Epilepsy: New Treatments
Debate between Baroness Wheeler and Baroness Jolly
Baroness Wheeler (Lab)
My Lords, on commissioning, CCGs have a strategic influence and make key commissioning decisions that impact on the lives of nearly half a million people with epilepsy in England. Yet, last year’s Epilepsy Action report showed that only 10% of them had produced written needs assessments for people with epilepsy and that 70% reported that they did not have any plans to do so, either for this or for people with other neurological conditions. What are the Government doing to remedy this appalling situation?
Baroness Jolly
If the noble Baroness is referring to the joint strategic needs assessment, that is produced by the clinical commissioning groups working in conjunction with local authorities. It is up to them to make decisions about what they consider to be important.
NHS: GP Salaries
Debate between Baroness Wheeler and Baroness Jolly
Baroness Jolly
My Lords, I am sorry, I missed the question in the whole of the tale.
Baroness Wheeler (Lab)
My Lords, I thank my noble friend Lord Reid for once again setting the record straight on this issue. Moreover, in Labour’s last year in office, 98% of patients were being seen by their GPs within four hours. Does the Minister agree that the key problems that need to be addressed were set out in the Nuffield Trust’s recent report—an emerging crisis in the GP workforce, not enough GPs being trained, more trainees now working part-time, more existing GPs planning to retire early, and the numbers just not keeping up with those of hospital doctors?
Medical Innovation Bill [HL]
Debate between Baroness Wheeler and Baroness Jolly(9 years, 11 months ago)
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Baroness Wheeler
This is a very important group dealing with patient safety. I shall briefly intervene in support of my noble friend Lord Turnberg’s Amendment 3, which refers to seeking the support of the appropriately qualified doctor rather than his or her views, and to support Amendment 7 from the noble Lord, Lord Saatchi, on recording the treatment and consultation on the patient’s notes.
Our firm preference was for the Bill to specify the need for the written consent of the appropriately qualified doctor, but we have heard senior medical doctors’ concerns about giving formal written consent to another doctor’s proposed course of treatment for the patient without knowing their full history and other circumstances.
As my noble friend Lord Turnberg said, there is something of an irony in a Bill designed to address doctors’ fears of litigation running the risk of opening up the fear of litigation from the supporting doctor. We consider “support” to be preferable to the doctor’s “views” and I hope that the noble Lord, Lord Saatchi, can respond positively to this as a way of reassuring patients and their carers and relatives and enhancing patient safety.
My noble friend Lord Winston’s Amendment 2 seeks additional safeguards for patient safety by reference to excluding treatment where a,
“body of responsible medical opinion”,
considers that the treatment is likely seriously or unreasonably to compromise patient safety. He has raised some very important issues here, particularly in response to cancer treatment, and I look forward to hearing from the noble Lord, Lord Saatchi, or the Minister.
The clarification the noble Lord, Lord Saatchi, provides in Amendment 7 concerning the issues to be recorded in the patient’s notes provides welcome safeguards. It does not include the full range of issues, covered under Clause 1(3), which noble Lords have been concerned to see recorded in the patient’s notes, but it goes some way to providing the greater transparency and accountability that we all wish to see, particularly in recording the doctor’s decision to depart from the existing range of accepted medical treatments for the patient’s condition and the explanation of the proposed treatment.
Finally, we have considerable sympathy with Amendment 13 for the reasons ably put forward by my noble friends Lord Winston and Lord Turnberg, and I look forward to hearing from the noble Lord, Lord Saatchi, or the Minister on this issue.
Baroness Jolly
My Lords, I shall start my remarks by addressing Amendment 13. This amendment seeks to exclude from the Bill treatments that involve the insertion or injection of cells, tissues or other biologically derived material into the body of a patient. The Government do not consider this amendment to be necessary. The use of human tissue and cells is a heavily regulated area of practice. It is regulated by the Human Tissue Authority, the Human Fertilisation and Embryology Authority and the Medicines and Healthcare products Regulatory Agency. As part of making a responsible decision to innovate, the Bill requires that a doctor must consider not only the risks and benefits of the proposed treatment but how they would compare with other treatments and with not carrying out any treatment. This requirement provides a robust objective test of whether an innovative treatment should be used.
