Health: Diabetes and Obesity

Baroness Finlay of Llandaff Excerpts

Thursday 30th June 2016 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness is clearly right that weight reduction can reverse diabetes. My father, for example, has lost weight and his diabetes has, effectively, been put into remission. There is no question that it works. However, it is very difficult to lose weight once you are overweight. The figure is that only one in 210 people with a BMI of over 30 can reduce it to a normal level; hence the emphasis that the Government are putting on explaining this to children and young people before they get fat. That is the critical place to aim. However, I entirely agree that greater access to structured education programmes is very important.

[Baroness Finlay of Llandaff (CB)]

I fully endorse that reply from the Minister, but will he also ensure that the guidance includes recognition of emerging research that children, if they never become obese, have a different type of fat—brown fat—which maintains a higher metabolic rate and therefore decreases their long-term risk of diabetes? The importance of avoiding obesity in the first place, particularly in children and in women, in pregnancy and post pregnancy, is the only way that we will stop this ever-growing curve of diabetes associated with adult obesity.

[Lord Prior of Brampton]

I entirely endorse the words of the noble Baroness, which I am sure will be reiterated in the obesity strategy when it is announced later in the summer.

National Clinical Director of Adult Neurology

Baroness Finlay of Llandaff Excerpts

Thursday 9th June 2016 Lords Chamber

[Lord Prior of Brampton]

I do not think that anyone is saying that the system was not working well enough. The argument that NHS England put was that it had to focus its resources on a smaller number of key national priorities—for example, mental health, cancer and learning disabilities—and that is what it is doing. It is poking the resource into a smaller number of well-focused and well-defined areas, but it can still get all the advice that it needs on neurology from the clinical reference groups and other sources.

[Baroness Finlay of Llandaff (CB)]

Do the Government recognise that the UK has only one-sixth of the number of neurologists that the rest of Europe has, which accounts for delays in diagnosis, poor outcomes for patients and wide variation in services? That needs to be addressed urgently for patients to have earlier diagnosis and better outcomes, and for their families to be better supported. Co-ordination of clinical and research efforts needs to be across the UK. I declare an interest at Cardiff University, where the amazing CUBRIC has just been opened by Her Majesty the Queen. It has the potential to transform neurological diagnosis in the UK, but there needs to be UK-wide effort.

[Lord Prior of Brampton]

Health is of course a devolved matter in the UK, but there is absolutely nothing to stop the devolved parts of the UK—Scotland, Wales, Northern Ireland and England—from working closely together on these issues. I do not think that the lack of a national clinical director prevents us in any way from doing that.

NHS England: Pre-exposure Prophylaxis for People at Risk of HIV

Baroness Finlay of Llandaff Excerpts

Tuesday 7th June 2016 Lords Chamber

[Lord Prior of Brampton]

All I can say in response is that NHS England has had independent legal advice that it does not have the power to commission this particular drug for this particular purpose, and for this purpose the drug itself is not yet licensed. It is not to do with any decision made on efficacy grounds for this drug; it is purely that they have received independent legal advice.

[Baroness Finlay of Llandaff (CB)]

Can the Minister confirm that that legal advice, as I understood it on reading it through, points out that there is weak evidence that NHS England does not have the power to commission PrEP? It says that NHS England does not have the power to fund PrEP but points out that under Section 7A, the Secretary of State has the power to delegate the commissioning of PrEP. Can the Minister therefore explain why, in the face of the evidence that has come through from the PROUD study and internationally, the Secretary of State has not used Section 7A to support NHS England? Is there a dispute going on between NHS England and Public Health England, and is this a fallout from the Health and Social Care Act?

[Lord Prior of Brampton]

I do not think that it is a fallout from the Health and Social Care Act. It is purely that the NHS specialist commissioning committee within NHS England has received clear independent legal advice, as I understand it, saying that it does not have the power to commission this product. That position may well be challenged legally, in which case it will be resolved one way or the other.

Obesity

Baroness Finlay of Llandaff Excerpts

Thursday 26th May 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, of course my noble friend is right that individual responsibility is critical to this. But we have to make it easy for people to make the right choices by providing the right information. Particularly for children, we have to make it easier for them and their parents to make the right choice.

