Health: Anorexia and Bulimia Nervosa

Countess of Mar Excerpts

Thursday 11th July 2013 Lords Chamber

[Earl Howe]

My noble friend is absolutely right. However, it is encouraging to see that in recent years a range of information and support has become available. The Royal College of Psychiatrists has published a fact sheet on eating disorders, which is aimed not just at the profession but particularly at parents, teachers and young people themselves. It is called Mental Health and Growing Up. The fact sheet discusses the causes of eating disorders, how to recognise them and gives advice on how to cope with a child who has an eating disorder.

[The Countess of Mar]

My Lords, I am sure that the noble Earl accepts that some young girls have an eating disorder that is not anorexia or bulimia—they may have CFS/ME or reactions to HPV vaccines. Very often, they are incarcerated in mental hospitals when they should receive a different form of treatment. I have spoken to the noble Earl about this but perhaps he could say what progress is being made in ensuring that such young people are not mistreated?

[Earl Howe]

My Lords, I am sure that this is an area that NICE will need to look at when it refreshes its guidance to the clinical community. The noble Countess is absolutely right to raise the issue. CFS/ME can often be misdiagnosed; it can be mistaken for other conditions without proper differential diagnosis having taken place. We know that there is more work to be done in this area. However, the range of programmes now available to GPs, some of which I have referred to, can be helpful in this area.

NHS: GP Dispensing

Countess of Mar Excerpts

Thursday 16th May 2013 Lords Chamber

Asked by

[The Countess of Mar]

To ask Her Majesty’s Government whether they will review the rule that prevents patients of dispensing doctors who live within 1.6 kilometres of a pharmacy from collecting their medication from a doctor’s dispensary.

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

My Lords, the current NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 continue an agreement reached between representatives of pharmacist and GP contractors setting out the circumstances under which patients living in designated rural areas are eligible to receive dispensing services from their GP. To make any significant change in the regulations would mean reopening complex and lengthy discussions. We believe that contractors’ representatives are satisfied with the current regulatory arrangements and would not support an extensive review.

[The Countess of Mar]

My Lords, does the Minister agree that “no decision about me without me” and the freedom of patient choice have been pivotal to the Government’s NHS reforms? Does he not think it crazy that I, as a patient of a dispensing doctor, can either ask my doctor for a prescription which I can take to a pharmacist in the nearest town or have my prescription dispensed by his staff, whereas my neighbour, who might live just within that 1.6 kilometre boundary, is allowed to get his prescription dispensed only in a pharmacy in the town? Does the Minister agree that the reasons for this rule are now obsolete? It was created in 1911 when there could have been corruption between doctors and patients, and that possibility no longer exists because of the controls.

[Earl Howe]

My Lords, there is a balance of interests here, not least the interests of the patient. We therefore need a set of rules which reflects those interests. Patients who live in a rural area can be dispensed to by their GP if there is no pharmacy within 1.6 kilometres of where the patient lives, or within 1.6 kilometres of the GP practice. Without these rules, it would rarely be viable for new pharmacies to open to serve rural areas. That would deprive people living in rural areas of the opportunity to benefit from the more comprehensive health service that a combination of a GP practice and a pharmacy can provide.

Health: Anorexia

Countess of Mar Excerpts

Monday 25th February 2013 Lords Chamber

[The Countess of Mar]

My Lords, I, too, am grateful to the noble Lord, Lord Giddens, for introducing this topic for debate tonight. The simple definition of anorexia is a “lack or loss of appetite for food”. Too often, we hear of awful cases of anorexia nervosa. I will leave the discussion on that and on bulimia nervosa to other noble Lords. The noble Lord, Lord Alderdice, has given us a very good grounding in them.

Numerous medical conditions give rise to the loss or lack of appetite for food. I think immediately of the many people with CFS/ME who are too exhausted to chew and swallow food and must be tube fed, either nasally or by a tube connected directly to their stomach. I think, too, of young girls who have had a bad reaction to the human papilloma virus—HPV—vaccine and who suffer fatigue, feverishness and an acute loss of appetite, with the accompanying weight loss. Some other conditions, including viral infections, hormonal imbalances, neurodegenerative diseases and brain tumours, have in their initial stages been labelled as CFS/ME because they present with the extreme fatigue, pain, digestive problems and other symptoms associated with that condition.