Clause 1(5) makes clear that the requirements in the law relating to best interests continue to apply in that nothing in the Bill permits a doctor to carry out treatment for any purpose other than the best interests of the patient. Further to this, the amended Bill requires doctors to act responsibly, including taking full account, in a responsible way, of the views of other appropriately qualified doctors. This clause provides a critical safeguard in ensuring that there is expert peer review of the doctor’s proposal and that the doctor acts responsibly in taking account of that review. Clause 1(3)(c) requires that doctors obtain any consents required by law when taking a decision to depart from the existing range of accepted medical treatments for a condition.
The Bill provides safeguards for patients while ensuring that doctors can use their clinical judgment and be flexible to individual patients’ circumstances.
I now move to Amendments 2, 3 and 7. It is essential that any legislation is safe for patients. That is why the Government are pleased that the package of amendments devised with advice from Sir Bruce Keogh, the medical director of NHS England, to make the Bill safe for patients was accepted in Committee in this House on 24 October. The noble Lord, Lord Winston, has tabled an amendment that seeks to ensure that a doctor cannot rely on the Bill where a body of responsible medical opinion considers the treatment to compromise patient safety. He referred to the recent debate in the other place where my honourable friend George Freeman, the Minister, asserted that the Government are dedicated to patient safety and evidence-based medicine. I should like to reassure noble Lords that the Bill does not remove any of the current safeguards in place to protect patient safety. If the innovative treatment was considered likely to compromise patient safety, it is extremely unlikely that it would be considered a responsible decision under the Bill when later judged in court. A doctor who innovated in such circumstances is highly likely to be aware that his or her decision would not be considered responsible.
The noble Lord, Lord Winston, raised a couple of points. One was about quack doctors and the other was about stem cell injection. The Bill does not remove any safeguards for patients. There is no escape for negligent doctors under the Bill. They still need to demonstrate that they have acted responsibly. Nothing in the Bill allows doctors to bypass any processes and requirements set by their trust in relation to undertaking innovative treatments in the NHS. This would include ensuring that the commissioners would fund any treatment if it is to be provided within the NHS. Individual innovation is incredibly important, but it is not a substitute for medical research, which usually tests the efficacy of treatments in a systematic way. Successful individual innovations are likely to lead to systematic research projects as evidence builds around a particular speciality. As part of their professional development, doctors should contribute to research as well as look for innovative ways to treat their patients. Noble Lords will be pleased to note that we will emphasise the importance of research in accompanying guidance to doctors on the use of the Bill.
On stem cell injection damaging patient safety, there is no reason for the Bill to damage patient safety. The decision to innovate under the Bill has to be responsible and the doctor would be negligent if he did not innovate responsibly. The Bill gives no extra leeway in respect of stem cell injection, as he suggested. Any decision to inject stem cells would have to comply with all existing safeguards and be responsible. The alarming examples given by the noble Lord are extremely unlikely to have been responsible. Quack treatments would simply not pass the hurdles of responsible decisions required by the Bill.
The amended Bill requires doctors to act responsibly, taking full account of the views of other appropriately qualified doctors. This clause provides a critical safeguard in ensuring that there is expert peer review of the doctor’s proposal and that the doctor acts responsibly in taking account of that review. Clause 1(3)(c) requires that doctors obtain any consents required by law when taking a decision to depart from the existing range of accepted medical treatments for a condition.
Unpaid Carers
Debate between Baroness Wheeler and Baroness Jolly
Baroness Jolly
I do not have figures that split out blood relatives from other carers. I shall find out whether such figures are available and let the noble Lord have them.
