National Health Service

Baroness Pitkeathley Excerpts

Tuesday 17th June 2014 Grand Committee

[Baroness Pitkeathley (Lab)]

My Lords, there are few Members of your Lordships’ House who know as much as the noble Lord, Lord Crisp, about the NHS, so I am grateful to him for his focus on citizen and patient power—and indeed, carer power, which he mentioned, something with which I have been concerned for much of my working life. I declare an interest as the current chair of the professional standards authority, which prides itself on being patient-centred and public-centred and being a strong, independent voice for patients in the regulation of healthcare professionals throughout the United Kingdom.

However, I want to start with a personal experience about changes in attitudes to patient involvement. I started in the mid-1980s, when I was first diagnosed with cancer. A young registrar came to my bedside and, with no preparation whatever, told me that the tumour they had removed was cancerous but that I was absolutely not to worry because almost 40% of his patients made a full recovery. I gathered my wits and asked him what I could do to ensure I was in this 40% and he leaned across, patted my arm and said, “There is nothing you can do, my dear, just leave it all to us”. I think I got better to spite him.

Contrast that with my next experience in the early 2000s when, during a prolonged stay in hospital of over six months, nothing was ever done to me by doctors, nurses or therapists without seeking permission, asking if it was okay and what my view of it was. All right, you could say that that was about me being an assertive patient, which I am, and there not being many Baronesses on NHS wards. But, as far as I could see, the same respect and attempts to involve the patient were offered to every patient, regardless of their age, background or ability to communicate. Of course, the odd consultant swept in with an entourage and attempted to talk about me as though I was not there, but that was far from general. Therefore, my personal, as well as my professional and parliamentary experience, tells me that much progress has been made. I was very glad to hear the noble Lord, Lord Crisp, confirm that.

We all know about the reports that put patients first. We know their names and could write them in our sleep. We are all familiar with the phrases—patients first, patient at the centre, listen to patients and more patients. Yet patient involvement is not the same as patient power. “How far have we have really come?” is the question that we must ask ourselves, especially in the wake of the Francis report; patients manifestly had no power at all and those who blew the whistle on behalf of the patient—their carers and their families but not the professionals who should have been concerned—were not only not believed but ignored and vilified.

It is striking that, even with the emphasis we all embrace on patient-centred care, it is still on the whole the health professionals who lead and the patients who follow. That is in spite of the welcome growth in patients’ organisations in the voluntary sector, of which there are many, as your Lordships will know. I speak as a founder member of National Voices, which has made an important contribution in that regard.

The ideas as regards patient leaders were developed by two long-term service users, David Gilbert and Mark Doughty. They asked why patients cannot lead rather than always follow the professionals when it comes to power. With that in mind, they set up the Centre for Patient Leadership to give service users the skills and confidence to lead change and not just be the beneficiaries of it. We all know how disempowering it can be to be the only patient representative on a committee—we might say the token representative. Not only is there no one to support that representative, but they do not know how the committee will work. They would not have had any input to the agenda or any idea of what is expected of them, and so on. They would know that they are there to represent the patients’ interests but would not be sure whether to represent their own interests, those of groups of patients or those of patients with particular disabilities and so on. That is a very disempowering role in which we frequently put patients and their representatives.

However, patient leaders have developed the skills and confidence to lead change. They take control of changes and improvements in healthcare, and shape and help drive that change. They become real partners in care because they share power with professionals. I commend that approach because it helps both patients and professionals to see the benefits that can be gained in terms of patient care.

Power must go with responsibility. Patients must understand that they must keep their appointment times, must let someone know if they cannot attend and must take medication in the prescribed and agreed way. Giving patients power means professionals have to give some away. That is how the power balance works. We know that many are still reluctant to do that but there can be no let-up in our efforts to make progress in this area because of the benefits which can be gained, as the noble Lord, Lord Crisp, reminded us.

Finally, the noble Lord, Lord Crisp, tempted me to talk about carers. If you engage with carers and empower them, unbelievably, you get cost savings. All the research shows that they habitually ask for less support than the professional thinks is necessary. Progress towards that kind of empowerment makes very sound economic, as well as moral, good judgment.

Health: Transition to Adult Health Services

Baroness Pitkeathley Excerpts

Wednesday 11th June 2014 Lords Chamber

[Earl Howe]

The noble and learned Baroness is quite right, and as she well knows, this has been a long-standing issue. Our document, Closing the Gap: Priorities for Essential Change in Mental Health, which we published recently, identifies the transition from child and adolescent mental health services into adult services as a priority for action. We are supporting the work of NHS England to develop the service specification which I have just referred to. CCGs and local authorities will be able to use that specification to build excellent person-centred services that take into account the developmental needs of the young person, as well as the need for age-appropriate services.

[Baroness Pitkeathley (Lab)]

My Lords, problems arising at the transition stage are often reported by the parents of these young people because they are their carers. Does the Minister agree that standards of care must include support for those much-needed parent carers?

[Earl Howe]

I fully agree. I think that much of this will succeed only if services work together around the needs of young people as well as their families and carers, and if the families and the young people themselves feel involved in the way in which their care is being organised and planned.

