Health: Medical Innovation

Lord Patel Excerpts

Wednesday 16th January 2013 Lords Chamber

[Lord Patel]

My Lords, I thank the noble Lord, Lord Saatchi, for initiating this debate and for presenting it so movingly. This ought to be the start of such debates. It ought not to be the last debate we have on this subject. I hope he will remain committed to leading us in future debates.

Some of the treatments the noble Lord described, particularly for some cancers, are medieval and this continues to be the situation for some cancers. Treatment for pancreatic cancer, to which the noble Baroness referred and of which both my mother and my mother-in-law died, remains the same. However, there is hope. Some novel and innovative treatments are now being tried out, such as molecular tagging of drugs to get at cancers that are not amenable to conventional treatment. There is also nanomedicine for targeting tumours that are not responsive to current treatments. There are other technologies that I will come to which could be used to target tumours that are not receptive to radiotherapy.

We should also be slightly more optimistic in this country about where our science is today compared with 10 years ago. For instance, we have had 12 Nobel Prize winners in medicine and physiology since 2001. We have to go back to 1998 for the previous one. Not only that, we have Nobel Prize winners in allied disciplines, such as Sir Venkatraman Ramakrishnan who won the chemistry prize in 2009 for his isolation of the structure of life science-related diseases.

We now have a commitment from the Government to investing in science and having strategies in life sciences and other fields. We should give credit for that. We hope that innovations will come but we must also ensure that regulation is proportionate and is not bureaucratic. We must always keep an eye on that.

There is also the question of investment in translational medicine. One example is in the field not of drug therapy but in cell therapy where big pharma will not invest and small countries do not have the money to do early translational research. There are many examples. One is the use of embryonic stem cells as a therapy for age-related macular degeneration. Currently, the first-phase translation of that is being funded through research councils and charities. The Government should be funding early-phase translation. What plans do the Government have to help with this?

I come now to technological advances and I use the example of focused radiotherapy which is often referred to as “cyberknife”. Of course it is not a knife: it is focused radiotherapy. You cannot use conventional radiotherapy for targeting tumours because you will do more harm to normal cells. Currently, to make that available to a patient who is not amenable to conventional treatment, the doctor will have to ask for finances from commissioners or PCTs. They do not have the expertise to know whether that is indicated for that patient or not, and they may or may not fund it. The Government should be commended for accepting in the Health and Social Care Act that all NHS organisations must have an awareness of research, but it is difficult to find money to fund an expensive, one-off treatment. However, that is sometimes the only thing that is available to the patient. We should support such technologies and make sure that whenever we find that they are not supported, we do something about supporting them. Will the Minister confirm that he will expect commissioners to look at such treatments and innovations in a more favourable way and provide the funding that individual patients require? These treatments are expensive.

I again thank the noble Lord, Lord Saatchi, for initiating this debate. We should debate some of these issues at length at the Second Reading of his Bill and I wish him luck with that.

Diabetes

Lord Patel Excerpts

Thursday 10th January 2013 Lords Chamber

[Earl Howe]

My Lords, there is no single magic bullet that will solve this problem, but undoubtedly better monitoring in general practice is one answer; the QOF incentivises that. The NHS outcomes framework will also incentivise clinical commissioning groups to ensure that those with long-term conditions—particularly diabetes—are properly looked after. The benefits of multidisciplinary teams are now proven. The evidence is there and, if we can shine a spotlight on the statistics—and there is, as the noble Lord knows, a wide variation in success rates across the country—that will be the key to driving better performance throughout the health service.

[Lord Patel]

My Lords, does the Minister agree that part of the problem is that while the NICE guidelines, if implemented throughout the country, would reduce the variation rate in amputations, particularly of lower limb extremities, it is not mandatory to implement those guidelines? He may be aware that several nations, including Scotland, have recently reported a reduction of 30% in the amputation rate, following strict protocols in diabetic management.

