Health: Chronic Fatigue Syndrome
Baroness Thornton Excerpts(13 years, 7 months ago)
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Earl Howe
My Lords, I understand why the noble Baroness asked that question. I believe that platelets cannot be stored in refrigerated conditions and are therefore, in theory, open to more infection. I am advised that SaBTO, the expert committee, looked at this and advised that no action was currently necessary.
Baroness Thornton
My Lords, I took a look at the blood transfusion service’s excellent website over the weekend to see what it had to say about who should and who should not donate blood. Basically, it said that you should be in good health. People with CFS/ME often experience a range of symptoms that could be made worse by donating blood. Notwithstanding the problem of diagnosis and that the precautionary principle is exactly right, surely that is the point. There should be a common-sense approach that people with ME should not give blood because they are not well enough.
Earl Howe
My Lords, the noble Baroness has put her finger on it. On a precautionary basis, even though the risk is considered low to those with CFS/ME when they are without symptoms, it was considered appropriate to exclude them permanently from being blood donors in case it affected their own health.
Health: Diabetes
Baroness Thornton Excerpts(13 years, 7 months ago)
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Baroness Thornton
My Lords, I congratulate my noble friend Lord Harrison on initiating this debate and on his tireless work on behalf of those with diabetes. I also congratulate the noble Baroness, Lady Young, on her new post. She is indeed a multi-purpose Baroness. When I first got to know her she was working on behalf of birds. Then she seemed to cover the whole environment, with a quick diversion into health regulation. I am sure that she will now hold the Minister’s feet to the fire on behalf of those with diabetes. We can indeed look forward to that.
By the time we get to the point where someone with diabetes has had a limb amputated or is in serious trouble with their feet, we have failed them at several levels. In two-thirds of the 2.5 million people with type 2 diabetes, the disease was preventable, which means that prevention still has a long way to go in terms of smoking, diet, alcohol consumption and lack of exercise. As the noble Baroness, Lady Hussein-Ece, said, prevention is vital. My noble friend Lord Graham of Edmonton was right to look to the future in terms of tackling obesity in children. It seems crucial that any new regime which the Government introduce should have at its heart prevention and the levers that will make prevention work.
Let us consider, for example, the issue of smoking. We know that things such as the smoking regulatory regime are often—pardon the pun—slow burning. However, over time smoking must become something that people simply will not and do not do. In this regard, can the Minister confirm that the tobacco regulations on vending machines and points of sale are still on track? I keep hearing rumours that the decision is being reopened by the Minister’s colleagues in BIS. Perhaps the Minister could take the opportunity to inform the House of the situation, because smoking is a major contributory factor in diabetes.
We know, and it has been said today, that foot problems are one of the many complications associated with diabetes and the most common cause of non-traumatic limb amputation in the UK. As many noble Lords have said, it is a shocking statistic that 100 people a week have limbs amputated as a result of these complications with their disease. I am also shocked—although I suppose I should have known this, having been a health Minister—that the tariff system pays for a limb to be amputated but not for it to be saved. I ask the Minister to explore that and what can be done about it.
As with many chronic conditions, there are several co-morbidities that often accompany diabetes. If people who have diabetes and those associated with them do not have access to accurate information about the management of the condition, support in managing it and knowledge about what to look out for, the NHS will have failed them in both the provision of information and the management of their condition from the outset. It is very important that the Minister gives us an idea of how the proposed information initiatives involved in the reorganisation of the NHS will deliver this important aspect of diabetes care.
We should emphasise the importance of the need to invest in prevention and the earlier stages of diabetes management in order to prevent a deterioration of health that leads to devastating complications such as ulcers, limb amputation and blindness. If it is the case that 10 per cent of NHS funding is spent on diabetes care and that this is set to rise because of ever-increasing numbers of people with diabetes in our ageing population, it seems absolutely self-evident—as many noble Lords have said—that preventing people developing diabetes and providing quality care and support for those with diabetes are essential to reducing the far-reaching emotional and physical consequences of foot disease, amputation and other issues.
I was also startled to learn about the cost of the specialist shoes—to be absolutely honest, I wondered whether you could not buy a pair of Jimmy Choo’s for that. I have never bought a pair myself, but it seems to me that that sort of comparison illustrates the absurd world in which we live.
We also know that the presence of specialist nurses and tailored care for diabetics is very cost effective. I agree with the comments of the noble Viscount, Lord Falkland, on the cost-benefit analysis of this. There is anxiety regarding the proposed reorganisation of the NHS vis-à-vis the community of specialists and the expertise that goes with them. Therefore, like other noble Lords, I seek comfort that, as with many other long-term conditions, we will not lose the growing expertise in this field. We do not want to have to reinvent that expertise when the dust settles around the new arrangements in the NHS.
We have to ask whether people who find themselves in danger of losing a limb or part of one will inevitably do so. Indeed, Professor Cliff Shearman, president of the Vascular Society of Great Britain and Ireland, said:
“Amputation is a devastating occurrence. It is estimated that in some groups of patients, 85% of amputations can be avoided. Early recognition of the patient together with early involvement of a multidisciplinary team can reduce amputation”.
Those comments make the fact that 100 people a week are losing a limb very shocking.
The issue is not a lack of available treatment, as my noble friend Lord Harrison said, because the appropriate technologies are available now. These technologies are used in the NHS but patients would benefit from having access to a multidisciplinary team to make timely decisions on the best course of action to prevent amputation, or minimise the extent of amputation if it is necessary. We fail if those multidisciplinary teams are not activated and available.
Therefore, I conclude by asking the Minister how the Government can ensure that both the teams and the technology are available and funded. It must surely be more cost effective to deliver prevention in order to minimise the number of people who present with diabetes, to deliver information so that they can manage their condition, to provide properly resourced clinical management of their condition and to make a serious effort to avoid the final and horrible fate of the loss of a limb.