Healthcare Professions: Regulation

Baroness Pitkeathley Excerpts

Tuesday 10th June 2014 Lords Chamber

[Earl Howe]

Yes, my Lords, we are working with the GMC to develop secondary legislation that will strengthen and protect the separation of the GMC’s investigation and adjudication functions by establishing the Medical Practitioners Tribunal Service in statute, as well as modernising the adjudication procedures, and to address a number of lacunas in the legislative framework. We are seeking to have the Section 60 order on the GMC’s fitness-to-practise processes in place before the general election.

[Baroness Pitkeathley (Lab)]

My Lords, I declare an interest—

[Lord Walton of Detchant (CB)]

My Lords, I declare an interest—

[Baroness Anelay of St Johns (Con)]

My Lords, there are many with an interest but it is the turn of the Opposition.

[Baroness Pitkeathley]

I declare an interest as chair of the Professional Standards Authority. The authority has already done preparatory work for the Department of Health on which changes to Section 60 orders would be in the interests of public protection and cost-effectiveness. Can the Minister say that the Government will take account of this work and the views of the regulators as they consider their next steps?

[Earl Howe]

My Lords, yes, I can give that assurance. In fact, there is a range of Section 60 orders that are at various stages of development, which we hope to introduce over the coming months.

NHS: Clinical Commissioning Groups

Baroness Pitkeathley Excerpts

Monday 9th June 2014 Lords Chamber

[Earl Howe]

I do agree with my noble friend, but I would point out to her that the thrust of the noble Baroness’s Question is about unpaid carers, of whom there are 5.4 million in this country, 1.4 million of whom work more than 50 hours a week as unpaid carers. It is to support those people that the attention of NHS England is being rightly directed.

[Baroness Pitkeathley (Lab)]

I thank the Minister for pointing that out and saving me having to do so. We are talking about so-called informal, unpaid carers in this Question. My noble friend’s Question has underlined how much progress is still to be made in bringing the needs of carers to the attention of local CCGs and health professionals. Will future versions of the carers strategy action plan address that issue?

[Earl Howe]

My Lords, yes. The action plan will of course be reviewed, as it needs to be, at regular intervals. I am sure that the noble Baroness will know that the action plan needs to be informed by the various legislative changes that we have recently made through both the Care Act and the Children and Families Act, both of which immeasurably strengthen the rights of carers and what they can expect from the system.

NHS: Mental Health Funding

Baroness Pitkeathley Excerpts

Wednesday 2nd April 2014 Lords Chamber

[Earl Howe]

I can only repeat what I already said to the noble Lord, Lord Hunt. We have expressed our dismay at ministerial level about that decision and will therefore scrutinise local commissioning plans to ensure that, if cuts are implemented and there is freedom not to do so, outcomes and access to services are not damaged.

[Baroness Pitkeathley (Lab)]

My Lords, there are three times as many deaths from suicide as from road accidents. The prescription of antidepressants went up by 10% last year and still only one-quarter of people with a mental illness are in treatment. Are the Government satisfied with the level of funding for preventive and psychological support services?

[Earl Howe]

This is the very reason that we have placed such emphasis on the IAPT programme, into which £400 million is going over the course of this Parliament. I am pleased to say that we are broadly on track to deliver a step change in access to those services.

Health: Local Healthwatch Funding

Baroness Pitkeathley Excerpts

Wednesday 19th March 2014 Lords Chamber

[Earl Howe]

My Lords, we will not have a comprehensive picture of the impact that local Healthwatch has made until it publishes its annual reports later in the year. At the moment, we have anecdotal reports of some considerable successes around the country, but until we have those annual reports, it would be premature for me to make a general comment.

[Baroness Pitkeathley (Lab)]

My Lords, it is surely disingenuous to think that local Healthwatch can properly represent the interests of patients—the Government made very strong commitments about that during the passage of recent health Bills—when it is being starved of cash. What discussions have been taking place between the Department of Health and the Department for Communities and Local Government to ensure that the money gets to the right place?

[Earl Howe]

I simply say to the noble Baroness that it is too soon to say whether local Healthwatch has been starved of cash. What matters most to local communities is the difference that their local Healthwatch is making, such as rooting out poor practice, ensuring that the views of local communities are heard in inspections and helping to improve local services. It is only after a period of time that we can make the relevant judgments. I can tell the noble Baroness that Healthwatch England is playing the role that it was designed to do: overseeing and supporting local Healthwatch where necessary.

Health: Multiple Sclerosis Nurses

Baroness Pitkeathley Excerpts

Wednesday 5th March 2014 Lords Chamber

[Earl Howe]

I have already mentioned the NICE guidelines, which we expect NHS professionals to take account of. In that context it is worth saying that the guidelines are due to be updated later this year, and patients and patient groups will have the opportunity to feed into that. However, in the end it is up to local healthcare organisations, with their knowledge of the needs of their local populations, to determine the workforce required to deliver safe and effective patient care within their available resources.

