Tobacco Products Directive

Baroness Gardner of Parkes Excerpts

Tuesday 15th October 2013 Lords Chamber

[Earl Howe]

My Lords, the tobacco products directive, as the noble Lord will know, does not seek to introduce standardised packaging. As he will also know, the Government have decided to wait before making a final decision on that issue but we want member states to have the flexibility to make further progress on domestic tobacco control measures in certain key areas that go beyond the new directive. We have been helping to shape the final text of article 24 to achieve that objective.

[Baroness Gardner of Parkes (Con)]

Is my noble friend aware that in this country people who have suffered even major amputations are still so addicted to tobacco that they will ask the doctor to hold up the cigarette to their mouth? I have had this report from doctors. Does he not think that what we really have to aim at is stopping smoking among the young? Is he aware that in Australia it is no longer cool to smoke if you are young? Apparently, that is more effective than any of the health warnings.

[Earl Howe]

My noble friend, as ever, makes some very wise comments. The good news is that the most recent figures on smoking prevalence are going in the right direction. It is undoubtedly true that we can never do enough to raise our game on smoking cessation measures, one of them being nicotine-containing products. That is of course a major focus for Public Health England.

Care Bill [HL]

Baroness Gardner of Parkes Excerpts

Wednesday 9th October 2013 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, on reading carefully the amendments in the name of the Minister, I hope that he will be able to provide reassurance that his amendments will go further than Amendments 22 and 25 to which I have added my name and that they will be much more about the whole person and the whole person’s needs. I recognise that there are dangers in putting a timeframe around anything; there is the danger that it will be used as a so-called minimum standard, down to which people will drop. I initially wanted to support these amendments and I suppose, if I had a choice, I would have added my name to those of the Minister now, because there is a real problem if care is not adequate in quality and promoting well-being in that it creates dependency rather than reablement towards increasing independence. There is a sense of personal worth that goes along with being able to do things, however slowly, rather than having to accept somebody doing them for you because they are in a terrible rush. I hope that the Minister will provide us with a much wider reassurance than the words suggest at first glance.

[Baroness Gardner of Parkes (Con)]

My Lords, I was most interested to hear the comments of the noble Baroness, Lady Meacher, and I agreed with every word, but I do think the time limit specified would not be right and I strongly support Amendment 27. However, there are other aspects of this care issue that we have not really thought about.

One that is covered in Amendment 27 is about the well-being of carers. I find it very disturbing that a woman I know who lives in with a person needing pretty comprehensive care every Saturday and Sunday and stays overnight on both nights, is appallingly paid for this because she is self-employed. I said to her that I could not believe she was earning so little when it is such a very important job and so very time consuming. I told her I would look on the internet to see what she is entitled to as a minimum wage. It turns out that there is no minimum wage for a self-employed person. That quite stunned me; there is a great reservoir of people who would be willing to take on self-employed caring positions and do them for quite long periods, not rushing people, but not at her rate of pay, which worked out at a little over £2 an hour for all the hours she was there. I suggested that, since she had done training in care, she should work instead for the people who provide a service for the local authority. She followed that up and it turned out that she would not earn much more, because they are not paid for travelling time. Unless the organisation improved so that her two, three, four or 10 jobs—whatever it is—were almost next door to one another, the unpaid travelling time would constitute much more of her day than the time actually caring for people.

The other point raised by the noble Baroness, Lady Finlay, is that it is more than just physical care. We have heard much in recent days about people’s extreme loneliness, how they can go almost for days with hardly a word with anyone. That is a most essential thing in life, to feel that you have not been abandoned. The woman in the television report talked about taking your coat off, making your booking and going through it all, and how you are left with 10 minutes in the middle and then you book in a final 10 minutes to reverse everything. That is exactly what I remember from when I was chairman of local social services 30 years ago; that was exactly the same problem then.

