Health and Care Bill

Debate between Lord Winston and Earl Howe

Lords Hansard _ Part 1 & Report stage
Wednesday 16th March 2022 Lords Chamber

[Lord Winston (Lab)]

My Lords, as a doctor and a wine drinker, I have serious concerns about this amendment, particularly, for example, when it comes to the use of fine wine—I think there is broad understanding in the House of what that is—where, in every case, those bottles are labelled with the amount of alcohol. One has to accept that labelling bottles in this way does not change behaviour. We have had committees looking at behaviour change, and the only time we managed to induce behaviour change was with smoking—certainly never with labelling. That is the only time it happened and there were all sorts of reasons for that.

Much of the evidence for alcohol being harmful in minor doses is still dubious and, more importantly, there is real concern that a lot of the so-called evidence is not being put to the real test of whether it makes a difference to behaviour. I must say to the House that I think the noble Lord—I am afraid I do not know his name; my eyes are bad enough not to have been able to see his name on the screen—is right that this is unworkable. It would probably do all sorts of untold damage to what is, for me and no doubt many others, a very fine drink. We need to look seriously at whether we can simply label all bottles.

I just remind the House that there is one amendment that I could have put down. In in vitro fertilisation, embryos are cultured in culture media, which are in fact commercially made and a commercial secret—nobody knows exactly what the composition of those media is. My laboratory is looking at this at the moment. It is really interesting, because some of the products in those culture media may indeed be quite dangerous in terms of epigenetic effects. To me, that seems far more important to regulate than what we are trying to do here with bottles of wine, which is probably not really workable.

[Earl Howe (Con)]

My Lords, this is an important topic, so let me start with an immediate reassurance to the House, which I hope will enable to the noble Baroness to consider withdrawing the amendment. The amendment calls on the Government to publish a report on alcohol labelling. The Government already plan to report on alcohol labelling, as it is a key part of our overall work on reducing alcohol harm. In no sense do we propose to ignore it and I undertake today that we will report on it. Part of what is taking the time is formulating what the proposals should look like, but I will come on to that.

As part of the Government’s tackling obesity strategy, published in July 2020, we are committed to consulting on whether mandatory calorie labelling should be introduced on all pre-packed alcohol as well as alcoholic drinks sold in the out-of-home sector. In addition, as part of our public consultation, respondents to the consultation will be able to provide suggestions and evidence for additional labelling requirements that they would like the Government to consider, including warning labels and nutritional information. In that sense, the consultation will be even more of a two-way process than perhaps noble Lords might have been expecting. Naturally enough, we make no assumptions in advance about any such proposals; they will have to be looked at on their merits. The consultation will be launched in due course and I can assure noble Lords that the Government will feed back the results to this House. Although, for reasons beyond my control, I have not been able to provide definitive news on the timing of the consultation—much as I would like to—I hope nevertheless that the firm commitment that I have given on the Government’s intention to carry out the consultation and on its scope will have provided the noble Baroness with sufficient reassurance to enable her to question whether she wishes to press her amendment.

House of Lords: Future Location

Debate between Lord Winston and Earl Howe

Monday 20th January 2020 Lords Chamber

[Earl Howe]

My Lords, I felt sure that all sorts of useful ideas would emerge from this debate. Getting back to my noble friend’s first point, we all know the people of York to be most hospitable, as I am sure they would be with 794 of our number arriving on their doorstep.

[Lord Winston (Lab)]

My Lords, with deference to the right reverend Prelate, am I right in remembering that the centre of the great city of York was the Shambles slaughterhouse? Is this not really an attempt by the Prime Minister to cull the House of Lords, and might that not end up being another shambles?

[Earl Howe]

My Lords, as I said earlier, I am sure that all logistical aspects of the idea will be examined. However, I take the noble Lord’s point.

Health: Obesity

Debate between Lord Winston and Earl Howe

Thursday 26th February 2015 Lords Chamber

[Earl Howe]

I think that we should give money to local authorities, nevertheless, but I take my noble friend’s point: overweight and obesity are a direct consequence of eating and drinking more calories and using up too few calories. That is the message that we need to get across.

[Lord Winston (Lab)]

My Lords, have the Government taken into account the issue of epigenetics in their advice on obesity? For example, is the Minister aware of the research by Gregory Dunn of the University of Pennsylvania which has shown that a great-grandmother can pass on imprinted genes which affect her great-grandchildren, but only the females and not the males? That argues environmental influences that we do not yet understand. Is that being factored in with the advice that the Department of Health is giving? It will be an increasingly important issue. This is not only a question of overeating; it is a very complicated problem.

[Earl Howe]

Yes, my Lords, that is being factored in, but I do not think that we should confuse that point with a certain sort of fatalistic approach to obesity. There are things that people can do with their lifestyle to influence their own states of health in all sorts of areas and we have to help people understand what those things are.

Medical Innovation Bill [HL]

Debate between Lord Winston and Earl Howe

Friday 23rd January 2015 Lords Chamber

[Lord Winston]

My Lords, briefly, I support the amendment of my noble friend Lord Hunt of Kings Heath as well. I was reminded by the noble Lord, Lord Ribeiro, of laparoscopic surgery. Of course, we gynaecologists were doing that 20 years before the noble Lord was and we did not have as many deaths. Having said that, what the surgeons did with laparoscopic surgery and recording those events was really important in bringing down the complication rate and the haemorrhages that occurred. That is a very good example and the noble Lord is to be thanked for bringing it to the House. It is exactly what would be covered here.

