Multiple Sclerosis

Baroness Gardner of Parkes Excerpts

Thursday 13th October 2011 Lords Chamber

[Lord Willis of Knaresborough]

My Lords, one of the great problems—

[Baroness Gardner of Parkes]

My Lords—

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

I know that my noble friend has been trying to get in and I think that we should let her.

[Baroness Gardner of Parkes]

My Lords, I declare an interest in that I have a daughter who has had MS for 30 years. Recent research announced in Russia indicated that they believe they are developing an answer to rebuilding the myelin sheath, which would be great progress in multiple sclerosis treatment. Can the Minister assure us that when that research is available we will follow it here and introduce it at the earliest possible time?

[Earl Howe]

My Lords, new and innovative treatments for MS are being developed in a number of countries. It is quite clear that any new treatment of this kind should be subject to the rigours of the regulatory system before it is made available to NHS patients. Many of them will not have been fully tested to ensure efficacy and safety, but we will of course examine every novel and innovative treatment that has the potential to benefit patients.

Health: Diabetes

Baroness Gardner of Parkes Excerpts

Thursday 14th July 2011 Lords Chamber

[Earl Howe]

I have already mentioned the Change4Life programme, which is designed to raise awareness across a number of public health areas, including obesity and overeating. I think also of the Healthy Schools programme, which instils the need to eat healthily and take exercise in youngsters at an early age. As the noble Lord will know, there is no magic bullet for the problem of obesity. It is something that must be addressed in a variety of ways through public health programmes and general practice.

[Baroness Gardner of Parkes]

My Lords, does the Minister agree that foot ulceration precedes 85 per cent of amputations? A study in Southampton showed that, by keeping people in hospital and treating them well through preventing foot ulcers, over 36 months not only did patient outcomes improve but the National Health Service saved £1.2 million in in-patient time.

[Earl Howe]

My Lords, I am grateful to my noble friend. I have an astonishing figure in my brief. On average, 73 amputations of lower limbs occur every week in England because of complications to do with diabetes. It is estimated that, with the right care, 80 per cent of amputations carried out on patients suffering from diabetes would be preventable. That is the scale of the challenge. We are clear that this is a major issue for diabetes. NICE has published guidelines on in-patient management of people with diabetic foot ulcers and infection. That is vital because amputations are often preceded by ulceration. That is also why the national clinical director for diabetes considers diabetic foot care and prevention to be a major priority.

Abattoirs

Baroness Gardner of Parkes Excerpts

Monday 11th July 2011 Lords Chamber

[Earl Howe]

My Lords, the agency has now proposed a stepped system of discounts. For the first 1,000 livestock units processed, the reduction on the full cost would be a maximum of 70 per cent. The next 1,000 livestock units would be subject to a 50 per cent reduction and the next 3,000 subject to a 25 per cent reduction. That will directly assist those smaller abattoirs, many of which are based in Wales.

[Baroness Gardner of Parkes]

I find it very unusual for the Minister who usually answers on health to be answering an abattoir Question, but I am very impressed by his knowledge. Can he tell us whether there is a health implication, whether the extra costs that were to be passed on were necessary for health and whether they will be continued to be carried out even if the costs are not being passed on?

[Earl Howe]

My Lords, there is no direct health implication. What has happened over the past few years is that the costs of regulation have progressively been borne by the Food Standards Agency, as opposed to the industry. There has been a decision taken in principle that the regulator should not subsidise the industry that it regulates. That is the reason for the review of the charging arrangements.

NHS: University Health Centres

Baroness Gardner of Parkes Excerpts

Monday 4th July 2011 Lords Chamber

Asked by

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government whether NHS university health centres are being disadvantaged by the weighting of the registered list size and the introduction of prevalence quotas for the quality and outcomes framework.

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

My Lords, no. Payments to practices are based on an agreed calculation of health need and on equitable funding. The funding formula recognises patient numbers, with adjustments for the characteristics of the patient population and practice circumstances. The disease prevalence formula in the quality and outcomes framework provides fair rewards to all practices, but with stronger incentives for them to identify and treat patients with the greatest health need.

[Baroness Gardner of Parkes]

My Lords, I thank the Minister for that Answer, but is he aware that, although some practices in university centres receive support from the university, others are linked to GP practices which run services as a separate contract? Many of those have looked into the finances and found that it is so disadvantageous to them that they are not considering renewing or extending their contracts to supply what I consider to be necessary services. What will the Minister do?

[Earl Howe]

My Lords, naturally, before preparing myself for this Question, I looked carefully into the way in which university practices are funded. The advice I received is that there is no reason to be concerned on that front. Many university GP practices are funded quite generously. Where they can lose out is over the quality and outcomes framework, which is targeted mainly at elderly patients with long-term chronic conditions, so it is not surprising that university campus practices do not earn the extra money that they could. Nevertheless, we believe that there is no case for making an exception for university practices in the way that they are funded.

NHS: Health Improvements

Baroness Gardner of Parkes Excerpts

Wednesday 29th June 2011 Lords Chamber

[Earl Howe]

My Lords, where it is deemed appropriate to commission a service at scale but below the level of the NHS commissioning board, as I described in my original Answer, it will be open to clinical commissioning groups either to establish a lead group to take control of the commissioning and to agree budgets and pathways or for clinical commissioning groups to collaborate jointly. The advantage of the system that we are proposing is its flexibility. Depending on population size and the needs of an area, commissioning can be done at several levels.