[Baroness Pitkeathley (Lab)]

My Lords, given what the Minister has said about the variations, can he explain a bit more about the tremendous regional variations in the numbers of patients who have access to an MS nurse, because this causes great confusion to patients and their families? For example, I understand that in the east of England there are 220 patients per MS nurse, whereas in the north-west there are as many as 650.

[Earl Howe]

I am aware of those variations. Making the NHS more responsive to the needs of people with long-term conditions such as MS is a key government priority. We have committed to it in the NHS mandate, the NHS constitution and the outcomes framework. Strategic clinical networks have a key role to play in providing expertise and guidance and to smooth out the variations that the noble Baroness mentions. She may be aware that NHS England has appointed David Bateman as the first national clinical director for neurological conditions, whose job it will be to look at the very issues that she has raised.

NHS: Cancer Treatment

Baroness Pitkeathley Excerpts

Wednesday 29th January 2014 Lords Chamber

Asked by

[Baroness Pitkeathley]

To ask Her Majesty’s Government what action they propose to take to ensure that older people receive equal access to NHS cancer treatment.

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

In December, the national clinical director for cancer at NHS England launched a call for action on the treatment for older people. NHS England is now setting up an advisory group to identify where improvements in cancer services for older people can be made. It is also supporting an initiative to ensure that patients are better informed about the options available to them and that they are fully involved in decisions about their treatment.

[Baroness Pitkeathley (Lab)]

I thank the Minister for that welcome Answer, but is he aware of the recently published Macmillan Cancer Support report, which shows that up to as 10,000 cancer patients die needlessly each year because of blatant ageism among doctors? For example, recommendations for chemotherapy diminish by as much as half if you are over 70. Since we are an ageing population and half of all new cancer diagnoses are in people over 70, does the Minister agree that it is of the utmost importance that we ensure that people are treated as individuals regardless of their age? How will he ensure that this view is held also among GPs and hospital consultants?

[Earl Howe]

My Lords, I completely agree. The noble Baroness is right that a series of reports has shown that the NHS has too often failed to provide the best possible services to older people. We cannot save lives without tackling inequalities. The NHS has a statutory duty to reduce health inequalities and to improve the health of those with the poorest outcomes. A ban on age discrimination in the NHS services was introduced in 2012, meaning that NHS services need to do everything they can to ensure that they do not discriminate against older people. We will hold the NHS to account for that through the mandate and the NHS outcomes framework.

Health: Confidential Patient Information

Baroness Pitkeathley Excerpts

Thursday 23rd January 2014 Lords Chamber

[Earl Howe]

My Lords, under the 2012 Act, the Health and Social Care Information Centre cannot release data that could be used to identify an individual without a legal basis to do so. As a result, there are strict controls about how such information is released. As regards the UK Biobank, the noble Lord is right to be concerned because the proposed text from the so-called LIBE committee would rule out the work of the UK Biobank, in that it would need explicit and time-limited consent for any research project that it undertook, instead of being able to support a range of research purposes, as it now can, using its existing consenting mechanism. So there is cause for concern if this text is adopted, but that is not yet clear.

[Baroness Pitkeathley (Lab)]

My Lords, many noble Lords will have received recently a leaflet through their letter box, saying that their records are going to be made available unless they opt out. The means of opting out is to contact your GP. First, has anyone noticed how difficult it is to contact your GP in some circumstances? Secondly, would it have been beyond the wit of the department to include a simple, tick-box form for people to use? Does the absence of such a simple process lead us to conclude that the Government do not actually want people to opt out of making their records available?

[Earl Howe]

My Lords, everybody in the country has a right to object to their data being shared. Those objections will always be respected. A practical way had to be found to enable that process to happen, and we believe that it is not unreasonable to expect a patient to have a conversation with their GP. I will, however, take the noble Baroness’s suggestions on board and feed them in.

NHS: Essential Services

Baroness Pitkeathley Excerpts

Tuesday 14th January 2014 Lords Chamber

[Earl Howe]

My Lords, the CCG assurance framework sets out how NHS England will ensure that CCGs are operating effectively to commission safe and high-quality sustainable services within their resources. Underpinning assurance are the developing relationships between CCGs and NHS England, which should not be overlooked. One key source of evidence is the national delivery dashboard, which provides a consistent set of national data on CCG performance. In addition, there is the CCG outcomes indicator set, which will be an important wider source of evidence from 2014-15 onwards.

[Baroness Pitkeathley (Lab)]

My Lords, I know that the noble Earl has disputed the figures but if the volume of operations such as knee and hip replacements and cataract removals is declining, does he accept that this is likely to cause further problems in the social care sector? If older people do not receive timely treatment that will transform, as these operations do, their mobility and ability to manage at home alone, surely they will continue to need more support in the community, which we know is under pressure because of shortages in local authority funding. We may call these operations non-essential—we often do—but they are not non-essential if you are an older person with mobility problems.

[Earl Howe]

I fully agree with the noble Baroness and her point about mobility is very well made. However, NHS England has stated to me explicitly that the assumption that there should be a rising trend in the number of operations proportionate to the rise in the number of elderly people may not necessarily be right, so we have to be wary of using a statistic in isolation to prove one thing or the other.