NHS: Clinical Negligence

Lord Roberts of Llandudno Excerpts

Tuesday 20th January 2015 Lords Chamber

[Earl Howe]

I agree with the noble Baroness. We view it as important that NHS organisations manage complaints in a positive manner and use the information obtained to improve service delivery. Saying sorry is important. People who complain often want an apology, an explanation and an assurance that the same thing will not happen to someone else.

[Lord Roberts of Llandudno (LD)]

My Lords, do the figures we have been given today include Wales, Scotland and Northern Ireland? Are those claims included in the total figure?

[Earl Howe]

My advice is that the figure includes England only, but if I am incorrect in any respect, I will write to my noble friend.

HIV: Stigma

Lord Roberts of Llandudno Excerpts

Monday 1st December 2014 Lords Chamber

[Earl Howe]

I shall expand on my previous answer. Sex and relationship education is compulsory in maintained secondary schools, although not in academies. All maintained schools and academies have a statutory requirement to have due regard to the Secretary of State’s sex and relationship education guidance, which dates from 2000, when teaching sex and relationship education. The guidance makes it clear that all such education should be age-appropriate and makes the following points about HIV and sexually transmitted infections:

“information and knowledge about HIV/AIDS is vital; young people need to understand what is risky behaviour and what is not; young people need factual information about safer sex and skills to enable them to negotiate safer sex … Young people need to be aware of the risks of contracting a STI and how to prevent it”.

They also need to know about the diagnosis and treatment of HIV and STIs.

[Lord Roberts of Llandudno (LD)]

My Lords, is this not the direction in which we need the devolved health commitment in Scotland, Wales and Northern Ireland to go? What co-operation is there between them and the English set-up through television programmes, advertising and in other ways? Is this not one of the areas where it is essential to have effective co-operation?

[Earl Howe]

Yes, indeed, my Lords. I can tell my noble friend that there is such co-operation and constant communication between the public health authorities in England and the devolved Administrations on this, as on many other matters.

Health: Multiple Sclerosis

Lord Roberts of Llandudno Excerpts

Monday 30th June 2014 Lords Chamber

[Earl Howe]

The noble Baroness is right that care plans have to be tailored to each individual patient. For those with serious neurological conditions, that is as important as for anyone. I do not have up-to-date information about what work NHS England is doing at the moment on this, but I am happy to write to her on the subject.

[Lord Roberts of Llandudno (LD)]

My Lords, how widely shared are these new medications? For instance, I know that some cancer medications are available to patients in England but not to patients in Wales. How widely is this information shared so that everyone can benefit, even if we are under the devolved Administrations?

[Earl Howe]

My noble friend will know that I cannot speak for the devolved Administrations, who have complete autonomy in their healthcare policies. I can say that a number of drugs have been recommended for use on the NHS for MS patients, including Tysabri, Gilenya, Aubagio and Lemtrada. However, it is ultimately for the devolved Administrations to decide whether they wish to have the same set of rules in place as we do in England.

Suicide

Lord Roberts of Llandudno Excerpts

Tuesday 23rd April 2013 Grand Committee

[Lord Roberts of Llandudno]

My Lords, I, too, thank the noble Baroness, Lady Buscombe, for giving us this opportunity, and for bringing to our attention, as the noble Lord, Lord Giddens, said, the statistic that three times as many young men between the ages of 30 and 44 commit suicide than women in that age range, or perhaps a wider age range. Does that not somehow reflect the economic situation—jobs and so on? A University of Liverpool study suggested that 1,000 suicides in the general age range were because of the recession. How true that is I do not know, but that is the figure that the University of Liverpool gives us.

In Wales we had a different situation. In 2007, seven youngsters in Bridgend committed suicide, six of them by hanging. In that year, there was a terrible dilemma in Wales: why were these people doing it? They were saying, “It is such a boring place, what else can I do? What other job can I get? I want to get out of here”. The only way they could see to get out of there was by committing suicide.

The great contribution of the Samaritans has already been mentioned, as have Childline, the NSPCC, Chad Varah and Esther Rantzen. All these deserve our thanks for what they have done and the countless lives that they have saved.

The reasons for suicide vary tremendously. As a minister, I encountered it fairly often—not too often but often enough. Why did they try to do this? Sometimes you just shook your head and said, “No idea”. At other times you would say, “Ah yes”—there were problems that we were aware of. According to the statistics, 1 million people commit suicide every year worldwide. Of these, 100,000 are young people, 15 to 19 year-olds. I suggest that there are 100,000 different reasons why they would try to commit suicide—so many different countries, so many different situations.