Baroness Wheeler (Lab)
My Lords, does the Minister agree that providing good quality home care and respite care is crucial to enabling carers to take up work and remain in jobs and not to descend into poverty or debt? Good care means dignity, respect and a better life for the person carers care for. What steps are the Government taking to ensure that health and social care commissioners recognise this point and provide for and pay for decent care?
Baroness Jolly
It is critical that carers have lives outside that of caring for the individual. The Government are therefore working very hard to ensure that carers can remain in employment or get employment but also have a social life outside their caring duties. Anyone who wants to return to work can get support from Jobcentre Plus and, as of 30 June this year, carers can request flexible working from their employers.
Carers Strategy
Debate between Baroness Wheeler and Baroness Jolly
Baroness Jolly
Yes. That issue came up throughout the passage of the Care Bill. There was a lot of anxiety on behalf of local authorities. The impact assessment has committed extra money for carers’ rights and an additional £69.4 million for 2015-16 through the Better Care Fund, rising to £192.6 million by 2020.
Baroness Wheeler (Lab)
My Lords, on the issue of benefits, Carers UK figures show that by 2018 the Government will have cut carers’ benefits by an estimated £1 billion through the reduction in support with council tax, housing costs, the overall numbers receiving the carer’s allowance and the benefits cap. With their carers and disabled people losing support from the benefits system in this way, what assessment have the Government made of the very serious knock-on impact on social care and families’ abilities to provide care?
Baroness Jolly
That assessment will come as a result of the work being done on the report that was referred to earlier. However, I can tell the noble Baroness that the carer’s allowance will increase faster than wages and in line with inflation this year, from £59.75 to £61.35. A household will be exempt from the benefit cap where someone is receiving carer’s allowance and also there is someone within the household in receipt of a qualifying disability benefit, such as PIP, DLA housing benefit or attendance allowance.
Food Poisoning
Debate between Baroness Wheeler and Baroness Jolly
Baroness Jolly
I have no information in my brief to that effect. However, it should be said that this scheme has been adopted by all but two local authorities in England, the two exceptions being the Royal Borough of Greenwich, which is ready to implement it, and Rutland, which is somewhat anxious about the success of businesses.
Baroness Wheeler (Lab)
Do the Government agree with Professor Chris Elliott, whom they commissioned to review food safety in the wake of the horsemeat scandal, that the Food Standards Agency should be given new powers to tackle fraud through a food crime unit?
Baroness Jolly
I regret that I shall have to write to the noble Baroness on that issue.
NHS: Hospital Medication
Debate between Baroness Wheeler and Baroness Jolly
Baroness Jolly
Certainly those technologies exist. I have seen some of them in action, and they are really impressive. Local hospitals are responsible for their own IT systems, and some are very much further ahead than others, but I am sure others are aiming to catch up.
Baroness Wheeler (Lab)
My Lords, the Minister referred to the guidance on the reconciliation of medicines drawn up by NICE and the National Patient Safety Agency in 2007. However, since the Government abolished the NPSA two years ago and transferred the work to NHS England, information about the agency’s work and how it is being carried out and taken forward is very hard to come by. Will the Minister reassure the House that monitoring, keeping the guidelines under review and updating them to ensure patient safety are priorities for NHS England and the Government?
Baroness Jolly
Patient safety is indeed critical. After Mid Staffs and the Francis report, safety, openness and accountability are key, along with the duty of candour. “Sign up to Safety” is to be announced later this week to ensure that efforts are reported. That will help local hospitals and care homes understand where mistakes are being made and make patients feel more comfortable by owning up to problems.
Care Bill [HL]
Debate between Baroness Wheeler and Baroness Jolly(11 years, 5 months ago)
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Baroness Jolly
My Lords, I thank the noble Lords, Lord Turnberg and Lord Patel, for helping me with these amendments. The noble Lord, Lord Willis of Knaresborough, is unwell and may not be returning to us in time to help with the Bill. His twin passions are training and research, and Amendments 37 and 39 to Clause 90, which are all about the functions of LETBs, completely underpin that. I would be doing him a disservice if I did not ask the Minister to explore these areas when he sums up.