From the reports that I have had, there are many people with genuine intolerances to foods and drugs whose symptoms are profound after eating. The symptoms, which may be diverse, are a reflection of a disturbance of the autonomic nervous system and may include nausea, vomiting, bloating, abdominal distension and diarrhoea. Because they occur after meals, these people try to ascertain which foods cause their problems and they assume a restricted diet. This can occur after, for example, gastro-intestinal infection or HPV vaccination. These people, instead of being respected, as all patients should for their observations of themselves, often find themselves castigated. They are wrongly diagnosed as being anorexic, forced into psychiatric facilities and made to eat those foods that they know have provoked their symptoms. Historically, the same fate befell people with coeliac disease until the 1940s, when researchers realised that their symptoms of diarrhoea and malabsorption were caused by wheat, which was accepted by the medical profession. Interestingly, during the war, they were given bananas instead of bread.

I am particularly concerned that young people, mostly girls, are wrongly being diagnosed with anorexia nervosa. Too frequently, their parents are accused of causing their child’s illness and care proceedings are initiated. Several youngsters have been obliged by social services to be confined in mental health units and are subjected to harsh “treatment” before their medical consultants realise that they do not have the condition. In other cases, the young person is blamed for failing to co-operate and not wanting to get well. I am sure that their prognosis would be much better if they were treated with more compassion.

The mother of one young girl wrote:

“After the HPV vaccine she lost three stones in three months. When admitted to hospital the professionals’ first concern was that she was anorexic or bulimic. I even tried to say that she normally loves her food and she actually eats more than normal. Before vaccination her attitude to food was positive. (Her worst nightmare was someone stealing the fridge). Whilst in hospital she was shadowed by a nurse 24 hours a day for seven days to check if she was really eating or making herself sick. The final conclusion was that she doesn’t suffer either from anorexia or bulimia”.

This child and her mother have now been abandoned to the nightmare of CFS/ME. She continued:

“After this diagnosis was made we were pretty much left on our own as there is no ME specialist covering our locality”.

Another mother wrote:

“After … vaccination and since becoming unwell her appetite has fluctuated massively. Some days she eats very little, other days she eats constantly. She suffers constant nausea and vomiting and has to eat what she feels will keep down, which isn’t the healthy choices she would have made. Eating disorders have been mentioned because she often vomits after eating but that is far from the truth. She still has a healthy attitude to food but her body is too broken to make it possible for her always to eat healthily”.

Another mother whose daughter suffered badly from CFS/ME wrote:

“She did not have the energy to eat food and sadly did not get the help she required. So when food is not eaten they assume she does not want to eat. They do not face the reality that she has not got the energy to eat. Therefore they put her into a psychiatric unit for eating disorders”.

I know that this young lady was discharged several months after being admitted in a worse condition than before she was admitted.

I cannot stress enough the importance of getting the diagnosis right, of listening carefully to the patient, of taking a proper history, and of ensuring that the right treatment is given early. Young lives can be ruined, family relationships destroyed and huge amounts of taxpayers’ money wasted when this is not done. I ask the noble Lord the Minister what measures are in place to ensure that these awful histories that I have been hearing for years are no longer repeated.

NHS: Clinical Networks

Countess of Mar Excerpts

Wednesday 12th December 2012 Lords Chamber

[Earl Howe]

My Lords, in some cases, yes, but we anticipate that many members of existing networks will be transferred across into the new ones.

[The Countess of Mar]

My Lords, the people with CFSME were greatly heartened in 2008 when the Chief Medical Officer ring-fenced £8 million to set up clinical networks on their behalf. They have become disillusioned as the funding of these networks has gradually been cut. There is also no provision for children in the clinical networks. What priority is given to CFSME?

