Health: Mental Health
Debate between Lord Dubs and Earl Howe(9 years, 11 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
Access and waiting times for people with mental health problems are a priority for this Government. We are committed to ensuring that access to services and waiting times are on a par with physical health. That is why we have put in place the first national waiting times standards in mental health.
Lord Dubs (Lab)
My Lords, will the Minister confirm that according to the widely respected Health Service Journal in April this year there were some 3,640 fewer nurses and some 213 fewer doctors working in mental health than two years ago? Surely it is unrealistic—not to say verging on the dishonest—to talk about the Government putting in place controls on access and waiting times when there is no prospect of achieving them.
Earl Howe
If the noble Lord looks across the piece at the workforce statistics he will perhaps be more reassured than he is at the moment. The £400 million that we are putting into talking therapies, for example, will result in a workforce of 6,000 practitioners trained to deliver IAPT. Health Education England has increased the number of mental health nursing training places by 1.5%. In delivering a multidisciplinary workforce, the aim is to have skills that are transferable between different care settings. NICE will be publishing its authoritative guideline on safe staffing. We have already mandated NHS organisations to publish ward-level nursing with midwifery care staffing levels so that there is an incentive for them to make sure that they have their staffing levels right.
NHS: Hospital Waiting Times
Debate between Lord Dubs and Earl Howe(10 years, 2 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, hospital waiting times are low and stable, but there are pressures from a growing and ageing population, and some patients are not receiving their treatment as soon as we would like. NHS England, the NHS Trust Development Authority and Monitor are working with the most challenged providers and commissioners. Operational resilience guidance, published in June, will help the system prepare for winter and improve waiting times sustainably for emergency and elective care.
Lord Dubs (Lab)
My Lords, that is a very impressive Answer. The Prime Minister said some time ago that the test will be to get NHS waiting times down. Judged by that test, will the Minister comment on this morning’s statistics from NHS England which showed that over the past year the number of patients waiting six months or longer for treatment has gone up by 20%? Does that not show that the Prime Minister has failed his own test?
Earl Howe
My Lords, I do not believe that that is a fair comment. In the past four years, since the Government came to office, we have substantially reduced the numbers of patients waiting longer than 18, 26 and 52 weeks to start treatment. Those numbers are lower than at any time under the previous Government. However, we need to address the build-up in patients waiting and, as a result, we are directing extra support and money for hospitals to do more than 100,000 additional operations over the next few months to meet the extra demand.
Health: Multiple Sclerosis Nurses
Debate between Lord Dubs and Earl Howe(10 years, 7 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
It is the responsibility of commissioners and local providers to ensure that services have the staff they need to deliver high-quality care for people with multiple sclerosis. Listening to and learning from patients to improve care is a top priority for the Government. We are committed to putting patients at the centre of services. Commissioners are under a legal duty to involve patients and the public in the commissioning of services.
Lord Dubs (Lab)
My Lords, that is a bit disappointing. Does the Minister agree that MS nurses provide an invaluable service for patients as regards treatment, advice and access to services? Does he further agree that MS nurses can save costs elsewhere in the health service because they can reduce the pressure on GPs and on hospital admissions? Would it not be sensible for the Minister to say positively, “We need to ensure that every patient with MS should have an MS nurse to provide help and support”?
Earl Howe
My Lords, I agree with the noble Lord, Lord Dubs; there is no doubt that MS specialist nurses provide support that is extremely valuable for MS patients and their carers. They help to manage relapses and give advice, they act as a gateway into counselling and physiotherapy, and they help to minimise hospital admissions and reduce the need for consultant appointments. I do not disagree with the noble Lord at all. However, it is worth reminding ourselves that NICE guidelines on multiple sclerosis set out that after diagnosis, patients should be,
“put in touch with … a skilled nurse or other support worker”.
We expect those who work in the NHS to take account of NICE guidance.
Care Bill [HL]
Debate between Lord Dubs and Earl Howe(11 years, 2 months ago)
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Earl Howe
Certainly, I anticipate that the results of the review will be available before the Bill has concluded its passage through Parliament. I stand to be corrected on that but I think I am right. In any case, changes to the way in which complaints are handled can be made through regulations under existing legislation, so I think that provides the necessary flexibility.
Earl Howe
That might prove helpful but I will take advice on it. We do not want to duplicate powers that already exist in legislation. However, if we decide that changes are needed, we need to make sure that they can be expedited properly. I am advised that the consultation will close in October this year and that the review of complaints arrangements, of which the consultation is a part, will conclude in the winter. Therefore, if changes need to be made to the Bill, they will need to be made in another place.
The noble Lord, Lord Dubs, said that in our response to the Joint Committee it is vital to consider redress. Of course, the principle of that is not in dispute. Our review of complaints arrangements is in line with our response to the Joint Committee’s recommendation, as I hope he acknowledges. In answer to the noble Lord, Lord Warner, I agree with him that there are likely to be teething problems as this system is established. That is precisely why we felt the need to review the current system. We will aim to ensure that any new mechanisms are in place before implementing the new system, as I have already indicated.