I would be astonished if the Government seriously opposed this amendment. I was very unconvinced by the noble Baroness, Lady Jolly, in the previous stages of the Bill. She did not seem to take on board exactly what we were trying to say about the need for keeping proper records, which is important in all sorts of ways. If you keep a record and it is done under this Bill then you are effectively legally protected. For that reason if no other that would be important, but in any case we have to build up the knowledge of our experience. We do that automatically in the laboratory. Every single thing we do in the laboratory, whether negative or positive, we record in our laboratory books. If we do not, we are not doing good science or science useful to the public. Here in innovative medicine, we are—whether we like it or not—doing a form of science because we are exploring our knowledge about what a treatment means. That is what science means. I urge the Government to support the amendment. I feel very strongly about this. If the Government were reluctant to support it and my noble friend Lord Hunt were to divide the House, I would certainly join him.

[Earl Howe]

Perhaps I may deal briefly with the question posed by the noble Baroness, Lady Masham, who asked whether the Bill would apply to patients receiving private treatment. The answer is yes. Any departure from the accepted range of medical treatments for a condition, whether that patient be receiving NHS or private treatment, would be covered under the Bill.

The amendment of the noble Lord, Lord Hunt, would change the test of negligence under the Bill. If accepted—and assuming that the appropriate professional requirements were created—the amendment would require a doctor to comply with any professional requirements as to registration of the treatment; that is, to register the treatment with a scheme for the purposes of taking a responsible decision to depart from the existing range of accepted medical treatments for a condition. In other words, registering details and results of an innovative treatment on a data-capturing scheme would form part of the steps that a doctor has to take under the Bill.

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[Lord Winston]

Before the noble Earl sits down—although I do notice that he has managed to take his seat on the Front Bench—I would argue that of course it is not research; we accept that completely. But it is science within the meaning of the Latin word, which has the notion of knowledge, and of course it is wrong for us to exclude knowledge being dispersed and promulgated. Of course, the Medical Innovation Bill hopes to do this, and that is the point of supporting it. Otherwise, I fear that the Bill when enacted will be almost useless. This has been an issue of great concern and was the cause of correspondence this week from many different medical sources. I hope that the Government will consider that very carefully.

[Earl Howe]

Of course the Government will consider this carefully. Let me make it clear that I do not want to sound negative about the idea of data gathering. I am the first to recognise that that could be a major advantage of the procedures that my noble friend Lord Saatchi is encouraging within the scope of the Bill. I would not dispute that for a moment. My concern is that to build a further requirement into the test of negligence would be the wrong course to take, because that is how this amendment is framed.

Also, what would be the benefit if we do not engage fully with the medical community to make sure that doctors are able to use any registry that might be created easily and simply? If it does not work for doctors, there will be no benefit—so I think that we need to take longer over this. It is not a case of kicking it into the long grass, but in the time available we have not been able to come up with a precise solution, despite our best endeavours in our discussions with the GMC.

Medical Innovation Bill [HL]

Debate between Lord Winston and Earl Howe

Friday 24th October 2014 Lords Chamber

[Earl Howe]

My Lords, the Government support these two amendments, which ensure that the Bolam test will remain unaffected by the Bill. In practice, this will mean that it is for the innovating doctor to decide whether to take the steps set out under the Bill or to rely on the existing Bolam test. In other words, there would be no requirement for doctors to follow the Bill when innovating.

The amendments clarify that, separate to the existing Bolam test which is applied by the courts, the Bill provides doctors with an alternative option for showing that they are acting or have acted responsibly. Furthermore, subsection (2)(b) of the proposed new clause provides that doctors are not negligent, and thus will not be judged adversely if their actions are later challenged, merely because they have not followed the Bill.

My noble friend Lord Kirkwood asked how the proposed new clause affects how a regulator approaches a complaint or fitness-to-practise procedures. This Bill addresses clinical negligence law and how the courts will assess these cases, not how the regulators will process fitness-to-practise cases.

The noble Baroness, Lady Wheeler, asked whether the Bill was necessary. The Department of Health’s consultation on the Bill revealed that some doctors find the threat of litigation to be a block to innovation, although this view was not universally held. The Bill is aimed at reassuring those doctors who feel unable to innovate due to concerns about litigation. There will also be many doctors who are not afraid to innovate and for whom litigation is not a material concern. Those doctors can continue to act as they have done previously and rely on the existing law of clinical negligence, or, as I have explained, they may choose to take advantage of the Bill instead.

I hope that noble Lords will accept these two amendments, which give flexibility and choice to doctors who want to innovate.

[Lord Winston]

There is something troubling me here. Let us say that somebody in an emergency or other situation does not have a chance to go through the required tests stipulated by the Bill, consulting other individuals who may be confident about or more experienced in that position. I still do not understand in the context of what the Minister has just said where that individual stands in innovating without those permissions. Is that still part of the Bill? How does that work? Is there a risk of that person being irresponsible in view of his not fulfilling what is required in the Bill when he is innovating?