Healthcare
Baroness Thornton Excerpts(13 years, 8 months ago)
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Baroness Thornton
My Lords, the Government in their White Paper propose to establish the independent NHS commissioning board, establish new local authority health and well-being boards, develop Monitor as an economic regulator, and expect to have the new commissioning system in place by April 2013, by which time SHAs and PCTs will have been abolished. The noble Lord, Lord Hunt, is perfectly right to say that this is big.
It is a shame, therefore, that we did not have double the amount of time for this debate to enable noble Lords to develop their arguments. We still need to have those discussions about the Government’s proposed reforms. These are reforms that will turn the NHS on its head if they are carried through, and bring with them considerable risks to patient care throughout the system—in transition, and possibly in the outcomes. As Philip Stephens said in the Financial Times on Tuesday:
“NHS reform, an accident waiting to happen”.
I agree.
The Minister will forgive me if I repeat the question that I have put to him on at least two other occasions: where is the evidence base for this revolution? The noble Earl has quoted to me international league tables, arguing that the NHS is not succeeding as well as the health services of other countries; but we can both play at that game. Indeed, I can quote a table which shows how well the NHS is doing and is at the top. I will make it my business to make it available to the noble Baroness, Lady Knight. Certainly, not one of the league tables suggests that the NHS is the kind of basket case of underachievement that the noble Lord, Lord Alderdice, suggested.
The question that the Minister fails to address is: where is the evidence that requires the wholesale disruption of the UK health services to deliver what may well be legitimate improvements that the noble Earl and his Government seek to make? The noble Earl’s failure to provide the evidence leads to only one conclusion: that the evidence to justify the wholesale disruption of the NHS does not exist, and that the Government have set their face against pilots which might provide us with the proof or otherwise that this proposal will work. Legislation could then follow the evaluation of those pilots. You may then add to this that the reorganisation was not proposed in either the Conservative or Liberal Democrat manifesto. The coalition agreement said exactly the opposite—that there would be no top-down disruption. We can only assume that this is driven from within the Conservative Party by an ideological commitment, presumably led by the Prime Minister—despite whatever he may have said during the general election.
I have increasingly felt over the past month that Andrew Lansley and I are reading different submissions about the White Paper. I am reading them all, and I expect that he is, too. He seems to think that they are wholly positive. Everyone agrees that the Government’s overall objectives of patient choice and clinical leadership are right—and most of the submissions state that. At that point, I can only think that Andrew Lansley stops paying attention, or stops reading. The reason I say that is because, with few exceptions, most of the submissions—from the most positive of the BMA, given that doctors have a great deal to gain from this not simply in terms of responsibility, to the most worried, including those of the Stroke Association or the British Thoracic Association—are all saying, “Whoa, slow down. Such a large upheaval and change needs to be properly piloted and evaluated”; or they are asking the type of questions that can lead you only to that conclusion. I am afraid that so far the Government have signally failed to provide answers to some very legitimate concerns.
Certainly, there has been an outpouring of consultation papers from the department, and were Andrew Lansley not in such a dangerous hurry, that would be good. There would be a reasoned and sensible debate across the piece, but the breakneck timetable of Andrew Lansley means that there has to be a question mark over how seriously the Government are taking the concerns and reservations of an increasingly loud chorus.
This puts huge responsibility on us in Parliament in both places to ensure that these voices are heard and their questions answered and that we do not allow such wholesale disruption of the UK's health services at the ideological whim of this Conservative Government. Can the Minister tell the House what is the timetable for the proposed legislation and whether there will be an opportunity for prelegislative scrutiny? That would go some way to making this process more accountable and more considered, which something of this magnitude deserves.
If only one in four doctors believe that the proposed reforms will improve the quality of the patient care and only 22 per cent of doctors believe that the NHS will be able to maintain its focus on increasing efficiency while implementing the proposed reforms—which is what the King’s Fund says—will the Government please heed the chorus which says slow down? This is £80 billion pounds of taxpayers’ money. This is too big without more thought and explanation. This needs to be properly tested and piloted. This is people's lives and well-being. Surely we all deserve time and consideration for something so big.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, this has been an extremely wide-ranging and well informed debate, and I thank my noble friend Lord Hunt of Wirral for raising these important issues and all noble Lords who have spoken very eloquently. I share the wish that we had more time to debate these matters.
Just three months ago, my right honourable friend the Secretary of State for Health published the White Paper, Equity and Excellence: Liberating the NHS. It is an ambitious plan for reform. It is focused around three key purposes, which are the three themes of today’s debate: first, to put patients first and for patients genuinely to feel that no decision is made about them without them; secondly, to concentrate not on inputs and processes but on outcomes and to build a culture of evidence and evaluation and for innovation and evidence to drive quality care; and thirdly, in aiming to deliver the best care, we must empower the people whose responsibility it is to deliver that care. We will give general practice the power to commission services on behalf of patients, combining clinical decision-making with control of resources.
The Government are determined to improve the quality of the NHS and the outcomes for patients. Our ambition is clear: it is for the health outcomes in this country to be among the best in the world. Today, the NHS has some of the best people and the best facilities in the world, and I do not in the least belittle the improvements made to the NHS by the previous Administration, but the fact of the matter is that when it comes to what is really important—to outcomes—we lag behind. I hope that all noble Lords agree that patients deserve better. The NHS can be better, and with the reforms we have set out in the White Paper, it will be better. I know that there is a wide range of opinion about the White Paper. There always is when you try to do something substantial and challenging, but the Government have been encouraged by the widespread acceptance of the vision that we have set out and the principles of our reforms.
To deliver the best care, we must empower the NHS staff whose responsibility it is to give that care. In essence, GP-led consortia, led by GPs in close partnership with other healthcare professionals, will establish the range of services and contracts needed to give their local population the high-quality services they need and the choices they want.