[Earl Howe]

My Lords, there are centres of excellence throughout the United Kingdom, from which I am sure the health service as a whole can learn. The noble Lord is absolutely right. He mentions the NICE guidelines; he is right that they are not mandatory, but they do point to best practice. By highlighting the data, we can ensure that commissioners and practitioners ask themselves the right questions about whether best practice is being followed.

NHS: Research and Development

Lord Patel Excerpts

Monday 17th December 2012 Lords Chamber

[Earl Howe]

I do agree with the noble Lord. Before the creation of the NIHR, research allocations to NHS hospitals were made essentially on a historical basis, with no assessment of quality or value and no ability for the funding to move in response to competition. The NIHR undoubtedly changed all that. The NHS funding for research is now awarded transparently and competitively and robust systems are in place to ensure that it is used only to support research rather than being diverted for other purposes.

[Lord Patel]

Does the Minister agree that the biomedical research centres established by NIHR funding are more likely to develop and deliver on the Government’s innovation strategy in health science and on the life sciences strategy?

[Earl Howe]

I agree with the noble Lord. The Government are providing a record £800 million over five years for NIHR biomedical research centres and units as from April of this year. The centres are based within the most outstanding NHS and university partnerships in the country; they are leaders in scientific translation; and they will play an integral part in the life sciences strategy which the Government published last year.

NHS: Clinical Networks

Lord Patel Excerpts

Wednesday 12th December 2012 Lords Chamber

[Earl Howe]

My Lords, strategic clinical networks are only one category of network in the new system. There is nothing to stop professional groups coming together to share best practice and support professional development. In addition, clinical commissioning groups may well wish to establish networks to support local priorities and ways of working; and providers may use a network model to enable the joint delivery of a service, such as pathology. The noble Baroness, Lady Thornton, rightly referred to the extent to which local providers and commissioners already support strategic clinical networks. So there is a variety of ways of doing this.

[Lord Patel]

Does the Minister recognise that reducing funding for cancer networks will lead to a reduction in staff and therefore a reduction in the effectiveness of cancer networks?

[Earl Howe]

My Lords, Professor Sir Mike Richards, the national cancer director, said the other day:

“Although cancer networks will have a smaller proportion of the budget in the future, there are still backroom efficiencies that can be made to make things work more effectively. Increasing the footprint of each network will make them more cost-efficient”.

I have spoken to him personally and he is confident that the available budget can still be used to ensure that there is at least equal cost-effectiveness of networks.

Nursing Quality and Compassion: The Future of Nursing Education

Lord Patel Excerpts

Tuesday 11th December 2012 Grand Committee

[Lord Patel]

My Lords, I realise that my time has been cut down; I was running the risk that I would be completely eliminated in a minute. However, I will try to cope with the three minutes that I now have.

First, I thank the noble Baroness for initiating this debate. I am sorry to hear that she is feeling unwell, but if she will kindly tell me what might be the best treatment, I will write a prescription. This is why I have always been used to taking advice from nurses first.

It is interesting that in this debate we have two nurses, two doctors, three former Health Ministers and a former teacher, who wrote the report on nursing education; and no doubt the current Minister will be the one to reply to it.

I had intended to concentrate on three issues: workforce planning, which the Willis report mentions; the education of nurses; and the registration of support workers. I will come to the last first.

I support what the noble Baroness, Lady Emerton, and the noble Lords, Lord Willis, and Lord MacKenzie, had to say. We have had this opportunity to discuss the large number of nursing support workers who are currently unemployed, and their training and registration. We will keep coming back to this until it is resolved. It is unacceptable that the Government still seem to think that employers should be responsible for whether these workers should be registered or not, and whether or not they should have training.

It is quite clear that the training of health workers who provide front-line healthcare should be mandatory. There should be a curriculum and an assessment, and they should then be registered. I understand that it is not possible to have a compulsory register straight away. However, we need to have a road map that will enable us to leave voluntary registration and move to proper registration.

I have no doubt that the Minister will not agree, but I am sure that we will keep coming back to this, and I look forward to a day when one of the political parties, when in government, will introduce registration. I hope that that will be the current Government.