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[Earl Howe]

I completely agree with the noble and learned Lord’s analysis of the situation. I hope that that has been helpful to the noble Lord, Lord Winston. Earlier, the noble Lord cited an example where a doctor was confronted by an emergency requiring innovative practice. Whether the doctor was acting responsibly or not, and the consequences, will depend on a number of factors. It will depend on the extent to which the doctor is confident in his or her judgment, based on experience in previous clinical practice and can, if necessary, show to a court that what he or she did was responsible and, at least in intent, in the best interests of the patient.

The noble Lord asked whether there was a risk of a doctor being found to be irresponsible in some emergency situations where innovative treatment is practised. Yes, there would be a risk if the process outlined in the Bill were not followed—but that situation obtains today.

[Lord Winston]

Both the Royal College of Surgeons of Edinburgh, of which I am a fellow, and the Royal College of Surgeons in London, absolutely support the idea that surgery should be excluded from the Bill for this very reason: they consider that there might be situations where the courts become unnecessarily involved. That involves extra expenses to the health service because of our current concern with litigation. As the noble Earl well knows, in obstetrics, for example, litigation already accounts for a huge proportion of the expenses devoted to maternal care. There are considerable knock-on effects where litigation may be started because of lack of clarity. It is possible that I am being stupid—I recognise that I am not nearly as intelligent as the noble and learned Lord, Lord Woolf—and I will have to go away to think about this, but there seems to me to be a misconstruction here which is puzzling and, I think, worrying.

Ebola

Debate between Lord Winston and Earl Howe

Monday 13th October 2014 Lords Chamber

[Earl Howe]

My Lords, we are reviewing those very questions all the time. Our position at the moment is that it would be disproportionate to alert the general public to the risk of Ebola, because it remains low. As for air passengers generally, it is important to understand that the virus is transmitted only by direct contact with the blood or bodily fluids of an infected person. It is not an airborne infection. So while I do not in the least belittle the importance of a public health campaign should that prove necessary, we do not consider that it is warranted at the current time.

[Lord Winston (Lab)]

My Lords, I am slightly concerned—I hope the noble Earl will forgive me for not giving him advance notice of this question—about the possible risk of seeming a little complacent about saying that this is low-risk. We know that viruses mutate, for example, and we know that the Ebola virus can mutate. We know perfectly well that it is not airborne at the moment, and we know that the pharyngeal and upper respiratory tract cells are unlikely to harbour the virus. However, can the noble Earl assure us that people are looking at the risk of mutation of this virus so that we can make certain that its mode of transmission does not change and that, therefore, it will continue to be low-risk?

[Earl Howe]

I can give the noble Lord that assurance. There is very close monitoring of the virus itself and the way in which it mutates. I repeat that the official advice is that risk to the public in this country remains low. That advice is based on the fact that we have robust, well developed and well tested systems for managing infectious diseases when they arise, supported by a wide range of experts. The Chief Medical Officer has estimated that we should expect Ebola in the UK, but not more than a handful of cases, and we would be able to cope with those cases.

Health: Secondary Care

Debate between Lord Winston and Earl Howe

Thursday 26th June 2014 Lords Chamber

[Earl Howe]

I am not aware of any disincentives in that sense. Indeed, the rate of referrals has gone up dramatically, particularly for cancer, which seems to indicate that GPs are not afraid to refer when they feel that they need to.

[Lord Winston (Lab)]

My Lords, governance, early diagnosis and visits to the general practitioner are all very well but, as the noble Earl will understand, many cancers such as lung cancer, which has just been mentioned, and pancreatic cancer depend on relatively silent tumours that are not going to be diagnosed on a clinical basis anyway. Surely the need is for markers for these diseases. What are the Government planning to do to increase research in this area, to ensure that we have markers for these diseases?

[Earl Howe]

Cancer research is a major priority for my department. Investment in cancer research by the National Institute for Health Research has risen from £101 million in 2010-11 to £133 million in 2012-13. However, that is only what my department is doing. As I am sure he is aware, a whole range of work is going on across many different types of cancer, which we regard as a priority.

Mental Health: Parity of Esteem

Debate between Lord Winston and Earl Howe

Monday 23rd June 2014 Lords Chamber

[Earl Howe]

My Lords, we are investing £54 million over the four-year period from 2011 to 2015 in the Children and Young People’s Improving Access to Psychological Therapies, CYP IAPT, programme. That, along with the measures that I referred to earlier, will, I hope, give a sense of the priority that we attach to children and young people’s mental health services.

[Lord Winston (Lab)]

My Lords, the Minister gave us a long list of things that the Government are doing. However, he does not mention research into mental health. Is not one of the key problems that clinicians are never able to identify the disease phenotype, and that makes further and better treatments impossible? Should there not be much more emphasis on the need to research mental ill health throughout the country?

[Earl Howe]

The noble Lord is quite right about the importance of mental health research. Unfortunately I do not have the figures in my brief, but I will gladly write to him on the research that is currently under way which my department is helping to fund.

Healthcare Professions: Regulation

Debate between Lord Winston and Earl Howe

Tuesday 10th June 2014 Lords Chamber

[Earl Howe]

My Lords, I have already said that we will introduce a Section 60 order amending the powers of the GMC, as it has requested and as we agree should happen. There is a range of changes that we hope to incorporate in that Section 60 order and I hope to have further news on that quite soon.

