Smoking: E-Cigarettes

Lord Patel Excerpts

Tuesday 3rd February 2015 Lords Chamber

[Earl Howe]

The noble Lord makes an extremely important point. It is one that is addressed in the tobacco products directive, which is due to come into force next year. The EU Commission is clear that any e-cigarettes sold need to be tamper-proof, particularly as regards children interfering with the contents.

[Lord Patel (CB)]

My Lords, it is good to know that the National Institute for Health Research would support a larger randomised study, but what the noble Viscount, Lord Ridley, said is true. The current evidence from the Cochrane analysis—the most robust method we know of analysing whether a product, device or a drug is effective against the desired outcome—is that, although the studies were small, 14 observational studies and two randomised trials show that e-cigarettes are more effective than nicotine patches or a placebo. Would the Minister agree that the industry should now also address a standard dosage of nicotine and ensure that the quality of the nicotine used in e-cigarettes is standardised across the industry to avoid subsequent risks?

[Earl Howe]

The noble Lord makes some important points. He has highlighted the fact that many products on sale are of, shall we say, variable quality. There are risks around the extent to which the dose of nicotine delivered varies; the quality of the ingredients can be suspect; and there is a question mark over the electrical safety of some products. We cannot make a general statement about products that are currently on sale. Nevertheless, it is right that the European Union has taken this matter in hand. From May 2016, only licensed e-cigarettes will be able to contain nicotine in strengths greater than 20 milligrams per millilitre. That will introduce some standardisation.

HIV

Lord Patel Excerpts

Thursday 15th January 2015 Lords Chamber

[Earl Howe]

My Lords, in November 2013 DfID conducted a review of our 2011 HIV position paper. The review paper highlighted three areas of particular focus in the international context. They were to identify the key affected populations—girls and women—and the integration of HIV responses into the wider health system, as well as broader development priorities. That of course includes tackling stigma and the unacceptable things that we see in certain overseas countries, including discriminatory legislation.

[Lord Patel (CB)]

My Lords, did the Minister refer to 26,000 people being undiagnosed? What is that number based on?

[Earl Howe]

My Lords, these figures inevitably have to be estimates but they rely on data from three surveys that measure undiagnosed HIV infection among sexual health clinic attendees, pregnant women and people who inject drugs. Comprehensive clinical data from sexual health clinics relating to patients newly diagnosed with HIV are also used to infer the risk of undiagnosed infection.

NHS: Five Year Forward View

Lord Patel Excerpts

Monday 1st December 2014 Lords Chamber

[Earl Howe]

My Lords, I will have to take advice about that question. What I can say is that we now have in place a system of workforce planning that is better than its predecessor. I do not think there can ever be such a thing as a perfect system of workforce planning. We now have a national body, Health Education England, that is responsible for making sure that we have adequate numbers of professionals with the right skills. However, we also have local education training boards whose members include representatives from the acute trusts. It is up to those boards to make clear what the requirements are for trained staff and feed those requirements up to Health Education England so that planning over the coming years can be done in a rational and sensible way. I would expect that spinal units should make their case in that fashion so that if there is a need for physiotherapists in spinal units, and those physios are—for any reason—not available, then they will come forward in adequate numbers in years to come.

[Lord Patel (CB)]

My Lords, the Minister started his Statement by saying that the Government recognise the importance of life sciences in both economic growth and in delivering mental health care. Of course, I would agree with that and I take it from the Statement that the Government therefore have no intention of cutting the budget of either clinical or medical research in the spending review to come. I welcome the suggestion that the Government will recruit more people to decode genetic information. Of course, we will need that if we are to develop better biomarkers or drugs for treatment, but the personalised medicine that would lead to is expensive and the budgets it will require will be far greater that what we have now.

I also welcome the idea that we integrate the care of patients and do not have a demarcation between primary care, community care and hospital care, but the model that he suggested might not quite do that. He might like to reassure us that the model he has in mind is of complete integration of care, otherwise we will not win the battle for better care for people suffering from long-term conditions.

The comment about future budgets requires a greater debate. I have read the review in detail and it is a bold statement to say we can conduct a five-year review of healthcare without any further restructuring. I, for one, do not mind some restructuring if it will lead to better delivery of healthcare.

[Earl Howe]

I think that the restructuring the Government believe is necessary is the restructuring of the delivery of care and the culture, as the Statement made clear. What we do not think necessary is a restructuring of the architecture of the National Health Service. That has been done and, as I have said, we are set fair for the future. As regards integration, will it be complete integration? “Integration” is a word that is bandied about and it will mean different things in different areas, depending on what is necessary. We are clear that the better care fund plans, for example, which focus on this idea of integration, should most definitely involve the acute sector and social care along with primary and community care, and in many cases other disciplines as well. Pharmacy, for example, has a major part to play in reducing unplanned hospital admissions and I could cite many other professional disciplines. It depends on what each area requires.

