Young People: Self-Harm

Debate between Lord Prior of Brampton and Lord Rennard

Tuesday 6th December 2016 Lords Chamber

[Lord Prior of Brampton]

Unquestionably, there is more that can be done. Some of those sites, certainly some of the pornographic sites, are being addressed in the Digital Economy Bill that is going through the House at the moment. But we are working with the national council and the Samaritans, which in turn are talking to people at Google and YouTube and the digital providers to see what we can do in this area. We have also commissioned a new prevalence study to look at cyberbullying and all those sorts of issues, which will, unfortunately, not produce its results until 2018. So we are very much apprised of this, but, frankly, there is always more that we can do.

[Lord Rennard (LD)]

My Lords, over half of all adults with mental health problems first had them diagnosed in childhood, yet fewer than half of those people diagnosed in childhood were treated appropriately at the time. Does not the Minister think that something is seriously wrong when, according to the Royal College of Psychiatrists, 25 clinical commissioning groups are spending less than £25 a year on child mental health issues and 10 CCGs are spending less than £10 a year?

[Lord Prior of Brampton]

My Lords, I think something is seriously wrong, and something has been seriously wrong since 1948. Mental health has been a Cinderella service, and children’s mental health has been, if anything, even worse. We are committed to spending an extra £1.4 billion; we are spending more money on mental health liaison services in A&E departments; and we are putting in 56 new beds in CAMHS units to prevent the out-of-area treatments or what have you. But we have a huge way to go, frankly.

Cataract Operations

Debate between Lord Prior of Brampton and Lord Rennard

Wednesday 16th November 2016 Lords Chamber

[Lord Prior of Brampton]

The cataract operation is a remarkable one. There is a huge variation in productivity around England: some surgeons are extremely fast, and in some hospitals the process has been streamlined. Interestingly, in India, where cataract operations are largely done by technicians not doctors, the cost per operation is below $10.

[Lord Rennard (LD)]

My Lords, does the Minister accept that greater use could be made of laser eye surgery for cataracts, as has been pioneered at Frimley Park Hospital? This could result in better outcomes for patients, reduce the risk of complications and, above all, reduce waiting times, which are unacceptable —up to 15 months—at present.

[Lord Prior of Brampton]

My Lords, I do not know enough about laser eye surgery to give the noble Lord a proper response, but I will investigate. The average wait time for a cataract operation is 12 weeks, and very few people wait for more than 18 weeks—but of course, that does not alter the fact that there are people who have not been referred for a cataract operation when perhaps they should.

Health: Diabetes and Obesity

Debate between Lord Prior of Brampton and Lord Rennard

Thursday 30th June 2016 Lords Chamber

[Lord Prior of Brampton]

My noble friend is absolutely right that specialist diabetic nurses have a huge role to play in helping to identify and then manage and treat people with type 1 and type 2 diabetes. I am sure that that role will grow over time.

[Lord Rennard (LD)]

My Lords, projections show that, in 20 years, 40% of the UK population may be defined as being obese and one-third as overweight. Is it not therefore important that we introduce restrictions, very shortly or even now, on the marketing of junk food to children?

[Lord Prior of Brampton]

My Lords, that issue will be addressed in the obesity strategy, which comes out later this year. The levy that has been announced will, I think, lead to the reformulation of high-sugar fizzy drinks, which is a start in the right direction. It is largely a question of diet, as the noble Lord said, but also exercise and many other factors, which will be in the obesity strategy that comes out later in the year. Clearly, making it more difficult for young people to access junk food will be an important part of that strategy.

NHS: Unsafe Hospital Discharges

Debate between Lord Prior of Brampton and Lord Rennard

Wednesday 15th June 2016 Lords Chamber

[Lord Prior of Brampton]

I cannot give the noble Lord a reason off the cuff. It is very much a part of the better care fund. There is a CQUIN for 2016-17 that is focused on delayed discharges. One of the fundamental purposes underlying the STPs and the vanguards, which are a critical part of taking the Five Year Forward View into a serious plan, is to reduce delayed discharges and improve the relationship between acute care and social care.

[Lord Rennard (LD)]

My Lords, given that those nine cases were considered to be representative of the problem, does the Minister agree that it might be cost-effective to make greater use of voluntary sector organisations such as Age UK in better preparing people who are frail, elderly and on their own for going into hospital, and then looking after them when they are leaving, to avoid unnecessary, expensive and painful readmissions to hospital?

[Lord Prior of Brampton]

The third and voluntary sectors have a potentially huge role to play. I was talking this week to the chairman of the Chelsea and Westminster Hospital about the plans he had for involving the voluntary sector far more in discharge planning, particularly for frail and elderly people. I agree entirely with the noble Lord’s sentiments.

Health: Treatment Rationing

Debate between Lord Prior of Brampton and Lord Rennard

Tuesday 26th April 2016 Lords Chamber

[Lord Prior of Brampton]

The noble Lord has encapsulated well the recommendation of the report of the Royal College of Surgeons, which is that all decisions about individual patients should be taken on clinical grounds as they affect the particular patient.

[Lord Rennard (LD)]

My Lords, does the Minister accept that the reduction in expenditure on public health of £200 million a year may make it harder to reduce the prevalence of tobacco smoking and obesity, and that in these circumstances patients referred to smoking cessation courses or weight management courses may find it more difficult to get the support they need? In those circumstances, they may need more guidance and support on how to challenge the decisions of CCGs, if they are being discriminated against unfairly and in breach of national guidelines.

[Lord Prior of Brampton]

My Lords, the success that this country has had on smoking reduction has been pretty exceptional. The strategy on obesity that the Government will announce soon will mark a new priority in addressing the problems of obesity. I do not think there is any evidence to suggest that the reductions to which the noble Lord referred are having any discernible impact on the number of people receiving support on smoking cessation and obesity reduction before surgery.