[Earl Howe]

My Lords, strategic clinical networks are only one category of network in the new system. There is nothing to stop professional groups coming together to share best practice and support professional development. In addition, clinical commissioning groups may well wish to establish networks to support local priorities and ways of working; and providers may use a network model to enable the joint delivery of a service, such as pathology. The noble Baroness, Lady Thornton, rightly referred to the extent to which local providers and commissioners already support strategic clinical networks. So there is a variety of ways of doing this.

Diabetes

Countess of Mar Excerpts

Tuesday 10th July 2012 Lords Chamber

[Earl Howe]

My Lords, I am aware of that research, which my department is looking at very carefully, but I should put a health warning on it in that we do not yet accept the conclusion that sugar is addictive, although clearly in the case of young children those who get into the habit of consuming sugar are likely to continue doing so, so the noble Baroness is quite right that it is a risk factor in the young. The advice from the School Food Trust is of course to have a healthy diet at school. Many schools are adhering to that, and we are doing our best to promote that with our colleagues in the Department for Education.

[The Countess of Mar]

My Lords, the Minister mentioned unexpected consequences. Does he agree that people who are afraid of eating too much sugar because they might get fat will turn to sugar substitutes such as aspartame? Is he aware that aspartame contains 10% methanol, which, uniquely in the human body, is turned into formaldehyde and has its own neurological hazards? Would he recommend having sugar or sweeteners?

[Earl Howe]

My Lords, the Department of Health recognises that artificially sweetened or low-calorie drinks can play a role in helping people to reduce the number of calories they consume and offer a wide choice of low-calorie options. As for the safety of artificial sweeteners, all food additives, including sweeteners, are thoroughly tested for safety prior to approval and are subject to review by independent expert bodies. The Food Standards Agency considers that all approved sweeteners can be safely consumed at current permitted levels.

NHS: Dental Care

Countess of Mar Excerpts

Tuesday 26th June 2012 Lords Chamber

[Earl Howe]

My Lords, I referred earlier to NHS Choices, the website that patients and the public can access. It contains the most up-to-date information on dental treatment costs and entitlements. The dental section of NHS Choices was updated at the end of February following suggestions and comments submitted by the public through the website itself and these changes include new pages that clearly explain dental charges and exemptions and inform patients how to get help with dental costs.

[The Countess of Mar]

My Lords, am I right in my understanding that children and young people get all NHS dental treatment free of charge? If so, what improvements have there been in dental health among this group?

[Earl Howe]

The noble Countess is quite right. The oral health of children, particularly those from disadvantaged families, is one of the biggest challenges we have and one of the main priorities in this policy area. While two-thirds of five year-olds are now caries free, the remaining one-third have an average of 3.45 decayed, missing or filled teeth. We are piloting new ways of supporting dentists to identify children at risk of tooth decay to get them the care and preventive advice they need, including engagement through schools, the wider community and local authorities.

Health and Social Care Bill

Countess of Mar Excerpts

Monday 13th February 2012 Lords Chamber

[Lord Ribeiro]

My Lords, I would like to comment on the good medical practice to which the noble Baroness, Lady Finlay, referred. It was introduced some time ago to ensure that medical practitioners would know how to communicate with their patients and were always honest and truthful when things went wrong. In surgery, we produce good surgical practice to complement that exercise. In relation to patient communication, we require surgeons to keep patients fully informed both during and after their treatment. We require them to act immediately when patients suffer harm and to apologise.

As for anecdotes, I had one patient on whom I operated for varicose veins. I pulled up something in the back of her leg that looked like a vein, but in fact it was a nerve. The net result was that the next day she had a foot drop. I went to see her and explained that I had made a mistake—I thought that it was a vein but it was a nerve. I said that we would get a plastic surgeon to see her and we would re-explore the nerve to see if it was all right. The operation was done, and, fortunately, the nerve was not torn. The period required for regeneration was likely to be six months. Every time she came to my out-patients’ clinic—although she was a private patient—I used to get a terrible feeling in the pit of my stomach, because I could hear her coming down the corridor as her foot drop made a flopping sound on the floor. She would sit down opposite me and say, “You know, I really ought to sue you”. She never did, however, because she had been told straight away the whole truth of what had gone on.