I cannot give an answer on the research budget in the next spending review because that spending review will be conducted by the next Government, whoever they will be. Meanwhile, we are clear that the research budget is an absolutely essential part of the NHS’s future ability to provide quality care for patients over the long term. As the noble Lord knows, we have protected that budget during this Parliament.

NHS: Funding

Lord Patel Excerpts

Monday 17th November 2014 Lords Chamber

[Lord Patel (CB)]

My Lords, as it is nearly Christmas I have not given the Minister the advantage of seeing the question beforehand, but with his dexterity in answering I am sure that he will answer it straight. Can he predict which party, elected into government next May, will keep the NHS free at the point of need?

[Earl Howe]

My Lords, I cannot speak for a party other than my own, but I can tell the noble Lord firmly that we are averse to any system of charging and wish to keep the NHS free at the point of use, regardless of ability to pay.

NHS: Health and Social Care Act 2012 Reforms

Lord Patel Excerpts

Wednesday 22nd October 2014 Lords Chamber

[Earl Howe]

I take issue with the phrase “grotesque mess”. If the noble Lord cares to look at the figures, he will see that waiting times are low and stable, MRSA and C. diff infections are at record lows, mixed-sex wards are down by 98% and the number of people waiting a long time for treatment is massively reduced. Yes, we know that many A&E departments are under pressure but many are coping. The work that we are doing, including channelling more money into the system for this winter, should, we hope, relieve the worst of the problems.

[Lord Patel (CB)]

Now that general practitioners will have incentives to diagnose dementia, will it lead to a better and more accurate diagnosis? Will it increase the number of people diagnosed with dementia or will it increase the number of people falsely diagnosed with dementia? Let us remember that there is no cure or treatment for any of them.

[Earl Howe]

My Lords, the noble Lord, in his ingenious way, is deviating slightly from the Question on the Order Paper which refers to the costs of the reforms. We are in dialogue with the medical profession to ensure that none of those perverse consequences happens.

Ebola

Lord Patel Excerpts

Monday 13th October 2014 Lords Chamber

[Lord Patel (CB)]

My Lords, I thank the noble Earl for his Statement. I have two quick questions. One relates to the staff who have volunteered to go out to Sierra Leone and to all soldiers. If any of them get infected while they are working there, will they be brought back to the United Kingdom for treatment? My second question relates to the treatment. While there are likely to be early trials of the vaccine that is being developed, it may well prove ineffective. But there are other companies developing other treatments. Are there plans to fast-track approval of these drugs if they are found to be effective? We know that the stock of ZMapp is now exhausted; further monoclonal antibodies development is likely to take some time.

[Earl Howe]

There is a limited amount that I can say to the noble Lord about his second question. A general answer is that we would naturally want to give as fast a passage as possible through the regulatory process to any breakthrough treatment for Ebola. It should be borne in mind, however, that safety is the paramount concern. This is why it is important that the vaccine, which is now in clinical trials, is thoroughly tested for safety as well as efficacy. If there is further news on this that I can impart to the noble Lord, I will be happy to write to him.

The noble Lord asked whether staff who volunteer will be repatriated if they contract the disease. My advice is that decisions on repatriation would be taken on a case-by-case basis, taking into account the clinical condition of the person and the benefit they may gain from repatriation. Repatriation involves a long journey that can potentially be dangerous for the patient. Once there is high-quality treatment available in Sierra Leone, it will not necessarily be in the best interests of the patient to be repatriated. That is why we are building the 12-bed unit specifically for national and international healthcare workers.

Health: Stroke

Lord Patel Excerpts

Wednesday 23rd July 2014 Grand Committee

[Lord Patel (CB)]

My Lords, it is a pleasure to take part in this debate. I declare an interest: at one time I was a council member of the Stroke Association and I chaired Stroke Scotland for a while. After the noble Baroness, Lady Wheeler, sat down I decided that my speech was not much good, so I will take a different approach to today’s debate.

I want to look at what an ideal service for children with stroke might look like. The ideal service would be when both parents and GPs are aware that children might have a stroke, but especially when paramedics and medical staff in accident and emergency departments have the knowledge that stroke is one of the differential diagnoses to consider for children with particular symptoms. These children should have rapid access to MRI scanning; currently that is not happening. They should have access to specialist staff to inform early acute intervention, either on-site or known at tertiary level centres for district-level medical professionals to contact for advice; a multidisciplinary team experienced in early sub-acute neurorehabilitation to commence the child on a pathway of care, including parent support and guidance from day one after diagnosis; supported transition into a rehabilitation setting, with in-patient beds for children and young people available equitably nationally; tertiary level out-patient services to support and guide local teams in their management and support of children and families; and flexibility in service delivery to work around the family, for example being able to respond when a new issue arises in the longer term around school, socialising, mobility and so on. A family support worker with experience of stroke should be available to the families from diagnosis through to long-term recovery, to signpost families to services across the NHS, social, education and charitable sectors. I know that that is a long list; but that is what an ideal service would deliver for the best outcome for children.