The success of GP commissioning decisions will be determined by the relationships that they develop with others. Local specialist community nurses will be there to help GPs design the best community services, just as hospital consultants will be essential for designing specialist pathways before, during and after a period in hospital. Local authorities will be crucial for helping to integrate health with other local public services to optimise outcomes.
GP commissioning will not turn GPs into managers but it will enhance their role as leaders. When it comes to day-to-day managerial and administrative tasks, consortia will have a separate budget with which to buy in the support that they need, be that from a local authority, a charity, an NHS provider, an independent contractor or elsewhere. I say to the noble Baroness, Lady Thornton, that, in effect, there are going to be pilots. We plan to roll out pathfinder consortia over the next few months that will indeed pave the way and learn lessons that others can follow. GP commissioning also opens up the potential for working closely with local authorities.
Baroness Thornton
My Lords, the pilots will be running at the same time as the legislation is going through Parliament. I fail to see how that will influence the legislation.
Earl Howe
My Lords, under current powers introduced by the noble Baroness’s own Government, GP commissioning can take place within certain limitations, but it is possible for GPs to engage now in the kind of joint working that we envisage and indeed that her Government put in place. I see no inconsistency there, and I think that that will helpfully inform our debates on the Bill.
GP commissioning, as I said, opens up the potential for working closely with local authorities to jointly commission services, even for the pooling of budgets to tackle local priorities. For example, by working closely with the local authority and social care providers, far more can be done to help older people or those with a disability to live independently, reducing their reliance on the NHS by avoiding things such as hospital admissions.
GPs will lead but they will not be alone. The NHS commissioning board will be there to support and advise GP commissioners and to share and spread their experiences. There will be no need to reinvent the wheel hundreds of times. One thing that the commissioning board will do as little as possible, though, is tell health professionals how to do their job.
We will also give far more power to patients. Research clearly demonstrates that treatment is better and often cheaper when the patient is an active participant in their care, not simply a passive recipient. In the coming years, we will give patients real control over when, where and by whom they are treated. They will be central to all decisions about their aftercare, often—where appropriate—spending their own budget in a way that suits their needs rather than the needs of the system.
Personal choice will not be the only way that people will be able to shape their care; they will also have a say in how local services develop. Strong local democratic accountability will be an essential part of the new system. Patients will have a strong voice in local decision-making through local authorities and HealthWatch, a new patient champion. For the first time, local people will have real powers of scrutiny over local health services.
We are very good at treating ill health in this country but we are less good at preventing it. We have the highest rates of obesity in Europe, rising levels of drug and alcohol use and, despite recent falls, stubbornly high rates of smoking. As a result, nearly one-quarter of all deaths in England stem at least in part from an unhealthy lifestyle. We have to do far more to stop people from needing treatment in the first place—to keep people healthy. We need a new emphasis on public health. Later this year we will publish a second White Paper on public health. Its aim will be to transform our approach to public health, protecting the public from health emergencies such as swine flu and improving the nation’s overall health and well-being.
I turn to some of the questions that have been asked. As I said earlier, the debate has ranged far and wide, and there have been a great many questions. We are short of time and I apologise to those noble Lords to whom I shall have to write, but I shall endeavour to cover as many topics as I can.
The speech of the noble Lord, Lord Winston, was uncharacteristic of him. I am sorry that he does not buy into the vision that we have set out. I am sorry that he does not think that we published the White Paper in good faith. The noble Lord gave the House to believe that the considerable efficiencies which we have signalled to the NHS it needs to achieve over the next four years were initiated by this Government. He will, I am sure, recall that they were in fact instigated by the previous Government. They are necessary and have nothing whatever to do with the Government’s White Paper. We need to treat more patients for approximately the same money without diminishing quality. That is the challenge.
I could hardly believe what the noble Lord said about the research budget. The announcements that we have made about research, arising out of the spending review, have been widely welcomed by the research community. We were clear that we wanted to protect science and we have done so. In the current economic climate, that is exceedingly good news.
The noble Lord, Lord Turnberg, in particular, should be reassured of our commitment to the promotion and conduct of research as a core NHS role. The White Paper makes that commitment clear. It also commits the department to a culture of evaluation. The reasons are straightforward. Research provides the NHS with the new knowledge needed to improve health outcomes. Research enables the department to know whether our policies are effective, cost effective and acceptable. The Government are committed to maintaining a ring-fence on research funding and will cut the bureaucracy involved in medical research. Work is in hand to achieve that.
The noble Lord, Lord Winston, also expressed scepticism about the whole idea of measuring health outcomes. Again, I was astonished that he, of all people, should pour cold water on our wish to do so. Just because it can sometimes be difficult to measure certain outcomes in a meaningful way does not mean that you should just give up. Great care must, of course, be taken when interpreting outcome indicators. You cannot simply make black-and-white judgments. However, if we focus only on processes, we risk creating a whole system of accountability that has lost sight of the overall purpose: improving the health of patients.
The noble Baroness, Lady Wall, asked me to underline the importance of local decision-making in the NHS. I readily do so. Those in a position to know what services are required to meet the needs of their patients are those closest to those patients—not politicians in Whitehall, but local doctors in general practice, local doctors and managers in hospitals and patient groups with local knowledge. All of this is part of our vision, which we intend to give substance. I was grateful to the noble Lord, Lord Mawson, for all that he said on this.
I welcome the remarks of the noble Lord, Lord Beecham, about health and well-being boards. It is not only they that will be scrutinising their own activities. As part of the public health service, health and well-being boards will be subject to quality and outcome standards set by the Secretary of State, and will be supported in their efforts by the public health service centrally.
The noble Baroness, Lady Masham, spoke in her characteristically impassioned way about patient safety. I agree with her that patient safety is absolutely vital. It is a key domain of our proposed outcomes framework; a key part of the quality agenda. My noble friend Lady Knight will, I am sure, agree that the most important thing that we need to do is bring about an open and transparent safety culture within all NHS organisations, a culture that is open about when mistakes are made and in which the number of serious incidents falls. Most importantly, it must be an NHS that learns from its mistakes.