[Lord Winston (Lab)]

My Lords, I draw the Minister’s attention to the regulation provided by the Human Fertilisation and Embryology Authority, which is allowing entirely unvalidated experimental treatments, such as pre-implantation genetic screening, for patients who then have to pay to experiment on themselves. Many clinics are also advertising on the Underground and some have relationships to do work that is not allowed by British regulation in other clinics overseas. Is the noble Earl prepared to respond to that really burning issue and the exploitation of infertile women?

[Earl Howe]

I recognise the importance of the issue that the noble Lord has raised. Some of those issues are extremely troubling. However, I do not have an up-to-date position on the policy position that the Government are taking but I will write to the noble Lord about that.

NHS: London

Debate between Lord Winston and Earl Howe

Wednesday 30th October 2013 Lords Chamber

[Earl Howe]

My noble friend, with her experience, asks some very pertinent questions. On the question of timescale, we believe that it will take between three and five years for the proposals to be actioned to their fullest extent. It will be necessary to take that kind of time. Some elements can happen relatively quickly, but my noble friend is absolutely right that there are important workforce issues to be taken into account. Indeed, one of the IRP recommendations was that the NHS should review its workforce programme and ensure that it has the means in place to deliver what is required. I am sure that in working through the proposals, local commissioners, as well as NHS England, will need to satisfy themselves on that point—not least with regard to the new posts to be created in the community, but also in terms of accident and emergency consultants in the A&E departments of the relevant trusts. On local communities, again I agree with my noble friend. As the Shaping a Healthier Future proposals are developed by the clinical commissioners, it will be vital that any further proposals are consulted on locally, and that there is real buy-in from patient groups and the public generally.

[Lord Winston (Lab)]

I declare an interest as a member of Imperial College London and a practitioner who has been a consultant in north London for a long time. It is right that the financial shortfall means that there has to be considerable reconfiguration. In this case that is a move in the right direction. However, it raises a number of questions to which I would be very grateful if the Minister would respond. One is that if you close casualty you affect the training of surgical trainees. Do the Government have a view on that issue?

The Minister also referred to obstetrics in west London. As he will almost certainly know, the neonatal paediatrics department at one of the best obstetric hospitals in the country—Queen Charlotte’s, based at Hammersmith Hospital—has always been somewhat threatened. Is that secure, given that one of the issues in north-west London is undoubtedly that of duplication in many hospitals, which is expensive? Does the Minister feel that this is the only reconfiguration that will be required, given the amount of duplication that there is?

[Earl Howe]

To answer the last point, it is clear from the IRP report that its authors believe that this is a comprehensive set of proposals which will stand the test of time in north-west London. It is a very thorough set of proposals which takes into account every aspect of healthcare provision. On maternity and paediatrics, I can tell the noble Lord that under these proposals there will be more obstetric consultants on duty 24/7 in labour wards. As he will know better than anyone, that, of course, is designed to reduce the number of complications during birth and to ensure one-to-one midwifery care for women during labour. Consultants in other specialties such as paediatrics will be on duty, as I mentioned, for 12 to 16 hours a day, seven days a week, providing much better cover than at present.

It was very striking in the IRP report that the first point made by the noble Lord, Lord Winston, did not elude the panel. The panel concluded that the pragmatic and explicit approach used by the NHS reflected the clarity of the aim to improve quality outcomes by implementing life-saving standards through the establishment of major hospitals. The report referred to the economic realities of the NHS and the urgency of making progress in the light of known risks to the sustainability of emergency services such as the abilities of staff, A&E and emergency surgery rotas, and the desire to minimise the negative impact on access of concentrating services. That was shorthand—as the noble Lord will see if he reads the rest of the report—for saying that the desirability of concentrating expertise in centres of excellence is a clear imperative for the quality of care that patients receive. As regards surgical experience, I think that if my noble friend Lord Ribeiro were here, he would confirm that that is absolutely the direction of travel, but that we must ensure that surgical expertise is built on a sufficient number of hours and cases for the quality of care to be maintained. That is exactly what underlies this whole set of proposals.

NHS: Health and Social Care Act 2012

Debate between Lord Winston and Earl Howe

Wednesday 9th October 2013 Lords Chamber

[Earl Howe]

My Lords, commissioners do not have to use competitive tendering for all services. First, acute elective care—which represents the vast majority of NHS services—is not secured through competitive tendering at all, and that will continue to be the case. Secondly, a single-tender action may be justified on the basis that there is only one provider able to meet the clinical quality and safety standards that the commissioner requires. There will be guidance coming out on that, and draft guidance has already been published. Any confusion that exists among commissioners should be clarified by that means.

[Lord Winston (Lab)]

My Lords, would it be fair to say that the noble Earl is somewhat between Scylla and Charybdis on this issue? On the one hand tendering is certainly more expensive but, on the other, if tendering does not take place, is there not a real risk that services will be offered at the price that the market will bear rather than the one that it really costs the health service? The health service has not always managed to cost out its treatments effectively.

[Earl Howe]

The noble Lord makes a good point. There is, I think, a desire on everybody’s part not to see competition result in a race to the bottom on price. That is why we have specified that commissioners must make clear what standards they expect and apply those consistently to whoever is tendering for the service in question at a price which reflects a fair value. We believe that the current rules protect the NHS but also protect those bidding. I emphasise that competition will not be pursued as an end in itself; it will be pursued as a means to drive up quality.

