Health: Cardiology

Baroness Masham of Ilton Excerpts

Monday 24th October 2011 Lords Chamber

[Earl Howe]

As my noble friend knows, the children’s heart surgery unit in Belfast is not part of the Safe and Sustainable review as it is the responsibility of the healthcare systems in the devolved Administration. It is for the Northern Irish health service to take a view on the safety and sustainability of those services and to consider the recommendations that flow out of the review in this country. We will, of course, share the learning from our experience in England, but I emphasise again that this is a matter for the NHS, and not Ministers, to resolve.

[Baroness Masham of Ilton]

My Lords, is the noble Earl aware that the north of England is a special case because of deprivation, long distances and cultural problems around the Bradford area? Does he agree that both Leeds and Newcastle need their children’s heart surgery units, and that deprivation is an important factor as far as travelling is concerned?

[Earl Howe]

My Lords, I agree that deprivation is an important consideration. The population density of the West Midlands conurbation and the very high case load of Birmingham Children’s Hospital suggested that the Birmingham service should be, as it were, a fixed point. However, I am afraid that the same cannot be applied to Leeds because although the Leeds catchment area has a high population it has a much lower case load than that of Birmingham. The analysis of the expert group suggested that there needed to be two centres in the north of England because of the population density; that was either Liverpool and Leeds or Liverpool and Newcastle. It was not possible to have a Leeds and Newcastle combination since Newcastle could not achieve a credible network.

Nursing: Elderly and Vulnerable Patients

Baroness Masham of Ilton Excerpts

Wednesday 19th October 2011 Lords Chamber

[Earl Howe]

My Lords, from my reading of the report —and I have looked through it—I think there is much there that we can pick up very usefully, so I agree.

[Baroness Masham of Ilton]

My Lords, does the noble Earl agree that district nurses do a very important job in keeping vulnerable, elderly and disabled people in the community? Is he aware that there is a shortage and that their training needs to be different because they go into other people’s homes?

[Earl Howe]

The noble Baroness, as ever, makes a very important point. It is one of the reasons we have a very ambitious programme of expanding the number of health visitors. She is right about tailoring the training to suit the environment. That is why there are local curricula as well as the core nursing curriculum that have approved standards from the NMC but are sensitive to local needs in individual areas.

Health: Non-communicable Diseases

Baroness Masham of Ilton Excerpts

Thursday 6th October 2011 Lords Chamber

[Baroness Masham of Ilton]

My Lords, I thank my noble friend Lord Crisp for bringing up this most important topic today in your Lordships’ House. He is an important ambassador, taking expert knowledge to the World Health Organisation and the United Nations and bringing information back to the UK. This is a timely debate for your Lordships as we will be debating the Health and Social Care Bill next week and non-communicable diseases need to be highlighted. They are a huge part of the health agenda.

My husband, who was a Member of your Lordships’ House and for a time Deputy Chief Whip, sustained several non-communicable diseases. He had several strokes, diabetes, Parkinson’s disease and a cancer tumour of his lower bowel. After 10 years of living with these conditions, he died of a respiratory disease—pneumonia—in an A&E department on a Sunday evening. My father died of coronary heart disease on a Sunday morning in Scotland when I was 18. The locum doctor thought he had a chest infection. He died half an hour later. Perhaps your Lordships will understand why I am so passionate to see correct diagnoses, care facilities improved, and the prevention of and research into the hundreds of different NCDs high on the agendas of countries across the world. In the mean time, however, the correct drugs should be available to help with the different diseases.

The UK, as a so-called developed country, has many improvements to make. Many people who watched the recent “Panorama” programme on the treatment of vulnerable people living in a care home near Bristol are still reeling from the horror of what they saw. Many people are surprised to learn that care assistants can get a job with no registration. They can be nurses who have been dismissed for dangerous and disgraceful practices and then be taken on as care assistants with no registration and no control. Surely all patients with non-communicable diseases who are vulnerable should feel safe and protected. I hope that the Government will take the safety of all patients very seriously. There have been far too many unkind and unacceptable incidents in recent years. That just cannot go on.

The Global Status Report on Noncommunicable Diseases 2010 states:

“Noncommunicable diseases (NCDs) are the leading global causes of death, causing more deaths than all other causes combined, and they strike hardest at the world’s low- and middle-income populations. These diseases have reached epidemic proportions, yet they could be significantly reduced, with millions of lives saved and untold suffering avoided, through reduction of their risk factors, early detection and timely treatments”.

The Global Status Report on Noncommunicable Diseases is the first worldwide report. It shows ways to map the epidemic, reduce its major risk factors and strengthen healthcare for people who already suffer from NCDs.

