NHS: Bed Capacity

Baroness Masham of Ilton Excerpts

Thursday 20th March 2014 Lords Chamber

[Earl Howe]

My noble friend is quite right. As she knows, there are far too many frail elderly people who end up in hospital in the first place. We must get better at the discharge arrangements for them and not keep them in hospital too long. This is the focus of much of the work going on in the department and NHS England at present concerning vulnerable older people. We will announce a comprehensive plan around this later in the year.

[Baroness Masham of Ilton (CB)]

My Lords, apart from distressing patients, is not moving them around bad for infection control, particularly if the beds are not properly cleaned?

[Earl Howe]

Yes, my Lords. As ever, the noble Baroness makes an extremely good point. It is heartening that infection rates have come dramatically down in hospitals over the past few years, but we can never be complacent and it is important that when a patient is moved the infection question is always considered.

Health: Local Healthwatch Funding

Baroness Masham of Ilton Excerpts

Wednesday 19th March 2014 Lords Chamber

[Earl Howe]

I simply say to the noble Baroness that it is too soon to say whether local Healthwatch has been starved of cash. What matters most to local communities is the difference that their local Healthwatch is making, such as rooting out poor practice, ensuring that the views of local communities are heard in inspections and helping to improve local services. It is only after a period of time that we can make the relevant judgments. I can tell the noble Baroness that Healthwatch England is playing the role that it was designed to do: overseeing and supporting local Healthwatch where necessary.

[Baroness Masham of Ilton (CB)]

My Lords, does not the Minister agree that this is an example of where money should be ring-fenced? The people who work for Healthwatch are volunteers. They should not be out of pocket and they need their expenses for travel.

[Earl Howe]

I agree with the noble Baroness that, in the normal course of events, expenses should be reimbursed, but I say again that it is not the role of Ministers to second-guess the judgments of local authorities. We believe in local autonomy. There are plenty of other ways in which many local authorities are supporting voluntary groups in their areas apart from Healthwatch, and making a difference in that way.

NHS: NICE-appraised Medicines

Baroness Masham of Ilton Excerpts

Thursday 27th February 2014 Lords Chamber

[Earl Howe]

My Lords, drugs which have not yet been assessed or approved by NICE are eligible for use under the Cancer Drugs Fund. I am pleased to say that the Government have made a total of £1 billion available under that fund and 44,000 patients have been treated under it. I appreciate the noble Lord bringing that particular drug to my attention and I undertake to look at it.

[Baroness Masham of Ilton (CB)]

My Lords, does the Minister realise the frustration that some clinicians have when there is a drug that gives a better quality of life to patients but they cannot give it to them?

[Earl Howe]

My Lords, if a drug is licensed in this country, it is open to a clinician to prescribe it as long as their clinical commissioning group will fund it. There are local funding policies for drugs. I understand the noble Baroness’s point, but when a drug is assessed by NICE, it can be assessed for quality-of-life properties—that element will have been included in the assessment. Indeed, that is the reason why we have the process that NICE goes through.

Health: Meningitis B Vaccine

Baroness Masham of Ilton Excerpts

Monday 24th February 2014 Lords Chamber

[Earl Howe]

The noble Lord makes a series of very important points. I know he will understand that it would be wrong for me to be drawn into going into too much detail on the clinical and cost-effectiveness of this vaccine because that is the job we have given to the JCVI.

[Baroness Masham of Ilton (CB)]

My Lords, how do we compare with other European countries in giving children this vaccine?

[Earl Howe]

Our childhood immunisation programme generally bears comparison with any country in the world and is very extensive and very successful. However, the incidence and prevalence of meningitis B is higher than in many other countries, which is why there is such concern about it.

NHS: Seven-day Working

Baroness Masham of Ilton Excerpts

Thursday 6th February 2014 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, I thank the noble Lord, Lord Ribeiro, for asking this question. I am sure all noble Lords speaking today want to see improvements in the NHS.

A few years ago, I attended an open day at the Harrogate hospital trust. When we were shown the MRI scanner and other equipment, one of my group asked, “Would it not be desirable and beneficial to keep everything running seven days a week?”. The radiologist said, rather forlornly, “There are only one and a half of us”. The public would be very pleased to see a seven-day service in the NHS, but this would need more trained staff right through the system, and a culture of co-operation and communication. There should be an eradication of bullying and fear among managers and all staff. There should be a duty of candour and transparency, and dedicated teams looking after patients. Patients need continuity of care. They are so dismayed when their operations are cancelled at the last minute. Is there too much pressure on our existing National Health Service? General practice is facing a growing crisis as it struggles to provide the care needed for an increasing patient population.