[Baroness Finlay of Llandaff (CB)]

Has the Minister asked NHS England to tackle the problem of obesity among healthcare staff? It is very difficult for the public to get a public health message about losing weight from a member of staff who is, frankly, obese.

[Lord Prior of Brampton]

The noble Baroness makes a very important point. That is what lies behind the chief executive of NHS England’s decision to address the presence of unhealthy food and drinks on NHS properties, and to encourage staff to live a much healthier lifestyle.

Health: Alcohol

Baroness Finlay of Llandaff Excerpts

Thursday 12th May 2016 Lords Chamber

[Lord Prior of Brampton]

Thinking very quickly, my Lords, our position is that alcohol is not safe but it is low risk depending on how you drink. It is a low-risk activity at a level of about 14 units spread evenly across the week. I am sure that the noble Lord will adhere strictly to that guideline.

[Baroness Finlay of Llandaff (CB)]

My Lords—

[Baroness Massey of Darwen (Lab)]

My Lords, does the Minister agree that attempts to alert the general public are often too little, too late?

[The Lord Privy Seal (Baroness Stowell of Beeston) (Con)]

My Lords, it is the turn of the Cross Benches.

[Baroness Finlay of Llandaff]

In the review to which the Minister referred, is the cost of accidents through alcohol-related driving and road accidents being costed? Is consideration being given to lowering the drink-driving limit, perhaps even to almost zero, as in some countries?

[Lord Prior of Brampton]

My Lords, traffic accidents caused by alcohol have been costed. I cannot give the noble Baroness that figure today but I will write to her with it. I do not believe that we are currently reviewing the alcohol limit for driving, although I know that in Scotland it has recently been reduced.

Health: Treatment Rationing

Baroness Finlay of Llandaff Excerpts

Tuesday 26th April 2016 Lords Chamber

[Lord Prior of Brampton]

Before long, my Lords.

[Baroness Finlay of Llandaff (CB)]

What action does the Minister intend to take against clinical commissioning groups which are commissioning services based on arbitrary, discriminatory decisions rather than on evidence?

[Lord Prior of Brampton]

My Lords, the whole purpose of local commissioning groups was that they would be guided and directed by local clinicians. They must be allowed to set their own local priorities. It would not be right for me to direct local commissioning groups how to behave.

Accident and Emergency Services: Staffing

Baroness Finlay of Llandaff Excerpts

Tuesday 23rd February 2016 Lords Chamber

[Lord Prior of Brampton]

The right reverend Prelate is right that reliance on agency and non-permanent staff has become far too high. It is something we must reduce, not just because it is very expensive to use agency staff, but because the continuity and quality of care suffers. We are taking strong action to reduce the role of agency staffing in the NHS.

[Baroness Finlay of Llandaff (CB)]

Do the Government accept that demand on services is now outstripping the increasing workforce that they have tried to invest in? The workforce crisis is made worse because of the brain drain, with emergency medicine trainees being attracted to other parts of the world that often have very good working conditions. The Government therefore need to take an urgent look at the whole pinch point of emergency departments, given the increased number of patients who go to where the lights are on all the time and where they know they will be seen properly by someone who is properly trained. The crisis means that they now will often be seen by a locum and the staff are on their knees.

[Lord Prior of Brampton]

My Lords, the noble Baroness raises an important point, but it is not new: 24% of all doctors who work in the NHS have been trained overseas. This problem goes back over 20 to 30 years. We must train more of our own doctors. On the specific point on emergency medicine, I was surprised that, over the last 10 years, there has been an increase in emergency doctors—A&E doctors in the main—of 9% per annum, against growth in demand of between 2% and 3%. That does not fully answer the noble Baroness’s point, but, compared with other parts of the NHS, there has been greater investment in doctors and other staff in emergency medicine.

Mental Health Taskforce

Baroness Finlay of Llandaff Excerpts

Tuesday 23rd February 2016 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness is right: psychiatry is one of the shortage areas, along with general practice and a few other specialties. Premia will be available in the new junior doctor’s contract to encourage people to do psychiatry. That does not answer the noble Baroness’s question all that fully; this is something I should like to look into more myself. However, within the extra spending that has been announced, there will be money for, I think, 1,700 therapists who are experienced in IAPT—cognitive behavioural therapy and the like—which should also help.