These are not new problems; because there are so many more older people who need more care, and there is more awareness, with people wanting to stay in their own homes, this problem has grown, and we do not have the solutions to match the need. I strongly support the emphasis on the well-being of carers, which is mentioned in Amendment 27—that is important. People should feel that they are doing a worthwhile job and that what they are doing is helping other people. They should also be reasonably remunerated for it. There is so much that we would all support; I feel that all noble Lords in this Chamber want to see more help and more efficiently used help. Amendment 27 in particular covers a lot, but whatever offers can be made, so much the better.

[Baroness Emerton (CB)]

My Lords, I apologise for not having heard the first part of the speech made by my noble friend Lady Meacher; I can only say how much I agree with her. In the past nine weeks, while the carer was away, I had the personal experience of doing two weeks’ full-time caring. I timed waking up, giving the medication, getting breakfast, rushing up to do my post while she was having her breakfast, and then attending to her personal care and getting her dressed. It took an hour and a half, every day, and that was just the morning.

On the point made by the noble Baroness, Lady Finlay, the minimum quality standards in the noble Earl’s amendment set a good standard. However, that needs to be supported by an assessment and care programme. There needs to be a proper assessment of what is required in terms of the total care, not just the minimum. We have a system for some of our residents in the retirement development where I live, where prevention to admission to hospital is done by an assessment of how much time care is required. Two people come from the unit—a nurse and a physiotherapist—and fully assess the patient. If there is a proper care programme, that gives the time element. Amendment 25 says “excluding travel time” and that a visit should not take less than 30 minutes. It is difficult to be so prescriptive, but if that was according to the care plan, it might go a long way.

Health: Anorexia and Bulimia Nervosa

Baroness Gardner of Parkes Excerpts

Thursday 11th July 2013 Lords Chamber

[Earl Howe]

My Lords, the mental health of children and young people is a major priority for the Government. Half of those with lifetime mental illness first experience symptoms by the age of 14 and three-quarters before their mid-20s. That is precisely why we are investing a large sum of money—£54 million—over the four-year period 2011-15 in the Children and Young People’s Improving Access to Psychological Therapies programme. We know, as the noble Baroness rightly emphasises, that those talking therapies can make the most difference, particularly if early intervention is achieved.

[Baroness Gardner of Parkes]

My Lords, is it not so that very often parents do not realise what is happening to their child? As for cancer or any other condition, early diagnosis is the secret. What can be done to speed that up? When I was chairman of a hospital, we had a whole ward full of people with this problem, but their condition had been recognised too late and therefore treatment was extremely difficult.

[Earl Howe]

My noble friend is absolutely right. However, it is encouraging to see that in recent years a range of information and support has become available. The Royal College of Psychiatrists has published a fact sheet on eating disorders, which is aimed not just at the profession but particularly at parents, teachers and young people themselves. It is called Mental Health and Growing Up. The fact sheet discusses the causes of eating disorders, how to recognise them and gives advice on how to cope with a child who has an eating disorder.

Public Health England Advisory Board Membership

Baroness Gardner of Parkes Excerpts

Thursday 4th July 2013 Lords Chamber

[Earl Howe]

We are very mindful of that, but I come back to the point that these appointments were made on merit in accordance with the published criteria. That is not to say that the unsuccessful candidates lacked merit, but we did not operate a policy of positive discrimination and I do not think that anyone would wish us to do that. Having said that, we are mindful in the department of the need to have gender balance whenever we can in public appointments. Our record is not bad; we are in the region of 44% of appointment rates for women appointed to public positions, which is quite high up in the departmental league table.

[Baroness Gardner of Parkes]

My Lords, does the Minister recall a famous speech of Baroness Thatcher’s, when she was Mrs Thatcher, when she said that the experience that women gain in life generally is not to be underestimated? It is all very well to have everyone with all the experience and qualifications in the world, but does he not think it is also important to have some women who could bring basic common sense to the board?

[Earl Howe]

My Lords, yes.

Medicine: Experimental Drugs

Baroness Gardner of Parkes Excerpts

Monday 10th June 2013 Lords Chamber

Asked by

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government whether they will enable the use of new experimental drugs by terminally ill patients who are prepared to waive their right to sue pharmaceutical companies in order to assist the development of new drugs and ease their own condition.