Therefore, I have tremendous sympathy for this duty of candour. What worries me is that we could end up with a contractual mechanism in legislation that leads to nothing more than a tick-box exercise. The problem with such exercises is that people will fill them in to try to avoid the legal implications that we have heard of. They will try to avoid litigation. The quality of any genuine explanation may well be lost in such a mechanistic approach. Although it has taken five or six years since the CMO first introduced this concept, we need to do very much more to change the culture. I hope that with the creation of new organisations such as local healthwatch there will be opportunities to raise the profile of the issue and to achieve the sort of explanations that patients rightly deserve.

[The Countess of Mar]

My Lords, when my daughter was a little girl I brought her up to tell me immediately if she had done something that she should not do or if she had had an accident, and to say sorry, and she would be forgiven immediately. It has been my experience with the OP sufferers from sheep dip, Gulf War veterans and ME sufferers that, if a mistake has been made, all they want is an apology and an explanation and to be able to say, “Please do not do it again”. That has happened over and over again. I have a drawer full of letters from people saying that.

I suspect that it is not necessarily the doctors and nurses—the medical practitioners—who are covering things up when there is a cover-up. It might be what we euphemistically call the pen-pushers—the people behind the doctors and behind the organisation who are afraid that the organisation will come into disrepute. That is where much of the problem lies. Many doctors would like to be able to say, “I’m sorry—I made a mistake”, but they are held back, which is what the noble Lord, Lord Harris of Haringey, said. If we are going to change the culture, we must start with leadership. We have heard about leadership in nursing. A nurse leader or a doctors’ leader can say to the whole of his team, “If you make a mistake please come and tell me immediately and we will go and tell the patient”. That would wipe out a whole lot of anxiety.

The noble Lord, Lord Faulks, talked about litigation. People go to law because they are angry. They have not had an explanation and they are worried that something has gone wrong with a relative or themselves. That is when they go to law. That is what happened with the sheep-dip farmers, and it certainly happened with the Gulf War veterans when Mr Soames, the MP with responsibility for the Gulf War veterans at the time, said, “See you in court”. They rise to that. If people have an explanation, they will accept it. Everybody makes mistakes, and they will understand it. So I support the noble Baroness, Lady Masham, in her cause.

[Lord Cormack]

I was not intending to take part in this debate, but it has been a thoroughly fascinating one. The noble Countess, Lady Mar, talks about people wanting an explanation, and of course she is absolutely right. People go to law when they are angry, she says—and that is also right—but they also go to law when they can afford it. One of the problems is that so many people cannot afford to contemplate it, yet as we have grown into this no-win no-fee culture more and more people have thought of the law and more and more doctors and nurses have become terrified of finishing up in a court of law. This is why I, as a former constituency Member for many years, who saw many of these cases, am persuaded by what my noble friend Lord Newton said. While we wish to see the Minister respond sympathetically to the amendment so movingly proposed by the noble Baroness, Lady Masham, I hope that he will give the undertaking for secondary legislation and guidelines that would meet our concerns this afternoon.

I have great confidence in my noble friend. I have an anecdote in which he is involved. For many years, I had a constituent who came to me with a series of stories, some of which were very plausible, others of which were less so. I referred this lady to my noble friend, who was the health spokesman for my party—we were in opposition at the time. I was tremendously impressed by the thoroughness with which he looked into these cases with me. Indeed, we came to the conclusion that there had been instances of neglect and even of malpractice. The way in which he looked into it and the thoroughness and compassion that he displayed makes me confident that when he replies this afternoon he will be able to give us an assurance that, whether or not this amendment goes into the Bill—and frankly I think that it probably should not—he will not forget what has been said in this Chamber. Rather, I hope that he will try to ensure that, although one cannot compel candour whatever one does, one has a right to expect it. Every patient in the National Health Service has the right to expect that those who care for him or her will do so with dedication, following a vocation, and that if mistakes are made, as from time to time inevitably in any human situation they are made, there will be a full and honest owning up to those mistakes. That, as the noble Countess indicated, is what people hope for and expect—and, if they receive it, we might gradually see the end of the litigation that has so distorted much of our public life in recent years.

