Carers: In Sickness and in Health

Baroness Gardner of Parkes Excerpts

Wednesday 11th July 2012 Lords Chamber

[Earl Howe]

I shall have to ask the noble Baroness to be patient for a few more minutes regarding the Statement I am about to make. However, I can tell her that the White Paper and the draft Bill will make a reality of our vision for transforming care and support both for carers and for the people they look after. As for the noble Baroness’s first point, she is absolutely right to flag this up as a concern. In the last financial year, we provided funding of almost £1 million to the Royal College of General Practitioners, Carers UK and the Carers Trust to take forward a range of initiatives, of which I am sure she will be aware, to increase awareness in primary healthcare of carers of all ages, including better training for GPs, and also to look at how we can build on that for the future with the medical colleges and nursing organisations and in hospitals and community health services. The NHS Health Check programme could be a very important ingredient in making sure that the health of carers is monitored and taken fully into account.

[Baroness Gardner of Parkes]

The Minister is aware of the great debt that we all owe to carers, particularly family carers. Can he assure me that respite care for those people, or those for whom they are caring, will be possible and will continue? It makes a very big difference if people can have even a small respite break.

[Earl Howe]

My noble friend is quite right. My department has allocated an additional £400 million to the NHS over four years, 2011 to 2015, to provide carers with breaks from their caring responsibilities. The 2012-13 NHS operating framework makes it clear that PCTs, local councils and local voluntary organisations should work together on plans to support carers. Those plans have to be published by 30 September at the latest. They must make clear the amount of money to be made available to support carers and separately identify the amount to be made available for carers’ breaks.

NHS: Definition of Exceptional Case

Baroness Gardner of Parkes Excerpts

Monday 2nd July 2012 Lords Chamber

[Earl Howe]

My Lords, under the NHS Constitution, all patients have the right to an individual review of a decision not to fund a particular treatment if they and their doctor believe that it would be appropriate. They also have the right to an explanation of the basis of the decision. The commissioner must in turn have a process to enable such individual funding requests to be considered, so the watchwords here are transparency and publishing an explanation.

[Baroness Gardner of Parkes]

Does the Minister agree that there are other decision-making bodies? I refer in particular to the UK National Screening Committee. Is he aware that, probably correctly, it makes its decisions only on research results? Why does it claim that it does not have the money to spend on research into Streptococcus B infections, when international research shows a clear choice for screening as opposed to risk assessment? That change that has been made in other countries has resulted in reductions of strep B infections in children of 80% in the USA, 60% in Spain, 82% in Australia and 71% in France. The screening of pregnant mothers could prevent that very serious condition, which can be fatal, being passed to a small number of babies.

[Earl Howe]

My Lords, the UK National Screening Committee advises Ministers and the National Health Service in all four UK countries on all aspects of screening policy, including for group B Streptococcus carriage in pregnancy. The committee is currently reviewing the evidence for screening for that condition in pregnancy against its criteria. It will take into account the international evidence and a public consultation on the screening review will be opening shortly.

NHS: Dental Care

Baroness Gardner of Parkes Excerpts

Tuesday 26th June 2012 Lords Chamber

Asked By

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government how many dentists are now providing NHS dental care under the general dental services contract introduced in 2006; and what is the annual cost of the care provided and the amount generated in patient charge revenues towards funding this care.

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

My Lords, the latest figures published by the NHS information centre show that 22,799 dentists provided NHS primary dental care in 2010-11. The net allocation for primary dental care in 2010-11, the latest year for which figures are available, was £2,200 million. Patient charge revenue for 2010-11 was £617 million.

[Baroness Gardner of Parkes]

It is good to have the updated figures, but is the Minister aware that the two major concerns for patients now are transparency and availability? Availability is something that we look to the health service to provide. However, the transparency issue has become very important, not only to patients but to other dentists, who are very dissatisfied that dentists are able to put up notices saying, “National Health Service treatment available”, yet after a patient goes to them it emerges that the treatment is very limited. Does the Minister not think that, in the interests of warning the consumer, the present NHS fee charts should show that conditions may apply?

[Earl Howe]

My Lords, I absolutely agree with my noble friend about the importance of transparency of information for NHS patients. NHS Choices, which is the department’s public-facing website, already displays a lot of information about fees, the treatment that should be received and how to make a complaint about NHS dentistry, but more work is being done in this area to improve information on patients’ ratings of different practices, and we are updating the patient leaflet as well. What a dentist should not do is mislead a patient or induce a patient to access the surgery and then not provide the treatment that the patient thought they were going to get. If they cannot provide NHS treatment for whatever reason, they should point the patient in the direction of a practice that can, or else refer him or her to the primary care trust helpline.