A new scheme is being brought in in Indiana in July this year. Everyone seeking an initial teaching qualification will have to study education and training in the prevention of child suicide and recognising the danger signs. Somehow, because we are talking to machinery, computers or whatever, we are losing the personal touch—in communities and families.

I have discussed this with ministers of other denominations—the number of priests and ministers in communities and the number of lively, active, alert churches is far fewer than it used to be. When that happens, the community is weakened because there is not the person there to support the most vulnerable. The figures from my own church in Wales are startling: 100 years ago we had 137 Welsh-speaking ministers of our own home-grown variety; today we have two or three. It is a big difference. A Presbyterian minister told me, “In my church at the time of the great Welsh Revival 100 years ago we had 1,000 ministers. We now have 40”. So the people who would be in the community to support and listen are not there in the same way, and the families who would also get their support in the churches are not there.

However, it is not only churches. I have a list here: policemen, village-based teachers, local shop-owners, local football teams, bands and choirs, even well run pubs—and I might well be struck off for praising well run pubs. These are all part of the community and they are not there to the same extent any longer. The local community is the strongest and best friend of those who are most vulnerable. We must somehow give it new strength so that it can fulfil what it used to do in treating and responding to needs.

Care Services: Elderly People

Lord Roberts of Llandudno Excerpts

Wednesday 6th March 2013 Grand Committee

[Lord Roberts of Llandudno]

My Lords, I also appreciate the opportunity to take part in this debate. Other noble Lords have much more expertise than I have, but I put my finger very gently into the water because this is something I experience. I am a Methodist minister and all my life I have been involved in the care of older people. I look now in my daily newspaper at the births, marriages and deaths, and whereas some years ago the majority of people died in their 60s and 70s, now we have them at 80, 90 or touching 100. This has changed the whole atmosphere and situation that we need to come to terms with.

In rural areas particularly these needs are very acute. A village community will support a person in that village. That person will feel part of that community. Some have lived there all their lives. They know the village and the people around them. Then suddenly everything has changed. I can think of a mixture of places where there were once shops. One village at the end of the war had 29 shops but has no shops now. If you do not have a car, you cannot get away to get your shopping. You cannot get to the post office now, but in any case the way pensions are paid has changed. The bakery has gone. We used to enjoy the bakery and friends of mine ran it. We had five chapels in the area and now four of them have closed and the village church is struggling. The choirs and bands that we used to have belong to yesterday. I did not think that I would ever support the case for keeping pubs open—Methodist ministers do not do that usually—but every week 16 pubs close. They, like the chapel or the church, were a vital part of the community where people could meet, but that is no longer the case. The doctor’s twice-weekly surgery is no more. Two banks used to come on a Friday morning. The banks do not come any more. In many cases, the small neighbouring hospital is already closed and in other places there is great anxiety because the hospital is under threat of closure. In Wales health is devolved, and I wonder whether we could not somehow relocate some of the specialist services that do not need as big a back-up as others, such as rheumatology or dialysis, so that those services would be the core that would justify the existence of that hospital which could then be involved in wider care in that community. I know the arguments for big hospitals. They are great arguments, but families have to travel.

In rural areas, bus services have been decimated. Your friends are elderly and cannot travel very far. We have these problems. In North Wales, we have problems with hospital closures. I ask that people think about whether we can do something in order to have beds available near the community from which that person comes. My mother-in-law kept the local bus service going. She lived in a village four miles from where I live. I used to offer her a lift home when she was 88. She would say, “I’m not having a lift with you. I’m the only passenger on the bus, so I’ve got to keep going on it”, but when she went, the service went as well.

Every part of the community is weakened by the change in lifestyle and so on, especially for older people. There must be intervention to improve the quality of life, the well-being, of the individual. The person needs to feel safe and comfortable in his or her local village. When you retire—I have experienced this, as have some other noble Lords in the Committee—what information do you get? You get information about pensions, but do you get an information pack about the services available in the local community and about how you will get help if you are in urgent need? Some of our organisations do this, but those who retire should be given not only financial information but community information about bus services and so on, if there are any, and volunteer organisations. I must not overstep the mark here all the time, but the best thing we have in Wales and the rest of the UK is the free bus service for elderly people. It has kept routes going. We have services that we must support, but there are ways, not always financial, in which we can help our older people.

