THE WEEK IN PARLIAMENT 4th to 10th March 2002CONTENTSEnglandAnnouncements: agreement on the powers of the new Council for the Regulation of HealthcareProfessionals; consultation on the selection of topics for NICE; new guidelines and progress on theNSF for diabetes; money announced for more intermediate care facilities; £100m for heart operations;latest waiting list figures; publication of document outlining the Govt’s vision for public services; GPappraisal guidance on the webNorthern Ireland AssemblyAnnouncements: Bairbre de Brun statement on Local Health and Social Care Groups; new waitinglist figuresChamber session: first stage of the Health and Personal Social Services Bill; final stages of thePersonal Social Services (preserved rights) BillWritten questions: fundholding deficitHealth Committee: report on cancer servicesNational Assembly for WalesAnnouncements: publication of annual Health Statistics WalesScottish ParliamentAnnouncements: new Quality and Standards Board for Scotland; nurse recruitment and retention;new NHS IT strategy; research on antibiotic resistance; meningitis B vaccine; foetal developmentresearch; action to reduce delays in hospital dischargesHealth and Community Care committee: evidence taken on tobacco advertisingChamber session: debate on community careThe CommonsWritten questions: falsification of answers to written questions on healthFuture ActivityHouse of Lords Committee stage for the NHS Reform and Health Care Professions BillENGLANDAnnouncementsGovernment meets Kennedy report recommendation for independent regulatory councilThe Government and regulators have reached agreement on the powers of the proposed new Councilfor the Regulation of Healthcare Professionals. The proposals, set out in the NHS Reform andHealthcare Professions Bill, to establish the new Council have been welcomed by the regulatorybodies such as the GMC, General Dental Council and the UKCC.The new Council will act as an overarching body which will oversee the individual regulators, butwill not get involved in the direct regulation of healthcare professionals. Instead, it will ensureconsistency in the work of the regulators. As a last resort, it will be able to require a regulator tochange its rules in the public interest provided both Houses of Parliament agree. Health Minister JohnHutton said that the new Council will be “a guardian of the public interest, totally independent fromGovernment and answerable to Parliament”.Subject to Parliamentary approval, the Council will be set up by early 2003. It will have 9members from the professions and 10 representing public interests and the NHS. Changes to the NHSReform and Health Care Professions Bill have already made clear that Ministers will not select any ofthe members of the new Council. It has also been agreed that there will be a Government amendmentfor the Lords Committee stage of the Bill which will ensure that before the Council could use itsreserve right to direct a regulator to change its rules, the direction would need to be approved byaffirmative resolutions of both Houses of Parliament.
Consultation on selection of topics for NICEThe DoH this week launched a consultation into the way that topics are selected for appraisal byNICE, to ensure that the process is clearer and allows stakeholders greater involvement in the process.This fulfils a commitment given in the governments response to the Bristol Royal Infirmary Inquiryreport, as well as a further commitment made in the Pharmaceutical Industry Competitiveness TaskForce (PICTF) report 2001 to review the timings of appraisals of new drugs and other newtechnologies.The main changes proposed are as follows:• To make it easier for organisations and individuals - NHS bodies, professionals, patient groups, individual patients, healthcare companies - to propose topics for NICE appraisal.• To strengthen the processes for considering proposed topics by broadening the membership of the main advisory committee, the Technologies Advisory Group (TAG), by including or strengthening the representation of the NHS, patient and professional groups, and industry.• To give fuller information on the rationale for topics referred to NICE.• To review the issue of the timing of appraisal of new technologies, which is recognised as a major interest for the pharmaceutical industry. Although in general, new technologies should be appraised at time of launch (when the need for guidance is most acute) there can be special circumstances in which some delay might be appropriate. The Government are proposing that the TAG should give explicit advice on this point for each topic they consider.The consultation paper is on the web at: http://www.doh.gov.uk/nice/consultation2002New guidelines and more progress on the NSF for diabetesNICE has this week issued two clinical guidelines for the management of Type 2 (non-insulindependent) diabetes. They cover the screening for and management of retinopathy and the preventionand management of renal disease. Also, following publication of the new national standards fordiabetes care in December 2001, work is now progressing on the Diabetes NSF delivery strategy,which is to be published later this year. The Implementation Group set up to inform the developmentof the Diabetes NSF delivery strategy met for the first time on 30 January and a summary note of themeeting has been posted on the Diabetes NSF website: www.doh.gov.uk/nsf/diabetesThe Group discussed what diabetes services should look like once the NSF is delivered. Central to thevision were empowered patients supported by integrated, community led services and a pro-activeapproach to care management. The Group also discussed potential obstacles to achieving