tobacco companies regard their brands as a form of marketing and they attach value to the intellectual property that they consider to be in those brands. However, the issue from a public health perspective is whether the design of a pack actually entices non-smokers to take up smoking or indeed deters smokers from giving up. That is the question that we will examine.

[Lord Naseby]

Is my noble friend aware that the oldest member of Surrey County Cricket Club last year claimed that his longevity was due to a combination of smoking fags and good sex?

[A noble Lord]

Rubbish.

[Lord Naseby]

Well, that was not his view.

Furthermore, in relation to intellectual property, which is what we are taking about with packaging, is it not a very brave Government—even a coalition Government—that interfere with international laws that are already on the statute book to protect intellectual property, which is basically what packaging is?

[Earl Howe]

My Lords, of course my noble friend is right that there are legal issues inherent in this whole question, which we will look into very closely.

On his first point, it is always a pleasure to hear of someone who has lived a long time in good health despite smoking. However, I say to my noble friend that the Royal College of Physicians estimates that more than 300,000 primary care consultations are recorded each year across the UK for conditions in children due to exposure to second-hand smoke.

Healthcare

Lord Naseby Excerpts

Thursday 28th October 2010 Lords Chamber

[Lord Naseby]

My Lords, the coalition Government’s strategy for the NHS is clear and very welcome. The first stage is the White Paper, consultation on which has just been completed. The responses were of a good volume. Three objectives were outlined in the White Paper: the one that we are discussing today, creating a patient-led NHS; improving healthcare outcomes; and increasing autonomy and accountability in the NHS. We also know from the comprehensive spending review that the funding is ring-fenced and is available only for the NHS.

Frankly, I sat in blank amazement listening to the noble Lord, Lord Winston, claim that at the general election the NHS was in its healthiest state for decades. I remind him that we were left with mixed wards, which we were told 13 years ago would be got rid of. We had the chaos of out-of-hours cover. I do not need to remind the noble Baroness on the Front Bench of a number of tragic cases. We had a situation where a number of brought-in, standby, out-of-hours doctors did not even speak English. We have had questionable care on the nursing front. I support what the noble Baroness said earlier. My wife is a retired GP and is pretty objective when it comes to nursing care. I am sorry to report that nursing care at Papworth is certainly not world-class. Frankly, it is pretty poor. We have a situation where cancer drugs have not been sorted out for the past 13 years. I make a plea to my noble friend on the Front Bench. If we have £200 million of ring-fenced money for cancer drugs, although it is to be deputed to the existing regional health authorities, can we not consult with cancer charities on which drugs they think would be a primary help in that particular budget? Perhaps I do not even have to mention IT and the billions that were spent on something that has not worked. Do not tell this Government that the NHS was left in the best state ever after the past 13 years.

I look back to a time when my wife was a second-phase GP fundholder. Most GPs were in the fundholding scheme: only a hard core were not. That was successful; it worked. It is no good the noble Lord shaking his head. GPs who went into fundholding achieved very short lists for operations. The scheme worked well and I am sorry to say that it was only through prejudice that the incoming Government got rid of GP fundholding and then produced modified targets that they thought were a substitute for it. They were not.

I will finish by saying a couple of words about medicines. Traditionally, medicines in the NHS have taken up between 10 and 12 per cent of the budget. I have noticed two worrying developments. First, the standard of generic substitutes is not what it should be. We have seen the recent case of Lipitor, and a number of other cases are documented in the pharmaceutical area. Something must be done about that situation. The second is counterfeit medicines, which I do not think were a problem 13 years ago. Again, I am not blaming the outgoing Government for this but there is now a problem across Europe with counterfeit medicines, and I shall mention two statistics. First, 62 per cent of medicines bought on the internet are counterfeit or substandard and, secondly, across the whole of Europe in 2006 no less than 2.7 million fake medicines were seized. I do not wish to say any more, other than that I look forward to receiving answers to the questions that I have raised.

Health: Spending Review 2010

Lord Naseby Excerpts

Tuesday 26th October 2010 Lords Chamber

[Earl Howe]

The noble Lord raises two issues: access to new medicines for sufferers from cancers, particularly rarer cancers; and prescription charges. On the first, he will know that we have already created a cancer drugs fund to enable those people who cannot access cancer drugs to apply for funding for those drugs. That was part of the spending review announcement made last week. On the issue of prescription charges, we are looking for ways to make the system fairer than it is at the moment. We have not implemented the previous Government's plan to exempt all people with chronic conditions. Frankly, it was not affordable in the current context. However, we are looking at other means of creating fairness in the system.

[Lord Naseby]

Is my noble friend aware how important it was that he re-emphasised that there had been absolutely no change in the targets for dealing with cancer patients? Is it not surprising to him that the opposition spokesman was not aware of that fact? If we are to have a further report before the end of the year, will it include a review of NICE’s attitude to all cancer drugs, and of their availability to NHS patients?

[Earl Howe]

My Lords, we believe that there is a long-term role for NICE, not least in the area of assessing the clinical effectiveness of drugs. In the longer term, we believe that the problem that my noble friend identifies can be addressed more satisfactorily by a system of value-based pricing for medicines, which will mean that the price of a medicine will reflect its value to the patient, as assessed. That is a longer-term exercise that we cannot bring in in a hurry, but we are extremely conscious of the problem that my noble friend alludes to. Having said that, I stress that NICE will remain at the centre of our plans to roll out quality in the NHS.

Health: NICE

Lord Naseby Excerpts

Wednesday 14th July 2010 Lords Chamber

Asked By

[Lord Naseby]

To ask Her Majesty’s Government whether they plan to review the management and procedures of the National Institute for Health and Clinical Excellence to ensure that patients suffering from the most prevalent conditions of cancer and Alzheimer’s disease are properly treated.

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

My Lords, our White Paper, Equity and Excellence: Liberating the NHS, published on 12 July 2010, sets out our commitment to renew the National Institute for Health and Clinical Excellence and, through primary legislation, to re-establish it as an executive non-departmental public body. Legislation on NICE will be included in a health Bill in the autumn.

[Lord Naseby]

The Minister’s Answer is extraordinarily welcome. So far as concerns those suffering from cancer and similar problems, is he aware that according to a report called Exceptional Progress?, published in March this year, fewer than four out of nine of the drugs put forward were refused by NICE, which left 16,000 patients with nowhere to go, whereas if they had been French or German those drugs would have been available? Furthermore, is he aware that there is currently great criticism of the processing, structures and methodology used by NICE and that, against that background, his news that the organisation is to be totally reformed is enormously welcome?

[Earl Howe]

My Lords, I am grateful to my noble friend. It is important for me to state that the Government respect the independent expertise provided by NICE and we think that it should be allowed to continue to issue guidance free from political interference. That is a point of principle. However, we also think that there are failings within the wider system regarding drug pricing and drug access. We are determined to address that but we are clear that NICE plays a vital advisory role.