Health: Hospital-acquired Infection

Baroness Pitkeathley Excerpts

Tuesday 7th June 2011 Lords Chamber

[Earl Howe]

The noble Baroness is quite right that delayed discharge poses a risk, not only in terms of infection but in terms of mobility and other issues that affect the elderly. We are clear that if this problem is to be eased, further funding is required at local authority level, which is why we have made available up to £1 billion over the period of the spending review to ensure that the issue is addressed.

[Baroness Pitkeathley]

I declare an interest as a recoverer from MRSA. Is the Minister making any assessment of the effectiveness of preventive measures, such as hand sanitisers and making sure that doctors do not wear ties, which droop in wounds, and so on?

[Earl Howe]

My Lords, the noble Baroness will know that a code of practice was issued some time ago, which the CQC uses to ensure that the registration requirements of a provider have been complied with. It is clear that the decline in numbers of hospital-acquired infections has coincided with the issue of that guidance. We believe that it has made a material difference. I am not aware that there has yet been systematic evidence-gathering of whether the guidance has had an effect, but it appears that it has.

Health: Multiple Sclerosis

Baroness Pitkeathley Excerpts

Tuesday 7th June 2011 Lords Chamber

[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.

[Baroness Pitkeathley]

My Lords, does the guide to which the Minister referred have anything to say about keeping records? MS patients, their families and carers always report that because it is an illness with long periods of remission—sometimes lasting years—the difficulty of keeping the records up to date causes them distress.

[Earl Howe]

The noble Baroness makes a very important point, and she is right. I will have to check whether the guide refers to that issue. I would be surprised if it did not. However, the central point that she makes is quite correct. The key to this, as so often, is good communication between those providing care at every stage of the care pathway. Sometimes, unfortunately, that breaks down.

NHS: Standards of Care and Commissioning

Baroness Pitkeathley Excerpts

Thursday 31st March 2011 Lords Chamber

[Baroness Pitkeathley]

My Lords, I thank my noble friend Lord Turnberg and declare two interests as chair of the Specialised Healthcare Alliance and as chair of the Council for Healthcare Regulatory Excellence.

However devoted we are to the NHS—I speak as one who owes her life to it—we must acknowledge that there are still far too many instances where it falls short. No one could fail to be shocked by the ombudsman’s report to which many noble Lords have referred. The universal standards which we all wish to see, of a compassionate and skilled service, are by no means universal as yet. The dismissive attitudes and indifference to deplorable standards encountered in all too many instances must be addressed and, as far as possible, eliminated. I say “as far as possible” because, as a regulator of healthcare, I know only too well that it is not possible for any form of regulation to bear on every safety or quality concern. We are dependent on the quality of the professionals delivering the service and we must judge this always from the experience of the patient and his or her family.

When we think about commissioning as being about improving health outcomes and reducing health inequalities, let us never forget what that means from the patient’s point of view. Most will have absolutely no idea what “improving health outcomes” means. They only know that they want to be treated safely, with dignity and compassion, and have timely and effective treatment. In all the discussions we are currently having about the reform of commissioning, I am often struck by how remote those discussions seem from the actual experience of patients. The test that we must apply is whether it is better for them, not whether it is better for the Secretary of State, the commissioning board and GP consortia.

It is also striking how removed our discussions are from the facts around patients’ experience, which are not linear but confused and complicated—a mixture of services from health, social care, housing, the voluntary sector and their own families. This complication of experience is little recognised, even now when some of us have been trying for 30 years to get it recognised. The question we have to ask is: will the new commissioning arrangements deliver that recognition? We do not know.

What we do know is that every bit of research ever done about changing institutional structures shows that only a part, and usually a small part, of the objectives are achieved, and the bigger the upheaval, the fewer of those objectives are achieved. Since we are largely dependent for quality outcomes on the skill, commitment and—let us not be afraid to use the word—dedication of our staff, how are we to maximise those and provide them with the support they so urgently need when, for the next two years at the very least, their energy will be directed towards the change itself in the form of applying for their own jobs, learning to work with a new set of partners and so on? Also, the history of co-operation between GPs and social services does not fill me with hope, while the lack of co-terminosity between consortia and local authorities is certainly not going to be helpful.

We know that the commissioning board will issue guidance on commissioning to the consortia, but when is this to happen? Do we not risk a mismatch in timing? Some of the consortia are already willing to go ahead and are following their own rules in the absence of any from the commissioning board. I hope that the Minister will be able to comment on this. Also, from the patient’s point of view, we need a great deal more clarity about what will happen when GP consortia refuse to commission a service that a patient requires. Where is the accountability?