It is important that the World Health Organisation gets support from Governments worldwide. Of the 57 million global deaths in 2008, 36 million—or 63 per cent—were due to non-communicable diseases, principally cardiovascular diseases, diabetes, cancers and chronic respiratory diseases. As the impact of NCDs increases, and as populations age, annual NCD deaths are projected to continue to rise worldwide. Accurate data from countries are vital to reverse the global rise in deaths and disabilities. At the high-level UN meeting this September, world leaders unanimously adopted the political declaration on non-communicable diseases, agreeing that the global burden and threat of NCDs continues to be one of the major challenges for development in the 21st century, undermining social and economic development throughout the world. The director-general of the World Health Organisation, Dr Margaret Chan, told the meeting that NCDs are,

“the diseases that break the bank”.

Recommendation No. 6 is of the utmost importance. It is to:

“Recognize the urgent need for greater measures at global, regional and national levels to prevent and control non-communicable diseases in order to contribute to the full realization of the right of everyone to the highest attainable standard of physical and mental health”.

There are thousands of non-communicable diseases across the world, but there seem to be clusters in different parts of the UK. Two such conditions are spina bifida and leukaemia. Why should that be? There is a vital need for ongoing increased research into all non-communicable diseases. The health department, universities, pharmaceutical bodies, specialised units of experts and voluntary associations should all be working together to address the multitude of needs.

Diabetes has become a serious global emergency. The epidemic is now imposing a heavy dual burden of infections and non-communicable diseases on already under-resourced health systems. To date, no country has succeeded in turning around the figures. There are 50.8 million people with diabetes in India and 92.4 million in China. Africa will have the highest percentage increase in the number of people with diabetes over the next 20 years; 80 per cent of people with diabetes in Africa are undiagnosed. It is encouraging that countries are working together to try to find ways to stem that ever-increasing problem.

The Neurological Alliance is the collective voice of 80 brain and spine charities, representing the 8 million people in England with a neurological condition. They are often called the neglected 8 million. I hope that the Minister will see that every person diagnosed with a neurological condition has access to high-quality, joined-up services and good information.

Being a member of the all-party group on cancer and rarer cancers, I must make your Lordships aware of the great concern that exists about late diagnoses, especially of rarer cancers. The Government must be congratulated on setting up the rarer cancer fund, but research from the fund on the diagnosis of rarer cancers revealed that GPs are failing to diagnose almost a third of people with rarer forms of cancer at an early stage, damaging their chances of long-term survival. Late diagnosis is the major reason why cancer survival rates in England lag behind those in other developed countries. GPs should be rewarded for identifying the signs and symptoms of cancer when they are at an early stage and for referring patients for investigation; they should not be encouraged to delay referrals, which seems to be a worrying trend. I hope that the Minister will help over this serious matter.

I hope that the specialist voluntary associations which bring members’ needs to the Government’s and the public’s attention, and which lobby for better conditions, will be listened to. I have experienced at first hand with my husband’s condition the value of specialist nurses when they are involved in the treatment of patients. They support patients with conditions such as diabetes, strokes, Parkinson’s disease, MS, rarer cancers, and so many others. Not having specialist care would downgrade treatment and care.

Many improvements can be made for adults and children with non-communicable diseases here in the UK. I refer to services such as wheelchairs and prosthetics. Assessments of patients and the supply of aids and equipment can take months, if not years. Someone with a condition such as motor neurone disease needs help immediately. Sometimes patients languish in hospitals far longer than necessary due to the inefficiency of the system.

I end by asking the Minister whether he is satisfied with the training of doctors in pain control for thousands of patients with non-communicable diseases, such as arthritis, when pain can interfere with employment and the quality of life. Is it not the case that several pain clinics have had to close down for lack of funds? I hope that this debate will highlight some of the needs of people living with non-communicable diseases.

Health: HIV/AIDS

Baroness Masham of Ilton Excerpts

Monday 5th September 2011 Lords Chamber

[Earl Howe]

The noble Baroness with her experience makes a central point here. We absolutely agree that increasing the offer and uptake of HIV testing in a variety of healthcare settings is important to reduce undiagnosed HIV. We welcome the BHIVA professional guidelines in this area, which have been extremely helpful. The sooner a person with HIV is diagnosed, the sooner they can benefit from treatment and also make any behavioural changes to prevent transmission. It is those behavioural changes that count most strongly.

The department funded pilots to support the implementation of recommendations from the BHIVA, and those were extremely successful. In the coming days, we will consider carefully the report that is due to be published by the Health Protection Agency to see how we can take forward its findings in this area.