NHS: Public Information and Advice

Baroness Gardner of Parkes Excerpts

Tuesday 12th June 2012 Lords Chamber

[Earl Howe]

My Lords, I share the noble Baroness’s concern. She has highlighted a major area on which Public Health England and local authorities will wish to focus going forward. This is the great advantage of the architecture that we have put in place, with health and well-being boards responsible for determining local needs and the way in which to address them. Public health awareness campaigns have their place but they are not the total answer. The noble Baroness has drawn attention to the importance of having sufficient treatment facilities, and access to them, available. So, with the support of Public Health England at a national level, local authorities should be addressing sexual health as one of their key areas.

[Baroness Gardner of Parkes]

My Lords, as the Minister has said, the situation is constantly being evaluated. Has he looked into the recent problems of patients who cannot see displayed the costs for National Health Service dentistry procedures? Would it not be a good idea to set up an online application so that patients can see the information for themselves, with a simple form to fill in that lets them know what they should be paying before they go? That would remove all the arguments about whether or not there is a notice in the waiting room.

[Earl Howe]

My noble friend is right. Many dentists are good at conforming to the terms of their contract, which means making it clear to patients what it will cost them to have a particular course of NHS treatment. Other dentists, I am afraid to say, are less scrupulous. It is part of the contractual arrangement that dentists should be open on that score and it is an area to which we are currently devoting a good deal of attention.

Social Care: Legislation

Baroness Gardner of Parkes Excerpts

Monday 11th June 2012 Lords Chamber

[Baroness Gardner of Parkes]

My Lords, is the noble Earl telling us that the Bill will be only about funding? Following the point raised by the noble Baroness, Lady Pitkeathley, can he assure us that there will be some sort of new training for those who will be doing a job that is half-way between that of a carer and that of a nurse? By losing the SENs we have lost a very powerful and useful facility that can operate in the middle. Surely there is a need for someone to bridge the gap between health and social care.

[Earl Howe]

My Lords, my noble friend raises an important issue, and I am sure that there will be an opportunity during the Bill’s passage to debate the subjects to which she referred. The draft Bill will be published after the Government publish their White Paper and the progress report on funding, and the Bill will set out the legislative framework for adult social care in the future. I have no doubt that noble Lords will wish to raise issues pertinent to that.

NHS: Health Tourism

Baroness Gardner of Parkes Excerpts

Monday 28th May 2012 Lords Chamber

Asked By

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government what is the cost to the National Health Service of international health tourism, and whether the Home Office has consulted the Department of Health on appropriate assessments of likely health needs or conditions before issuing visas to visitors to the United Kingdom.

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

My Lords, estimated written-off debt for NHS treatment provided to chargeable overseas visitors in 2010-11 was £14 million. However, this will include debts for visitors requiring unexpected treatment as well as those actively seeking NHS treatment to which they are not entitled. On 21 May, the Home Office announced the introduction of pre-entry screening for tuberculosis for long-term migrants from countries with high TB incidence. The department and the Health Protection Agency worked with the Home Office to review current arrangements.

[Baroness Gardner of Parkes]

That is a considerable increase. In his Written Answer last year, the noble Earl gave the figure for the previous year as under £7 million, so the amount has doubled. I do not know whether the £14 million includes the previous £7 million, but obviously the amount is growing. In the same Written Answer, he said that the Home Office was now consulting. On screening—for TB, for example—does the visa application ask applicants to declare any pre-existing medical condition, as is the case in many overseas countries?

[Earl Howe]

My Lords, the Home Office, with our agreement, drew up a list of high-risk countries where TB was prevalent. In those countries, if someone seeks a visa to come to this country for six months or more, they will have to undergo TB testing. Questions on other medical conditions are not relevant in this context. We do not screen for other things. TB is an exceptional case because it is an airborne disease and poses a public health risk.

NHS: General Practitioners

Baroness Gardner of Parkes Excerpts

Wednesday 23rd May 2012 Lords Chamber

[Earl Howe]

The noble Lord raises a central issue that is certainly a major part of the Government’s programme—to shift services in general out of acute settings, where appropriate, and into the community. We expect that clinical commissioning groups will wish to engage with health professionals from across the full range of disciplines to design care in better ways, and in particular to ensure that the shift goes on. The noble Lord mentioned patient input, which is another key responsibility of clinical commissioning groups—and a legal duty that we made sure was in the legislation.

[Baroness Gardner of Parkes]

Will the Minister tell me the position on homeopathic medicine? I had a lot of letters this week from patients who were concerned that they might no longer be able to benefit from it, and from GPs who practise homeopathy.

[Earl Howe]

My Lords, the Government have laid down no bar on homeopathic medicine. The prescribing of homeopathic remedies is very much a matter of clinical judgment and we would not wish to fetter that.