Health: Sugar Consumption

Lord Roberts of Llandudno Excerpts

Wednesday 6th February 2013 Lords Chamber

[Earl Howe]

I am sure that that is a message which I should take back to my colleagues in the Department for Transport, and I will gladly do so.

[Lord Roberts of Llandudno]

My Lords, we have already heard mention of the importance of the proper labelling of foods. Could that labelling be such that even the youngest child, perhaps with type 1 diabetes, would be able to understand it without having to go into some mathematical equation to decide exactly what is good for him to eat?

NHS: Diabetic Services

Lord Roberts of Llandudno Excerpts

Thursday 29th November 2012 Lords Chamber

[Lord Roberts of Llandudno]

My Lords, first, can I say how much I appreciate the opportunity granted to me by the noble Lord, Lord Harrison, by his entering this area? I enter with tremendous humility as well as deep concern because many have spoken in a personal way. They know the problems while we on the outside—we are possibly not going to be there long on the outside—do not know in depth what the real problem is, while they face this situation day after day.

Last year, on a wet night, I was crossing Westminster Bridge. We had just finished here, so it must have been after 10 o’clock. On the other side, just where County Hall used to be, a man was lying in the pouring rain. What should I do? Was he bait? Would other men attack me and mug me? Or was he desperately ill and in need of attention? I did not know. Rightly or wrongly, I went on my way, but others might have been more Christian than me.

We need awareness of the various conditions that people face. There has been a series of television advertisements about stroke, and HIV/AIDS had a tremendous media and television presence. Do we not need something—television adverts—so that we, the ordinary public, are made aware of the emergency that some people might encounter? Low blood sugar can induce something that might be thought of as drunkenness, but we do not know that. We must learn. Some sort of advertising is necessary in order to make us aware because, as my noble friend Lord Rennard said, 3 million people are now suffering from diabetes. I tried to work out what that means in Wales. It means 150,000 people in Wales, or about 5,000 or 6,000 people in each parliamentary constituency. It is a massive number that we have to take great notice of. We could produce adverts for television about what to do if you see somebody ill and have some idea of what the problem might be.

A good place to start is with children in schools. I am told that most children who have diabetes have type 1 diabetes. Other children in their school should be made aware that there is a problem. Teachers must also be aware so that they are able to be confident in the way that they deal with children who have problems. We are told that there are 26,500 children under the age of 15 with type 1 diabetes. In the home, in school and in the playground, youngsters with diabetes have my tremendous admiration: little youngsters who need to inject themselves and check exactly how many carbohydrates there are in every meal they are eating. For some youngsters, it is extremely difficult, so they need all the support we can give them.

I am trying to pronounce a word here: ketoacidosis. I am glad I have got it right. Twenty-five per cent of newly diagnosed children of all ages suffer in this way, and it is a life-threatening situation, and 35% of children under five years of age. We know the consequences. They have been mentioned: amputations, kidney failure and blindness. To tackle them early, as has already been urged upon us, is essential. When we are looking at expenditure in the NHS, in the long term, we would deeply regret doing anything to undermine this. You can reduce taxes, but not at the cost of threatening health and life. The lives of children come first.

Children with diabetes are often excluded from school trips, physical education and sports. A school can be afraid of admitting children with diabetes, although I am told that 52% of schools have such children. Only this morning, I was told of the common assessment framework, in which every child, every individual, particularly those who might have problems, is assessed and has individual concern and treatment for whatever might be their particular need. It is important that fellow pupils as well as teachers and other staff can recognise children with these conditions.

Some schools hold assemblies in which the children and staff are informed as to exactly what the situation is. Some schools also issue help cards to children, information telling them that if their diabetic classmate is showing symptoms, they should please take some action. Of course, a certain number of teachers are given courses on what they have to do if any child is in diabetic difficulties.

The recommendation of Diabetes UK is that every school should have people who are well versed in the relevant needs, and that secondary schools should have a school nurse. I have heard recently of the cuts made in school nursing levels. Is this a cut that we can really justify? Is it not time that we should assess this according to the need of the particular school? It is also suggested that there should be a nurse for a cluster of smaller schools, such as junior and infant schools: somebody who is well versed in and able to tackle these problems. In rural Wales, you could not have a nurse who would reach a school in time. That means that it is even more important that teachers and other school staff know exactly what to do when an emergency arises. We must all find the best way possible to ensure that no child suffers without somebody being there who can help them.