Homeopathy

Debate between Lord Winston and Earl Howe

Tuesday 19th March 2013 Lords Chamber

[Earl Howe]

My Lords, we have been consistently clear that no treatments should be arbitrarily rationed on cost grounds. The NHS constitution sets out that patients have a right to expect local decisions on the funding of drugs and treatments to be made rationally following a proper consideration of the evidence. More importantly in this context, it is the responsibility of the NHS to make decisions about commissioning and funding of healthcare treatments and not for Ministers to second-guess that process.

[Lord Winston]

My Lords, perhaps I may be permitted to help the Minister. Many years ago, there was a very interesting study in Wales of a placebo-controlled trial that showed that, whatever was given, the best chance of a treatment working, placebo or not, was whether the doctor who was giving the medicine actually believed in it. Does the same apply for homeopathy and the Secretary of State?

NHS: Private Companies

Debate between Lord Winston and Earl Howe

Monday 11th February 2013 Lords Chamber

[Lord Winston]

To ask Her Majesty’s Government whether they have plans to exempt private companies providing services to the NHS from corporation tax.

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

My Lords, the Government will not be exempting private sector providers of NHS services from corporation tax. The purpose of Monitor’s fair playing-field review is to ensure that any providers, be they NHS, for-profit, community or voluntary sector organisations, that are able to improve the services offered to patients are given a fair opportunity to do so.

[Lord Winston]

I am grateful to the noble Earl for that reply and deeply reassured that corporation tax will not be in the equation. Given that the NHS is not good at costing out its treatments, how can he be sure that the private sector will not charge what it thinks the market will bear rather than the actual cost of the treatment it is delivering?

[Earl Howe]

My Lords, the Government’s policy is that competition should never be deployed for competition’s sake but only in the interests of patients. Furthermore, competition should be on the basis of quality and not price. The answer to the noble Lord’s question is that we need to arrive progressively at a system of tariffs that fairly reflect the value and cost of the work that providers do, and that all providers should compete equally on that basis.

NHS: Reconfiguration of Services

Debate between Lord Winston and Earl Howe

Tuesday 15th January 2013 Lords Chamber

[Earl Howe]

I am grateful to my noble friend and I can give the confirmation that he seeks. Monitor’s advice was sought and obtained by the OFT. He is quite right that that it is one of the benefits from the Health and Social Care Act. In situations of this kind we expect Monitor and the NHS Commissioning Board to engage with the Competition Commission on FT mergers but before that with the OFT because Monitor, as a health-specific regulator, has the insight into the considerations that bear most closely on the interests of patients.

[Lord Winston]

My Lords, does the noble Earl agree that, whatever the explanation, the involvement of the OFT suggests an increasing privatisation of the health service? Given that the health service so often does not cost out individual treatments per patient very successfully, that raises the issue of competition between private providers in such areas as this. Would the noble Earl be kind enough to comment on that?

[Earl Howe]

I do not agree with the noble Lord. Competition issues arise within the health service and the matter in the noble Lord’s Question is specifically a health service issue. There are, of course, competition issues involving the independent sector and the charitable sector as well but that is not the focus here. It was the previous Government who recognised the benefits of competition for patients. Our attitude to it is very pragmatic. The key objective for commissioners is to ensure that patients receive the best possible services irrespective of whether they are from the public, voluntary or private sectors. It is for commissioners working with patients to decide where competition is appropriate. It is a means rather than an end in itself.

NHS: Research and Development

Debate between Lord Winston and Earl Howe

Monday 17th December 2012 Lords Chamber

[Earl Howe]

My Lords, every NHS trust or foundation trust has to oversee the governance of the research taking place within it. That is an inescapable part of the process. I do not think there is any confusion in anyone’s mind between support for research governance and the actual research itself, which is done by academics and clinicians working in academic and clinical departments. It is up to each trust to determine how its budget for research is allocated, but I can reassure my noble friend that the money is getting to where it needs to go.

[Lord Winston]

My Lords, would the Minister agree that since Sally Davies took charge of how research is done within trusts, there has been a significant improvement in insuring that more of this money actually goes to serious translational research, which is an area that the health service really needs to concentrate on? I hope that the Minister will agree that that job has been done rather effectively.

NHS: Health Workers

Debate between Lord Winston and Earl Howe

Thursday 19th July 2012 Lords Chamber

[Earl Howe]

My Lords, the noble Lord’s Question addresses the central issue facing the NHS, which is how to deliver the best outcomes for patients and do so in the most cost-effective way. He is right to single out the role of Health Education England because I believe that, in conjunction with local providers who will be feeding in their view of what the workforce priorities are in their local areas, together with the Centre for Workforce Intelligence, which has a horizon-scanning capability, we can at last crack a nut that has been so difficult to crack in the past, that of good workforce planning in the NHS to make the workforce as productive and effective as we can. He is also right to single out the CQC because in areas such as staff ratios, the commission has a role in making sure that providers have thought about the right way to deliver care in individual settings.

[Lord Winston]

My Lords, in order to produce a skilled workforce with wide diversity in the health service, one of the real needs is that of attracting more young people into this very large workforce. At the present time, as I think the noble Earl may be aware, there is massive resistance to having young people on work experience in the health service. All sorts of barriers are put up—risk of infection, lack of privacy and so on—most of which are absolute nonsense. Could the Minister do more to encourage the university trusts in particular to ensure that more young people can gain work experience in our hospitals?