Health and Social Care Bill

Baroness Gardner of Parkes Excerpts

Wednesday 29th February 2012 Lords Chamber

[Lord Colwyn]

My Lords, I support everything that the noble Lord, Lord Hunt, has said and declare an interest as vice-president of the British Fluoridation Society. I believe in the efficacy of the fluoride ion, and during my own dental career have seen the beneficial results of this public health measure.

I do not want to repeat what the noble Lord, Lord Hunt, has said, but the Government envisage that, in future, local authorities will be the bodies that consult on fluoridation and decide whether to introduce and maintain a scheme. The issue is about funding for existing schemes and for possible future schemes. The Bill as it stands would mean that on 1 April 2013 the money currently spent by the NHS on existing schemes would pass to local authorities, which would then have to pass it on to the Secretary of State via the new organisation, Public Health England, to pay the bills presented by water companies. This would be a complex, bureaucratic process. If, for example, the money got stuck somewhere, the water company affected would quickly get fed up and stop fluoridating. How much smoother and quicker it would be if the money that the NHS is currently spending went directly on 1 April 2013 to the Secretary of State and Public Health England. This would mean that the organisation that will actually pay the bills will have the money in its account and not be reliant on local authorities transferring it.

The Bill as it stands also means that if any of the new schemes are ever voted for by local authorities when they take charge of consultations on fluoridation, the Secretary of State will look to them to pay for those schemes. Yet local authorities are not responsible for dentistry and have no dental budget. So where would they get the money from? In all probability they would not get it and, as a result, no new schemes would ever be implemented. This amendment means that, although the local authorities will be the decision-making bodies in future, the money for any fluoridation schemes that they support will come from the dental health services budget of the NHS Commissioning Board, the body that stands to benefit from the reduced treatment costs that would follow. The NHS Commissioning Board would transfer funds to the Secretary of State, who would pay the bills submitted by the water companies. I may have got this wrong, but I would be delighted to hear what my noble friend the Minister has to say.

[Baroness Gardner of Parkes]

Everything that needs to be said has been said; I thoroughly approve of this amendment and ask the Minister to note my support as a former dentist.

Organ Transplantation

Baroness Gardner of Parkes Excerpts

Monday 27th February 2012 Lords Chamber

Asked by

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government how they intend to reduce any waste of organs for transplantation arising from inadequate co-ordination of the process and the extent of out-of-hours and weekend services.

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

My Lords, the National Organ Retrieval Service—NORS—provides continuous 24/7 cover. I understand there have been two exceptional occasions when a NORS team could not be provided. Contingency arrangements enable other teams to stand in when needed or for local kidney transplant centres to be reimbursed for retrieving from kidney-only donors. NHS Blood and Transplant is also considering a tariff to fund National Organ Retrieval Service teams willing to provide additional cover.

[Baroness Gardner of Parkes]

Can the Minister confirm for me a statement that was made when I was chairman of one of the London teaching hospitals—that when you die your body is no longer your own? That is a highly significant point in the case of people who carry donor cards but whose relatives reject them. Can he also assure me that they will do something to ensure that when potential donors come to accident and emergency at weekends due to accidents, the retrieval team is alerted to the possibility that such organs—each of which is very precious to the recipient—may be available?

[Earl Howe]

My Lords, it is a well established principle of law that there is no property in a corpse. This means that, as a general rule, the law does not regard a corpse as property protected by rights. In other words, there can be no ownership of a dead body. However, the law does prescribe what may lawfully be done with the body of a deceased person. For example, a person can say while they are alive what they would like to happen to their body after death, such as donation of organs. My noble friend raises an extremely important point about A&E. The number of donors from A&E units is improving but it is generally recognised that it had to because performance was not good. Since 2007-08 there has been a 388 per cent increase in donations from emergency medicine, which is good news, but there is much more that could be done. The transitional steering group that we have set up under the chairmanship of Chris Rudge is looking at that area as a priority.

Health: Neurological Conditions

Baroness Gardner of Parkes Excerpts

Monday 27th February 2012 Lords Chamber

[Baroness Gardner of Parkes]

Has the Minister seen the reports in the newspaper today about the worry that people have about the shortage of medication for those with Parkinson’s disease, for example? Is it a worry more in the press than in reality? How can the Government ensure adequate supplies of necessary medication for these cases?

[Earl Howe]

There have been shortages of certain medicines over the past two or three years for a number of reasons; there is not a single reason. The Department of Health is working with the medicines supply chain established under the previous Government, and is doing very effective work. It is liaising with manufacturers, wholesalers and the pharmacy trade to ensure that medicines are available when needed. I have not seen the article to which my noble friend refers, but we are not of the view that there is any need for undue concern. However, we are keeping the position under review.