[Baroness Gardner of Parkes]

My Lords, the Question was so difficult to understand that I thought it was about telemedicine. Does it cover the issue of reducing the number of accident and emergency services in London so that they are more equivalent to the stroke units, which, as the noble Baroness said, have worked so well? Many people say that fewer but more effective accident and emergency services would be better. On the other hand, is the Minister aware of the concern over the closure of the Royal Brompton’s heart section for children, which is essential to the future of that hospital?

[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.

Health: Hepatitis C

Baroness Gardner of Parkes Excerpts

Monday 20th June 2011 Lords Chamber

[Earl Howe]

The noble Lord is quite right that generally speaking there is no problem about using human tissue samples for research purposes where those samples are anonymised. In other circumstances, of course, the Act demands that the principle of consent should apply.

[Baroness Gardner of Parkes]

My Lords, obviously there is no general screening programme for hepatitis, and we appreciate the severity of cases such as that involving contaminated blood, which has just been referred to, but can the Minister explain what an ordinary person should be looking for before submitting themselves for screening? It must be advantageous to have such conditions diagnosed early rather than late.

[Earl Howe]

My noble friend is absolutely right that early diagnosis is always a good thing for this condition as it is for many others. We know who the risk groups are, and therefore the important thing is to target screening and testing at those groups. Predominantly, the at-risk groups are injecting drug users or former injecting drug users; they account for well over 80 per cent of cases of hepatitis C. Those groups are the focus of our efforts in primary and community care, and especially in prisons.

Health: Multiple Sclerosis

Baroness Gardner of Parkes Excerpts

Tuesday 7th June 2011 Lords Chamber

[Earl Howe]

My Lords, I am aware of those reports. We have received concerns from most, if not all, of the neurological patient groups, as the noble Lord mentioned. He might like to know, however, that to help trusts develop specialist nursing roles, the department published some time ago a guidance document, Long Term Neurological Conditions: A Good Practice Guide to the Development of the Multidisciplinary Team and the Value of the Specialist Nurse. That was created in conjunction with a number of healthcare charitable organisations. It outlines why services for neurological conditions are important, it shows the importance of those multidisciplinary teams, and it clarifies the contribution of specialist nurses.

[Baroness Gardner of Parkes]

What is the position when a specialist nurse for MS or any other condition—I declare an interest as I have a daughter with MS—leaves a hospital and the hospital decides that it is not recruiting any more people? I know that local providers are independent, but can the department give some sort of guidance that specialist nurses should not be overlooked when they replace staff and that they should consider the special role that they have carried out?

[Earl Howe]

My noble friend makes an important point. The guide that I have just referred to in answering the noble Lord, Lord Walton, emphasises the important role of specialist nurses in the care of patients with neurological conditions. However, the key in the future will be better commissioning at a local level joined with better workforce planning at a provider level. If those charged with training and workforce planning tap into the commissioning plans that commissioning consortia determine, we will have a genuinely joined-up system that is also informed by the patient’s point of view.

NHS: Chiropody and Podiatry Services

Baroness Gardner of Parkes Excerpts

Tuesday 26th April 2011 Lords Chamber

Asked By

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government what plans they have to ensure the continuing provision of training and practice in chiropody and podiatry services under new commissioning consortia and the National Commissioning Board.

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

My Lords, it is the responsibility of local National Health Service organisations to commission services to meet the needs of their community and the education and training necessary to deliver them, including the provision of chiropody and podiatry services. This will continue in the future.

[Baroness Gardner of Parkes]

I thank the Minister for that reply. Does he share my concern that GP consortia may lack the necessary strategic overview to prioritise longer-term preventive care options and ensure future podiatric care? Can he further clarify whether Health Education England, or some other body, will have full responsibility for seeing that adequate numbers of podiatrists and chiropodists are trained?

NHS: Reorganisation

Baroness Gardner of Parkes Excerpts

Thursday 24th March 2011 Lords Chamber

[Baroness Jolly]

My Lords—

[Baroness Gardner of Parkes]

Following the question from the noble Baroness, Lady Thornton, could I ask my noble friend more about this transfer? Does he recall that, in previous reorganisations of the health service, large numbers of people claimed redundancy payments and then got very favourable jobs afterwards? Does he not think that the six months that he mentioned as the claw-back period is probably not enough at a time when the health service is very stretched? Also, will he consider what the noble Lord, Lord Walton, said about reorganising some of those posts now to avoid that situation?

[Earl Howe]

My Lords, we are beginning to reorganise the system. Under current rules, we are enabled to do so. I understand my noble friend’s particular point about the claw-back arrangements but there is perhaps a countervailing argument over what is fair and unfair in redundancy arrangements. In that sense, one cannot push the issue too far. Having said that, we are on track with the retirement scheme. We are seeing a deliberate and carefully managed process of reducing staff numbers at primary care trust level, leading up to the clustering of primary care trusts, which I am sure my noble friend knows about.

Health: Sickle-Cell Disease

Baroness Gardner of Parkes Excerpts

Monday 14th March 2011 Lords Chamber

[Earl Howe]

The noble Lord is quite right. One of the successes in recent years has been the universal screening programme for sickle cell that has certainly raised awareness among all communities about this devastating condition. The screening programme alerts healthcare professionals to the needs of children with the disease and also enables them to provide the necessary support for families.

[Baroness Gardner of Parkes]

Do people who have sickle-cell disease carry any form of card or identification as people with various other conditions do? As a dentist, I know that the definitive test is a blood test. Patients told you they had it, but no one expected you to pick it out in some person coming in the door. I wonder whether there might be a case for having some kind of identification.

[Earl Howe]

I am sure my noble friend’s suggestion is a very good one. I do not think that the practice of carrying identification is by any means universal, but is it perhaps one that could be commended to the relevant patient groups.