The noble Baroness, Lady Masham, referred to the case of the tetraplegic man in Wiltshire whose life-support machine was cut off. This is a tragic and deeply distressing case, currently being investigated by the Nursing and Midwifery Council. Under the new registration framework, introduced in April 2010 for NHS trusts, all providers of regulated activities must register with the Care Quality Commission and meet a set of 16 requirements of essential safety and quality. These include a requirement to ensure that all staff have the necessary qualifications, skills and experience, which are necessary for the work to be performed. All agency staff must meet the same professional standards as permanent staff, as set out by the independent regulator, the CQC and each local safeguarding board. The Department of Health expects all NHS trusts to ensure that they employ appropriately qualified and supervised locums and agency staff.
My noble friend Lady Miller set out her view on which outcomes patients want. Her remarks were very helpful. I am pleased that there appears to be much commonality between what she set out and what was included in our proposals for the NHS outcomes framework. At the highest level, the outcomes that we felt mattered were preventing people dying prematurely; enhancing the quality of life of patients with long-term conditions; supporting people to recover from acute episodes of ill health and following injury; ensuring people have a positive experience of care; and, finally, treating people in a safe environment and protecting them from avoidable harm. Those domains get very close to what most of us would regard as a synoptic view of what good outcomes mean.
The noble Lord, Lord Turnberg, spoke about the need to achieve integrated care across primary and secondary sectors. I agree with him. The purchaser and provider split that the White Paper refers to must not be seen as a reason or excuse for GP consortia not to seek the advice, support and collaboration of clinical expertise on the provider side to ensure that the best possible services are commissioned for patients.
The noble Lord, Lord Mawson, asked how we can ensure that GPs will work across the community and public sector generally. Health and well-being boards have a critical role to play in co-ordinating a strategic patient-centred approach at a local level. GPs, local community representatives and democratically elected councillors will be tasked with making sure that they act on behalf of their patients and communities to deliver integrated services. A board will have a formal duty to involve and consult local people.
The noble Lord, Lord Beecham, asked in particular how GP consortia will work with local authorities. We have proposed that local government should have an enhanced responsibility for promoting partnership working and integrated delivery of services across the NHS, social care, public health and other services. It will be important for GP consortia to work in partnership with local authorities—for example, contributing to joint assessments of the health and care needs of local people and neighbourhoods, and ensuring that their commissioning plans reflect these needs.
Health: Spending Review 2010
Baroness Thornton Excerpts(13 years, 8 months ago)
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Baroness Thornton
To ask Her Majesty’s Government whether, in the light of Spending Review 2010, they will meet the commitment to free prescriptions for people with long-term conditions, the right to one-to-one nursing for cancer patients and the target of a one-week wait for cancer diagnostics.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, following the spending review, some of the programmes announced but not implemented by the previous Government will not be taken forward. We will, however, explore options for creating a fairer system of prescription charges and exemptions, taking into account the financial context. We are committed to improving early diagnosis of cancer and to ensuring that cancer patients have the care and support they need. Our updated cancer strategy, published later this winter, will set out the future direction for cancer care.
Baroness Thornton
I thank the noble Earl for that Answer, which goes some part, but not definitively, towards answering my Question. According to the Conservative Government’s own figures, waiting lists to detect cancer and other serious conditions have almost doubled since Andrew Lansley scrapped the 18-week target and other targets. We know that the quicker cancer can be detected, the better the likely outcomes. How does the Minister justify this growth in waiting lists, made worse by the CSR, and what do the Government intend to do to get back to a situation of reduced and reducing waiting lists that previously existed during the Labour Government? How long does the Minister think that that will take?
Earl Howe
My Lords, the noble Baroness is completely misinformed and wrong. The Government have not scrapped the cancer waiting time standards. Therefore, the figures that she referred to can have no bearing on the scrapping of the 18-week target, which is quite separate. People with suspected cancer will still benefit from the two-week waiting time target. That is clinically underpinned and we are keeping it. The statistics for those waiting for diagnosis on cancer are down very sharply over the longer term. There are, of course, fluctuations from quarter to quarter. The median waiting time at the moment is just under two weeks, and 95.5 per cent of people are seen within two weeks. That is an acceptable figure, although we of course maintain a close watch on the trends.
Human Fertilisation and Embryology: Regulation
Baroness Thornton Excerpts(13 years, 8 months ago)
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Earl Howe
My Lords, I need to make it clear that our proposal is not to bring the regulation in house; it is to distribute the regulatory function between several different bodies. I also emphasise that there is absolutely no suggestion that we are changing the special status of the embryo. We have no plans to re-examine those parts of the legislation which recognise that status. We fully recognise the role which the HFEA has played in establishing the UK as a world leader in this area, but times change and so has the way in which we regulate the delivery of healthcare. That is the basis on which we have looked at this.
Baroness Thornton
My Lords, when I was a government Minister and the BMA, the Royal College of Obstetricians and Gynaecologists, the Royal College of Pathologists and the Royal College of Nursing ganged up on me, I always thought it was wise to listen. All those bodies have expressed very serious concerns about the government proposal. Has the Minister had meetings with the royal colleges and the BMA about their concerns? Has he discussed in particular the real risk to loss of specialist expertise and public confidence and the risk to patient safety?
Earl Howe
My Lords, we intend to engage fully with all interested parties on this matter but it is early days. The noble Baroness quite rightly raises the specialist expertise available to the HFEA. We fully recognise that. We are very keen that the expertise is not lost but is made available to the CQC or to the new research regulator, if we set up one. I understand that, where a function of one organisation transfers to another organisation, it is customary for the relevant staff to transfer as well. I emphasise that matters are at a very early stage.
