NHS Reform

Lord Naseby Excerpts

Monday 4th April 2011 Lords Chamber

[Earl Howe]

My Lords, we are clear that the essential functions of the primary care trusts should continue. That includes monitoring clinical governance within primary care. Having said that, I am sure that the noble Baroness will agree that clinical governance in the primary care context has not been all that it might be, which is why we believe that the new arrangements will considerably strengthen that governance.

[Lord Naseby]

My Lords, does my noble friend agree that it was common knowledge that PCTs needed reorganising because they were not meeting patient needs? Furthermore, doctors themselves found that the PCTs were getting in the way of treating their patients properly. Frankly, had not PCTs also created a huge bureaucracy, so that money was being soaked up in bureaucracy rather than being used for patient care?

[Earl Howe]

I agree with every word my noble friend said. It is illustrative of the truth of his remarks that, in the final year of the Labour Government, the administrative costs of the NHS rose by no less than £220 million. The rise in administrative costs was exponential. My noble friend is right: at the moment we largely have an NHS that is managerially and administratively led, rather than clinically led. We want to reverse that balance.

Health: Preventable Sight Loss

Lord Naseby Excerpts

Tuesday 29th March 2011 Lords Chamber

[Earl Howe]

My Lords, I join the noble Baroness in welcoming the formation of the Macular Disease Society, and I can assure her that my department will wish to engage closely with it; I think that it is a very positive development. Reducing avoidable sight loss is clearly an issue that we have to take seriously. The prevention of sight loss will be an aim of work undertaken across the new public health system, as I have indicated. At national level we are proposing that Public Health England will design some specific public health services including screening, as has been mentioned, and locally we propose new responsibilities for local authorities.

[Lord Naseby]

As financial resources are limited, is not avoidable sight loss an absolute public health priority? Is it not better to spend money on that than restricting small and large retailers further in terms of their display of tobacco in a market that is declining in any case?

[Earl Howe]

My Lords, I will simply say to my noble friend that public health clearly has an important contribution to make to reducing avoidable sight loss by addressing the obvious risk factors for sight loss, but also by delivering on our general public health outcomes, such as reducing smoking and obesity and diabetes, all of which are associated with the development of eye disease. The tobacco strategy has a direct bearing on this question.

Health: Passive Smoking

Lord Naseby Excerpts

Tuesday 30th November 2010 Lords Chamber

[Earl Howe]

My Lords, that is the very question that we want to look at. Of course, tobacco companies regard their brands as a form of marketing and they attach value to the intellectual property that they consider to be in those brands. However, the issue from a public health perspective is whether the design of a pack actually entices non-smokers to take up smoking or indeed deters smokers from giving up. That is the question that we will examine.

[Lord Naseby]

Is my noble friend aware that the oldest member of Surrey County Cricket Club last year claimed that his longevity was due to a combination of smoking fags and good sex?

[A noble Lord]

Rubbish.

[Lord Naseby]

Well, that was not his view.

Furthermore, in relation to intellectual property, which is what we are taking about with packaging, is it not a very brave Government—even a coalition Government—that interfere with international laws that are already on the statute book to protect intellectual property, which is basically what packaging is?

[Earl Howe]

My Lords, of course my noble friend is right that there are legal issues inherent in this whole question, which we will look into very closely.

On his first point, it is always a pleasure to hear of someone who has lived a long time in good health despite smoking. However, I say to my noble friend that the Royal College of Physicians estimates that more than 300,000 primary care consultations are recorded each year across the UK for conditions in children due to exposure to second-hand smoke.

Healthcare

Lord Naseby Excerpts

Thursday 28th October 2010 Lords Chamber

[Lord Naseby]

My Lords, the coalition Government’s strategy for the NHS is clear and very welcome. The first stage is the White Paper, consultation on which has just been completed. The responses were of a good volume. Three objectives were outlined in the White Paper: the one that we are discussing today, creating a patient-led NHS; improving healthcare outcomes; and increasing autonomy and accountability in the NHS. We also know from the comprehensive spending review that the funding is ring-fenced and is available only for the NHS.

Frankly, I sat in blank amazement listening to the noble Lord, Lord Winston, claim that at the general election the NHS was in its healthiest state for decades. I remind him that we were left with mixed wards, which we were told 13 years ago would be got rid of. We had the chaos of out-of-hours cover. I do not need to remind the noble Baroness on the Front Bench of a number of tragic cases. We had a situation where a number of brought-in, standby, out-of-hours doctors did not even speak English. We have had questionable care on the nursing front. I support what the noble Baroness said earlier. My wife is a retired GP and is pretty objective when it comes to nursing care. I am sorry to report that nursing care at Papworth is certainly not world-class. Frankly, it is pretty poor. We have a situation where cancer drugs have not been sorted out for the past 13 years. I make a plea to my noble friend on the Front Bench. If we have £200 million of ring-fenced money for cancer drugs, although it is to be deputed to the existing regional health authorities, can we not consult with cancer charities on which drugs they think would be a primary help in that particular budget? Perhaps I do not even have to mention IT and the billions that were spent on something that has not worked. Do not tell this Government that the NHS was left in the best state ever after the past 13 years.

