NHS: Waiting Times

Baroness Hussein-Ece Excerpts

Tuesday 3rd May 2011 Lords Chamber

[Earl Howe]

My Lords, the noble Baroness is right to raise the question of consultant numbers. I simply say that one of the clinical indicators that we have set for A&E is that there should be consultant sign-off. That in itself should encourage consultant capacity over time.

[Baroness Hussein-Ece]

My Lords, attendance at A&E has steadily gone up by more than 1.3 million over the past five years. How much is this the result of the lack of access to GP out-of-hours services? Is it not the case that too many people are presenting at A&E who should be seen at a primary care setting?

[Earl Howe]

My Lords, I agree with my noble friend completely. That is why we are quite clear that general practitioners have to take much greater direct responsibility for out-of-hours care. At the moment they can, if they choose, divorce themselves from that responsibility and I think that was a retrograde move. Equally, we are clear that we should encourage general practitioners to look at ways of avoiding unplanned emergency admissions to hospital in the first place. That will reduce pressure on A&E.

Health: Influenza Vaccination

Baroness Hussein-Ece Excerpts

Thursday 20th January 2011 Lords Chamber

[Earl Howe]

My Lords, the main lesson is one to which I referred a minute ago. We are considering bringing back into central procurement the purchasing of the seasonal flu vaccine, which is an exception to the normal rule. We purchase most vaccines centrally, apart from that one. There is a lot to be said for changing the ordering system so that we can keep better track of supplies and, perhaps, have more cost-effective procurement at the same time.

[Baroness Hussein-Ece]

My Lords, I read a report in the media last week saying that, in light of the high incidence of children under five contracting flu, the Government are preparing to examine new evidence from the advisory group that could allow for all under-fives to be vaccinated. Have the Government reached a view on this?

[Earl Howe]

We have not reached a view on this because the JCVI’s advice remains unchanged. In fact, current evidence shows that children under five are not the age group with the highest risk of death. The age group with the highest risk of death from the flu that is circulating currently is middle-aged adults. Nevertheless, those with risk factors have the highest risk of severe disease and death from flu compared with healthy age groups. However, I can tell my noble friend that nothing is set in stone. We do not wish to constrain the JCVI in any way and we will listen to its advice, as we always do.

Health: Influenza

Baroness Hussein-Ece Excerpts

Tuesday 11th January 2011 Lords Chamber

[Earl Howe]

My Lords, it is quite difficult to substantiate that suggestion, because the immunisation figures do not bear out the noble Baroness’s argument. The level of vaccine uptake in the over-65s is 70 per cent, which is better than in most countries of Europe. Among the at-risk under-65s, it is 45.5 per cent, which is comparable to the past two years. Therefore, it is not clear that a generalised campaign would have added value.

On the question of pregnant women, the normal procedure is for the Chief Medical Officer to write to all GPs in the summer, setting out all the at-risk groups. She did that in June. We were then alerted in December by the Health Protection Agency to a worryingly high number of pregnant women who had contracted influenza, so we wrote to both the BMA and the Royal College of Midwives to emphasise the desirability of encouraging that group of patients to get vaccinated. We did the right thing, which was to respond to emerging data.

[Baroness Hussein-Ece]

My Lords, is it the case that the highest rate of flu has been among those aged one to four? Have the parents of children in that age group been encouraged to have their children vaccinated over and above others? Also, have the Government changed their policy of publicising the need for the flu jab, which they did during last year’s outbreak?

[Earl Howe]

We did see a higher than expected number of under-fives contracting influenza, so we took urgent advice from the Joint Committee on Vaccination and Immunisation in December and asked it to confirm its previous advice that not all under-fives need get vaccinated unless they were in an at-risk group. It confirmed that advice and we have followed it.

Health: Parkinson’s Disease

Baroness Hussein-Ece Excerpts

Monday 10th January 2011 Lords Chamber

[Baroness Hussein-Ece]

My Lords, I congratulate the noble Baroness, Lady Gale, on securing the debate. I also pay tribute to the tireless work that she has done in chairing the All-Party Parliamentary Group for Parkinson’s Disease, which is a disease that, like other long-term conditions, can have a devastating impact on patients and their families. As we have heard, one person in every 500 has Parkinson’s, which equates to about 120,000 people in the UK.