Health: Neural Tube Defects

Debate between Lord Prior of Brampton and Lord Rennard

Monday 21st March 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I am not going to argue the science, because the link between folate levels and neural tube defects is fairly well proven. Although our decisions should be informed by scientists and doctors, I do not think that they should be determined by them. The balance between individual responsibility and state responsibility is best left to political judgment.

[Lord Rennard (LD)]

My Lords, given that the Minister accepts the link between a lack of folic acid in the diet and neural tube defects, why will he not look again at the advice from, for example, the Royal College of Obstetricians and Gynaecologists, the Food Standards Agency and the BMA that we should be putting folic acid into food products, as is done in many other countries, including the United States of America?

[Lord Prior of Brampton]

Fortifying bread with folic acid is not a silver bullet that would cure all babies with neural tube defects. The estimate is that it would have an impact on between 15% and 30% of babies. Some 965 babies suffer from neural tube defects a year, so we are talking about fortifying flour for the whole population in order to reach about 120 babies.

NHS: Hospital Overcrowding

Debate between Lord Prior of Brampton and Lord Rennard

Tuesday 15th March 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the tariff has been changed. Acute hospitals now receive 70% of the tariff, rather than 50%, for the excess numbers of people coming into A&E departments. The noble Lord is absolutely right, though, that those hospitals that have collocated GPs and A&E departments, and have invested in psychiatry liaison nurses and other people, have seen huge improvement. The question is: do we want to invest? Are A&E departments the right places to invest, or ought we to be putting that investment into primary and community care? That is the big issue that will be decided over the next five years.

[Lord Rennard (LD)]

My Lords, does the Minister agree with the president of the Society for Acute Medicine that there are no more efficiencies to be made and that we must now start to invest in care again to bring us on a par with other developed nations? Does he accept that the planned increases in expenditure for the NHS will not be adequate to deal with the crisis in it, and that we need to consider a hypothecated tax to fund health and social care?

[Lord Prior of Brampton]

My Lords, a lot of what was said by the person, whose name I cannot remember, to whom the noble Lord refers, was absolutely right, but when he said that there were no more efficiencies to be gained he was completely wrong. We can still achieve huge efficiencies throughout the whole healthcare system, in the context that the NHS is one of the most efficient systems in the world, but it can be better. It would be completely wrong to say that no more efficiencies can be achieved.

National Health Service: In-Patients with Learning Disabilities

Debate between Lord Prior of Brampton and Lord Rennard

Monday 18th January 2016 Lords Chamber

[Lord Prior of Brampton]

My noble friend makes a number of very good points. I will draw them to the attention of Mike Richards, the chief inspector for acute care in England, who is about to embark on a thematic review of avoidable deaths. He will look in particular at those with learning difficulties and I am sure that he will take into account the words of my noble friend.

[Lord Rennard (LD)]

My Lords, does the Minister accept that something is seriously wrong when two-thirds of the unexplained deaths of these highly vulnerable people with learning difficulties who die in NHS hospitals in England are not properly investigated? Does he accept that this is a much more serious scandal than that based upon some highly dubious statistics used by the Secretary of State for Health to talk about unexplained deaths in hospitals at weekends?

[Lord Prior of Brampton]

I tried to explain the difference between avoidable deaths and excess deaths earlier in my answers, without trying to make any political point about it. There is an important distinction to be made, and I hope that I made it. I agree with the noble Lord that this is a very serious issue, and the Government are approaching it in a very serious way.

Sugar Tax

Debate between Lord Prior of Brampton and Lord Rennard

Wednesday 13th January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, reduction of sugar is a critical part of the Government’s obesity strategy. It has been made clear by the reports of Public Health England, the McKinsey institute and others that there is no silver bullet. It is not just a question of passing a tax and getting the results that you wish to have. If a tax were to come in, it would be part of a whole range of other measures.

[Lord Rennard (LD)]

My Lords, does the Minister accept that the introduction of a modest sugary drinks tax should be a win-win policy in that, if it works, people would be deterred from consuming those drinks, switch to alternatives and lead healthier lifestyles, and, if it does not work, it would raise money much needed by the NHS to deal with the problems of the obesity and diabetes epidemics?

[Lord Prior of Brampton]

My Lords, as I said earlier, the Prime Minister and the Secretary of State for Health are thinking long and hard about what should be part of the obesity strategy. I am not sure that the noble Lord is right when he says that a modest tax would have much of an impact; it would have to be a significant tax to have a major impact on the consumption of sugary drinks.

Alcohol

Debate between Lord Prior of Brampton and Lord Rennard

Wednesday 9th December 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, I am not sure who considers alcohol to be habit-forming and hallucinatory—whether it is my noble friend or others. I think it depends very much on the quantities in which it is taken.

[Lord Rennard (LD)]

My Lords, does the Minister accept that the 1.3 billion unit reduction in alcohol consumption of which he spoke represents a reduction of only 2%, and that the alcohol industry itself cannot be relied on to assess objectively the scientific evidence that points strongly towards the need for things such as minimum unit pricing and for alcohol taxation to be proportionate to the alcohol content of drinks?

[Lord Prior of Brampton]

My Lords, as I say, an independent assessment of the responsibility deal will be done by the London School of Hygiene and Tropical Medicine. It is important that the assessment is independent and certainly is not undertaken by the industry or, indeed, by the Department of Health. It is worth noting that the consumption of alcohol seemed to peak in 2005 and has declined slightly since then. I am not in any way minimising the appalling damage that alcohol does to the lives of many people, but consumption is coming down slowly.