[Earl Howe]

My Lords, the noble Lord has made an extremely creative and important point, and I will gladly take it back to the workforce colleagues in the department.

NHS: Primary Care Trusts

Debate between Lord Winston and Earl Howe

Tuesday 17th July 2012 Lords Chamber

[Earl Howe]

My Lords, I do not have the figures for North Yorkshire in front of me but, as the noble Baroness is aware, there is a process for patients to make an exceptional case application to their primary care trust where the circumstances are deemed to be exceptional. We had a short debate about this matter the other day. However, there will inevitably be variation around the country in the extent to which treatments are seen as a priority for the local population in a given area.

[Lord Winston]

My Lords, it is a question not just of treatment but of investigations for treatment. Only last week, I saw a couple complaining of long-standing infertility who were refused a laparoscopy or an X-ray of the uterus on the grounds that they were not permissible as investigations under the National Health Service. It was limited by their primary care trust. Would the noble Earl care to comment on that?

[Earl Howe]

My Lords, if that case was a consequence of the primary care trust taking a blanket decision over a clinically valid investigation process then I would be very concerned and should be interested to hear the details from the noble Lord.

NHS: Definition of Exceptional Case

Debate between Lord Winston and Earl Howe

Monday 2nd July 2012 Lords Chamber

[Earl Howe]

My Lords, no, that is not the reason. My noble friend is quite right that this treatment has been around for a little while. However, it is not yet in mainstream practice. It is expensive, it is not routinely available in the NHS, and indeed NICE has published interventional procedure guidance which concludes that it,

“shows some short term efficacy, although most patients require insulin therapy in the long term”.

That does not seem to me to be a resounding endorsement of this treatment.

[Lord Winston]

My Lords, will the Minister be kind enough to help us by defining what is meant by exceptional clinical needs?

[Earl Howe]

There is no clear-cut answer to that question. A patient might be suffering unusually severe symptoms from a given condition, or they might suffer from some comorbidity, with the result that in the absence of treatment his or her quality of life would be unusually severely affected. The underlying principle should be that the patient has some exceptional characteristic which would justify more favourable treatment being given to them than to the average patient with that condition.

Health and Social Care Bill

Debate between Lord Winston and Earl Howe

Monday 27th February 2012 Lords Chamber

[Lord Winston]

I am sure that the Minister will want to answer my question because it is not aggressive or political; it is really to find out how this Bill will work. When somebody goes to casualty after a month with a broken nose and complains, “Look, my main problem is the pain in my sinuses which I have had for a long time”, and is told by the doctor when they had already waited six hours, “I’m afraid the sinuses are a different department. You’ll have to make another appointment”, that is a problem with integration. How does the Minister think we might accomplish better integration with this Bill?

[Earl Howe]

It is a very interesting question from the noble Lord. When I visited Oldham a few weeks ago, I saw for myself how they were getting around that problem in the context of musculoskeletal services. Instead of patients being shunted from pillar to post, they had a system whereby the patient could move seamlessly and immediately from one specialist to another. They did not have to be referred; they could ring up the centre and ask to see a particular person. That is the kind of integrated model that we need to see rolled out more generally in other services. I recognise the issue that the noble Lord raises, but it is one that we are seeing inventive solutions arising to address. I hope that the work being done will do that.

NHS: Management Consultants

Debate between Lord Winston and Earl Howe

Monday 13th February 2012 Lords Chamber

[Earl Howe]

Yes, we do, my Lords. Part of the benefit of the modernisation programme will be to streamline the architecture of the NHS so that year by year we will be saving £1.5 billion in administration costs and £3.2 billion net during this Parliament. We need good advice in order to achieve that.

[Lord Winston]

My Lords, the noble Earl said that this Government have spent less on consultants than the previous Government. Does he agree that, perhaps had they spent a bit more, we might have had a Bill that damaged the health service a great deal less?

[Earl Howe]

My Lords, I cannot help observing confused and contradictory messages coming from the Benches opposite. I would be happy to take that advice back to my department.

Health and Social Care Bill

Debate between Lord Winston and Earl Howe

Monday 7th November 2011 Lords Chamber

[Lord Winston]

I listened carefully to the Minister’s answers to and rebuttals of many of these amendments, which he made with cogent force, and I found it difficult to disagree with them. However, in the case of the amendment of the noble Baroness, Lady Bakewell, I have a problem. The issue of age is such a special case that there is a strong reason to consider writing her amendment into the Bill at this stage, because it is clear from what has happened historically and recently that aged patients are in a particularly difficult situation in an ageing community. They are often not communicated with and left unable to feed themselves, and people are not there to feed them, and so on. The Minister knows all this very well. Is there not a serious case for a caring Government to think seriously about the issues that the noble Baroness has raised?

[Earl Howe]

Of course there is, and I am grateful to the noble Lord. We are anxious to ensure, however, that any measures that we put in place in the outcomes framework are robust in terms of their verifiability. As I have said, I completely agree with the need for good data that have to underpin any system of accountability. I strongly feel that the Bill takes a significant step in the right direction. The NHS Information Centre will be the powerhouse for improving data in the NHS. It will look at how we can improve data for all age groups, not just the over-75s. I take on board what the noble Lord said. If I can add to what I have said, I should be happy to do so in writing.