Like those who suffer from other progressive neurological conditions, Parkinson’s sufferers and their families are entitled to a standard of care and treatment no matter where they live in the UK. When the national service framework for long-term neurological conditions was published in 2005 after considerable consultation with patients and groups, the framework was very much welcomed because it set out 11 quality standards with the aim of reducing differences in the treatment, care and support for people with long-term conditions—including Parkinson’s disease—to ensure that their care is more accessible and better co-ordinated.

The national service framework applies to health and social care services that work with local agencies involved in supporting people to live independently. Such services include providers of transport, housing, employment, education, benefits and pensions. When the framework was first published, a main target was to reduce emergency bed days by 5 per cent by 2008 through improved care in primary and community settings for people with long-term conditions. As we have heard, there are places in the country where the target has been met successfully—for example, in north Devon, the provision of a Parkinson’s nurse has helped to reduce emergency admissions by 66 per cent—but that has not happened in other places. Will the Minister perhaps comment on the accessibility of such specialist nurses around the country?

Patients with Parkinson’s disease continue to suffer delays in diagnosis and in access to specialist treatment because of appalling gaps in NHS care, as the All-Party Parliamentary Group for Parkinson’s Disease report mentions. The report also found severe inequalities in access to services across the country. At the time, there was a chronic shortage of specialist nurses. The report blames Ministers and health service managers for a lack of leadership on neurological services at national and local level.

Another concern is about access to appropriate services for people living in care homes and for black and minority ethnic groups. Does the Minister have any evidence to suggest that the situation for such people has improved?

In June 2006, the National Institute for Health and Clinical Excellence issued implementation advice to accompany clinical guidelines on diagnosis and management in primary and secondary care settings, in particular for primary care trusts and acute trusts. The advice also set out what support is available to help people with a condition to cope and how to plan for the future, with aims such as establishing individual care packages, establishing lines of communication, building support for the patients and looking out for any complications.

On care plans, which I think are very important, my previous experience from working in the NHS was that many patients were not really aware that the care plan belongs to them—they own it—and that they should have a copy of it. They should be able to take it home and share it with their families and relatives, but that is not always the case. Given that people are now living much longer with these long-term neurological conditions—indeed, people are living longer generally and are therefore more prone to developing such conditions—are care plans being reviewed to take that into account? Are care plans updated regularly? A patient’s needs and conditions will change and vary quite radically over the years, but the care plan might not always be updated to reflect that. That is one of my concerns.

Other problems cited by the all-party group’s report include poor access to therapy services, which has already been mentioned, and a lack of information for patients about what services are available. The limited provision of respite care is also an issue.

The NICE guidelines set out the importance of access to occupational health services and other allied health professionals. The key principle must be that it is important to treat the patient rather than just the condition because everyone is different and everyone has different circumstances. By doing that, we could prevent unnecessary deterioration and thereby reduce the burden on the health and social care system. Is the Minister satisfied that, in line with the NICE guidelines, patients have access to the full range of services, regardless of their postcode?

Finally, I pay tribute to Parkinson’s UK, which has been at the forefront of campaigning for greater research and information on the disease and on treatment and therapies for patients living with Parkinson’s disease.

People with Parkinson’s disease deserve the right to access the essential services that they need, notwithstanding the inevitable budget cuts and other restraints on local authority budgets. There are concerns that the eligibility criteria will be tightened in some councils, as has already happened over the years, and that the criteria will differ from council to council. Does the Minister agree that standards should be set for such eligibility criteria, given that it does not seem fair that the criteria for people living in one borough might be tightened to a greater extent than in another borough next door with the result that people might not be entitled to the level of support in social care services on which they rely?