Health: Neurological Conditions
Baroness Thornton Excerpts(13 years, 8 months ago)
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Baroness Thornton
My Lords, I join other noble Lords in congratulating the noble Baroness, Lady Gardner of Parkes, on initiating this debate. I suspect that there would have been more takers for it had there been more notice, although it is clear that the quality of the debate has not suffered as a result. On balance, the fact that important issues are getting an airing because the Government do not seem to have got their head around scheduling legislation for the House is definitely of benefit to some of us.
I am grateful to the Motor Neurone Disease Association, Parkinson’s UK and the MS Society for their comments on this important issue. Those organisations and many others care about this issue with great passion and with great experience. It is my understanding that around 15.4 million people in the UK are living with long-term conditions and that of them 8 million have neurological conditions. I note that other speakers have given different figures, but it is a very large number and I am sure that the Minister will have the most up-to-date and accurate figures to give us.
I want to take a moment to look at the vital role that allied health professionals play in the care of those with motor neurone disease. The Motor Neurone Disease Association research carried out between 1996 and 2000 found that having a multidisciplinary motor neurone disease clinic extended survival for people with that disease by 7.5 months. We know that specialist MDT care can significantly improve the quality of life. The complexity of the symptoms presented by motor neurone disease means that a large number of health and social care professionals may be involved in the care of someone. It is common to have up to 18 professionals involved in caring for a person with motor neurone disease at any time. Therefore, examples of good practice in co-ordinating this care take a variety of different forms and different models suit different local situations. The models that work best for the people with motor neurone disease are typically those that involve a designated key worker—often themselves a clinical nurse specialist, a motor neurone disease care centre co-ordinator or other specialist clinician—co-ordinating care across different services. The key worker often achieves the best results by bringing together and co-ordinating a multidisciplinary team to care for the person with motor neurone disease.
That co-ordination of care and treatment is vital. If the treatment is poorly co-ordinated, untimely and without specialist knowledge of motor neurone disease, it can result in treatment being missed, the person’s condition becoming more acute more rapidly—in fact, the kind of issues that the noble Baroness, Lady Finlay, talked about earlier—leading to greater expense and suffering as more intensive treatment and care is then needed.
Parkinson’s UK sent me some case studies which definitely bear repeating:
“With occupational therapists, physios and speech and language therapists, it would be very beneficial to be able to access regular, routine follow-up rather than being ‘signed off’ at the end of a treatment”.
That was said by a person with Parkinson’s disease, who also went on to say,
“I have worked hard to get counselling with a qualified, experienced psychologist … my GP has been very helpful but the waiting time has been many months”.
Parkinson's UK conducted a case study into the value of physiotherapists in the system; as we have already noted, they provide a high-quality, cost-effective service, especially those who specialise in conditions such as Parkinson’s. They offer an immensely important service and patients can often see them in place of a medical consultant, which is a significant cost saving. According to one physiotherapist:
“Condition-specific exercise classes are a wonderful way of maintaining people’s fitness initially and building confidence to then carry on at a gym, or out with the family”.
There is no doubt that, as Parkinson's UK states, providing access to a range of therapies and other services is cost-effective. It helps people with Parkinson's to stay independent longer, preventing costly admissions to hospital and care homes. Existing clinical guidelines, including those from NICE and the royal colleges, of the various therapies recognise how important that is.
Allied health professionals must form part of a specialist, multidisciplinary Parkinson’s team that looks at the full range of therapies needed by someone with Parkinson's. In order to treat the individual patient, not just the condition, it is important that each patient receives the therapies they need at the right time to ensure the best management of their condition. This will prevent unnecessary deterioration and reduce the burden on the health and social care system.
The Multiple Sclerosis Society, along with many other organisations concerned with long-term neurological conditions, supported the NHS outcomes framework and believes that insufficient resources have been dedicated to the implementation of the NSF for long-term conditions, resulting in patchy neurological services across the country. The recent report, Half-way Through—Are We Half-way There?, which considers the progress of the national framework on long-term conditions, shows that there is still a great deal to do. I am anxious that the progress that has been made will be lost under the new regime proposed by the Conservative Government. The previous Government initiated the 10-year strategy and, in January this year, published what I thought was a great document about the commissioning of such services.
I have spent the past few months talking to organisations and individuals about what they think about the Government's proposals for the NHS and how those proposals might affect the issue with which they are concerned. I must say that great concern is being expressed across the piece. I went into some detail about the kind of integrated care required for those neurological conditions because it begs the question: how will it be maintained and developed under the new regime? That is at the heart of my final remarks.
I heard the Secretary of State, Andrew Lansley, on Radio 4 at the weekend saying that although people had raised justifiable questions in the consultation, he could not see that there was real opposition to the Government's proposals. He is behaving something like an ostrich, because every day there are more and more appeals to the Government to slow down. Doctors, nurses, royal colleges and many organisations concerned with things such as long-term neurological conditions are saying, “Please slow down. We are confused and anxious about what is going to happen to the issue with which we are concerned”. When the solution lies, as it does with long-term neurological conditions, in pathways dependent on teamworking across disciplines of health and social care, they are right to be concerned. It is a long process to secure the right services for people with long-term neurological conditions. How will that be maintained within the new structure? It is not clear where and how, for example, the care of people with motor neurone disease will be commissioned and how effective it will be. There are significant risks of deteriorating standards of care and spiralling costs if the wrong choices are made over the next few years.
In conclusion, it is clear that the work of allied health professions is integral to the successful care of and prospects for those with long-term neurological conditions. Organisations that work with those who have such conditions have a right to be concerned about where the funding for those conditions will sit. I note, for example, that in its submission on the White Paper one of them asked whether its condition would be commissioned at a specialist care level by the commissioning board or whether it would be done by GP commissioners, and how the integrated pathways will be assured under those circumstances. I searched the Department of Health website in vain for some enlightenment about those questions. Perhaps the Minister will be able to shed some light on them.