the visionand ways of overcoming them.Money announced for extra intermediate care facilities for older peopleHealth Minister Jacqui Smith has this week announced initial allocations from a pot of £66 million toprovide extra intermediate care facilities for older people. She announced that the first phaseallocations of £46m would produce an extra 1,300 intermediate care beds, with more to follow in the£20m second phase, to be developed with the support from the health and social care change agentsteam. The change agents, set up last autumn as part of the drive to tackle delayed transfers of carefrom hospitals, will be working with a number of localities where capacity needs to be increased toensure that robust plans are in place. Once those plans have been agreed, further allocations will beconfirmed and details will be released.Ms Smith said that it is vital that older people and their carers get better information about servicesand that the NHS and social care use information to develop, manage, assess and monitor thoseservices. To underpin these developments, she announced the launch of the Information Strategy forOlder People, which is on the web at: http://www.doh.gov.uk/ipu/strategy/nsf/4.htm£100m announced to pay for thousands of heart operationsHealth Secretary Alan Milburn has announced that NHS hospitals across the country are to be invitedto bid to undertake thousands of additional heart operations paid for through a new £100m fund. Thecash will help the Government deliver on its commitment to give heart patients who have waited more
than six months for their operation a choice of being treated in their local hospital, or elsewhere if thatis quicker. Bids will be invited from private sector and overseas health organisations next week tocarry out the work. The £100m will pay for at least 4,000 additional heart operations next year andwill also fund about 40 patient care advisors who will help patients make an informed choice aboutwhere they have their operation. The advisors, who will be trained nurses, will ensure patient safetyand give them a greater influence over their own care.The details of the scheme are revealed in a discussion document entitled Extending Choice forPatients, Information and Advice on Establishing the Heart Surgery Scheme published this week andon the web at www.doh.gov.uk/extendingchoice/index.htmNHS waiting list figuresFigures released this week show that the total number of patients waiting to be admitted to NHShospitals in England rose by 7,900 (0.8%) between the end of December 2001 and the endof January 2002 and to 1,058,100. The total number waiting rose by 19,200 (1.8%) between January2001 and January 2002.The figures also show that the number of English residents waiting over one year at the end ofJanuary 2002 fell by 1,800 (5.7%) since December 2001 to 29,600; and was 17,600 (37.3%) lowerthan January 2001 when the total was 47,200. 28 patients had been waiting for longer than 18 monthsat the end of January 2002. Additionally, the statistics show that 95% of patients urgently referred bytheir GP with suspected cancer are being seen within two weeks. This compares with 91% for theprevious quarter.Government publishes its vision for public servicesNumber 10 published its pamphlet on public sector reform “Reforming our public services –principles into practice” yesterday (Thursday). It stated four key principles of public service reform –National standards, Devolution, Flexibility and Choice; set out the Government’s public sectorreforms to date; and the aims purpose behind them. The content was more in keeping with an appealto public sector workers rather than a strategy document.The document restates several well publicised tenets of government thinking, including the idea thatpublic sector providers should enjoy “intervention in inverse proportion to success” and be allowed toexpand if successful. In relation to hospitals the document mentions the “possibility of specialistpatient organisations having a more direct role in the management of services”. There is continuedsupport for a diversity of service providers but it takes care to state that “it is important to understandthat public private partnerships (and Private Finance Initiative (PFI) scheme) are different fromprivatisation.”Significantly it supports performance related pay and equivocates on the rights of workers transferredto the private sector. At one point it states “where the private sector is used it should not be at theexpense of proper working conditions for staff” and later in the concluding chapter that “goodcustomer service cannot be compromised by labour market rigidities”.The document also states that cuts in bureaucracy have saved over 540,000 GP appointments per yearplus an estimated 146,000 hours of GP time.Information on GP appraisalGuidance and forms for GP appraisal are available on the DoH website at:http://www.doh.gov.uk/gpappraisal/index.htmNORTHERN IRELAND ASSEMBLYAnnouncementsGP services