Blood and Blood Products

Baroness Hussein-Ece Excerpts

Monday 10th January 2011 Lords Chamber

[Earl Howe]

My Lords, the noble Lord, Lord Morris of Manchester, to whose efforts I pay particular tribute in the context of this debate, as in many other contexts, has reminded us of the devastating effect of this tragedy on individuals and families. The previous Government recognised this and significantly improved the payments that were available to the victims of this disaster. We felt that there was still further to go, hence today’s Statement. We have arrived at this point following a brief but nevertheless thorough review of the arrangements, informed by a scientific report which is also published today—noble Lords can read the advice that we received—to enable us to understand rather better the suffering that these victims endure in clinical terms as well as in human terms. On the basis of that, we have arrived at the arrangements whose details I have repeated.

We believe that this is a fair and reasonable package of support for these poor victims. We do not intend to revisit it in the future. I acknowledge that some people might have different views on the appropriate level of payments for this patient group, but the package needs to be considered in the context of the whole range of support that is available for the group, especially Department for Work and Pensions benefits, the care available under the NHS and the care available from social services. Having consulted widely, we consider that the sums announced in this package, taken in the round with the other support available to this patient group, are both appropriate and reasonable. So, while I understand the noble Lord’s request, I am not in a position to accede to it at this point.

[Baroness Hussein-Ece]

My Lords, I congratulate my noble friend the Minister on the package announced in the Statement today. We very much welcome both it and, as the noble Baroness, Lady Thornton, said, the huge progress that has been made. Given that the commitment to review the current arrangements was made just last October, the Minister is to be congratulated on the swiftness with which this matter has been brought back to your Lordships' House. I hope that it serves to bring some comfort to those who have for so many years campaigned for justice, and particularly to the relatives of the deceased and the many other victims of this tragic episode.

The Minister announced that there would be a window for posthumous claims until the end of March 2011. There is concern that that is not a very big window and that it does not offer a lot of time to locate people and, for the many who may need assistance, to put a claim together. Perhaps the Minister can say why it is such a small window. Is he satisfied that it is sufficient time in which to track down as many people as possible who may have lost out?

It is not quite clear from the Statement who will receive posthumous payments. Will widows, partners and children be included in the arrangements? I would appreciate clarification on those points.

Autism

Baroness Hussein-Ece Excerpts

Tuesday 7th December 2010 Lords Chamber

[Earl Howe]

The noble Baroness raises a very important point. We know from general practitioners that they feel an absence of knowledge and training in this area. We are talking to the royal colleges about this.

[Baroness Hussein-Ece]

My Lords, how will the Minister ensure that the guidance ties in with the reforms to the NHS, for example, ensuring that the NHS bodies have due regard to any quality standards on autism that will be produced by NICE?

[Earl Howe]

My Lords, when the National Health Service commissioning board is established, it will have a duty to promote quality in the NHS. One way of doing that will be to utilise the quality standards produced by NICE, to produce commissioning guidance based on those quality standards and, in that way, to promote consistency of commissioning across the health and social care sector.

Department of Health: Arm’s-length Bodies

Baroness Hussein-Ece Excerpts

Tuesday 16th November 2010 Lords Chamber

[Earl Howe]

My Lords, we will obviously have an opportunity to debate these matters in Committee on the Public Bodies Bill, but I would just make a couple of general points. There are clear synergies between some of the functions performed by the HFEA, the HTA and the Care Quality Commission—they all license treatment. In addition, there is significant read-across to the potential scope of a new research regulator. All political parties at the election were agreed that we have too many of these bodies—too many quangos—and we have to reduce the cost of administration across government as a whole. We can debate at greater length the merits, and perhaps demerits, of the Government’s proposals. I look forward to that debate.

[Baroness Hussein-Ece]

My Lords, will my noble friend give an assurance that the necessary functions of these bodies will continue and, importantly, will they be more accountable?

[Earl Howe]

My Lords, the key point to make about our proposals around the HFEA and the HTA is that we are not proposing to change the functions or alter the provisions of the underlying statutes. All we are doing is proposing to transfer various functions in different directions. As for the independence of the advice, I see no reason at all why the current independence should not be maintained under the new arrangements.

