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House of Lords

Tuesday, 30 June 2009.

2.30 pm

Prayers-read by the Lord Bishop of Bradford.

Introduction: Baroness Kinnock of Holyhead

2.38 pm

Glenys Elizabeth Lady Kinnock, wife of the right honourable Neil Gordon Lord Kinnock, having been created Baroness Kinnock of Holyhead, of Holyhead in the County of Ynys Môn, was introduced and made the solemn affirmation, supported by Lord Judd and Baroness Royall of Blaisdon.

NHS: Incontinence Services


2.45 pm

Asked By Baroness Greengross

Baroness Thornton: My Lords, we have made good progress using some of the following tools: NICE guidelines, the national framework, audits conducted by the Royal College of Physicians, the productive community services programme and a commissioning programme aimed at female incontinence. We are aware of local variations in the provision of incontinence services and so continue to work for a high level of integrated incontinence services across the country.

Baroness Greengross: My Lords, I thank the Minister for that helpful reply. Bearing in mind that incontinence is the last great health taboo, a massive public health problem that affects 4 million to 6 million people-men, women and children-and is more prevalent than asthma, epilepsy and even dementia, will the Government consider adding incontinence management to the list of national health improvement programmes?

Baroness Thornton: My Lords, the health improvement programmes are currently focused on the priorities set out by my noble friend Lord Darzi in the next-stage review, but we know that a modest investment by the NHS in developing early intervention and assessment services would produce important benefits in terms of a better quality of life for patients and significant cost savings, so incontinence care is being taken seriously by the Department of Health. It will be incorporated into a later phase of a package for older people in order to promote improvements to health and well-being in later life.

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Baroness Tonge: My Lords, that is all very fine, but at the last count only a fifth of trusts actually had someone in post who was in charge of incontinence services, which simply will not do. Will the Minister say whether there is a date by which we can expect someone responsible and trained in handling incontinence problems to be in post in all trusts? Will she also say whether incontinence products other than the usual, bog standard ones-I apologise for the pun-can be made available to meet the very different needs of incontinence sufferers?

Baroness Thornton: My Lords, it is clear that the management of incontinence issues has to be developed and delivered at the local level. The noble Baroness is correct to point out the need to make available the right guidance and support to deliver these services. Those things are in place, but we now need to make sure that our monitoring services pinpoint those areas that are not delivering a proper level of care to patients with incontinence. The development of products is a matter that we have under review. I cannot give the noble Baroness any more detail on that now, so I will write to her.

Baroness Wilkins: My Lords, as a spinal cord-injured person, I declare an interest. Maintaining our continence is fundamental to ensuring our dignity, yet the current practice of some PCTs is resulting in some people being forced to use basic products that do not meet their needs. Can my noble friend give an assurance that the NHS will provide users with the most appropriate product, not the cheapest?

Baroness Thornton: My Lords, my noble friend makes an important point. Good practice in incontinence services recommends that a range of pads should be available in all categories, including bedpans and a variety of sizes of pads with different absorbencies. Rationing is totally unacceptable and the Government have made it completely clear that incontinence pads should be provided in sufficient quantities to meet individuals' needs.

Lord Ashley of Stoke: My Lords, this is not an easy subject, but it is made more complex by the insistence of primary care trusts on adopting their own policies, thereby causing a great deal of confusion. That means that people are deprived of important medical facilities and treatments. The Government should intervene, regardless of their present stance.

Baroness Thornton: My Lords, there can be no doubt that PCTs have been given the message that the Government regard incontinence care as a priority. They have been given the guidance, the toolkits and the support. Most are doing well. We have to bear down on those that are not doing well and we have to make sure that they improve the services.

Baroness Howarth of Breckland: My Lords, the Minister mentioned monitoring. I understand that NICE is undertaking a review of the quality and outcomes framework indicators. Would this not be a

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good moment to have a look at these again and will the Government support the inclusion of incontinence care in the review?

Baroness Thornton: My Lords, the noble Baroness is right. In April 2009, NICE took over the responsibility for overseeing a new independent process for prioritising, developing and reviewing the quality and outputs framework of what happens in clinical and health improvements. Any new topic for inclusion in what is known as the QOF will need to be made to NICE as part of this process. The noble Baroness points to an important matter. The process of prioritisation of topics will be made by the advisory committee and decisions on whether to include things will be based on evidence of clinical and cost effectiveness. I think that I feel a campaign coming on.