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

My Lords, there are existing provisions under medicines legislation for access to unlicensed medicines without requiring changes to the law. The Government are committed to ensuring access to new and promising medicines for patients while ensuring that medicines continue to meet high standards of safety, efficacy and quality. This is why the Government have been taking forward work on an early access scheme, adaptive licensing and promotion of clinical trials in the UK.

[Baroness Gardner of Parkes]

I welcome that Answer as it means that many valuable drugs might come to the market much earlier and be available for patients. Does the Minister agree that many elderly patients with a terminal condition will definitely get treatment that they may not particularly want themselves but that hope is terribly important in all our lives? Any of the new, experimental drugs can provide this valuable ingredient of hope to such patients.

[Earl Howe]

My Lords, I agree with my noble friend, and it is one of the reasons why the NHS constitution contains a pledge to inform patients of research studies in which they may be eligible to participate if there is a promising new medicine in the pipeline.

Emergency Services: Paramedics

Baroness Gardner of Parkes Excerpts

Wednesday 15th May 2013 Lords Chamber

Asked by

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government under what circumstances unsupervised, unqualified paramedics may be sent to respond to an emergency call.

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

My Lords, ambulance trusts have a range of staff with different skill levels who are able to respond to patients depending on the severity of their illness or injury. It is the responsibility of individual ambulance trusts to determine how best to deploy those resources, ensuring that suitably qualified, skilled and experienced staff are sent to respond to calls.

[Baroness Gardner of Parkes]

Will the Minister tell me, therefore, whether he thinks that it was just an individual case or whether a general principle was at fault in the case of Sarah Mulenga, which has been widely publicised? The coroner ruled that neglect contributed to her death and found,

“a gross failure to provide basic medical attention”.

That was when two unqualified paramedics went to her call and, apparently, did not take her to hospital or even register her normal condition. How often does that sort of thing happen? Is it necessary to change the training system so that there will be more people qualified and trained?

[Earl Howe]

My Lords, the London Ambulance Service has advised that the article in the Sunday Times was slightly misleading, in that the two members of staff who attended that particular patient were student paramedics in their third and final year of training and so were sufficiently qualified to work unsupervised. It is inaccurate to call them “unqualified”. The issue in this case was that, despite their qualifications and experience, the crew did not act in accordance with their training or the procedures that were laid down. That has been acknowledged by the London Ambulance Service, which has said that it believes that the failings are not reflective of the hundreds of ambulance staff who provide a high level of patient care to Londoners every day.

NHS: ECMO Machines

Baroness Gardner of Parkes Excerpts

Monday 22nd April 2013 Lords Chamber

Asked by

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government whether extra-corporal membrane oxygenation (ECMO) machines that are capable of restoring heart functions some hours after an apparently fatal heart attack are in use in any NHS hospitals; and, if not, what consideration is being given to their installation.

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

My Lords, the equipment and facilities to undertake cardiac ECMO support are available in all five NHS adult cardiothoracic transplant centres in England and in the five national respiratory ECMO centres, three of which share a location. Provision of cardiac ECMO support is a complex intervention with significant risks attached to it. A cardiac ECMO service requires a fully trained team to be available around the clock and does not consist of simply purchasing the medical equipment.

[Baroness Gardner of Parkes]

That is very good news and I thank the Minister for it. It is desirable to have these facilities available. Does he agree that the group which would benefit most of all from this would be young people who die suddenly and unexpectedly, often in the sporting field? This is a much greater tragedy for families than the more usual cardiac attack at a later age. Should not more publicity be given so that people involved in those activities know that such facilities are available? You could get a young person by helicopter to one of those centres within the number of hours that your life would be prolonged for.

[Earl Howe]

My Lords, there is, I understand, no intervention capable of restoring heart function some hours after a heart attack. The only exception is not applicable to heart attacks but to people who have had circulatory arrest due to hypothermia—for example, people who have been buried in avalanches or immersed in very cold water. That area is currently being researched. It is only in a very limited number of circumstances that ECMO support can improve a patient’s chances of survival following cardiac arrest—usually in patients who suffer in-hospital cardiac arrest following surgery.