Health and Social Care Bill

Countess of Mar Excerpts

Wednesday 8th February 2012 Lords Chamber

[The Countess of Mar]

My Lords, I too support this amendment very strongly, and I think the Minister knows why.

In my dealings with people with ME/CFS, I have found that many of them have been sectioned and put into wards that I can only describe as barbaric. There was one recent case where the man had a very clear physical illness and he spent nearly nine months in a hospital in Torbay—Torbay, the hospital that has been praised left, right and centre; but its mental ward is not worthy of praise. If the funding is equal for mental and physical treatment, this will somehow redress the balance.

My mother was mentally ill for 17 years and she was treated barbarically by psychiatrists. She was hooked on barbiturates and she was given a leucotomy. I thought those days had gone but we are not far from them with the things that I have seen with ME patients.

[Lord Eden of Winton]

My Lords, we have listened to many powerful and persuasive speeches. I am tempted to go all the way with those who have advocated the inclusion of this amendment in the Bill, but I take up the words of the noble Baroness, Lady Finlay, who referred to the need for a cultural change. I think all noble Lords would agree that there is the need for a cultural change. I only question whether it is right to try to achieve that change through legislation. Surely what we are seeking to do is to change attitudes and get people to understand that there is no difference between physical and mental illness. For that reason, I think we need to hesitate before including words in legislation. What we need to do is to make people throughout the health service and everyone associated with the administration aware of the fact that there is no difference between physical and mental illness, and that those with mental illness need to be treated on an absolutely level footing with those with physical illness.

Tobacco

Countess of Mar Excerpts

Monday 6th February 2012 Lords Chamber

[Earl Howe]

My Lords, Her Majesty’s Revenue and Customs and the UK Border Agency published a renewed strategy in April last year to tackle the illicit trade in tobacco products. Our tobacco control plan complemented that strategy by stressing the importance of cracking down on illicit tobacco sales, which will in turn reduce tobacco consumption and organised crime, and support legitimate retailers. In fact, the latest figures show that fewer and fewer people are using illicit tobacco. The market for illicit cigarettes was down to 10 per cent in 2010 from 21 per cent in 2000.

[The Countess of Mar]

My Lords, some years ago I was given a statutory instrument, the Sheep Scab Order, which was dated about 1914 and had an excellent recipe for sheep dip made from tobacco. I wonder whether the current tobacco problem could be relieved by diverting tobacco from smoking to sheep dip.

[Earl Howe]

My Lords, I wonder too.

Health: Children and Young People

Countess of Mar Excerpts

Monday 6th February 2012 Lords Chamber

[Earl Howe]

My Lords, the Secretary of State will retain ultimate accountability for children's health services. Under the Bill, as the noble Baroness knows, the functions will be conferred directly by Parliament on specific organisations. That will strengthen accountability. In answer to the first part of her question, the reform of the health system offers a real opportunity to address some of the well documented challenges that the current system presents. We are moving, through the Bill and through our reforms, to a system that will focus on promoting good health, which we see as important as delivering good care. Informed and expert knowledge will underpin the commissioning of integrated services, where we will measure success on improvements in the outcomes that are achieved. Treatment will be evidence-based and children will be involved in decisions about their care. All these things are embodied in the Bill.

[The Countess of Mar]

My Lords, recent research at Bristol indicated that as many as one in 100 children who are absent from school long-term suffers from CFS/ME. There is a dearth of centres for the treatment and diagnosis of children with CFS/ME. Does the Minister envisage this improving under the new proposals?

[Earl Howe]

My Lords, it is yet to be decided finally which services will be commissioned at a national level. I cannot give the noble Countess a definitive answer on where services for CFS/ME will be commissioned. However, we are sure that the arrangements will provide much better, more locally responsive ways of commissioning services generally. Whether clinical commissioning groups join together in commissioning services, whether lead commissioners do that or whether commissioning takes place at a higher level, we are clear that in all services this needs to improve.