Earl Howe: My Lords, the Minister gave what I am sure will be a very well received assurance to the noble Baroness, Lady Wilkins, but the fact remains that there is a great deal of concern out there about a postcode lottery. Will the Government consider putting in place a system to monitor the practices of PCTs to ensure that some of the commissioning processes that I am aware of, including local formularies and very restrictive tendering procedures, are not used to the detriment of incontinence patients?

Baroness Thornton: My Lords, what we will find with world-class commissioning and its monitoring process is that this is an issue that will be tackled at that level. Where PCTs are not using commissioning processes that provide the end result of a good-quality service for incontinence sufferers, that will be highlighted and we will need to make sure that we pick it up.

Lord Skelmersdale: My Lords, the Minister talked about prioritising incontinence services within the health service. Can she let the House know how many priorities there are within the health service? Surely each one that is added devalues the rest.

Baroness Thornton: My Lords, my point was that we regard this as a priority, but the delivery of the service has to be done at local level. That is for obvious reasons: the resources are at local level. The Government have said, "We regard this as important and this is how we think you need to deliver a proper service".

Health: Tuberculosis


2.52 pm

Asked By Baroness Masham of Ilton

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Baroness Thornton: My Lords, my department accepts the recommendations of the Health Protection Agency evaluation, which clearly showed the benefits of the mobile X-ray unit. We will continue to fund the mobile unit through the find and treat programme, which actively screens homeless hostels across London until 2010. It will then be up to the London commissioners to reach a consensus on future support for find and treat, including whether there should be a second mobile x-ray unit.

Baroness Masham of Ilton: My Lords, I thank the Minister for that Answer, which was not quite what I had hoped. Is she aware that there is now an exceedingly serious situation in London with drug-resistant tuberculosis among the homeless and within the prisons, which is where the mobile unit goes? The recommendation was that there should be at least two units, but the Health Protection Agency has actually recommended that there should be three. The only unit that there is at present is now getting very old, so they desperately need another one. That would enable them also to do schools and children.

Baroness Thornton: My Lords, I am absolutely in agreement with the noble Baroness, as are the Government. What is required here is that the London PCTs agree to take this programme forward. The cost of one mobile unit per PCT in London would be £16,000 per year, and the cost of two would be £32,000 per year. We are not talking about enormous sums, but it will require co-operation among the London PCTs. We are doing our very best to encourage this.

I know that the noble Baroness has a particular interest in TB in prisons, and I am very pleased to report that we are funding the installation of screening systems in eight of the high turnover prisons, with a link into their local acute trusts. Those are Belmarsh, Brixton, Pentonville, Wandsworth and Wormwood Scrubs, with three other prisons outside London being chosen for those facilities later this year.

Lord Walpole: My Lords, I am not absolutely clear who is meant to make the capital payment for these things and who is meant to run them. Is it the same person, and which budget does it come from?

Baroness Thornton: My Lords, because of the concern about the prevalence of TB in London, the Government have centrally funded what is called the find and treat programme, including a mobile X-ray unit, until 2010. After that, the London PCTs will combine to take on the programme, if the evaluation proves to be right, and the mobile units. We now know through the HPA of the recommendation to have two units. We are urging the London PCTs to undertake to pick up the funding in 2010 and to run that programme.

Baroness Tonge: My Lords, when the find and treat programme was set up, it was a service for socially excluded groups. Does that include failed asylum seekers, who still do not qualify for NHS treatment? They may not have TB when they become failed asylum seekers but can contract it while awaiting deportation, especially

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if they have underlying conditions such as diabetes and AIDS, for which they cannot at the moment get treatment under the National Health Service.

Baroness Thornton: My Lords, arriving passengers who claim asylum at the port of entry are referred for medical examination and, indeed, assessment for TB. If it is found that they have TB, they will receive treatment. Failed asylum seekers will also receive treatment. This is a health protection issue, apart from anything else. Our aim is to locate the people who are most vulnerable, assess whether they have contracted TB and then provide treatment.

Lord Soulsby of Swaffham Prior: My Lords, when the House of Lords Select Committee on fighting infection visited New York, we were most impressed when we visited the Harlem Hospital to discover its programme of tuberculosis detection and control. It has a very good TB-screening programme as well as a programme of directly observed therapy, or DOT. Is DOT also applied to the down-and-out population of London?