I agree with the forum’s ambitions but, first, it is surely important to improve the safety of patients and the training of staff, so that they become experts in diagnosis and treatment. So much money is wasted on compensation and there is so much heartbreak for the nearest and dearest—and for the patients, if they live—when something goes wrong. Before the much hoped for seven-day working there should be improvements for what we already have in the NHS. For example, hospital A&E costs for stand-in doctors have increased by millions over three years. Blood donors are turned away by clinics because of late-running sessions and sick staff. If they feel their gift is not respected and they are not well treated, they will not turn up next time. I have an interest, as blood transfusions saved my life. Volunteers play an important part in the NHS, and they should be appreciated. There are huge variations in how GP surgeries provide a service to patients across the country.

I for one appreciate our health service, but we need to keep it safe and sustainable, and it has to grow with the increasing demands. Carrots are better than sticks. How can we keep our good doctors in a competitive world? How can we make nurses put patients first, giving them TLC? Without commitment and enthusiasm, it will be difficult to keep the NHS in full sail for seven days a week. Does the Minister agree that safety of patients at weekends should be addressed now?

NHS: Cancer Treatment

Baroness Masham of Ilton Excerpts

Wednesday 29th January 2014 Lords Chamber

[Earl Howe]

My Lords, the Government invested £23 million aimed at increasing the capacity of radiotherapy centres in England to deliver intensity-modulated radiotherapy. The latest analysis shows that the median average of IMRT activity in England is at 29%, with the vast majority of centres delivering at 24% or above. That 24% was the magic figure recommended a few years ago by the national radiotherapy implementation group. We continue to monitor progress and local action plans closely.

[Baroness Masham of Ilton (CB)]

My Lords, I declare an interest as vice-chair of the all-party cancer group. Does the Minister agree that many older people develop cancer and, therefore, to stop treatment would ensure that many Members of your Lordships’ House would not get treatment? Will he therefore take this really very seriously?

[Earl Howe]

My Lords, I am with the noble Baroness all the way in wishing to see your Lordships live a healthy and long life but, as regards the population generally, I hope that I have made clear the Government’s determination to see that all citizens of this country receive treatment according to their ability to benefit from it.

Children and Families Bill

Baroness Masham of Ilton Excerpts

Wednesday 29th January 2014 Lords Chamber

[Lord Cormack]

No, frankly, I do not. I respect the noble Lord—he knows that—and we agree on many issues, but we will have to disagree on this one. I think it would make the job of the police even more difficult than it is at the moment and endanger what popularity they have with many law-abiding citizens. It is a burden that we should not place on them.

I repeat: let us do everything we can to educate; let us do everything we can to deter; let us have the plain packaging; let us listen very carefully to what Sir Cyril says in his report; but let us not take the ultimate step that the noble Lord advocates.

[Baroness Masham of Ilton (CB)]

My Lords, I shall be brief. I congratulate the Government on having listened about packaging of tobacco. I also support the amendments to protect children from people smoking in vehicles. Apart from damaging children’s health, smoke gets in their eyes and is very unpleasant. There are also small babies and pregnant mothers whose unborn children need protecting. I hope that the noble Earl can give the House some assurance that there will be regulations that will protect these vulnerable babies and children. I would add that people with asthma, and all chest problems, should also be protected because this is really dangerous for their health.

[Baroness Benjamin (LD)]

My Lords, I ask noble Lords to consider the following points as we debate these amendments. More than 800 children visit their doctors every day due to the serious effect of second-hand smoke exposure, according to research published by the Royal College of Physicians. The survey also highlights that 65% of parents who smoke admit to doing so in the car with their children and other people’s children present, and that 75% of smoking parents were shocked to hear that second-hand smoke affects the health of so many children. If they had not been asked that question they would not have been aware of this, so they really need to be educated.

Asthma UK has stated quite clearly that second-hand smoke is a major trigger for asthma attacks, making the symptoms even worse. It believes that if we take action to reduce second-hand smoke, we will be a step closer to a world where asthma begins to be no longer a daily struggle, or where no one dies from that condition. The children’s charity Sparks—I declare an interest as one of its trustees—spends millions of pounds on research to eradicate asthma among children, a condition which is growing daily. Sparks dearly believes that if we take action to protect children from second-hand smoke, that will be helpful to children. So let us give careful consideration to what action we should take to protect children from the result of second-hand smoking and act robustly in the best interests of the child.