In a statement on Local Health and Social Care Groups Bairbre de Brun stated that "All the Boardshave agreed that all services currently provided by GP fund holders will be maintained until theLHSCGs can decide on their future.” She also said that a review of remuneration for boardmembership might take place if the level was seen as too low.Waiting ListsNumbers of inpatients on waiting lists have risen by 991, the number of outpatients has fallen by3000. The full report on figures from the final quarter of 2001 is available here :-http://www.dhsspsni.gov.uk/publications/2002/waitdec01.pdfLegislationThe Health and Personal Social Services Bill passed its first stage without challenge.The Personal and Social Services (amendment) Bill was amended to protect the rights of children whobecome carers, in particular their right to education and local authority support. Another amendment,placing a duty on local authorities to provide information to carers, was passed. It places a specificduty to inform carers if they are eligible for an assessment. In addition the title of the Bill waschanged to The Personal Social Services (Carers and Direct Payments) Bill.The Personal Social Services (preserved rights) Bill passed its final stage.QuestionsFundholding deficitThe projected deficit in GP Fundholding for the 2001/02 financial year is £2,082,000. The major partof the deficit has arisen from prescribing budgetsCommitteesHealth Committee Report on Cancer ServicesThe Health Committee launched its report on Cancer services. The main planks included an attack onthe Barnet formula (which allocates funding to the regions of the UK) and exhortation to proceed withthe Regional Cancer Centre recommended in the 1996 Campbell report. The report recognises thevital role played by primary care and calls for more collaboration between services. It advocatespatient-held medical records as a device to improve communication between different branches ofhealth care and calls for more investment in district nurses. The full report is not currently availableon-line.NATIONAL ASSEMBLY FOR WALESAnnouncementsPublication of health data showing both progress and challenges for the NHS in WalesHealth Minister Jane Hutt has stated that the annual Health Statistics Wales (published this week)shows the progress which has been achieved in improving health in Wales but also highlights thechallenges which remain. The publication sets out a range of data covering all aspects of health, frombirth to death, and covers lifestyle issues alongside the use and performance of the health service inWales. The data shows how busy the health service is, with virtually every indicator of demandshowing an increase – for example, the percentage of adults seeing a GP in the last 12 months hasgone up by 1%, from 77.5% to 78.5%.
The full document can be viewed at:http://www.wales.gov.uk/keypubstatisticsforwales/content/publication/health/2002/hsw2001/hsw2001-intro-e.htmSCOTTISH PARLIAMENTProduced by Anne Barry, RCGP ScotlandAnnouncementsNew Quality and Standards Board for ScotlandThe Scottish Executive has launched a three-month consultation on the structure of Scotland’s threeclinical effectiveness bodies: the Clinical Standards Board for Scotland; Health Technology Board forScotland; and the Scottish Health Advisory Service. The paper will seek the views of healthprofessionals, clinical effectiveness organisations and patients on integrating these bodies into onenew organisation: the Quality and Standards Board for Scotland.Nurse recruitment and retentionMalcolm Chisholm announced a trebling of investment in nurse recruitment and retention initiativesthis year to £5 million. The initiatives will include an expanded Return to Practice programme toencourage up to 150 experienced nurses to retrain and rejoin the NHS, to be implemented in 6 areas ofthe country; 250 more student nurse places in Scotland for the coming academic year backed by £1.5million of extra investment; and a guaranteed minimum of one year’s employment in the NHS for the1,500 newly qualified nurses and midwives graduating by October this year.New NHS IT StrategyThe Scottish Executive has launched a new drive to cut the 10 million pieces of paper that are passedbetween GP practices and hospitals in Scotland each year. A new IT strategy aims to speed up patientcare, reduce the anxiety experienced by patients as they wait for hospital appointments or test results,and provide better access to patient medical information for staff and patients alike. The strategy willbe supported by £2 million in new funding next year, on top of an existing 3-year £50 millioninvestment programme. The investment will ensure more staff have access to the new IT and will help‘step up’ the implementation of IT initiatives throughout NHSScotland including Electronic ClinicalCommunications Implementation (ECCI), which is already receiving £11m of Executive funding.By 2003, ECCI will be in place throughout Scotland, electronically linking GP surgeries andhospitals. Key benefits for patients will include:• electronic booking of hospital out-patient appointments by patients and their GPs, via the GP surgery. This will provide greater convenience for patients and tackle the number of ‘no-shows’ at out-patient clinics by giving patients appointments at the most appropriate appointment time• immediate exchange of test requests and results between primary care and hospitals, reducing the time patients wait for tests and test results, and easing the anxiety associated with waiting and enabling discharge letters, summaries and clinic letters to be sent to GPs as soon as possible so they can make arrangements for any necessary follow-up patient care and support.Research on Antibiotic resistanceA three-year research programme designed to discover if antibiotic resistance be transferred betweenbacteria is now under way at the Rowett Research Institute in Aberdeen. More and more bacteria arebecoming resistant to the antibiotics used to treat them and what is not known, is if and how non-harmful bacteria transfer their antibiotic resistance to disease-causing bacteria. The new project,costing £200,000, is investigating whether transfer of antibiotic resistance can happen betweenbacteria that live in the guts of humans and animals, and if it does how it is triggered and theconsequences for health.Meningitis B Vaccine
