Vol. 739 Tuesday No. 36 17 July 2012 PARLIAMENTARY DEBATES (HANSARD) HOUSE OF LORDS OFFICIAL REPORT ORDER OF BUSINESS Royal Assent Questions NHS: Primary Care Trusts NHS: Mental Illness Social Care: Sustainable Funding Olympic Games 2012: Traffic Draft Electricity and Gas (Smart Meters Licensable Activity) Order 2012 Motion to Refer to Grand Committee Local Authorities (Mayoral Elections) (England and Wales) (Amendment) Regulations 2012 Motion to Approve Parliamentary Commission on Banking Standards Membership Motion Defence Equipment and Support Statement Justice and Security Bill [HL] Committee (3rd Day) Education (Exemption from School Inspection) (England) Regulations 2012 Motion of Regret Justice and Security Bill [HL] Committee (3rd Day) (Continued) Grand Committee Designation of Features (Appeals) (England) Regulations 2012 Public Bodies (Abolition of Environment Protection Advisory Committees) Order 2012 Public Bodies (Abolition of Regional and Local Fisheries Advisory Committees) Order 2012 Financial Services and Markets Act 2000 (Regulated Activities) (Amendment) Order 2012 Equality Act 2010 (Age Exceptions) Order 2012 Considered in Grand Committee Written Statements Written Answers For column numbers see back page £3·50 Lords wishing to be supplied with these Daily Reports should give notice to this effect to the Printed Paper Office. 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BOUND VOLUMES OF DEBATES are issued periodically during the session. Single copies: Commons, £105; Lords, £40. Standing orders will be accepted. THE INDEX to each Bound Volume of House of Commons Debates is published separately at £9·00 and can be supplied to standing order. All prices are inclusive of postage. © Parliamentary Copyright House of Lords 2012, this publication may be reproduced under the terms of the Parliamentary Click-Use Licence, available online through The National Archives website at www.nationalarchives.gov.uk/information-management/our-services/parliamentary-licence-information.htm Enquiries to The National Archives, Kew, Richmond, Surrey, TW9 4DU; email: [email protected] 99 Royal Assent[17 JULY 2012] NHS: Primary Care Trusts 100 Baroness Masham of Ilton: My Lords, will the noble House of Lords Earl find out to how many cases the PCT in North Yorkshire has denied treatment in the past year? Is he Tuesday, 17 July 2012. aware of how distressing it is for very ill patients to have to appeal? 2.30 pm Earl Howe: My Lords, I do not have the figures for Prayers—read by the Lord Bishop of Newcastle. North Yorkshire in front of me but, as the noble Baroness is aware, there is a process for patients to make an exceptional case application to their primary Royal Assent care trust where the circumstances are deemed to be exceptional. We had a short debate about this matter 2.36 pm the other day. However, there will inevitably be variation around the country in the extent to which treatments are seen as a priority for the local population in a The following Acts were given Royal Assent: given area. Supply and Appropriation (Main Estimates) Act, Finance Act. Lord Winston: My Lords, it is a question not just of treatment but of investigations for treatment. Only NHS: Primary Care Trusts last week, I saw a couple complaining of long-standing Question infertility who were refused a laparoscopy or an X-ray of the uterus on the grounds that they were not permissible as investigations under the National Health 2.36 pm Service. It was limited by their primary care trust. Asked By Lord Hunt of Kings Heath Would the noble Earl care to comment on that? To ask Her Majesty’s Government what action Earl Howe: My Lords, if that case was a consequence they will take to prevent primary care trusts of the primary care trust taking a blanket decision inappropriately restricting access to patient treatments. over a clinically valid investigation process then I would be very concerned and should be interested to hear the The Parliamentary Under-Secretary of State, Department details from the noble Lord. of Health (Earl Howe): My Lords, it is inappropriate for a primary care trust to impose blanket bans on Baroness Brinton: My Lords, given that there is no treatments, or to restrict access to treatments on the consistency in the name that PCT committees are basis of cost alone. The department will ask strategic calling themselves to make these judgments about health authorities to investigate any examples of such treatments and pathways, and often these matters are behaviour, and appropriate action will be taken. reported or hidden in longer performance reports, can my noble friend ensure that PCTs are open and transparent Lord Hunt of Kings Heath: My Lords, in thanking in their decision-making on these treatments, including the noble Earl, I remind the House of my health referencing how their decision reflects NICE guidelines, interests in the register. The noble Earl will be aware and also insist that the appeals process is equally that there is now abundant evidence that some primary accessible? care trusts are restricting treatments that are deemed appropriate, in some cases against the guidelines issued Earl Howe: Yes, my Lords, we emphasise this principle by NICE. Given that, will he go further and seek to at every opportunity. Indeed, transparency is a central ensure that he and his ministerial colleagues intervene principle, as my noble friend will be aware, in the way in the NHS where this is happening so that we can be that the NHS constitution instructs the health service satisfied that the NHS will still provide a comprehensive to make decisions rationally and transparently so that service? patients can see the basis on which those decisions have been arrived at. Again, if that is not happening in Earl Howe: My Lords, yes, we will intervene if ever any area I should be very glad to hear about it. it is demonstrated that primary care trusts are restricting treatments on a blanket basis or on a cost basis Lord Walton of Detchant: My Lords, in relation to unrelated to clinical need. Any arbitrary restriction on the point made by my noble friend Lady Masham, is access to treatment of that kind is unacceptable. We the Minister aware that the particular primary care have made that clear repeatedly, as has Sir Bruce Keogh, trust in North Yorkshire has refused the funding for the NHS medical director, on a number of occasions. an operation for a bright young lady doctor who is However, that is not the same as saying that the NHS enrolled on a training scheme in that area and who should be unconcerned about value for money. It turns out to have a rare hereditary form of pancreatitis? should be very concerned about it. It should not spend Three surgeons, two in Newcastle and one in Leicester, money on treating a patient when that patient is have agreed as a team to operate on her, otherwise the unlikely to derive clinical benefit from the treatment. condition will be progressive and eventually fatal, but Therefore, we need to distinguish that kind of case the primary care trust has refused funding for the from the kind cited by the noble Lord. procedure on the grounds that it is somewhat experimental, 101 NHS: Primary Care Trusts[LORDS] NHS: Mental Illness 102 [LORD WALTON OF DETCHANT] NHS: Mental Illness even though it has been carried out successfully on a Question number of occasions before. Is this not a case that ought to be referred to the Advisory Group for National Specialised Services? 2.45 pm Asked By Baroness Thornton Earl Howe: My Lords, we had a debate about that To ask Her Majesty’s Government what is their very case the other day, as the noble Lord will be response to the report How mental illness loses out aware, and as I said then, this matter is under close in the NHS, published by the London School of scrutiny at the Department of Health. I am hopeful of Economics and Political Science on 18 June. a happy outcome. The Parliamentary Under-Secretary of State, Department Lord Soulsby of Swaffham Prior: My Lords— of Health (Earl Howe): My Lords, we agree with the report’s insistence on both the importance of investment Lord Bach: My Lords— in mental health services and on the necessity of treating mental ill health as seriously as physical ill health. Our mental health strategy, No Health Without Mental The Chancellor of the Duchy of Lancaster (Lord Health, makes our commitment to these principles Strathclyde): My Lords, perhaps we could hear from clear, and we are soon to publish an implementation the noble Lord, Lord Soulsby. framework that will help to embed them in NHS practice. Lord Soulsby of Swaffham Prior: Thank you, my Lords. This is an unfortunate Question in that it tends Baroness Thornton: I thank the Minister for that to imply that this system is widespread.