[Baroness Finlay of Llandaff (CB)]

Given the problems experienced by emergency departments when they have an acutely distressed and ill mental health patient who cannot be cared for in the community and who needs to have a bed found for them, do the Government recognise that, at the moment, beds in the emergency department have to be blocked off—sometimes for hours, occasionally for days—while a bed is sought for this person, who could not possibly be cared for in the community because they are so acutely disturbed? Will the task force be asked to look specifically at that area of acute provision, separately from some of the other areas of more chronic mental health provision?

[Lord Prior of Brampton]

My Lords, it is very serious when someone going through a severe psychotic episode ends up in an A&E department, there is no local bed available in a mental health hospital, and they therefore spend time being specially guarded by two or three people, often in wholly inappropriate surroundings. This is the issue that the noble Lord, Lord Crisp, addressed in his report which came out a week earlier than the task force’s: people are moved, often many hundreds of miles away, out of their area, to find a bed. Sometimes they get there and the bed is full and they are a long way from their family. It is a highly unsatisfactory, often very dangerous, situation. The approach of the task force is to try to ensure that more money goes into the home treatment and home resolution area, to free up beds in the acute sector. By providing more care in the community, more beds are freed up in acute hospitals, increasing capacity and enabling people who are in A&E departments to be transferred more quickly to the right place. This is clearly a very serious issue.

Health: Adult Psychiatric Care

Baroness Finlay of Llandaff Excerpts

Monday 22nd February 2016 Lords Chamber

[Lord Prior of Brampton]

No, it is not very simple, or at least it is not simple to me; but then I perhaps have a smaller brain than the noble Lord opposite. It is certainly additional to the £1.5 billion for children and young people. I cannot tell the noble Lord now, without fear of making a mistake, whether it will be £1 billion every year from 2016-17 to 2021. It is certainly £1 billion in 2021. If it is all right, I will write to the noble Lord to confirm and clarify that.

[Baroness Finlay of Llandaff (CB)]

How do the Government intend to monitor the efficacy of this investment, and against what performance indicators will this investment be audited?

[Lord Prior of Brampton]

My Lords, that is a very hard question to answer. The talking therapies, for example, seem to be effective in about 50% of the cases, and whether they are effective is clearly a clinical decision. As for other standards, we tend to rely, as the noble Baroness will know, on proxies such as waiting times and the four-hour standard, which the noble Lord recommended in his report. We are considering the introduction of a four-hour waiting-time standard for people suffering from psychotic problems, in the same way as we have for physical health.

Allied Health Professionals: Training

Baroness Finlay of Llandaff Excerpts

Monday 8th February 2016 Lords Chamber

Asked by

[Baroness Finlay of Llandaff]

To ask Her Majesty’s Government what discussions they have had with Health Education England to ensure that the number of student commissions for 2016–17 supports the goal of increasing the number of student places for allied health professionals set out in the comprehensive spending review, and ensures stability in allied health professionals’ education provision and workforce supply.

[Baroness Finlay of Llandaff (CB)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and I declare an interest as the honorary president of the Chartered Society of Physiotherapy.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, Health Education England plans to commission, overall, 7,554 AHP training places in 2016-17—an increase of 344, or 4.8%, compared to 2015-16. The announcement in the 2015 spending review to move nursing, midwifery and AHP students on to the standard student loan system is for new students commencing their courses from 2017 only and therefore does not affect students commencing their courses in 2016-17.

--- Later in debate ---

[Baroness Finlay of Llandaff]

Do the Government recognise that 500 more physiotherapy places will be needed in training each year until 2020 just to meet current needs? With Health Education England proposing cuts in training places in six out of 10 of the allied health professions—cuts ranging from 3.4% to 9.7%—how will the new models of care in prevention, patient treatment and reablement be met, given that they depend on these professionals taking on extended roles? This goes across sectors commissioned by the NHS and by other departments, including the Department for Education, the Home Office and the Ministry of Defence.

[Lord Prior of Brampton]

My Lords, Health Education England is proposing a net increase of 334 places in 2016-17 and we expect a growth in overall numbers of nurses and AHPs from 2017 onwards as a result of moving on to the standard student loan system.