Health: Diabetes

Baroness Hussein-Ece Excerpts

Thursday 4th November 2010 Lords Chamber

[Baroness Hussein-Ece]

My Lords, I thank the noble Lord, Lord Harrison, for securing this debate on a very important health issue, and I also pay tribute to him for the eloquent way in which he has shared his extensive experience and knowledge.

We all know of someone affected by diabetes. Those alarmingly high numbers of people who are more likely to develop type 2 diabetes are over three times more likely to go on to develop serious complications of diabetes which include stroke, kidney damage and heart disease. People living in deprived areas who are socially disadvantaged are two and a half times more likely to develop diabetes. They are more likely to have problems with late diagnosis and have poor lifestyles and poor care, which often compound the difficulties in managing their condition. That, of course, includes poor foot care.

The overwhelming evidence demonstrates that reducing health inequalities in deprived areas and for people from disadvantaged backgrounds, including those with mental illness, would almost certainly lead to more prevention and better management of diabetes. I want to talk about how this condition disproportionately affects people from black and minority ethnic communities, which was mentioned earlier.

Diabetes is increasingly recognised as a public health problem of potentially enormous proportions. This poses significant clinical and economic challenges for the NHS. According to UK studies, the prevalence of diabetes is significantly higher in some minority ethnic groups, which are six times more likely to develop diabetes. Figures suggest that up to 20 per cent of people from south Asian backgrounds and 17 per cent of people who are black African-Caribbean are living with type 2 diabetes, compared with some 3 per cent of the general population. I know from my own background that people from the Turkish community are also at greater risk of developing diabetes. Both my parents developed type 2 diabetes in later years and I confess that that has given me greater first-hand experience in caring for someone with diabetes and the importance, which I never realised before, of good foot care and healthcare generally.

Whereas within the general population type 2 diabetes usually occurs over the age of 40, people from black and minority ethnic communities can get it from the age of around 25. Getting treatment early can reduce the risk of developing complications such as stroke, blindness, heart disease and amputations. There are a number of factors why it impacts disproportionately on black and minority ethnic communities, which include genetic differences in how the body processes fat, but poor knowledge of services, poor housing and social deprivation are huge factors. I was pleased to read how in some parts of the UK with significant numbers of ethnic minority communities, the health services are responding and proactively working with organisations such as Diabetes UK to address some of these unmet needs.

For example, in the past few months NHS Haringey, in partnership with Diabetes UK, has developed the community champions training courses. People from minority ethnic communities, health trainers and religious and community leaders attend sessions about what type 2 diabetes is, who is at risk, signs and symptoms, myths and misconceptions—of which there are many—complications and the NHS services that are available. After qualifying, the community champions then spread the word about diabetes in their local communities by organising stands, talks and healthy-living days. To date, more than 30 community leaders, nutritionists and NHS health trainers in Haringey have qualified as diabetes community champions and they are keen to raise awareness at community events^. Several more training projects are planned in other parts of London. When I was working in the NHS in north London in the 1990s, projects on simple foot care such as nail clipping for older people were done at daycare and health centres. They were simple and cost-effective, and helped many vulnerable people with their foot care.

We know that prevention is often better than cure. That is why we need a more consistent public health strategy across areas with the greatest need and risk. Early diagnosis of those at greatest risk and better management would prevent the acute conditions that far too many people go on to develop, which result in greater risk to the individual and their families, the need for more intensive health services and hospital admission.

The problems are often not just about diagnosis, but about continuing care and managing the condition after diagnosis. Unfortunately, people from deprived backgrounds, including people from ethnic minorities, are less likely to have annual or regular health checks for blood pressure and cholesterol, for example, and, worryingly, many primary care trusts have not had strategies in place to deal with this.

I would like to see more consistent work to raise the profile of diabetes care within minority ethnic groups; strengthen leadership at national and local levels, particularly with GPs; improve practices and change general attitudes through the delivery and uptake of effective and appropriate training; and support a wider community development approach by going out into communities to listen to and involve people in the pathways of their diabetes care. The level and type of services should not necessarily rely on where you live or how involved your GP may be. There should be consistency and equal access to support and services regardless of your background or where you live.