I shall cover briefly the questions from the noble Lord, Lord Hunt, about NICE. NICE is a body for which we have the highest regard. In the Bill, we are widening its duties and placing it on a much firmer statutory footing. I hope that that in itself will indicate to the noble Lord that, far from downplaying the role of NICE, we want to do the opposite. We are giving it responsibility for defining excellence in social care and for producing a library of quality standards, which it has already started to do. In connection with technology appraisals, we see it continuing to have a very important role. What the noble Lord may have heard on the grapevine, if I can put it that way, related to our plans for value-based pricing of medicines. If we succeed in defining a good system—a good framework—for value-based pricing, the role of NICE will inevitably shift somewhat, because it will be asked a slightly different question from that which it is asked at the moment, but it will retain an absolutely central role, particularly in the pharmacoeconomic evaluation of new medicines.

The noble Lord asked me about the concern that clinical commissioning groups would, as it were, be able to take their own decisions and perhaps disregard NICE guidance. We have made absolutely clear that the funding direction associated with NICE-approved medicines will continue, not only up to the end of 2013, which is when the current pharmaceutical price regulation scheme comes to an end, but thereafter in the new world of value-based pricing.

I agree with the spirit of all the amendments, but I hope that noble Lords will accept from me that they are either not needed or would have an unintended and retrograde effect, which I have tried to outline. I hope that, with that, noble Lords will feel able not to press the amendments.

Health and Social Care Bill

Debate between Lord Winston and Earl Howe

Tuesday 25th October 2011 Lords Chamber

[Earl Howe]

It did happen, but it did not happen with the system that I have outlined in place. As I have just said, NHS Future Forum is talking to a great many people about where exactly responsibilities should sit for what, and how the system should work, which is why—I confess freely—I am in difficulties. While I would love to be able to answer detailed questions about the system, we have quite consciously deferred these matters to a second Bill.

[Lord Winston]

Perhaps I could ask the Minister a general question. The noble Lord has been specific in picking up some of the details of the amendments. The beauty of the amendment proposed by the noble Lords, Lord Patel and Lord Walton, is its simplicity and ethos. Government Amendment 43, proposed by the Minister, refers to the,

“delivery of education and training to persons who are employed, or who are considering becoming employed”,

in the health service. Considering becoming employed can mean a whole range of things. A lot of people who are considering becoming employed in the health service may not actually apply for a job. How is that possibly enforceable within the context of this amendment?

[Earl Howe]

I am surprised by that criticism because that is designed to capture trainees, who may not have a guaranteed job at the end of the day. If you simply refer to people who are already employed, you surely cut that cohort out of the equation. That is the purpose of those words, and I think they are entirely appropriate.

--- Later in debate ---

[Earl Howe]

I am grateful to my noble friend and, naturally, I will give full consideration to his suggestion. The government amendment represents the fulfilment of our undertaking, made in another place and more publicly, to put clearly in the Bill the Secretary of State’s accountability for an education and training system. That is what we have done. It may be that we can go further in the Bill; I will certainly consider that. Our intentions, as I have enunciated them, are clear, but I come back to saying that we do not want to pre-empt the findings of the Future Forum and the wider consultation that we are engaged in.

[Lord Winston]

I am sorry to interrupt the Minister again, but I find it incredible that we are now in Committee in the second Chamber on this large Bill and the Government are still apparently in the middle of their listening exercise. Does this not argue that the Bill is extraordinarily badly prepared and that these things should have been thrashed out well in advance? Is that not what the noble Baroness, Lady Tonge, was talking about? It is something that will shock people who are listening to this debate.

[Earl Howe]

No, my Lords, that is not the case. I completely reject not only that remark but also the remark of the noble Lord, Lord Davies of Stamford. Our plans for education and training have been moving forward ever since the election. The White Paper in July 2010 set out the broad principles underpinning education and training reforms. A consultation paper was then published in December last year, with the consultation finishing in March of this year. The Future Forum then listened to further views. It recommended the new duty which we are discussing today in the form of Amendment 43, and we accepted that recommendation. Meanwhile, the Future Forum continues to listen to the views of the wide range of stakeholders and its report will feed into future legislation on this topic. We have consciously deferred the meat of this issue to a future Bill, because we have to get it right. We have committed to publishing further proposals on education and training once the Future Forum has concluded its report and there will be a chance for noble Lords and others to feed in at that point if they so wish.

Health: Stroke Care

Debate between Lord Winston and Earl Howe

Monday 4th July 2011 Lords Chamber

[Lord Winston]

My Lords, various reports show that the mortality for stroke can be as high as 30 per cent. Sadly, in the United Kingdom mortality is higher than almost anywhere else in Europe, although there is great geographical variation all over the world. One of the issues that Professor Peter Rothwell, of the University of Oxford, has pointed out is that speed is the essence of success. Therefore, it is not merely a question of informing patients, but of making certain that the right availability is present in our hospitals. If we do that we can reduce the risk of a further stroke by 80 per cent and probably, as he says, reduce the cost to the National Health Service in primary care by somewhere between £100 million and £200 million annually. Would the Minister be kind enough to explain how that will work in the future of the health service?