As to the voluntary sector, for so long the provider of good preventive care and services, we hear a great deal about organisations being encouraged to take on a greater share in providing public services and for the commissioners to recognise this. If we are serious about pushing power as close to individuals as possible and for citizens and communities to define the priorities and expectations of public services like the NHS, as the big society concept suggests we should, it is certainly important for the voluntary sector to be involved. However, many organisations are having their funding savagely cut, and more than half of them say they are going to have to cut staff in the next three months. Given that, I doubt their capacity.

Herbal Medicines

Baroness Pitkeathley Excerpts

Thursday 13th January 2011 Lords Chamber

[Earl Howe]

My Lords, again I think that the House is well aware of the noble Lord’s views, which I know are sincerely held, although personally I regret his comments about the Prince of Wales. However, I am sure that, with regard to herbal medicines, he will be aware that there is an international trade in sometimes poor-quality, unregulated and unlicensed herbal preparations. Some of these have been found to contain banned substances, heavy metals or pharmaceutical ingredients or substances from outside the UK that may not be subject to any form of regulation at all, so there is a public safety issue.

[Baroness Pitkeathley]

My Lords, does the noble Earl agree that, while statutory regulation has its place, regulation in healthcare and anything else should always be proportionate? Would he therefore endorse the concept of light-touch regulation, which is promoted by the Council for Healthcare Regulatory Excellence? I declare an interest as its chair.

[Earl Howe]

My Lords, I pay tribute to the noble Baroness for the work that she does and I entirely endorse the approach to regulation that she has outlined. Certainly, we need to adopt a targeted, risk-based approach to regulation.

Autism

Baroness Pitkeathley Excerpts

Tuesday 7th December 2010 Lords Chamber

[Earl Howe]

My Lords, I am very grateful to my noble friend for raising that issue. I can reassure her that under Section 47(1) of the National Health Service and Community Care Act 1990 local authorities have a duty to assess a person who may be in need of community care services. This duty applies to people with autism. The revised Fair Access to Care Services guidance already makes it clear that an assessment of eligibility for care services cannot be denied on the grounds of a person’s IQ. We intend to reiterate this very clearly in the autism statutory guidance.

[Baroness Pitkeathley]

My Lords, does the Minister agree that delivering the vision for people with autism and their families is, in many cases, dependent on local authority resources? Has he any anxiety about that, especially as many of the services are delivered in the voluntary and community sector, which is already reporting major cuts to its grants?

[Earl Howe]

My Lords, clearly, local government grants will come under pressure over the coming years. To my mind, that makes it even more important that decisions about priorities are taken at a local level and the joint strategic needs assessment is, of course, the tool which will enable local authorities to decide on their priorities locally.

Disabled People: Dementia

Baroness Pitkeathley Excerpts

Monday 11th October 2010 Lords Chamber

[Earl Howe]

My Lords, an informed and effective workforce is clearly central to the delivery of the dementia strategy. The Department of Health has recently published reports which map the current level of training, and these have been widely disseminated to key bodies involved in providing education and training. Professor Alistair Burns, who is the National Clinical Director for Dementia, is chairing an advisory group that will aim to ensure the development of proper education and training for all staff involved, and he will be engaging with all the key organisations in doing so.

[Baroness Pitkeathley]

My Lords, the Minister will be aware that family carers have two main concerns about dementia services. The first is that they are patchy and are not uniform across the country and the second is that they are not co-ordinated across acute voluntary, independent and family care. How will the Minister ensure that those two issues are better addressed under the proposals in the White Paper?

[Earl Howe]

My Lords, there are several prongs to the strategy which will be needed to meet the concern of the noble Baroness. One is to drive up quality standards through a proper tariff for these services and another is better regulation of providers. As the House will know, the NICE quality standard was published in the summer, which will improve commissioning to deliver greater efficiencies, not simply in a financial sense but also to deliver a better pathway of care for patients, with a focus on outcomes.

Health Protection Agency

Baroness Pitkeathley Excerpts

Thursday 7th October 2010 Lords Chamber

[Baroness Pitkeathley]

My Lords, I know that the Minister is always very concerned about the needs of patients. Will he assure the House how two things will be addressed: first, how the patients themselves will be protected during the inevitable turbulence of a period of transition; and, secondly, how the Government intend to deal with the possibility of the leaching away of scientific expertise during such a period of turbulence?