I look back to a time when my wife was a second-phase GP fundholder. Most GPs were in the fundholding scheme: only a hard core were not. That was successful; it worked. It is no good the noble Lord shaking his head. GPs who went into fundholding achieved very short lists for operations. The scheme worked well and I am sorry to say that it was only through prejudice that the incoming Government got rid of GP fundholding and then produced modified targets that they thought were a substitute for it. They were not.

I will finish by saying a couple of words about medicines. Traditionally, medicines in the NHS have taken up between 10 and 12 per cent of the budget. I have noticed two worrying developments. First, the standard of generic substitutes is not what it should be. We have seen the recent case of Lipitor, and a number of other cases are documented in the pharmaceutical area. Something must be done about that situation. The second is counterfeit medicines, which I do not think were a problem 13 years ago. Again, I am not blaming the outgoing Government for this but there is now a problem across Europe with counterfeit medicines, and I shall mention two statistics. First, 62 per cent of medicines bought on the internet are counterfeit or substandard and, secondly, across the whole of Europe in 2006 no less than 2.7 million fake medicines were seized. I do not wish to say any more, other than that I look forward to receiving answers to the questions that I have raised.

Health: Spending Review 2010

Lord Naseby Excerpts

Tuesday 26th October 2010 Lords Chamber

[Earl Howe]

The noble Lord raises two issues: access to new medicines for sufferers from cancers, particularly rarer cancers; and prescription charges. On the first, he will know that we have already created a cancer drugs fund to enable those people who cannot access cancer drugs to apply for funding for those drugs. That was part of the spending review announcement made last week. On the issue of prescription charges, we are looking for ways to make the system fairer than it is at the moment. We have not implemented the previous Government's plan to exempt all people with chronic conditions. Frankly, it was not affordable in the current context. However, we are looking at other means of creating fairness in the system.

[Lord Naseby]

Is my noble friend aware how important it was that he re-emphasised that there had been absolutely no change in the targets for dealing with cancer patients? Is it not surprising to him that the opposition spokesman was not aware of that fact? If we are to have a further report before the end of the year, will it include a review of NICE’s attitude to all cancer drugs, and of their availability to NHS patients?

[Earl Howe]

My Lords, we believe that there is a long-term role for NICE, not least in the area of assessing the clinical effectiveness of drugs. In the longer term, we believe that the problem that my noble friend identifies can be addressed more satisfactorily by a system of value-based pricing for medicines, which will mean that the price of a medicine will reflect its value to the patient, as assessed. That is a longer-term exercise that we cannot bring in in a hurry, but we are extremely conscious of the problem that my noble friend alludes to. Having said that, I stress that NICE will remain at the centre of our plans to roll out quality in the NHS.

Health: NICE

Lord Naseby Excerpts

Wednesday 14th July 2010 Lords Chamber

Asked By

[Lord Naseby]

To ask Her Majesty’s Government whether they plan to review the management and procedures of the National Institute for Health and Clinical Excellence to ensure that patients suffering from the most prevalent conditions of cancer and Alzheimer’s disease are properly treated.

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

My Lords, our White Paper, Equity and Excellence: Liberating the NHS, published on 12 July 2010, sets out our commitment to renew the National Institute for Health and Clinical Excellence and, through primary legislation, to re-establish it as an executive non-departmental public body. Legislation on NICE will be included in a health Bill in the autumn.

[Lord Naseby]

The Minister’s Answer is extraordinarily welcome. So far as concerns those suffering from cancer and similar problems, is he aware that according to a report called Exceptional Progress?, published in March this year, fewer than four out of nine of the drugs put forward were refused by NICE, which left 16,000 patients with nowhere to go, whereas if they had been French or German those drugs would have been available? Furthermore, is he aware that there is currently great criticism of the processing, structures and methodology used by NICE and that, against that background, his news that the organisation is to be totally reformed is enormously welcome?

[Earl Howe]

My Lords, I am grateful to my noble friend. It is important for me to state that the Government respect the independent expertise provided by NICE and we think that it should be allowed to continue to issue guidance free from political interference. That is a point of principle. However, we also think that there are failings within the wider system regarding drug pricing and drug access. We are determined to address that but we are clear that NICE plays a vital advisory role.