With that, I hope that I have provided at least some reassurance to noble Lords opposite that we take this issue seriously. We understand the concerns that have prompted this amendment and will certainly give further consideration to the noble Lord’s idea of a tribunal system in the light of the outcome of the consultation. I hope therefore that for the time being he will feel content to withdraw his amendment.
Lord Dubs
I am grateful to the Minister and I am interested in what he has to say. First, I thank my noble friends who have contributed to the debate and for the useful suggestions that they made, some of which, however, have been overtaken by what the Minister has said. My noble friend Lord Hunt talked about a simple, low-cost appeals system. That is very much in line with what the Minister said. The only issue is what chance we have to discuss further the outcome of the review and the Government’s further proposals.
I think the Minister said that either it will be possible in the Commons to consider any proposals the Government put forward as a result of their review; alternatively, it may be done by order, in which case we would all have a chance to look at it. In any case, that takes us quite a lot further. I am grateful to the Minister for what he has said and I beg leave to withdraw the amendment.
NHS: Accident and Emergency Services
Debate between Lord Dubs and Earl Howe(11 years, 2 months ago)
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Earl Howe
Not for the first time, the noble Lord hits on an extremely important aspect of the problem that we are facing. It is the frail elderly who often turn up at A&E with a crisis in their health when that crisis could have been averted. That is why Sir Bruce Keogh has been tasked to look across the piece at the whole system to see how we can ensure that the frail elderly in particular are served better by the health service, not least to prevent the exacerbation of long-term conditions.
Lord Dubs
The Minister has suggested that the problems of A&E are going to get worse in future. How will the Government’s attempt to tackle those problems be helped by the closure of A&E departments in many parts of the country? In particular, how will they be helped in west London with the impending closure of A&E departments at Hammersmith and Charing Cross hospitals?
Earl Howe
As the noble Lord will be aware, the latter issue is currently being scrutinised by the Independent Reconfiguration Panel, so it would be wrong of me to comment on that. On the question of reconfigurations generally, we are clear that this is a matter for local decisions by doctors, nurses and all those with a stake in the system. It is not for Ministers to issue edicts from the top. We are clear that any reconfiguration of A&E services has to take into account the capacity of the system to absorb any closures of A&E and the capacity of community services to step in where that is appropriate.
NHS: West London Hospitals
Debate between Lord Dubs and Earl Howe(11 years, 7 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the reconfiguration of front-line health services is a matter for the local NHS. Any decisions regarding changes to services are taken locally and are subject to the four tests for service change. On 19 February, the NHS North West London Joint Committee of Primary Care Trusts decided to proceed with a “Shaping a Healthier Future” service reconfiguration programme in north-west London.
Lord Dubs
My Lords, will the Minister confirm that A&E waiting times are increasing in the areas covered by the four hospitals even before the closures have taken place? There is enormous local concern about a plan to, as it were, reduce services in a series of hospitals more savagely than anything else in the history of the NHS. In particular, the plan includes the proposed demolition of Charing Cross Hospital and its replacement by a handful of beds. Is it not the case that the Minister or the Secretary of State has the final decision and that it is quite possible for the Secretary of State to say, “No, I do not accept this. Think again.”?
Earl Howe
My Lords, we believe very firmly as a general principle that the reconfiguration of services works best when there is a partnership approach between the NHS, local government and the public. That is why we are strengthening local partnership arrangements through the health and well-being boards. To answer the noble Lord’s question, it is entirely possible for a reconfiguration decision to be referred upwards to the Secretary of State by the overview and scrutiny committee of a local authority, and in that event it is customary practice for the Secretary of State to receive independent advice from the independent reconfiguration panel. However, we have not reached that stage yet. We have agreement locally as to what these arrangements should look like and I think that we should wait to see how the plans develop.
Earl Howe
I agree with the noble Baroness that this is most certainly a factor. In the case of north-west London, an independent equalities impact assessment was undertaken to check how the proposed options would affect all strata of local population under the Equality Act in particular. The assessment found that the impact on travel times by car, and indeed by blue light ambulance, would be minimal under all three of the options that were being looked at. The point that I am making is that in any context, it is important to factor in the effect on travel for all patients likely to be affected.
Lord Dubs
My Lords, I am shocked that the use of the word “reconfiguration” by the Government has brought into the English language an alternative to “cuts”. Will the Minister not accept that what is being proposed in the four hospitals in the north-west London region are savage cuts which will damage services for local people? That is the bottom line.
NHS: Walk-in Centres
Debate between Lord Dubs and Earl Howe(11 years, 12 months ago)
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Earl Howe
My Lords, the noble Lord raises an important point. I am aware that in certain parts of the country there is considerable concern about the length of time that patients sometimes need to wait for a GP appointment. However, that is not the case all over the country. We expect GP practices to configure themselves so as to ensure that the waiting time is kept to a minimum. It is an area on which we are working closely with the profession to resolve.
