Drugs: Prescribed Drug Addiction and Withdrawal

Baroness Jolly Excerpts

Thursday 23rd June 2011 Lords Chamber

[Earl Howe]

I agree with the noble Lord that it would be very nice to have a better handle on the numbers here, but the two reports found that nationally available data do not actually provide a definitive prevalence estimate of dependence on prescription and over-the-counter medicines, much as we would wish otherwise. The reports, not unreasonably, consider the full spectrum of need in relation to the issue of addiction. The key point here is that, while different people might start taking these medicines for different reasons and may present with a different range of needs, no one at all should be excluded from the treatment and support that they require. The reports distinguish between the two groups of patients, not just those who are dependent on prescription and over-the-counter medicines but also those who are dependent on illegal drug use. That enables us to make some useful comparisons.

[Baroness Jolly]

Cognitive behaviour therapy is often considered as an alternative to benzodiazepines. Does the Minister believe that that low-risk alternative might be available more readily through the proposed clinical commissioning groups?

[Earl Howe]

My Lords, my noble friend will know that we have set aside a very considerable sum of money over the spending review period to expand the availability of talking therapies. I entirely agree that it is an important avenue of treatment.

NHS: Chiropody and Podiatry Services

Baroness Jolly Excerpts

Tuesday 26th April 2011 Lords Chamber

[Baroness Jolly]

My Lords, in some parts of the UK it is not possible to train as a podiatric surgeon. Consequently, podiatric surgery is not widely available. Will my noble friend tell the House whether in England the Government are planning to encourage more centres for training appropriately qualified podiatrists, thus remedying the situation?

[Earl Howe]

My Lords, my noble friend makes an important point. She will know that there are universities that specialise in the training of chiropodists and podiatrists, and we place great reliance on them. What will emerge from the new architecture that is foreshadowed by the Health and Social Care Bill is a much greater sense of local prioritisation regarding needs. Flowing from that, with the advice and guidance of Health Education England, which will be the national body supervising workforce requirements, we may well see further centres of excellence in training emerging.

NHS Reform

Baroness Jolly Excerpts

Monday 4th April 2011 Lords Chamber

[Earl Howe]

That is a very interesting question. GPs should already be subscribing to the Nolan principles. They are attributes which they would wish to demonstrate in their working lives anyway—having said which, it is the responsibility of every public body to ensure that it takes account of the Nolan principles. Consortia will be public bodies, ergo they will have to take account of the Nolan principles.

[Baroness Jolly]

Would my noble friend tell the House whether any staff have already been seconded to the pathfinder commissioning consortia, as a result of the clustering of the PCTs?

[Earl Howe]

We are assigning particular staff to pathfinder consortia. Those staff will remain within the PCT clusters. They will not transfer officially to the consortia because the consortia are not officially in existence yet. The point here is to have staff who are dedicated to supporting the emerging consortia over the next few months. This is already in train.

Health: Neuromuscular Services

Baroness Jolly Excerpts

Wednesday 30th March 2011 Grand Committee

[Baroness Jolly]

My Lords, I should like to outline some issues around the treatment, care and quality of life of those with motor neurone disease, and then give an example of how the NHS in the south-west is dealing with Duchenne muscular dystrophy. I will conclude by gathering together points for my noble friend to consider in the context of research, NICE and commissioning these services in the new NHS.

Motor neurone disease is a disease of low prevalence but high need and very high cost. MND is a progressive neurodegenerative disease that attacks the upper and lower motor neurones. Their degeneration leads to weakness and wasting of muscles, causing increasing loss of mobility in the limbs and difficulties with speech, swallowing and breathing.

Perhaps I may tell the Committee about Patrick, an artist who was diagnosed in 2008 with MND. Patrick is determined to live a life that is as full as possible with his wife Kathy and three young children. He said:

“I have found out first hand what MND does to individuals and their families. I am gutted that I won’t get to see my children grow up. It’s like watching a great film and not being able to see the end. I want to help stop this. I want to get better care for me and my fellow sufferers and I want a cure. To do this we need to raise awareness and get more money for research. I will not get to see my daughter go to school and want to do anything I can to stop that happening to others”.

A salutary tale.

The rapid progression and wide range of symptoms mean that people with MND have complex and demanding care and support requirements. Someone with motor neurone disease may need as many as 18 health and social care professionals providing care at any one time—a complex care pathway and one that will differ from patient to patient. In the UK, the MND Association estimates that good care costs around £200,000 per person per year. However, where poor care results in crises and unplanned hospital admissions, this cost can easily double or even triple.

Fortunately, the numbers are low—around 5,000 in the UK, an incidence of around seven per 100,000. Here, I echo the call of my noble friend Lady Thomas: there is currently no national guidance for MND, and the MND Association is calling for the National Institute for Health and Clinical Excellence to produce a clinical guideline and a quality standard.