Healthcare

Baroness Hussein-Ece Excerpts

Thursday 28th October 2010 Lords Chamber

[Baroness Hussein-Ece]

My Lords, I, too, will focus on what we mean by patient-led healthcare, which others have mentioned before me. In November 2005 a best-practice document called Now I Feel Tall: What a Patient-Led NHS Feels Like was published. It said:

“I strongly encourage all NHS organisations to take a close look at how they deliver their services and to ask their patients if their emotional needs are being met as well as their physical ones”.

It goes through what patients should look for. This includes,

“getting good treatment in a comfortable, caring and safe environment, delivered in a calm and reassuring way … having information to make choices, to feel confident and feel in control … being talked to and listened to as an equal; and … being treated with honesty, respect and dignity”.

The core and developmental standards for the NHS were set out in seven domains, the fourth of which is patient focus. It says:

“Health care is provided in partnership with patients, their carers and relatives, respecting their diverse needs, preferences and choices, and in partnership with other organisations … whose services impact on patient well-being”.

It therefore requires,

“healthcare organisations to have systems in place to make sure that staff treat patients, their relatives and carers with dignity and respect”.

Healthcare organisations must monitor their performance with regard to treating patients and carers with dignity and respect. The evidence has always been clear that if the NHS listens to what patients are saying, it can result in new ideas, better value for money and better care. How do you measure targets in an area such as patients being treated with dignity and respect, and being listened to, when trusts will point to the often relatively low number of complaints as a measure?

There have been numerous inquiries and other pieces of legislation setting out how to empower both individuals and communities in shaping health and social care services. Since community health councils were abolished in 2003—a great mistake in my view, and I declare an interest as I previously worked as the chief officer of a community health council—we have seen numerous attempts to make the NHS more meaningful and accountable. The establishment of local government overview and scrutiny committees with new duties went a long way to bringing accountability to healthcare services and in my view, as a previous chair of an overview and scrutiny committee, shone a welcome light into areas of healthcare services that had not previously been scrutinised. It brought about the need for greater partnership and collaborative working between local government and health. However, again, it relied on local PCTs and other healthcare trusts welcoming and being open to this scrutiny and accountability.

I welcome the Government’s plans to create local government health and well-being boards, but there have been problems on the ground in the way local government and the NHS have to work to bring about greater public and patient involvement in the NHS. In my own area, the local PCT last year took the decision to close a much loved and important health centre, in the most deprived part of the borough—the Finsbury Health Centre. The health and well-being committee scrutinised this decision in some detail and at considerable length, hearing evidence from patients, the public and clinicians. Eventually, after careful consideration, it presented its findings to the PCT, which fairly quickly rejected them. It found itself at loggerheads with the whole health and well-being committee, the council and the overview and scrutiny committee. It did not allow, for example, the chair of the committee to address or present its findings to the PCT board. As a result, the relationship between elected councillors and an unelected board of rather anonymous people, led by the chief executive, who had no accountability to the public, suffered. So, too, did local community confidence in the PCT.

People increasingly want to be able to exercise choice and control over their care. To do this it is clear that people must have the right to reliable information to help them make choices. Things have improved dramatically in some areas over recent years but what has not improved is the consistency across the NHS. My family’s experience of the NHS has been patchy. Three years ago my father spent seven weeks in hospital, suffering from terminal cancer. I saw at first hand how this 87 year-old man was gradually stripped of his dignity. While some of the nursing staff were enormously professional and provided excellent healthcare, others did not. He was not treated with the respect and dignity he should have expected. He was left in pain, with bed sores, little personal care, and alone on the floor after a fall in his room. This was a proud man, who would not leave the house without a shirt and tie, reduced to tears of humiliation just days before he sadly died. After my father’s death, I decided to complain formally about the senior member of nursing staff who had been so unprofessional to my father and my family. I was perhaps not surprised to learn that there had been a number of complaints about this individual, but none had been taken very far, due to the sheer difficulty, time and bureaucracy involved. This is not an easy time for families and carers.