We can begin by in the first instance—as the noble Baroness, Lady Wheeler, mentioned—getting the guidelines updated, this time from the Royal College of Paediatrics and Child Health, with the help of NICE, which would possibly set the standards, which would then improve the commissioning process. We will have to go further than that. One other way would be to carry out in the first instance a national audit of stroke in children, as that would inform us how the services perform.

I will briefly address research areas that might be useful to improve the services in future. Currently we do not know much about interventions at the early stage—even, for instance, when anti-coagulation or blood-clotting drugs should be used. Research might be in areas such as what therapeutic interventions work and the type of intervention and dosage of drugs that will be required, in particular in motor/movement interventions for preschoolers and infants, and social, emotional and behavioural input for adolescents.

Intervention effects could be evaluated at the level of neural pathways through innovations and MRI imaging. For instance, I know that two centres in the United States are currently carrying out research into MRI imaging through neural pathways—as well as clinical evaluation of functional change. Questions that could be answered, but realistically only through multicentre studies to support a large sample size, include, when is the optimal time after diagnosis to intervene? How old should a child be to gain maximum effect? How intensive a dose of intervention should there be? What models of remote access to intervention are effective, such as telehealth, for parents and for children and young people, to support parents in managing stress, build resilience in young people to manage daily life challenges, and enable people to meet each other and provide mutual support? Those are some of the key areas of research that are required and should be supported.

In conclusion, the current service is not ideal, but we can begin to make it ideal. We have, even in this city, the Evelina Children’s Hospital and Great Ormond Street, which will match up pretty closely to this ideal service. They could be used as good practice places which other units can learn from. I hope that we might hear some positive answers from the noble Earl; I have no questions for him.

NHS: Hospital Waiting Times

Lord Patel Excerpts

Thursday 10th July 2014 Lords Chamber

[Earl Howe]

My noble friend is a very eloquent advocate of this particular issue and he is of course right.

[Lord Patel (CB)]

Can the Minister tell us how those trusts that do not report on their waiting times, although they are small in number, are dealt with? How can they be held responsible when they do not report?

[Earl Howe]

A handful of trusts are unable to report the full range of figures on their waiting times. They are given support to enable them to do so either by Monitor if they are foundation trusts or by the NHS Trust Development Authority.

Healthcare Professions: Regulation

Lord Patel Excerpts

Tuesday 10th June 2014 Lords Chamber

[Earl Howe]

My Lords, as my noble friend will know, we have debated the regulation of healthcare assistants on a number of occasions. The Government’s view is well known. However, I agree with him that the content of the Law Commission’s draft Bill is welcome to many parties—indeed, the Government are keen to see it progress. Much of the proposed legislation is already law in one form or another. The review is about pulling together all the different bits of legislation, introducing consistency across the professional regulators where practicable, making sure legislation is fit for purpose and, importantly, introducing flexibility for the regulators to respond to changing situations.

[Lord Patel (CB)]

Will the Minister confirm that the Department of Health intends to bring in an urgent amendment via a Section 60 order to allow the GMC to implement the urgent reforms that it needs to protect patients and bring doctors to account?

[Earl Howe]

Yes, my Lords, we are working with the GMC to develop secondary legislation that will strengthen and protect the separation of the GMC’s investigation and adjudication functions by establishing the Medical Practitioners Tribunal Service in statute, as well as modernising the adjudication procedures, and to address a number of lacunas in the legislative framework. We are seeking to have the Section 60 order on the GMC’s fitness-to-practise processes in place before the general election.

NHS England: Health and Social Care Act 2012

Lord Patel Excerpts

Wednesday 7th May 2014 Lords Chamber

[Earl Howe]

My Lords, I do not accept that CCGs are subject to unreasonable controls from NHS England. It is the task of NHS England to support CCGs and hold them to account, and that is what I believe it is properly doing, not least through the outcomes framework. Ministers are not intervening on the question of mental health funding because funding is just one part of the story when it comes to parity of esteem. We have set NHS England a strategic objective to make measurable progress towards achieving true parity of esteem for mental health. NHS England is responsible for allocating funds to clinical commissioning groups, which are best placed to invest in services that meet the needs of their local communities. However, we will of course hold NHS England to account for that. What we must not do is to single out certain elements of the equation at this stage.

[Lord Patel (CB)]

Can the Minister say whether the Ministers in the Department of Health are happy that NHS England has recommended a 20% deflater to tariffs for mental health that destroys any possibility of achieving any kind of parity of esteem?

[Earl Howe]

My Lords, we are not happy with that and, as I have said in the House before, Ministers have made it very clear to NHS England that this decision is both surprising and unwelcome in view of the need to maintain parity of esteem. NHS England, the NHS Trust Development Authority and Monitor are addressing this issue vigorously and we have regular discussions with those bodies to ensure that mental health services do not suffer.