Positive pre-clinical tests in Scotland have signaled an early breakthrough in the search for a vaccineagainst the potentially fatal meningitis B virus. Meningitis B is a dangerous condition affecting thebrain and spine. 106 people in Scotland developed the disease last year, three of whom died. Ifapproved, the potential new vaccination could drastically cut the number of sufferers in Scotland andcould also provide additional protection against meningitis C and the rarer A strain of the disease.This potential new vaccine is not yet available, but pre-clinical tests have proved to be extremelypositive. Any vaccine still has to undergo a series of rigorous tests, assessments and licensing toensure safety and efficacy before it can be recommended for use by GPs. It is estimated that a vaccinecould be available within the next 4 to 5 years.Foetal Development ResearchThe Executive is supporting new research that will explore the relationship between poor foetalgrowth and abnormal hormone levels in the foetus. Many studies in animals and humans show thatsmall babies, even within the normal range, have higher risks of disease in adulthood. The reasons forthis are poorly understood, yet it is a major concern for both human health and agriculture. Recentresearch by scientists in Aberdeen at the Rowett Research Institute, Scottish Agricultural College andUniversity of Aberdeen has shown that poor foetal growth can be detected very early in pregnancyand is associated with abnormal hormone levels in the foetus. In the new research the scientists willstudy how these changes affect the function of the placenta and the nutrition and development of thefoetus.Delay in DischargeA major new Action Plan to reduce unacceptable delays in hospital discharges by creating at least1,000 extra care packages by April 2003, was launched today. An extra £20 million to be invested inlocal NHS/local authority partnerships to help them jointly tackle delays. Each area of the countrywill be asked to come up with detailed plans for their area before they get a full share of the extramoney. Plans will be tested against two key priorities: reducing the impact of delayed discharge onacute hospital services; and delivering effective care packages for the 300 people in Scotland whohave waited over one year to be appropriately placed.Health and Community Care CommitteeThe Health and Community Care Committee took evidence from on Tobacco Advertising andPromotion (Scotland) Bill from Mr Tim Lord, Chief Executive, Tobacco Manufacturers’ Association;and Mr Chris Ogden, Director of Trade and Industry Affairs, Tobacco Manufacturers’ Association.A number of items were taken in private. The outcomes of items of particular interest have beennoted: • The Committee agreed to seek clarification on the future work of the Auditor General on Hospital Acquired Infection, and to reconsider the matter subsequently. • The Committee agreed to contact the Executive regarding Arbuthnott Allocations. • The Committee considered possible future action on the Executive’s health plan. • The Committee considered possible action on Proposed Mental Health Legislation.Parliament - Thursday, 7 March 2002Debate on Community CareA debate on Community Care was held on Thursday, 7 March. It was agreed that MalcolmChisholm’s amendment to the motion submitted by Mary Scanlon, should be allowed:That the Parliament acknowledges the progress that is being made towards joint resourcing and jointmanagement of older peoples services; looks forward to further developments in the Joint Futureagenda; welcomes the provision of significant extra resources for dealing with the problems ofdelayed discharge and care home fees, and recognises that such resources are part of the biggest everinvestment in care services for older people.The motion was agreed.
THE COMMONSWritten questionsFalsification of answers to written questions on healthJoan Humble (Lab) asked Alan Milburn if he will make a statement on the time taken to reply towritten questions tabled for answer by his Department.The Minister replied that action has been taken in the Department to reduce the number of outstandingparliamentary questions, which now come in at the rate of around 45 a day, almost double the rate ofthe last session. There are currently 411 outstanding questions due for reply before 14 February 2002and the aim is for these to be answered by 12 March 2002.Several Members have raised concerns about unanswered questions and the length of time it has takenfor questions to be answered. Last week in the course of dealing with these inquiries evidence cameto light of what appears to be systematic falsification in recording the handling of parliamentaryquestions in the Departments parliamentary section. This included recording questions as havingbeen answered when no such reply had been given to the Member or to the Official Report. Some ofthese questions date back to the beginning of this session. The falsification that took place meant thatboth officials and Ministers were wrongly led to believe that Members had received replies to theirquestions when they had not. A full investigation is now under way to ensure that all the facts areknown and that the necessary remedial action is taken. An official from the Departmentsparliamentary section has been suspended and is now the subject of a disciplinary investigation.FUTURE ACTIVITYNHS Reform and Health Care Professions BillThe date for the Committee of the Whole House is Thursday 14 March. ISS will produce a brief onthe whole debate, concentrating on medical regulation and the Council for the Regulation of HealthCare Professionals. * * * Produced by the RCGP’s Information Services Section Scottish Parliament content produced by Anne Barry, RCGP Scotland