[Baroness Masham of Ilton]

My Lords, as a member of the House of Lords committee that produced the report, I pay tribute to our chairman, the noble Lord, Lord Fowler, for his excellent work. Is the Minister aware that one-quarter of the people with HIV do not know that they have it? That is extremely dangerous; late diagnosis costs a lot and many of those people die early. Will he do more to promote prevention?

[Earl Howe]

The noble Baroness is correct that about one-quarter of those with HIV are unaware of it, which is why testing in a variety of healthcare settings is vital and a targeted preventative approach to the two communities that I mentioned has to continue.

Southern Cross

Baroness Masham of Ilton Excerpts

Thursday 16th June 2011 Lords Chamber

[Earl Howe]

My Lords, I cannot issue a government guarantee on the continuing business health of every single care home provider in the country; that would be extremely rash. Of course, we know that over the years some providers have gone out of business. What we are seeing in the country at the moment is much more of a trend towards looking after people in their own homes rather than in residential settings. At the same time, the market is doing the opposite because there are more and more elderly people requiring care of some kind. This industry is not going to disappear overnight or, indeed, at all. Over the indefinite future we will require a residential care home industry, particularly as the number of elderly continues to increase. The key will be to ensure that the quality of provision is maintained. Competition will undoubtedly remain, but it is a telling indicator of the current state of the market that there is an overprovision at present of about 50,000 care home places nationally. That perhaps is a sign that local authorities are successfully meeting the wishes and needs of their service users in providing care in the settings which most people want; namely, their own homes.

[Baroness Masham of Ilton]

My Lords, what safeguards are being put into place so that this situation does not happen again in other care homes and possibly in hospitals?

[Earl Howe]

My Lords, I think I have already indicated that the Government are proactively engaged with all the key parties involved in this situation, not just Southern Cross but the LGA, ADASS, the CQC and others. The precise situation in which we find ourselves with Southern Cross is unlikely to arise again because my understanding is that the business model adopted by Southern Cross is unique. Nevertheless, every privately operated residential care home business will, no doubt, have its own level of business risk, whatever that may be—either slight or something rather less slight. However, the alternative that the noble Lord, Lord Beecham, seemed to desire was a return to the state provision of care homes. The noble Lord is shaking his head, and I am glad of that, because I think neither his party when in government, nor certainly ours, would wish that on the public. I think that all of us believe in choice for the individual, and this is what the current market provides. Nevertheless, there are risks.

The noble Baroness asked about hospitals. To the extent that NHS care is delivered in independent settings, a business risk is inevitably associated with that. However, we are clear in the Health and Social Care Bill that there needs to be a system whereby essential services are protected for the benefit of patients. When the Bill reaches us, we will no doubt debate those provisions.

Health: Transmissible Spongiform Encephalopathies

Baroness Masham of Ilton Excerpts

Monday 13th June 2011 Lords Chamber

[Earl Howe]

My noble friend asks a very good question. Over 20-odd years, we in this country have invested almost £0.5 billion in research into TSEs. That is a significant amount of money. The total amount is declining, but that is because in the early days it was important to invest in research to ascertain the pathogenesis of this condition in cattle in particular. We are much further forward in understanding how this disease develops in cattle. Nevertheless, as I indicated to the noble Countess, important questions remain unanswered, and I think we will continue to see this research funded well into the future.

[Baroness Masham of Ilton]

My Lords, what is happening about the P-Capt filter for prions? Are we not lagging behind Ireland and China in this research?

[Earl Howe]

My Lords, the noble Baroness will know that the independent Advisory Committee on the Safety of Blood, Tissues and Organs—SaBTO—has advised that there is evidence that a particular filter can reduce potential infectivity in a unit of red blood cells. It has recommended the introduction of filtered blood to those born since 1 January 1996, subject to a satisfactory clinical trial to assess safety. We are undertaking an evaluation of the costs, benefits and impacts to inform a decision on whether to implement that recommendation, and we are awaiting the results of clinical trials, which are expected in early 2012.

Health: Hospital-acquired Infection

Baroness Masham of Ilton Excerpts

Tuesday 7th June 2011 Lords Chamber

[Earl Howe]

My Lords, the noble Baroness will know that a code of practice was issued some time ago, which the CQC uses to ensure that the registration requirements of a provider have been complied with. It is clear that the decline in numbers of hospital-acquired infections has coincided with the issue of that guidance. We believe that it has made a material difference. I am not aware that there has yet been systematic evidence-gathering of whether the guidance has had an effect, but it appears that it has.

[Baroness Masham of Ilton]

Does the Minister not think it is about time that the figures for infections were kept nationally? Is he aware that some hospitals have got better and some have got worse, and the outcomes across the country are very patchy?