I refer to two reports, both from the Royal College of Nursing. One, the Willis report, was commissioned by it, and the other was the Royal College of Nursing report, Overstretched. Under-resourced. The UK Nursing Labour Market Review 2012, which was published in October. Both of them highlighted the issue of what will happen to the workforce planning of nurses.

Experience in the 1990s showed that cutting student numbers led to a year on year reduction of new entrants, from 18,980 in 1990-91, to 12,000 in 1997-98. This contributed to an acknowledged nursing shortage later in the decade. The report highlights that there is a risk of repeating this funding and planning, for in 2011-12 there were approximately 22,640 places across the UK for nurse training, compared to 24,800 in 2010-11. Next year, there will be another 1,260 fewer places, with a total of around 23,000.

Workforce planning will be left at the local level, first of all with the local education and training boards, which will work with the commissioners to define how many training places there should be. Health Education England will then be charged with funding the numbers, and the national Commissioning Board will be responsible for providing oversight. The whole thing, therefore, will be left, with all due respect, to the managers, without any reference to the professionals who provide direct patient care.

In the report of the noble Lord, Lord Willis, the managers, NHS employers, felt that they,

“have confidence that through a co-operative and collaborative approach between service and education providers, the future workforce will not only continue to deliver quality care but will also be equipped to develop and deliver new and dynamic services for patients”.

I come back to my first point about support workers. The result of this will be more support workers, because costs will be cut, and there will be fewer graduate nurses. I declare an interest as the chancellor of the University of Dundee, where I have graduated several hundred nurses, the last occasion being on 14 November. I was also pleased to award several PhDs, so nursing is developing as an academic profession as well. I am therefore totally signed up to nurse graduates. I therefore plead with the Minister to look again at the training and registration of support workers.

Health: Mental Health

Lord Patel Excerpts

Wednesday 21st November 2012 Lords Chamber

[Earl Howe]

My Lords, my noble friend makes an important point, and I can reassure him on that. I know that he is concerned that IAPT services may be displacing other psychological therapies. In fact, having looked into this, I can tell him that data from the NHS finance mapping exercise shows that IAPT services are not displacing other therapies; I have figures here to prove that. Spending on non-IAPT psychological therapies has reduced very slightly, by just over 5%, but the overall picture is one of a dramatic expansion in the availability and range of psychological therapies.

[Lord Patel]

My Lords, as the mover of the amendment that put equality of mental and psychical health in legislation, I am pleased that the Government did not contest it again—albeit that it was won by a Division. I am also pleased that mental health is to be treated equally in the mandate.

[A noble Lord]

Question!

[Lord Patel]

I am coming to the question which is important. Having put it in the mandate, would it not now be right for the department to ask the Commissioning Board to produce a framework outcome for mental health so it can assess progress in treatment equality for mental health?

[Earl Howe]

My Lords, we expect the equal priority for mental and physical health to be reflected in all relevant aspects of the NHS’s work. There can be no single measure of parity. As I said earlier, we expect the board to be able to demonstrate measureable progress towards parity by 2015. However, there are some specific areas where we expect progress; for example, relevant measures from the NHS outcomes framework, including reducing excess mortality of people with severe mental illness; delivering the IAPT programme in full and extending it further; addressing unacceptable delays, and significantly improving access and waiting times; and working with others to support vulnerable and troubled families. Those are very detailed objectives for the board, all of which bear upon the key question of parity between mental and physical health.

Health: Cancer

Lord Patel Excerpts

Wednesday 7th November 2012 Lords Chamber

[Earl Howe]

I absolutely accept that one of the benefits we have seen from the clinical networks is the spread of innovative best practice through the health service, particularly in local areas. That is very much what we wish to preserve. The networks will help local commissioners of NHS care to reduce unwarranted variation in services and encourage innovation. We are determined to see that continue.