Homeopathy

Baroness Gardner of Parkes Excerpts

Tuesday 19th March 2013 Lords Chamber

[Earl Howe]

My Lords, the best way I can answer the noble Lord is to refer him to the page on NHS Choices that explicitly refers to the placebo effect. As he will know, the 2010 House of Commons Science and Technology Committee report on homeopathy said that homeopathic remedies perform no better than placebos. It is important to emphasise that message. On the other hand, many people have found benefit from homeopathic medicines and, in a way, that is their privilege and right.

[Baroness Gardner of Parkes]

My Lords, is the Minister aware that homeopathy started at a time when the one treatment they gave people was to bleed them? It was effective because they did not bleed them and allowed them to recover normally; I was on the board of the Royal London Homeopathic Hospital for a good many years, where I learnt that. Does the Minister not think that, faced with a situation where antibiotics have been used too casually, it is time to look at what we should not be taking? Does he think it important that patients should have the right to whatever treatment they choose provided that homeopathy does not allow them to escape proper diagnosis for cancer or some other tragic condition, which could be overlooked if it is not combined with ordinary medicine?

[Earl Howe]

My noble friend makes an important point. We are clear in recommending that patients should talk to their GPs before stopping any treatment that has been prescribed by a doctor in favour of homeopathy and before they start taking homeopathic remedies. It is important that people understand that homeopathy may not be effective in many situations.

NHS: Healthcare UK

Baroness Gardner of Parkes Excerpts

Thursday 14th February 2013 Lords Chamber

Asked by

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government how they will ensure that the National Health Service benefits from the establishment of Healthcare UK to market the NHS brand abroad.

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

My Lords, Healthcare UK will focus on high-value opportunities internationally for both industry and the NHS. Where NHS expertise is used, those NHS organisations will benefit financially, with the income being reinvested into patient care for patients here in the UK. Furthermore, any activity undertaken by Healthcare UK will be overseen by a board, which will be jointly administered by the Department of Health, UKTI and the NHS Commissioning Board.

[Baroness Gardner of Parkes]

Can the Minister tell me whether, with the establishment of Healthcare UK, there is a danger that some areas of this country might be advantaged at the expense of other areas of this country?

[Earl Howe]

My Lords, we are determined that that should not happen. We recognise that the whole of the UK healthcare sector, both private and public, has a great deal to offer internationally. This does not just apply to a few elite organisations. We want to support any NHS organisation that wants to work internationally by helping it to build its capacity and capability to do so. We also want to help industry. In doing that, I stress that we view it as of paramount importance that any work undertaken in no way harms or compromises the quality of patient care here in the UK.

Health: Healthcare Assistance

Baroness Gardner of Parkes Excerpts

Wednesday 13th February 2013 Lords Chamber

[Earl Howe]

My Lords, we have made it clear that each and every one of Robert Francis’s recommendations will be considered extremely carefully, including the recommendation in relation to healthcare assistants. However, it is worth noting that while the Health and Care Professions Council has signalled some potential limitations to a statutory regulator holding a voluntary register, and we take account of that, nevertheless that does not mean that these potential limitations would apply to other organisations wanting to set up a voluntary register. Our view is that that avenue should be explored. The HCPC also flagged up some major limitations in attempting to regulate healthcare assistance. Those messages bear thinking about.

[Baroness Gardner of Parkes]

I ask the Minister again—I have asked him this so many times—whether he will ask the Nursing and Midwifery Council to look again at some intermediate training level, which I think is sadly needed since the abolition of the SENs, for which you could qualify without having to have academic university entrance.

[Earl Howe]

My Lords, the policy on nursing is clear: there is general acceptance that nursing should be a graduate profession. The problem with giving responsibility to the NMC for healthcare assistance is that that is not currently within its remit, and I think it would say that it has enough on its plate to deal with, without that added dimension as well.