Health Protection Agency
Baroness Thornton Excerpts(13 years, 8 months ago)
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Baroness Thornton
To ask Her Majesty’s Government how they will ensure that emergencies and pandemics are dealt with properly in the period before the abolition of the Health Protection Agency.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
The Health Protection Agency is one of many resources used by the Government to prepare for emergencies and pandemics. We propose to abolish the HPA as a statutory body but its functions will continue as a key part of the planned public health service. The Government continue to prepare and strengthen the UK’s resilience to emergencies, and we will ensure that this is maintained both before and after the HPA’s functions are incorporated into the public health service.
Baroness Thornton
I thank the Minister for that Answer but I am not sure it offered the reassurance that I was seeking. I raise the issue of the independent expert advice of the HPA, which from time to time might be uncomfortable for Ministers to hear. How will the Government ensure that the independence of the HPA is guaranteed, and will the scientific advice be made publicly available? For example, scientific advisory committees such as the one on dangerous pathogens are obliged to publish their agendas, minutes and papers and to have a dedicated website. If these committees are subsumed into the department, will they lose their independence? This is a very important matter and the Government need to provide some clarity.
Earl Howe
My Lords, transparency is one of the aims of our proposals. As regards independence, the Government will continue to rely on their scientific advisory committees, the members of which, as the noble Baroness knows, are drawn from the foremost experts in their respective fields. The fact that the scientific secretariat to each committee is provided by experts formerly within the department, instead of within the HPA, will not prevent the committees reporting as they judge to be appropriate.
Food: Regulation and Guidance
Baroness Thornton Excerpts(13 years, 8 months ago)
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Baroness Thornton
My Lords, I congratulate my noble friend Lord Whitty on obtaining this important debate and I congratulate all the other speakers. On 30 July 1999, during the winding up of the Second Reading debate on the Food Standards Bill, the late and much loved Lord Carter, the Chief Whip at the time and an enthusiastic farmer and fruit producer, said on behalf of the Government:
“We have had a wide-ranging debate on this Bill and the related issues concerned with the food standards agency. We feel that the Bill represents a major step forward. It shows how the Government are continuing to give public health and the interests of consumers the high priority they deserve. The proposals have from the start been exposed to the fullest scrutiny and comment, despite what some noble Lords have said. We feel that the Bill is now a well developed piece of legislation, with three rounds of consultation having shown what consumers want … The painstaking process of consultation, with two years of hard work by Ministers and officials, have laid the ground for these major changes”.—[Official Report, 30/7/1999; cols. 1819-20.]
I was a bit player at the time and made a speech in that debate as well as participating in debates throughout the passage of the Bill. I mention that because of the contrast with the approach that this Conservative Government have taken in introducing their proposals to change the work of the FSA. Given the number of times that the Minister has chided me over the past few years for what he called a lack of evidence base for the various proposals that the Labour Government brought forward, it is a bit rich and a great contrast to the way that the Secretary of State announced major changes to the FSA and its work. We are entitled to ask: where is the evidence base that food labelling will do better back at Defra, since some will argue that it did not do so well before the creation of the FSA, and where is the evidence base that national policy on nutrition will be improved by putting it in the English and Welsh departments?
On the FSA website, I found a rather sad message. It said:
“If you wish to look at our old content on nutrition you can see it on the National Archive website. Nutrition research reports remain in our research repository”.
I suggest that the Minister visits this website as it is a marvellous library of the evidence of the food-base archive that has underpinned some of the campaigns that the FSA has led in the past 10 years or so, setting targets, as it did, for reductions in salt, sugar and fats in food. In May 2009, the FSA published revised salt-reduction targets for 2012 for 80 categories of food. They are more challenging than the previous targets for 2010. Will they be maintained? I know that the reduction of salt in food is work in progress. Indeed, I have very vivid memories of when I worked for the Co-operative movement when the Food and Drink Federation was violently opposed to any suggestion that government or a government body might interfere or comment on food manufacturers’ right to put pretty much what they liked in our foodstuffs. I am glad to say that they have modified their practices over the intervening years. Perhaps I may suggest that they do not take the proposed reduction in the FSA’s remit in this area as a signal that they can revert back to their bad, unhealthy habits. However, I have to say to your Lordships’ House that, after remarks like those from the Secretary of State when he said that he will scale back public funding for Change4Life and is asking the food industry to fill the gap in return for,
“an expectation of non-regulatory approaches”,
we have a right to be anxious.
I should like to explore a little further the powerful medical health case for salt reduction put forward by the noble Lord, Lord Patel. In 2006, the FSA published the original voluntary salt reduction targets for 85 categories of food as guidance for the food industry. The agency committed to review the target in 2008 to formally assess progress to date and to establish what further reductions were necessary to maintain progress towards a six grams daily intake target, as mentioned by the noble Lord.
The setting of the targets, backed by scientific and nutritional evidence, gave the exercise credibility and led to some serious improvements. For example, salt has been reduced by one-third in pre-packed sliced bread. There has been a 44 per cent reduction in branded breakfast cereals and a reduction of between 16 per cent and 50 per cent in cakes and biscuits. There has been up to a 55 per cent reduction of salt in snacks and crisps, 50 per cent less salt in UK white cheese and a 32 per cent reduction in retail standard cheese slices. I am sure that the noble Earl, Lord Erroll, probably will disapprove of this, but I think that this is great progress and that our food manufacturers should be congratulated. Huge progress is still to be made, but it is a success story. How does the department propose to maintain reductions of salt in food?
As my noble friend Lord Whitty said, it is no exaggeration to say that there is a crisis in children’s diet. The National Diet and Nutrition Survey found that 92 per cent of children consume more saturated fat than is recommended, 86 per cent consume too much sugar, 72 per cent consume too much salt and 96 per cent do not get enough fruit and vegetables. As my noble friend Lord Giddens said, the Chief Medical Officer has compared this to a health time-bomb which we have to diffuse.