My noble friend Lady Thomas has spoken with personal experience of muscular dystrophy. In 2007 in the south-west of England, which is where I live and where 5,000 children and adults are living with muscular dystrophy, on average a young man with Duchenne would die at the age of 18—and that, compared with the average in the north-east of 30 years, was unacceptable. It was thanks to an effective campaign run by members of the public—families affected by this condition and parliamentarians—ably assisted by Muscular Dystrophy Campaign, that a south-west muscular dystrophy clinical network was set up. This was wonderful news for the families affected: it meant that journeys to Oxford or Oswestry for treatment—from Penzance, Cornwall or wherever— would be a thing of the past. This managed clinical network, set up by the south-west commissioning group, is making a huge impact across the peninsula, from Truro to Bristol to Exeter and Salisbury, providing three consultants, three and a half specialist physiotherapists, care advisers, a psychologist and extra support. It is seriously good news and costs PCTs in the region less than £9 per patient per month.

By setting up this service, its importance was recognised by the strategic health authority. Both motor neurone disease and muscular dystrophy Duchenne services will need expert commissioning. Smaller GP commissioning consortia will see very few of these patients from year to year. Motor neurone disease does not even figure on NICE’s radar. I would be grateful if the Minister could shed some light on how the proposed NHS Commissioning Board will deal with the commissioning of these services after NHS reorganisation. Would he also indicate the willingness of the Government to include motor neurone disease in NICE guidelines and indicate what levels of research support, and from where it might come, will be given to these organisations that work so hard for this small but important group of patients?

Health: Preventable Sight Loss

Baroness Jolly Excerpts

Tuesday 29th March 2011 Lords Chamber

[Earl Howe]

My Lords, the noble Lord makes some extremely important points. This is a good news story and very good progress has been made; more people with diabetes are being offered screening for retinopathy than ever before, and to higher standards. More people are being offered screening now than when the screening programme was announced in January 2003. At that time, 1.3 million people with diagnosed diabetes in England were being screened. The latest figures, for December 2010, show that 2.21 million people were offered screening.

[Baroness Jolly]

My Lords, given that sight loss will cost the economy £8 billion a year by 2013, will the Minister outline for the House the determining factors in extending free sight tests to all?

[Earl Howe]

My Lords, various categories of patients are eligible for free sight tests. Free tests are available under the NHS to a large number of people, including people aged 60 and over, children under 16 and people on low incomes. As I mentioned, the uptake of sight tests is increasing, which shows that people are continuing to get good access to NHS eye care services; but as regards an extension of the numbers, that will of course depend on available funding.

NHS: Reorganisation

Baroness Jolly Excerpts

Thursday 24th March 2011 Lords Chamber

[Earl Howe]

I am very grateful for the noble Lord’s question, because it gives me the opportunity to pay tribute to the skill and dedication of our managers and administrators in PCTs and strategic health authorities, whose skills we will most certainly need once the modernisation plans have been completed. We are clear that those who are able to provide these skills and can give us continuity into the new system are people we want to keep. We are encouraging them to stay and hope that they will. We are encouraging also the pathfinder consortia to engage with the PCTs to enable that to happen.

[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?

[Lord Patel]

My Lords, can the Minister say—

[Baroness Jolly]

My Lords—

[Noble Lords]

This side!

Health: Visitor Service

Baroness Jolly Excerpts

Monday 14th March 2011 Lords Chamber

[Earl Howe]

The right reverend Prelate draws attention to a very important area. Family Nurse Partnership is essentially a preventive programme for vulnerable young first-time mothers. It complements and supports the work of health visitors, providing intensive care. We are committed to expanding the Family Nurse Partnership Programme for those families and doubling the number of places on the programme by 2015.

[Baroness Jolly]

My Lords, this is a really large programme. Will the noble Earl clarify whether, if these posts are filled from within the NHS, those posts will in turn be backfilled?

[Earl Howe]

My Lords, we hope to recruit nurses and midwives for upskilling from a variety of sources. Some will come out of retirement, we hope, while others will, we trust, come from the acute sector. As my noble friend knows, the trend for a long time has been to try to get care increasingly out of acute settings and into the community. I think that we will see that transfer of skills taking place from a variety of sources.

Health: Alcohol Minimum Pricing

Baroness Jolly Excerpts

Tuesday 1st March 2011 Lords Chamber

[Lord Brooke of Alverthorpe]

My Lords—

[Baroness Jolly]

My Lords—

[Lord Brooke of Alverthorpe]

My Lords, now that the Minister and the Government have accepted that raising the price of alcohol is one of the ways in which we can minimise harm to those who are abusing alcohol, why have the Government’s recent proposals been so minimal? The cost of a can of lager will be increased, or minimised, to 38p under the new arrangements. This is hardly going to make any change whatsoever. We have to wait for the White Paper in the summer, but in the mean time why could a more positive approach to raising the cost of alcohol not have been taken and more fundamental changes made to the ever increasing easy access to alcohol, which is another problem that needs addressing?