[Earl Howe]

The noble Baroness is absolutely right. The headline figures disguise considerable variations between the best and worst performers. Our approach has been to adopt a zero tolerance policy to all avoidable healthcare-associated infections. To support that we have introduced a number of specific actions, including establishing clear objectives under the NHS operating framework, which are requirements for all trusts to meet, and for primary care organisations, and extending to health and social care settings the regulations on infection prevention and control. We have also increased the requirements on publishing data trust by trust.

Health: Cancer

Baroness Masham of Ilton Excerpts

Tuesday 10th May 2011 Lords Chamber

[Earl Howe]

I am grateful to my noble friend. He is absolutely right; these are very difficult decisions to make. NICE issues final guidance on the use of a drug only after very careful consideration of the evidence and wide consultation with stakeholders. The noble Lord, Lord Davies, and, I am sure, my noble friend will be aware that one particular drug has been refused or not recommended by NICE. However, we have established the cancer drugs fund, which will enable individual clinicians on a patient-by-patient basis to apply to access drugs even though they have not been recommended by NICE.

[Baroness Masham of Ilton]

My Lords, will the Minister look at the problem of neuroblastoma, which is an aggressive type of child cancer? I have to declare an interest as I had a small cousin who had his kidney removed at five with a tumour. He had to go to America for treatment. Will the Minister ensure that the UK, which does not have a good survival rate for these children, looks with America at the research needed for them? There are only about 100 a year in the UK who have neuroblastoma.

[Earl Howe]

The noble Baroness raises an important issue, because these conditions are devastating even though they affect only a comparatively small number. There is a good deal of research going on into cancer, some of it funded by my department. I do not have details of whether that condition is the focus of any such programme but I will take away her concern and write to her if I have further information.

NHS: Consultation on Reform

Baroness Masham of Ilton Excerpts

Tuesday 26th April 2011 Lords Chamber

[Earl Howe]

My noble friend is quite right: the principles that underpin the Bill and—I emphasise this—the principles that have always underpinned the National Health Service, are not going to change. He is right that the approach that we are adopting is in many senses an evolutionary one, following on from initiatives taken by the previous Government. I am grateful to him for pointing that out and I am sure that this will be a feature of the government response that we shall publish in due course.

[Baroness Masham of Ilton]

My Lords, does the Minister agree with me that there is some concern about so much of public health going over to local authorities? Will he give an assurance that directors of public health will be well qualified in public health?

[Earl Howe]

The noble Baroness makes a very important point about local directors of public health, who most certainly do need the right qualifications for that role. As she will know, they will be jointly appointed by local authorities and by the Secretary of State and we need to ensure that they can perform their role properly. The four main themes to the listening exercise are: choice and competition; public accountability and patient involvement; clinical advice and leadership—that may be an area that impacts on her question; and education and training. In some ways it is difficult to separate those issues; they are all of a piece and we do need to look at them very carefully.

NHS Reform

Baroness Masham of Ilton Excerpts

Monday 4th April 2011 Lords Chamber

[Lord Beecham]

My Lords—

[Baroness Masham of Ilton]

My Lords—

[Baroness Northover]

My Lords, I think that we have time for both speakers. It is time to hear from the Labour Party and then the Cross Benches.

[Earl Howe]

My Lords, those who have been re-engaged by the health service, having taken redundancy or early retirement, will forfeit their redundancy pay because there is a clawback arrangement in force, as I told the House the other day.

The noble Lord asked a number of questions. I want to be very brief because I am aware that the noble Baroness, Lady Masham, wants to get in before the time is up. Monitor was described as a promoter of competition. Expressed in stark terms like that, it sounds as though its job will be to go around drumming up competition where there is none already. That is not a correct reading of its functions; it is there to bear down on anti-competitive conduct and to ensure fair competition. The composition of consortia is a concern that we have heard about, and we will listen to that concern. It is now up to the pathfinder consortium to think about this kind of question. The early implementers of health and well-being boards are starting to think about those powers and how they can be used and we will listen to whatever they have to tell us.

[Baroness Masham of Ilton]

My Lords, is the Minister aware that patients very often cannot get an appointment with the GP of their choice so there is no continuity? If GPs have to undertake administration on the consortia, will this not get worse? Would it not be better if the consortia consisted of a mixture of GPs, specialists, nurses, administrators and patients? Working together would surely be better than working in conflict.

[Earl Howe]

The noble Baroness is absolutely right about working together, and our vision for good, clinically led commissioning is that all clinicians, not just GPs but everyone with a stake in the patient pathway, should join together and determine what good care looks like. However, she is mistaken in her first assumption. We are not asking thousands of GPs to become administrators. It will take only a very few to took after the commissioning of care in consortia, and the administration will be taken care of by management employed by the consortia.