I welcome the fact that patients will have more choice in terms of their GP. I hope the reforms will underpin not only greater choice but more consistency across healthcare services, so that people like my father have a better experience of the NHS.

[Baroness Northover]

I remind noble Lords that this is a time-limited debate. There is another important debate following ours. We need to give noble Lords in that debate the courtesy of being able to start and finish on time. I remind people that when the clock reaches four minutes, noble Lords have spoken for four minutes. There is also somebody who wants to speak in the gap.

Contaminated Blood (Support for Infected and Bereaved Persons) Bill [HL]

Baroness Hussein-Ece Excerpts

Friday 22nd October 2010 Lords Chamber

[Baroness Hussein-Ece]

My Lords, I am grateful to be able to contribute to this debate on this important Bill. Unfortunately, I see from recent debates in Hansard that this is a long-running and much debated issue that has not yet been concluded. More importantly, the victims and families affected have not had the justice that they deserve.

As a new Member of your Lordships’ House, I come to this matter with a fresh outlook, and have been surprised and disappointed at the apparent lack of urgency and what seems like prevarication over successive Governments and over the intervening decades in coming to a fair and just settlement. I pay tribute to the noble Lord, Lord Morris, and the noble and learned Lord, Lord Archer, for their tireless and exemplary work on this.

It is even more unfortunate, in my view, that a resolution was not arrived at in previous years, as the noble and learned Lord has just mentioned, when we did not face the economic pressures that we face today. The treatment of patients with contaminated blood has been described as one of the most tragic episodes in the history of the NHS; it has also been described as the “contaminated blood scandal”. It is hard to argue with either of these descriptions; through no fault of their own, patients were treated with contaminated blood products and many have subsequently suffered poor health, needing specialist help, treatment and support. Many more have sadly died. We also know that many have suffered, and are still suffering, exceptional hardship.

I was, however, a little heartened to read the public health Minister’s statement in the other place last week that, while ruling out a suggestion to match the compensation to those in the Irish Republic, as was mentioned earlier, she would look again at some aspects of the report of the noble and learned Lord, Lord Archer, and would report by Christmas this year. Although we know that this will disappoint many families and campaigners, at least it provides some movement and hope, and I welcome the review.

I feel that we have arrived at the last chance saloon, and that a resolution needs to be negotiated with the assistance of sufferers of hepatitis C, their families and carers and other interested parties. It cannot be right that we have such a disparity between sufferers who contracted HIV and those who contracted hepatitis C. We know that HIV has become a much more manageable disease than it once was, while hepatitis C is treated by a gruelling six to 12 months of antiviral therapy, which can have severe side effects comparable to chemotherapy and successfully clears the virus in only around 50 per cent of cases. We know that sufferers can develop cancer and other serious medical conditions.

As we heard earlier, many sufferers face continuing hardship and rely on handouts from charities. This is not sustainable or acceptable in the long term. For many, it means a lack of access to insurance, crippling prescription charges and a reliance on social care services, which have to be paid for, depending on their circumstances. Any form of compensation should be awarded on the basis of a needs assessment.

To pluck out one example, it seems very unfair that the dependants of those who died after 5 July 2004 can apply for support from the Skipton Fund only if the victim had applied to the fund before dying. This does not seem to take into account all the merits of each case. I hope that this can be looked at. I also welcome the intention to establish a proper appeal mechanism for those whose claims may be or have been rejected; that is very welcome.

Like others, I believe that it is the responsibility of the Government to address the needs of their citizens. It is a question not of blame but of doing the right thing—of ameliorating the ongoing suffering and distress. The added challenge in today’s climate is to achieve this within the economic constraints that we find ourselves in. Sufferers and families must be treated with decency and fairness. The many expressions of sympathy that we have heard over many years, and which I have read, have probably been welcome but will no longer pay the bills, offer support or address the exceptional hardship.

I welcome the review and support efforts to establish, within a limited period, a timetable to reach a conclusion to this matter. I hope that we are not going to wait another period of years until the matter resolves itself. The dwindling numbers of sufferers deserve our support; they deserve closure and justice.