--- Later in debate ---

[Earl Howe]

I have noted the way the noble Lord’s amendment has been drafted. However, we need to be very careful before accepting it, for the reasons that I am explaining now. One of the points made about enforcement was that we could make a useful comparison with seat-belt legislation. I understand why that comparison has been made but it needs to be borne in mind that we are not comparing like with like. Seat-belt legislation is a road safety measure which is properly enforced by the police; smoking in cars is a public health matter and the police have no public health role or functions. That is part of the reason that the issue is so complex. Before launching into the kind of amendment that the noble Lord, Lord Hunt, invites us to accept, we need to take stock of these questions. There is no point in putting something on the statute book if it is impractical to implement.

[Baroness Masham of Ilton]

Can I just ask the noble Earl whether the police have a duty in respect of alcohol abuse and violence in the streets?

[Earl Howe]

My Lords, the police obviously have public order responsibilities, which they can enforce—but not public health responsibilities, which is rather a different issue.

NHS: Walk-in Centres

Baroness Masham of Ilton Excerpts

Tuesday 10th December 2013 Lords Chamber

[Earl Howe]

The noble Baroness makes an extremely good point. One of the findings of the Monitor review was that, when responsibility for walk-in centres was handed down to local commissioners in 2007, many of them were decommissioned because they were duplicating services locally and GPs felt that they were paying twice for the same thing. I am sure that the ideas the noble Baroness has put forward will have a resonance in many areas.

[Baroness Masham of Ilton (CB)]

My Lords, is it true that doctors are being paid not to send patients to hospital? Does the Minister agree that when patients are ill they have no alternative but to go to A&E departments?

[Earl Howe]

I agree with the noble Baroness that A&E often presents the easiest and most convenient route into the NHS. That is why Sir Bruce Keogh is currently conducting his system-wide review and looking at pressures on the system. I am not aware of any doctors who are being paid not to refer patients to hospital. Indeed, as the noble Baroness may be aware, the BMA has been steadfast in its opposition to any such scheme.

NHS: Clinical Commissioning Groups

Baroness Masham of Ilton Excerpts

Wednesday 27th November 2013 Lords Chamber

[Earl Howe]

My Lords, age is and has always been, in the formula, the primary driver of an individual’s need for health services. The very young and elderly, whose populations are not evenly distributed throughout the country, tend to make more use of health services than the rest of the population. Having said that, the formula contains elements relating to unavoidable differences in the costs of providing services due to location alone—that is, the market forces factor—and a number of other measures of adjustment. As I say, we are assured by NHS England that deprivation will feature in the formula that is published for next year.

[Baroness Masham of Ilton (CB)]

My Lords, is the noble Earl aware that in Yorkshire, many of the hospitals which are PFI are very seriously in debt? Is there not a rumour that the poorer north will have its money taken to the richer south?

NHS: Accident and Emergency Units

Baroness Masham of Ilton Excerpts

Tuesday 26th November 2013 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, there is confusion at the moment about where people go when they need treatment at weekends and at night. There is considerable difference between urban and rural health. I thank the noble Baroness, Lady McDonagh, for initiating this very topical debate.

Rural health has changed so much from the days of the family doctor, when he or she knew their patients. Now the doctor is dependent on the computer. My surgery in rural North Yorkshire opens at 9 am, is closed each day from 12.30 pm to 2 pm, has a historical half-day on a Thursday, shuts each day at 6 pm and is shut over the weekend. The out-of-hours service at Ripon is 10 miles away and does not have anyone to operate the X-ray so it has to be the hospitals, which are 26 and 16 miles away. There are no alternatives to the A&E departments. This is not good for elderly, frail people who need attention.

In rural areas there are serious farming injuries and all the usual conditions, but also such conditions as leptospirosis—Weil’s disease—which can be a killer. I agree that serious conditions should go to the correct hospital, however far away, and I must say that the air ambulance is invaluable and supported by the rural communities. Will having two types of emergency department—one an emergency centre and the other a major emergency centre—not cause more confusion? To which centre should a parent take a child with suspected meningitis B, which can kill within 24 hours?

More integrated care in the community is essential. With all the long-term rare conditions and conditions such as diabetes and liver disease, a specialist nurse is vital and can be a lifeline. One of the problems in the community is not being able to have a drip for antibiotics, and not being able to get antibiotics without a doctor means that ill people have to go to hospital. I am sure that if everyone learnt first aid and it was taught in schools, colleges, prisons and the community, lives would be saved.

Up-to-date information about what is available and where to go for treatment in rural areas would be helpful and would reduce confusion. I end by asking the Minister: with the shortage of emergency doctors working in A&E departments, what is being done to recruit and retain them? They need support so they do not get overburdened and disillusioned. They are essential.