[Earl Howe]

My Lords, the noble Lord is quite right in all that he says. I would just point out that the official statistics are rather historic and it is important that we take stock when the revised figures are before us in some months’ time. As regards how best practice will be driven when the health service reforms are in place, I would repeat my earlier comments about the ability of the NHS commissioning board to drive forward higher quality, informed by the new quality standard produced by NICE. More particularly I think we can do a lot through the tariff. At the moment, best practice tariffs are starting to play a role in encouraging and driving best practice at hospital level.

NHS: Health Improvements

Debate between Lord Winston and Earl Howe

Wednesday 29th June 2011 Lords Chamber

[Earl Howe]

My Lords, my noble friend will know that an independent inquiry into children’s heart services is under way at the moment. It would be inappropriate for me to comment. I have not been involved at all but it would be inappropriate for Ministers to become involved. As regards ambulance and A&E services, we envisage that clinical commissioning groups will commission the great majority of NHS services for their patients, including urgent and emergency care and ambulance services. Prior to that, PCT clusters, which are being formed from the primary care trusts, will be responsible for commissioning ambulance services until 1 April 2013.

[Lord Winston]

My Lords, does the Minister agree that we are facing one of the greatest revolutions in medicine—that is, genomic medicine? It will make medical treatment more effective and efficient and will reduce the national drug bill. Therefore, does he not agree that one of the most urgent needs of a large population is for increased computing power and proper information technology?

[Earl Howe]

I absolutely agree with the noble Lord. The information agenda, which should run in parallel with our plans, is essential for delivering the improvement in outcomes that we all want to see. Part of that will involve new technology. As the noble Lord knows, work is under way on genomic medicine, which is extremely exciting. We have included in the amendments tabled to the Health and Social Care Bill in another place a duty on both the Secretary of State and clinical commissioning groups to promote research in the health service.

Health: Multiple Sclerosis

Debate between Lord Winston and Earl Howe

Wednesday 2nd February 2011 Lords Chamber

[Earl Howe]

My Lords, I have extensive briefing on some upcoming and promising treatments that may or may not emerge in the National Health Service, but I have to say that that is not one of them. I shall go away and ask the department to inform me.

[Lord Winston]

My Lords, in addition to the important point made by the noble Lord, Lord Walton, about drugs that should be available under the National Health Service, is the Minister aware that some years ago a Select Committee for Science and Technology inquiry gave clear evidence that, in small doses, cannabis is of great benefit to some patients who have spasms and other problems with multiple sclerosis? Do the Government have any plans to allow the use of that drug in those circumstances?

[Earl Howe]

My Lords, the noble Lord will know that a drug called Sativex was recently licensed, which is derived from an extract of cannabis, as he will be aware. Having said that, I believe that NICE has issued no guidance to the NHS on the use of Sativex, so it is for local primary care trusts to make funding decisions based on an assessment of the available evidence and on the basis of the patient’s individual circumstances. As the noble Lord rightly said, Sativex treats the symptoms of severe spasticity caused by MS and is not a disease-modifying drug as such.

Health: Influenza

Debate between Lord Winston and Earl Howe

Tuesday 11th January 2011 Lords Chamber

[Earl Howe]

That is precisely why we have an independent Joint Committee on Vaccination and Immunisation: to advise Ministers on these matters. Ministers are bound to take that advice. Indeed, the previous Government determined that they were legally obliged to take the committee’s advice, which is what we have done.

[Lord Winston]

My Lords, is the Minister aware that many pregnant women are particularly nervous about all kinds of vaccination during pregnancy, including the flu vaccination? I know that from first-hand experience. Does he feel that the Government are doing enough to inform pregnant women about the risks or otherwise in that instance? Could more be done?

[Earl Howe]

I am sure, as I have just said, that lessons can always be learnt about what more can be done. As I mentioned, we saw a lower than desirable uptake of the vaccine in the early weeks among pregnant women. I am happy to say that that has now been rectified and a lot more pregnant women are coming forward. However, it emphasises the noble Lord’s central point that perhaps GPs have a special duty at the moment to encourage pregnant women and to reassure them that the vaccine is absolutely safe.

Health: Prostate Cancer

Debate between Lord Winston and Earl Howe

Monday 19th July 2010 Lords Chamber

[Earl Howe]

My Lords, my noble friend raises an extremely important point. He may like to know that last year the department wrote to primary care trusts to remind them that any man without symptoms of prostate cancer who wishes to have a PSA test is entitled to have one. However, it is important that anyone availing themselves of the test does so on a fully informed basis, because, as I said, it is unreliable and can lead to unpleasant side effects.

[Lord Winston]

My Lords, is not one of the problems with the PSA test the fact that it produces a vast number of false positives, meaning that a number of people could be at risk of mutilating treatment? Will the Minister give an answer to the question about advances in genomics, which might help in the long term with regard to prostate cancer?

[Earl Howe]

My Lords, the noble Lord, Lord Winston, is probably in a better position to advise the House on advances in that area of research. I can tell the House that the National Cancer Research Network, set up by the Department of Health in 2001, has brought about a tripling of the number of cancer patients entered into clinical trials. About 12 per cent of cancer patients in England enter NCRN trials, which is the highest per capita rate of cancer-trial participation in the world. The network currently supports about 51 prostate cancer studies, so there is no shortage of research going on.