[Lord Patel]

As the Minister responsible for quality outcomes in healthcare, will the noble Earl report to the House on whether he is monitoring the effects on cancer outcomes of the reduction in the staffing of cancer networks?

[Earl Howe]

We will certainly be monitoring the outcomes in the field of cancer, but I would just like to impress upon the noble Lord that the creation of the clinical support teams—the network support teams—will ensure that the whole service is more efficiently delivered. By having 12 support teams there to underpin all the networks, we will ensure that we have a more cost-effective system.

NHS: Women Doctors

Lord Patel Excerpts

Tuesday 6th November 2012 Lords Chamber

[Earl Howe]

My Lords, the Government fully support flexible working. We encourage organisations to take account of the recommendation made by the noble Baroness, Lady Deech, on that subject and adopt working arrangements that are amenable both to doctors who are parents and doctors who are carers.

[Lord Patel]

My Lords, first, I declare an interest. In my family there are four women doctors—I do not call them “girls”. They are all higher achievers than I could ever be. Does the Minister agree that there are in some of the most demanding specialties more women doctors in higher positions than in some of the other specialties and that in the specialties where there are not, it is the attitude of the senior doctors—possibly even male doctors—that is the problem?

[Earl Howe]

I discussed this subject in my briefing with departmental officials. There are multiple and quite complex barriers to career progression, including a conflict of roles between someone’s clinical responsibilities and their domestic responsibilities. There are structural barriers, as I have mentioned, in relation to part-time work, and in terms of general practice there is the sessional GP contract, which is another barrier to progression. The lack of role models is a factor and we should not overlook individual and organisational mind-sets, to which the noble Lord alluded, which result in lower personal aspiration in this area.

Care Services: Elderly People

Lord Patel Excerpts

Wednesday 17th October 2012 Lords Chamber

[Earl Howe]

My Lords, it is the responsibility of the employing organisation to carry out appropriate checks on the people they intend to employ. They should take decisions in the context of their responsibility for the well-being of the people who use the service. That position has not changed, and indeed it must be at the core of the safeguarding agenda. Organisations need to risk-assess the suitability of their staff for the role, considering all the information they have on the person, including criminal record checks. If someone has a criminal conviction, the employer should consider how old and relevant that conviction is in the context of the activities that the person would be undertaking and the characteristics of the people they would be looking after. That situation cannot, I think, change substantively.

[Lord Patel]

My Lords, will the Minister follow up on the question asked by the noble Lord, Lord Hunt? What progress is his department making towards establishing skills requirements in the training and regulation of nurse support workers and care assistants?

[Earl Howe]

My Lords, we recognise that there is a need to drive up standards in this area. More care workers will be trained, including an ambition to double the number of care apprenticeships by 2017. We have commissioned Skills for Health and Skills for Care to develop, before the end of January next year, a code of conduct and minimum training standards for healthcare support workers and adult social care workers in England. We expect that these will cover minimum training or induction standards for a range of support tasks, including personal care and other activities. Through the Health and Social Care Act 2012 we are creating a system of external quality assurance for voluntary registers.

Care Homes

Lord Patel Excerpts

Wednesday 27th June 2012 Lords Chamber

[Earl Howe]

My Lords, it is true that CQC inspectors found that for the kind of services they inspected, there was more non-compliance in services run by the private sector. But the information the CQC gathered for its report does not enable it to analyse the reasons for that. I would simply say that all providers of services, whether in the independent sector or the NHS, need to ensure that they comply with essential standards. The noble Baroness summarised a number of the areas where the CQC found failings and I endorse her view that there is a fundamental failing across the system, not just in providers but in terms of commissioning as well. The examples of poor care show up a fundamental need for commissioners to review commissioning plans and care plans, and make sure not just that the providers are capable of offering and providing care to the right standards but that they are actually doing so at the right level for the patients and service users they look after.

[Lord Patel]

My Lords—

[The Chancellor of the Duchy of Lancaster (Lord Strathclyde)]

The noble Baroness, Lady Campbell, is trying to get in.