The history of the previous Conservative Government in this matter is truly abysmal, so the Minister should not be surprised at the anxiety and scepticism being expressed today. For years, school meals services suffered from neglect and underinvestment with kitchen and canteen facilities in many schools removed or allowed to deteriorate. The previous Conservative Government removed any guidance about nutrition for children’s school meals. Staff were not given proper training to allow them to prepare food from scratch. Their job was reduced to heating up and serving pre-prepared food delivered from large catering firms. Menus in many schools were limited to a regular selection of processed and deep-fried foods, including pizza, chips and the infamous turkey twizzlers. Such options tended to be high in fat, salt and sugar, and contained little fruit and vegetables or other fresh ingredients. Junk food and unhealthy soft drinks were widely available in vending machines and tuck shops.
There is no question that we have Jamie Oliver to thank in part for what happened next, which is why the Secretary of State’s remarks to the BMA on 30 June about Jamie Oliver’s efforts to provide healthy schools were singularly inappropriate. Combining his other utterances on these issues with the facile comments from his colleague, Anne Milton, about obesity and calling people fat instead of obese, creates legitimate concerns about the seriousness that exists within the ministerial team to deliver on this agenda and their willingness to do so.
When the Labour Government established the Schools Food Trust, a non-departmental public body, in 2005, new standards for the type and nutritional quality of school food were introduced in primary and secondary schools. After the success of campaigns, such as the schools food campaign and Jamie Oliver, we need to thank them for their efforts. The new rules for food in schools ensure that school lunches are free from low-quality meat products, fizzy drinks, crisps and chocolate. Deep-fried items are restricted to no more than two portions a week. Schools have also ended the sale of junk food in vending machines and tuck shops, including confectionery, chocolate and fizzy drinks. The School Food Trust now works with schools and vending operators to promote the sale of healthy snacks and drinks such as water, milk, fruit juices and yoghurt drinks. In addition to the school food standards, a series of measures have been put in place to,
“embed the school food revolution for the long term and help tackle childhood obesity”.
This includes investment in healthy ingredients, training kitchens, the entitlement to learn to cook, a specific fund for building kitchens in addition to the £1 billion Building Schools for the Future programme, as well as increasing tendering opportunities for small and local producers. I pay tribute to the work of the trust and ask the Minister how he intends to deliver good health for the nation’s children if the Government withdraw their support.
It is important to look at what third parties have to say about these proposals. The chief executive of Which?, Peter Vicary-Smith, has said:
“The Food Standards Agency has revolutionised the way that food issues are handled in the UK, so we’re pleased today’s announcement ensures it can continue to independently monitor food safety. Unfortunately, some issues that would be best handled by the FSA have been moved to other departments. With these changes the government must ensure the interests of consumers remain at the heart of food policy”.
Tam Fry of the National Obesity Forum has said that it is “crazy” to dismember the FSA:
“It had a hugely important role in improving the quality of foodstuffs in Britain and it was vital to have at the centre of government a body that championed healthy food. This appears just the old Conservative party being the political wing of business”.
Tom MacMillan of the Food Ethics Council has said:
“The agency was set up to earn public trust after a succession of food scares. Its wobbles, like the latest row over GM foods, have come when that commitment has wavered. Any departments absorbing the FSA’s role should heed that lesson carefully, doing even more to invite scrutiny and banish the slightest whiff of secrecy, or the new government could face another BSE”.
Patrick Holden, director of the Soil Association, the organic food standard bearer which had several run-ins with the first chair of the FSA, the noble Lord, Lord Krebs, has said:
“Many NGOs campaigning on food thought for a long time the food industry has an unhealthy degree of influence over the Department of Health, so the great risk is the corporate vested interests of the food industry will have too strong an influence on future policy”.
How will the noble Earl respond to the fact that so many respected organisations are worried about what the future holds? Indeed, his noble friend Lady Miller believes that food regulation needs more teeth, so will his department be delivering on that?
I am grateful to the noble Baroness, Lady Finlay, for her wise words and for reminding the House about Every Child Matters. She underlined the importance of diet for pregnant women. I thank also my noble friend Lord Giddens for his analysis of the separation of food production and consumption. His words filled me with dread at the challenges ahead, and I cannot see how the Government’s proposals will add to the solution. I enjoyed the speech of the noble Earl, Lord Erroll, but I wondered if he had been at the e-numbers recently. My noble friend Lord Rea was right to remind us of the roots of our public health regime, and of how hard vested interests work, but not only for consumers.
In conclusion, the FSA is neither overstaffed nor overresourced, and it has made significant economies over recent years. Will the Minister inform the House how his honourable friend has responded to the letters he received from my noble friend Lord Rooker, the current chair of the FSA, in June and July? The letters are on the public record and are available on the FSA website. My noble friend says:
“The core principles of the FSA are to put the consumer first; making policy in an open and transparent environment; operate independently; and be science and evidence-based. The FSA Board is concerned that these principles, which have served consumers well in the food policy environment since 2000, would be at risk by moving nutrition and dietary health work from a non-political to a political department”.
I could not have put it better myself.
Health: Addiction to Prescribed Drugs
Baroness Thornton Excerpts(13 years, 8 months ago)
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Baroness Thornton
My Lords, I am very pleased that the noble Earl, Lord Sandwich, has succeeded in securing this debate. His persistence in raising this important issue is to be commended.
Last November, the noble Earl pressed me as the then Minister about this important matter and I assured him that the promised review would report this year, 2010. I understand that this has now been extended to next year. I join the noble Earl in his disappointment, given that we know the scale of the problem. I also join the noble Baroness, Lady Bottomley, in saying that this issue should not fall between the cracks of reorganisation.