[Earl Howe]

My Lords, I should emphasise that the functions of the Health Protection Agency will be transferred into the department. In the mean time, we intend to make it business as usual throughout the transition process, with an emphasis on the smooth transition both of functions and of individuals on whom we rely to give advice. The functions of the HPA will not be lost in the wake of its abolition. It will continue to contribute to the Government’s response to emergencies and other areas of responsibility. I assure the noble Baroness that we have her concerns very much in mind.

NHS: Pain Management Services

Baroness Pitkeathley Excerpts

Wednesday 7th July 2010 Lords Chamber

[Baroness Pitkeathley]

My Lords, like other noble Lords, I want to confine my remarks to my own experience of pain and pain relief and to speak solely as a patient. Unlike the noble Lord, Lord Luce—I thank him for securing this debate—my experience is more of acute rather than chronic pain, and I am happy to say that I am now pain free. However, the principles I want to set out apply equally to both. While I endorse absolutely the view that co-ordination is all-important and a multi-disciplinary approach entirely the right one, when it comes to pain relief, I believe that these must be supplemented by the very best of communication.

This communication must have two aspects, the first of which is communication between professionals—the doctors and nurses, of course, but also the professionals ancillary to medicine such as the physiotherapists, radiographers and dieticians. If the medication for pain relief means that my feet are too numb to enable me to do the walking practice that the physiotherapist has recommended, what help is that to my recovery? If I can take absolutely nothing by mouth, and everything has to go by a Hickman line, the staff administering pain relief have to be very aware of it. I must put in a plea here for the extra services so often provided by volunteers in hospitals which all contribute to patient recovery but are not necessarily prescribed. I remember how, at a time of the most awful physical pain, the most relief I experienced did not come from drugs but from a nice young man who gave me a foot massage with scented oils.

Communication between departments is also vital. When you come out of intensive care, especially when coming back on to a ward, as I did four times in one hospital, there is nothing more frustrating than to lie there in pain with no one able to give you relief because your notes are caught up somewhere in the system. This applies particularly at night. Many patients still experience being in severe distress, but because far fewer doctors are available during those hours, they have to wait for someone—and at that point you feel that anyone would do—to administer some pain relief. So communication between professionals and between departments is vital, but in my view, no communication is more vital than that between the person administering the pain relief and the patient.

It is fine for an anaesthetist to say that an epidural is best for severe abdominal surgery, but if the epidural means that incontinence is a result, many a patient would prefer to endure the pain. Similarly, if the result of self-administered measured doses of morphine—in theory an excellent idea—is severe nausea to the point of exhaustion, surely the patient should be allowed to decide on other forms of relief. In one stay in hospital that lasted for about seven months, my worst memories are not about the pain, awful though it often was, but about the times when my wishes regarding pain control were ignored. However, I am happy to record that it is to the great credit of the NHS that those occasions were mercifully few. The best memories always centre around the way that caring people were prepared to consider me as an individual, and even to depart slightly from the rules; to discuss with me how drugs could be administered when I was unable to swallow anything for five months; and to maintain my dignity when those drugs had to be administered in most undignified ways. I recall also people like the young Nigerian charge nurse who would himself shed tears of sympathy when trying to find somewhere to inject me that did not cause excruciating pain to a body already like a pin cushion from repeated injections. As in many things, nothing can substitute for good communication when it comes to pain relief, either for chronic or acute pain.

I hope that the Minister will be able to endorse the importance of communication when any new policies are being developed.

Health: Stroke Treatment

Baroness Pitkeathley Excerpts

Wednesday 30th June 2010 Lords Chamber

[Baroness Pitkeathley]

My Lords, I thank the noble Lord, Lord Rodgers, for securing the debate and I heartily endorse what he said about its importance vis-à-vis yesterday’s debate, notwithstanding the difference in attendance. I thank him, too, for his excellent exposition about the support services available to stroke sufferers and his concern about the services available to support them and their families, and especially the sustainability of such services.

I am as concerned as he is about these issues, and especially about the negative effects that some of these developments may have on families and carers. I have spoken many times in this House about carer issues and the House—and, indeed, the Minister—will be familiar with most of them. So far as stroke is concerned, carers have two difficulties which make their plight extremely serious. The first is the sudden onset of most strokes, with very little warning or time to prepare. This means that carers are even worse off than many others because they are trying to get information about help and support at a time when they and the sufferer are in most distress and most worried and are therefore less able to find the time or the attention to get in touch with helping agencies. Carers always find a difficulty with accessing information and in these circumstances it is even more of a problem.

The second major problem for carers is the length of time the caring process goes on. Unless you die during the stroke itself you are probably going to live quite a long time, sometimes with a great degree of disability and sometimes with your ability to communicate severely impaired. This means that all the problems of shortage of finance, the threat to their own health, both physical and mental, and the sheer emotional stress of caring for someone who is disabled, and sometimes suffering a change of personality into the bargain, are not only acute but chronic.