It is critical not only at a national level, with HEE, but at a local level, with the LETBs, that this area is not forgotten. Staff must understand not only the implications but all aspects of research. That must be plugged in at HEE and, with these amendments to Clause 90, at the LETB level.
Baroness Wheeler
I strongly support this group of amendments, the case for which has been ably made by my noble friend Lord Turnberg, the noble Lord, Lord Patel, and the noble Baroness, Lady Jolly.
The importance to the NHS of research and innovation has come under close scrutiny and debate in the House in recent times, under the Health and Social Care Bill, in the powerful debate of the noble Lord, Lord Saatchi, earlier this year, and in the debate that we almost had in the name of the noble Lord, Lord Kakkar, on the life sciences industry’s important contribution to healthcare and to our economy.
Under the Health and Social Care Act, Labour fully supported placing duties on the Secretary of State, the NCB and CCGs to promote research. Indeed, my noble friends Lady Thornton and Lord Hunt proposed amendments to that Bill reinforcing the importance of research, and we were pleased to work with noble Lords across the House in strengthening these provisions. That is why amendments to Clause 86, which deals with quality improvement in education and training, are so important.
Amendment 17 deletes the current reference to HEE needing to promote,
“the use in those activities of evidence obtained from the research”,
and replaces it with a proactive reference to using this,
“evidence to ensure the rapid uptake of innovations into practice”.
Amendment 20 underlines the need for HEE,
“to secure that research and innovation are incorporated into education and training”.
This was a recommendation of the Joint Committee, which we fully support. All NHS staff should be equipped with the tools to understand and support research and to assess and use evidence to inform their decisions when caring for patients or supporting clinical staff. They also need to be able to make use of research throughout their careers—a point that my noble friend Lord Turnberg made strongly—and be familiar with the NHS research infrastructure, which can provide further help and support.
The recent survey by the Association of Medical Research Charities showed the challenges to be phased in in this regard. Some 91% of staff surveyed, including doctors and nurses, identified the barriers that they had experienced to taking part in research. Lack of time was the predominant reason given by respondents. Other reasons included funding, practical support and difficulties in navigating regulation. GPs are an important gateway for getting patients involved in research, but although a majority of GPs believes that it is important for the NHS to support research into treatments for their patients, only 32% felt that it was important for them personally to be involved. As AMRC emphasises, we still have a long way to go if the Government’s goal of every clinician being a researcher and every willing patient a research participant is to be achieved.
Amendment 32 to Clause 87 adds promoting innovation and research in clinical practice to the matters that the HEE should have regard to—a logical and crucial next step in our support for innovation and research under HEE’s national functions. Amendment 37 on the local functions that LETBs exercise on behalf of HEE makes the important cross-reference between Clause 90 and Clause 86, rather than Clause 84, on the issue of ensuring that there are sufficient skilled healthcare workers promoting research and the use of research evidence in the health service. We believe that if LETBs are performing other duties of behalf of HEE under Clause 90, there is no reason why they should not also promote research, obviously within the LETB area. Amendment 39 would confirm in legislation that HEE’s research duty applies to LETBs as a main function, and we strongly support that.
Throughout the debates on innovation and research, we heard continued concerns and frustrations at the often painfully slow, complex and bureaucratic process of getting innovation in care and treatment adopted in the NHS. There was frustration, too, that existing processes and pathways, such as conditional approval in the named patient schemes and the opportunities under existing legislation, are not being fully used. In the January debate, the Minister reminded us that it took an estimated 17 years for only 14% of new scientific discoveries to enter day-to-day clinical practice. That is why these amendments to ensure that HEE actively promotes innovation and research and carries that through in the education and training of healthcare workers needs to be supported by the Government. I look forward to the Minister’s response.