I understand that the extended review includes a literature review, an audit of selected PCT prescribing data and a survey of the withdrawal assistance that is available from the voluntary sector. However, many believe the review to be a case of too little, too late. The terms of reference have been shrunk; the completion date is repeatedly extended; and patients have been excluded from the process. This is a far from satisfactory situation and I hope that the Minister will be able to give us more comfort than seems apparent. It is simply not acceptable in these days of sophisticated medication that people should take prescribed drugs in good faith and then find themselves incapacitated when they try to stop taking them.
Given the limitation in the time that we have this evening, I wish to address two areas. The first is in the context of the treatment of depression. As the Minister will know, NICE guidance on the treatment of mild to moderate depression and anxiety disorders recommends cognitive behavioural therapy as the treatment with the strongest evidence base for efficacy. For this reason, the Labour Government invested £173 million in the Improving Access to Psychological Therapies programme to train a new workforce of 3,600 people in cognitive behavioural therapy in the three years to 2010-11. Will the Minister explain what the future holds for psychological therapies? With GP commissioning coming down the track, this seems to be yet another matter that is riven with uncertainties.
I raise, secondly, SSRI antidepressants, which I discussed with the noble Earl before our debate. I think that we agree that this is also a matter that is linked to this discussion. We know that they are effective treatments which have benefited millions of people. Since completion of the review by the expert working group in 2004, every effort has been made to issue updated advice as appropriate, and communications are issued to healthcare professionals via the central alerting system, the MHRA website and the Drug Safety Update. What is the current position on the usage and ongoing reviews of SSRIs? Can we be sure, for example, that no person under 18 is prescribed a drug such as Seroxat? I feel strongly about this issue, because a relative of mine has never recovered from having been prescribed Seroxat when he was 15 years old, many years ago. All companies have a responsibility to patients and should report any adverse data signals to us as soon as they discover them. The investigation into GlaxoSmithKline and the use of Seroxat revealed important weaknesses in the drug safety legislation in force at the time. Can the Minister assure the House that steps being taken to strengthen the law will ensure that there can be no doubt as to companies' obligations to report safety issues?
I urge the Minister to take up this important issue of dependence on benzodiazepines and to ensure that a co-ordinated action plan results from the review now being undertaken.
Health and Social Care Act 2008 (Consequential Amendments No. 3) Order 2010
Baroness Thornton Excerpts(13 years, 11 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, this order makes a consequential amendment to the Water Industry Act 1991. The amendment is required as a result of the implementation of a new registration system under the Health and Social Care Act 2008, which set out a system of registration for providers of health and adult social care that the Care Quality Commission operates. To manage the registration process, providers are being brought into the new system in stages. The dates for these stages are set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
As of 1 April this year, all NHS providers were subject to the new system of registration. It will cover private and voluntary healthcare providers, and adult social care providers, from 1 October 2010. The providers are registered under the Care Standards Act 2000. Therefore, on 1 October, certain provisions of the Care Standards Act will be repealed. One of these will be the definition, in Section 2 of the Act, of an “independent hospital in England”. A previous order—the Health and Social Care Act 2008 (Consequential Amendments No. 2) Order 2010—made a number of consequential amendments to primary legislation using this definition. Unfortunately, an amendment to the Water Industry Act 1991 was missed, so this order is necessary because of that omission. Anyone who buys, or has bought, the earlier order will be entitled to a copy of this order free of charge.
A further order, subject to the negative parliamentary procedure, has been laid today and will make the necessary amendments to secondary legislation. Schedule 4A to the Water Industry Act 1991 contains a list of premises that should not be disconnected for the non-payment of water charges, including,
“an independent hospital within the meaning of the Care Standards Act 2000”.
As the definition of “independent hospital” in the Care Standards Act 2000 will no longer be applicable in England, this order makes a consequential amendment to the definition in the Water Industry Act 1991. It replaces the current cross-reference to the Care Standards Act 2000 with a new definition of an “independent hospital” for England. This new definition covers the same kinds of premises that were previously covered, but does not rely on a reference to the definition in the Care Standards Act 2000. The definition for Wales remains unchanged. I commend this order to the Committee.
Baroness Thornton
I thank the Minister for explaining this small order arising out of Section 162 of the Health and Social Care Act 2008. I suppose that I should apologise to the Committee for the earlier omission, which is why we are here. Section 162 is a part that confers power on the Minister to ensure that the Act is in compliance with existing legislation, and indeed that is what the Minister explained in a more than adequate fashion.
I confess that I was not sure that I could see the necessity of this order until I realised that the healthcare facilities mentioned can have their water cut off as a result of non-payment. Can the Minister confirm whether this has happened in the interim period?
The key matter on which I should like further clarification is the definition of an “independent hospital”. I think that I heard the Minister confirm that this covers the public, private and charitable sectors, any one of which may be providing healthcare as listed in new paragraph (5). Am I right to assume that this does not cover care homes or nursing homes, and that they are covered elsewhere?
Finally, I am relieved that body piercing and tattooing parlours are exempt from the order. I also wonder whether chemical peels, which are fashionable now, are covered under paragraph (5)(e)(iii) and (iv) for the purposes of this order.
This order is otherwise perfectly straightforward and I support the Minister in moving the Motion.
Earl Howe
My Lords, I am grateful to the noble Baroness for her questions. The first point to make is that we are in time with this order, because the operative date is 1 October, so there is no retrospective element. There is therefore no question of any hospital having fallen between two stools, so to speak, as regards water disconnection. I am not aware that there has been a problem on that front.
The noble Baroness asked about the definition. Schedule 4A to the Water Industry Act 1991 lists a number of premises that are not to be disconnected for non-payment of water charges. These include, among other premises, NHS hospitals, premises used to provide medical or dental services by registered practitioners, children’s homes, schools and care homes. These premises will continue to be protected from disconnection for the non-payment of water charges. No changes are being made to these parts of the schedule.
The noble Baroness also asked whether chemical peels were excluded under new paragraph (5)(e). As that procedure is not counted as surgery, chemical peels are not included and therefore do not receive protection from disconnection under paragraph (5)(e).