As the Public Accounts Committee report reminds us,

“it is in the months and years after discharge that … their families and carers will experience the full impact of the stroke”.

Add to that the fact that if the carer is a spouse, it is likely that they themselves are rather elderly and frail. We have to remember that as well. So support services are vital and frequently make the difference between the carer being able to continue and being unable to, however great their desire to do so.

I am the first to acknowledge that much progress has been made not only with the treatment of strokes, as the noble Lord has reminded us, but also with the support of the carers and families. The fact that there is a national strategy in position for carers as well as stroke sufferers and their families is only one aspect of the progress made. These are cross-party issues that are of concern to the whole of society. While I pay tribute to the previous Administration for the fact that carers can never any longer be ignored, as was once the case, I acknowledge too the commitment of other political parties and of individuals such as the Minister himself.

I want my intervention today to focus on two particular issues because of my experience with carers when funding was not ring-fenced and my experience of the community, charitable and voluntary sector in the provision of services. I remind your Lordships that as part of the national carers strategy £150 million was allocated to primary care trusts to provide respite care for carers. Everyone rejoiced; this was a way of getting health professionals—especially GPs, who are so important to carers—to take their responsibilities seriously and to have money specifically allocated to them to help carers. However, the money was not ring-fenced. As a consequence, only 10 per cent of that money was ever spent on respite for carers. The rest disappeared into the black holes of PCT deficits and budget problems. This is what happens if you do not ring-fence money, and it will happen to the money for stroke as well—of that there is no doubt.

In the light of that, I wonder what assurances the Minister can give that stroke support services developed by local authorities in response to the national stroke strategy will be sustained this year and in the future, now that that ring-fencing has been removed. Does he feel that the ending of ring-fencing for stroke grants sends a rather unfortunate message to local authorities—that this kind of support is no longer a top priority?

In view of that, do we need to worry about other forms of support that are made available to those in need? For example, is the £200 million given to local authorities under the local authority settlement to support carers also under threat? I would be pleased to hear the Minister’s reaction to that.

As with carers, much progress has been made with support services for stroke sufferers. Much of the improvement and innovation in these services has been spearheaded by the voluntary and community sector, such as the Stroke Association, at both local and national level. Many of these services have been funded under contract from local authorities with the ring-fenced allocation. Noble Lords will know that local authorities are under considerable pressure at present, and this is likely to get worse in the next year. If the money is not ring-fenced, the likely outcome is that services will wither on the vine. The services that you get from the voluntary and community sector are extremely good value but they are not cost-free, and unless they have that kind of support they will not go on being provided.

Let us not forget that carers often require only a very small amount of support, provided that it is given at the right time. Two hours’ respite given to a carer in a week—that is often all that they ask for, in spite of what people fear they are going to demand—will often result in the carer giving not an extra week or month but extra years of support in return. The return on a comparatively small investment is very great indeed. I have often reminded the House that it makes good economic as well as moral sense to support the families who provide the majority of our health and social care willingly and over long periods. At a time of economic stringency it is even more important to remember that, and I hope that the coalition Government will do so.

NHS: Patient Targets

Baroness Pitkeathley Excerpts

Wednesday 23rd June 2010 Lords Chamber

[Earl Howe]

My Lords, it is right for me to make clear that the previous Government achieved a great deal in bringing down waiting times—there is no doubt that that was a major worry for patients—and they are to be commended for that. The noble Baroness is concerned that we do not let the situation slip, and I fully share that concern. As I have indicated in brief terms, two main issues will prevent it happening. The first is that the legal duty on commissioners to commission services that comply with operational standards around the 18-week referral time still applies. The second is the NHS constitution, which contains the right to access services within minimum waiting times, as she knows. Those patient rights within the constitution have not been diluted.

[Baroness Pitkeathley]

My Lords, the noble Earl emphasises localism in the NHS, and that is very welcome, but is he aware that patients and their organisations have expressed great anxiety about not having enough people and structures to check how their local services are doing, especially—as patients and their organisations know very well—because there are some conditions for which early diagnosis is essential if cure is to be achieved?

[Earl Howe]

My Lords, the noble Baroness is quite right. For example, on the waiting time targets for cancer referrals, we have made no changes because there is a clinical underpinning to those targets. She is also right to say that there is often insufficient information for patients on which to base decisions. We are very keen to build and develop information channels so that patients can be better informed and are able to make better choices about their care.