I will be visiting on Wednesday of next week a school with disabled and disadvantaged children; that is, those who are not able to cope quite as well as others. These are a particular problem: a child who possibly cannot read, or inject him or herself. How are we helping them? I am sure that this needs to be another of our priorities.

School meals need to be labelled in such a way that their content is easily understood. How much insulin is going to be needed in order to cope with this meal? That information is often difficult to understand. A youngster of seven, eight, nine or 10 years of age is trying to work out this complicated arithmetic to know exactly how much insulin to inject. What is the sugar level? Is it low or high? Somehow we need to signify that on every meal, wherever it is.

I am glad that some of the fast food chains, like McDonald’s, are providing the necessary information on their food tray papers. Other shops, hotels and others should follow suit. We are glad about what is happening. There is a lot more to be done. I am at least grateful for the opportunity to contribute in some way to this debate.

NHS: Health Tourism

Lord Roberts of Llandudno Excerpts

Monday 28th May 2012 Lords Chamber

[Earl Howe]

The best answer I can give the noble Lord is that this entire area of health tourism is one which we in the department are looking at extremely closely. A review has been carried out by officials and Ministers are considering the recommendations flowing from that. It is a complex set of issues but clearly the context to which the noble Lord rightly refers will need to come under the spotlight.

[Lord Roberts of Llandudno]

My Lords, if this is devolved to Scotland, Northern Ireland and Wales, how are the Government relating this particular problem to the Assemblies and the Parliament?

[Earl Howe]

My Lords, we are in constant contact with our counterparts in the devolved Administrations. The policy adopted in England need not necessarily be replicated in those Administrations but we seek to keep officials in those parts of the country fully informed as we go forward.

Health: Cancer Drugs Fund

Lord Roberts of Llandudno Excerpts

Monday 14th November 2011 Lords Chamber

[Earl Howe]

We plan to ensure that value-based pricing will take care of the gap that currently exists in the availability of cancer drugs, which the cancer drugs fund is trying to address. In theory, until then any drug that a clinician wishes to prescribe for a cancer patient is available under the cancer drugs fund. There is no restriction that we have set; it is a clinical judgment.

[Lord Roberts of Llandudno]

My Lords, many patients from north Wales go to Christie’s Hospital in Manchester or Clatterbridge on Merseyside. How will this fund be available to them? How does Wales come out of the complexity of this situation?

[Earl Howe]

My Lords, it is of course for the devolved Administrations to make their own decisions about their individual needs and budgets. It will depend on whether commissioners in Wales are willing to accept the cost of treating a patient with a drug that is not normally available in Wales. I cannot generalise but it is up to Welsh commissioners to take that decision.

Health: Funding

Lord Roberts of Llandudno Excerpts

Tuesday 1st November 2011 Lords Chamber

Asked By

[Lord Roberts of Llandudno]

To ask Her Majesty’s Government whether they will take action to ensure that there is no delay in funding medical treatment in hospitals in England for residents of Wales, Scotland and Northern Ireland.

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

My Lords, in the future it will be the role of the NHS Commissioning Board to act as the steward of NHS resources in England, including managing the structure of payments for NHS services. During the transition to the new NHS structure, officials from the Department of Health are working with colleagues from the devolved Administrations to understand and resolve any issues which are arising as the result of the devolution of the responsibility for healthcare.

[Lord Roberts of Llandudno]

I thank the Minister for that reply. Will he give us an assurance that no person needing medical attention, wherever they are in the United Kingdom, shall be denied the very best attention possible, and that in order to facilitate that—and I have some indication that this is already happening—there should be immediate discussions between the devolved health administrations and here to make sure that neither funding nor procedure nor anything else will prevent the best treatment for patients wherever they are in this kingdom?

[Earl Howe]

I fully agree with my noble friend that the same principles should apply across the United Kingdom as regards access to NHS treatment and facilities. The majority of cross-border flows occur in relation to Welsh patients coming in to England, and I am not aware that there are particular problems there. The Department of Health and the Welsh Government have agreed a protocol for cross-border healthcare commissioning, to define commissioning and payment arrangements for those living along the border. I believe that that is working well.