Health: Neurological Conditions

Monday 27th February 2012 Lords Chamber

Question

14:59

Asked by

[Lord Walton of Detchant]

To ask Her Majesty’s Government how they propose to improve outcomes-led neurological services following the National Audit Office report Services for People with Neurological Conditions published in December 2011.

[Lord Walton of Detchant]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In so doing, I declare an interest as a former neurologist holding honorary positions with many neurological charities.

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

My Lords, we will be providing a detailed written response to the National Audit Office report Services for People with Neurological Conditions in due course. While some progress has been made, we acknowledge that there is more to do to improve care for people with neurological conditions. Work is under way to develop a new outcome strategy for long-term conditions and to introduce more personalised care, including piloting of personal health budgets.

[Lord Walton of Detchant]

My Lords, I thank the noble Earl for that reply. This report was extremely critical in demonstrating serious inequalities in the standards of care for patients with various neurological conditions, not least Parkinson’s disease, multiple sclerosis, neuromuscular disease and many more, in different parts of the UK. That is highlighted by two major inquiries conducted by all-party groups demonstrating serious deficiencies in the care of patients with parkinsonism and neuromuscular disease. Is it not time that the Government appointed a neurological tsar to oversee the situation and to recommend improvements?

[Earl Howe]

My Lords, I pay tribute to the noble Lord’s extensive work in Parliament on behalf of those with neurological conditions. We have taken the view that the appointment of a tsar or a clinical specialist in this area should be one for the NHS Commissioning Board. It is satisfied with that position and we must await its determination on that.

[Baroness Hussein-Ece]

My Lords, the report also highlighted important indicators that the quality of care for people with neurological conditions in some instances had worsened. For example, the number of people admitted to hospital as an emergency had increased significantly and, indeed, emergency readmissions after spending a night in hospital have increased for patients with Parkinson’s disease, multiple sclerosis and motor neurone disease, to give three examples. What are the Government doing to address this?

[Earl Howe]

My noble friend is quite right. We know that people with long-term neurological conditions are high users of NHS services and, as the NAO report identifies, they often have high levels of unplanned admissions to hospital. To help to provide personalised care and to support better-planned care, there is quite a deal of evidence—of the generic kind, but nevertheless very useful—out there for neurological patients. It focuses on the individual, on planning, on supported self-care and on how patients themselves can improve their own outcomes. We are building a strategy on that model to set out how local authorities, the voluntary sector and government agencies can work together to prevent the kind of emergency admissions to which my noble friend refers.

[Baroness Masham of Ilton]

My Lords, does the Minister agree that specialised nurses working on these very complicated neurological conditions are very important? Would he see to it that their services are not cut but increased?

[Earl Howe]

The noble Baroness is quite right that specialist nurses provide an important source of support and advice to patients with a range of neurological conditions. They enable patients to manage their own condition effectively, as I mentioned just now. Guidance issued by NICE is clear on the important role that specialist nurses can play in the provision of effective services for those living with a range of neurological conditions.

[Baroness Gardner of Parkes]

Has the Minister seen the reports in the newspaper today about the worry that people have about the shortage of medication for those with Parkinson’s disease, for example? Is it a worry more in the press than in reality? How can the Government ensure adequate supplies of necessary medication for these cases?

[Earl Howe]

There have been shortages of certain medicines over the past two or three years for a number of reasons; there is not a single reason. The Department of Health is working with the medicines supply chain established under the previous Government, and is doing very effective work. It is liaising with manufacturers, wholesalers and the pharmacy trade to ensure that medicines are available when needed. I have not seen the article to which my noble friend refers, but we are not of the view that there is any need for undue concern. However, we are keeping the position under review.

[Baroness Thornton]

My Lords, it has been suggested that the UK currently does not have enough neurologists—that there should be one neurologist per 40,000 people, and at the moment we have one neurologist per 125,000 people. How will the Government increase the number of neurologists; and how will they do that under the current proposals for the reform of the NHS? Who will drive that increase?

[Earl Howe]

As the noble Baroness may remember, the National Service Framework for Long-term Neurological Conditions set out as a principal requirement the need for an appropriately skilled workforce to manage the care of people with long-term neurological conditions. At the moment that is the responsibility of primary care trusts. The good news is that full-time equivalent numbers of consultants have been rising steadily. According to the Information Centre census, there were 523 in 2010, an increase from 517 the previous year and from 449 in 2004. To answer the latter part of the noble Baroness’s question, I can say that the Centre for Workforce Intelligence will feed into Health Education England, which will in turn inform the local partnerships that we intend to establish under the reforms, so that there is both a national and a local input on workforce numbers and the numbers we need to train to deliver the service that patients require.

[Lord Brooke of Sutton Mandeville]

My Lords, in the context of the all-party report to which the noble Lord, Lord Walton of Detchant, referred, is my noble friend aware that, of the time invested in the production of that report, some 97 per cent was provided by Members of your Lordships’ House? Does he think that that has any relevance in the context of discussion about the future of the House of Lords?

[Earl Howe]

I am sure that my noble friend will introduce that and other considerations when we come to debate House of Lords reform. I will observe that, when I was on the opposition Benches and used to attend all-party group meetings on neurological conditions, practically the only people there were Members of your Lordships’ House.