Health: Multiple Sclerosis

Baroness Jolly Excerpts

Wednesday 2nd February 2011 Lords Chamber

[Earl Howe]

My Lords, at the moment, the appeal process is to the primary care trust. Under the Government's proposals, the appeal will be, in the first instance, to the GP-led consortium and, thereafter, if appropriate, to the NHS commissioning board.

[Baroness Jolly]

My Lords, medication is clearly critical for patients with MS, but a whole range of aids are also available. How does my noble friend think that those aids might be more readily available under the new, reformed NHS?

[Earl Howe]

Again, my Lords, the requirement for aids will emerge from two driving processes: one will be the clinically led commissioning process and the other will be patient-led groups. Neurological Commissioning Support is already driving forward an extremely coherent and up-to-the-minute commissioning pattern of pathways for the emerging GP consortia. Patient power will have a big influence as well.

NHS: Front-line and Specialised Services

Baroness Jolly Excerpts

Thursday 13th January 2011 Lords Chamber

[Baroness Jolly]

My Lords, I start by thanking noble Lords kindly for the warm welcome that I have found since my introduction on Tuesday—from Members opposite as well as from my own Benches. Advice about my speech was to keep it simple, but most of all to keep it short. I extend these thanks to members of staff who have been exceptionally helpful in all manner of ways. I must say that I am not without trepidation. My introduction by comparison was easy, as once in my robes I was but an actor. Today, I feel somewhat naked without them, particularly in such eminent company.

I live in Cornwall in a community of some six or seven houses overlooking Bodmin Moor. We have little choice in our services. We use them where we can find them and so rely on them all to be excellent, as the noble Lord, Lord Winston, said. Disappointment is rare. My sponsors, my noble friends Lord Tyler and Lord Teverson, have both left their mark on Cornwall, and I am delighted that today another friend of Cornwall was introduced—my noble friend Lord Marks of Henley-on-Thames. The bottom left-hand corner may be far away, but in this place it will not be forgotten.

I trained as a control engineer, taught maths for 15 years, and spent time living and working in the Gulf. On coming home, I joined an NHS trust board. Some years later, a couple of NHS reorganisations found me chairing a Cornish PCT and managing a budget of £120 million. Recently, I have been working for Macmillan Cancer Support, a charity dedicated to providing excellent services to those whose lives are affected by cancer, as well as for a campaigning organisation on issues as varied as fuel poverty and survivorship. It was difficult delivering services in such a rural environment, especially ensuring that services are linked as seamlessly as possible with our social services. Not a year went by when we did not have to find savings to be passed on to services.

In the past, my family has had brief engagements with the NHS, but it was not until last November when my father had a heart attack that I saw the NHS in action for real, for one of mine. One evening, he went to bed feeling unwell. We called NHS Direct. It called an ambulance, which was with us in 15 minutes. After a half-hour dash he was admitted directly to the South West Cardiothoracic Centre in Plymouth. His ECG had been e-mailed ahead by the ambulance crew and he was met by a team called in on a Saturday night. Led by Dr Haywood, his team was professional, caring and candid. The ward really resembled the bridge from the starship “Enterprise”, but it was here too that I heard talk of patient dignity and advocacy. My father mattered, as did my mother—a lady who will be 90 on her next birthday.

Cornwall still has a network of community hospitals that allows patients to be treated nearer their homes, relieves beds in the pressured acute units and prepares patients to return home. In time, at my local community hospital in Launceston, I saw at first hand social services working with the ward team, the physio and occupational therapists. The patient came first and together they got my Dad home. Sadly, the NHS was no match finally for age and frailty. He died one month ago today. We saw the NHS at its finest, from the highest of high-tech medicine to the best of nursing care, working seamlessly across four NHS organisations and social services.

In the PCT our decisions involved executive directors, non-executive directors and, most importantly, health professionals. We were committed to a comprehensive service that is available to all, free at the point of use and based on need and not on the ability to pay. We took into consideration local issues—rurality, sparcity, atypical demographics and huge population increases in the summer. We did not run or commission services in the same way in Cornwall as they are here in the capital.

In conclusion, the points made by the noble Lord, Lord Turnberg, are well made. I would add that in reframing the NHS, I trust that the noble Earl will give every care and consideration to service delivery and, more importantly, to appropriate and adequate funding for far-flung remote rural areas, such as Cornwall.