Health: Multiple Sclerosis
Debate between Lord Dubs and Earl Howe(13 years, 4 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the information requested is not collected centrally. In England, it is the responsibility of local health bodies to make decisions on the number of multiple sclerosis nurse posts and for local providers to ensure that they have a workforce skilled to deliver these services.
Lord Dubs
Does the Minister agree that the majority of patients suffering from MS do not have access to an MS nurse and that the absence of an MS nurse makes it very hard for patients to live independently? Does he further agree that the absence of an MS nurse puts enormously more pressure on consultants and GPs?
Earl Howe
My Lords, the Government recognise the very valuable contribution made by nurse specialists. It remains our view that local providers should have the freedom to determine their own workforce based on clinical need as they assess it. The commissioning consortia that will be in place subject to the passage of the Health and Social Care Bill and led by clinicians will recognise that nurse specialists have an essential role in improving outcomes and experiences for patients. That is part of the key to ensuring that these valuable posts remain in place.
NHS Reform
Debate between Lord Dubs and Earl Howe(13 years, 6 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the NHS operating framework 2011-12 set out that, to retain effective management capacity in all PCTs until their abolition in 2013, subject to parliamentary approval, PCTs should form clusters managed by single executive teams. This clustering arrangement will support PCTs in preparing for and transitioning functions to GP consortia.
Lord Dubs
My Lords, does the Minister not agree that too much reorganisation is more than the health service can stand? What on earth is the point of abolishing PCTs and re-establishing them in clusters two years before they are going to be abolished? It makes no sense at all unless the Government are going to change their mind about the main legislation.
Earl Howe
My Lords, when we went out to consultation on the White Paper last summer, concerns were raised that the transition could lead to too much disruption and a decline in the quality of services, as well as a loss of accountability, so the department decided to expand the approach to managed consolidation of PCT capacity and establish the clusters nationwide. That has been done already in London and the north-east and will pave the way for the NHS commissioning board to develop its roles. It will maintain accountability and grip during 2011-12 and the subsequent year, once strategic health authorities have been abolished. We are using existing legislative powers and it will help to oversee delivery in the coming two years.
Health: Multiple Sclerosis
Debate between Lord Dubs and Earl Howe(13 years, 8 months ago)
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Earl Howe
My noble friend is absolutely right. There are two drugs, Cladribin and Fingolimod, which are oral treatments but they have not yet received licences. The trial results for Fingolimod are promising, but it is premature to say that the treatment will remove the need for the drugs in the risk-sharing scheme. Clearly, oral treatments are likely to have advantages over alternative treatments given by injection or infusion, but some concern has been expressed about possible side-effects and the likely cost to the NHS.
Earl Howe
In recent years the number of specialist MS nurses has increased—I understand that the number has almost doubled—partly as a result of the risk-sharing scheme introduced in 2002. However, we hear anecdotal reports that the numbers are dwindling, which is a matter of concern. Under the new NHS architecture, which will be characterised by clinically-led commissioning responding to the health needs of the local area, we will see that the workforce planning that will emerge will lead to the training of more of these specialist nurses.
Health: NICE
Debate between Lord Dubs and Earl Howe(14 years, 2 months ago)
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Earl Howe
My Lords, the noble Baroness makes a very important point about dementia. She will be aware that when the Alzheimer’s drugs were appraised by NICE some years ago, there was disquiet that the role played by carers had not received adequate attention in the appraisal process. It is an issue of great importance to many people, but it is very complex. Given the finite, overall health budget, if we give greater weight to one factor, such as carers or getting people back to work, we automatically, by default, give less weight to others, such as people at the end of their lives. We need to look at this, but it is complex. We shall not let it go, but I cannot give the noble Baroness a definitive answer today.
Lord Dubs
My Lords, I wonder whether the Minister can do better than the Prime Minister did in Prime Minister’s Questions earlier today, when he declined to give a guarantee that the 14-day period, within which cancer patients should receive hospital treatment, would be upheld. Can he confirm that the Government will stick to the 14-day period?
Health: Isle of Man
Debate between Lord Dubs and Earl Howe(14 years, 3 months ago)
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Earl Howe
My Lords, I am afraid that I cannot help my noble friend as I have not had access to the papers relating to the previous Administration. However, I can tell him that very cordial discussions and negotiations are proceeding at the moment, and the devolved Administrations will be consulted.
Lord Dubs
My Lords, the Minister in an earlier answer referred to the United States as being a parallel, but does he not agree that what we are after is that British tourists who go on holiday to the Isle of Man feel that they are covered at least as well as if they had gone on holiday to France? Does he agree that that is not the case and, unless insurance arrangements change, our people will suffer, as will Isle of Man people? Surely the right thing to do is to keep these reciprocal arrangements going.
Earl Howe
My Lords, if a UK resident were to travel to the Isle of Man, as I have said, and were to fall ill and need emergency care, they would receive that care free of charge. That is what the agreement currently covers. It was extended by the previous Government in March and will last until the end of September. We are using that window of opportunity to negotiate with the Isle of Man Government and, as I have said, these discussions at official level are proceeding very cordially.