Baroness Thornton: My Lords, the programme in New York was successful and DOT was used. The success of that programme has informed how we treat the most vulnerable groups of the homeless, in particular, once we have identified them. About half of them now receive their treatment through the directly observed treatment method so that they are being supported.

Lord Desai: My Lords, I recall that the Chief Medical Officer announced a TB strategy five years ago. What has been the effect of that plan?

Baroness Thornton: My Lords, in 2004, the Chief Medical Officer produced a TB action plan with 10 actions to bring TB under control. We are committed to tackling TB. The action plan involves reducing the number of people at risk of being newly infected by TB, providing high-quality treatment and care for them, and maintaining low levels of drug resistance, which has already been referred to, for multi-drug TB. We do this in several ways, including raising awareness of TB within the medical profession. The incidence of TB in the population has been stable for the past two years. The Care Quality Commission's assessments of how these issues are delivered will include TB within the broad framework of how organisations are delivering at local level.

Lord Roberts of Llandudno: My Lords, what links do the Government have with organisations such as St Mungo's or the Barka community, which go out to rough sleepers, homeless people and, increasingly, failed asylum seekers?

Baroness Thornton: My Lords, one reason that the programme of find and treat in London is so successful is that we work with those organisations. Co-ordination between all the organisations in London that work with homeless people and drug abusers is vital.

30 Jun 2009 : Column 112

Baroness Masham of Ilton: My Lords-

The Minister of State, Department of Energy and Climate Change (Lord Hunt of Kings Heath): My Lords, it is time to move on.

War Crimes


3 pm

Asked By Lord Hamilton of Epsom

Lord Brett: My Lords, the Government are clear that individuals who have committed war crimes or crimes against humanity should not be given a safe haven in the United Kingdom. We screen immigrant applicants for involvement in war crimes. Since April 2004, the war crimes team of the UK Border Agency has considered 2,869 cases. It has recommended refusal of asylum or other immigration status in 421 cases and referred 30 cases to the Metropolitan Police.

Lord Hamilton of Epsom: My Lords, many people will be extremely surprised to know that people suspected of war crimes are in this country at all. What are the Government doing about those people who entered this country prior to 2004 who may be guilty of war crimes?

Lord Brett: My Lords, as I said, this country should not provide a safe haven. That also requires us to look at ways in which we can ensure it. The Government are considering whether our own law can be strengthened. Information on the number of suspected war criminals can be collected only through international co-operation, NGOs and many other parts of the community. At present, we do not have that information to hand.

Lord Anderson of Swansea: My Lords, my noble friend mentioned the problem of those who are known to be war criminals, but what about those who come in clandestinely or when we do not know their background of potential war crimes? How does he respond to the dilemma that most of those accused of war crimes by definition come from countries where we have doubts about their legal system? Is there not a danger that this judgment will give a signal to those guilty or suspected of war crimes that they have only to come to this country, clandestinely or otherwise, to find safe haven?

Lord Brett: My Lords, that is why we have screened applicants for involvement in war crimes since 2004. That screening process looks at countries of origin,

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the perpetrators of conflict, and the areas and types of conflict. It is also why we are looking at whether we can strengthen UK law.

Lord Carlile of Berriew: My Lords, in thanking the noble Lord for recent conversations which some of us have had with Ministers concerning potential changes in our own law relating to genocide, war crimes and crimes against humanity, may I remind him of the introduction into the United States Senate only last week of a crimes against humanity Bill? That Bill provides for jurisdiction founded not on residence but on presence. Will the Minister confirm that the Government are looking sympathetically at potential changes in UK law of a similar effect to ensure that the United Kingdom is not a safe haven for war criminals?

Lord Brett: My Lords, we remain certain that tackling crimes of genocide and other such atrocities requires international co-operation. The Government will continue to work with other countries, of course including the United States and the European Union, to ensure that criminal justice systems around the world are designed to deal with cases of this nature. We also consider the role of international institutions in these matters. I have no personal knowledge of the matter before the Senate in the United States, but it is clear that it would be of both interest and education in terms of what we are seeking to do in this country.

Lord Hannay of Chiswick: My Lords, does the Minister not agree that the most recent case in the High Court has advertised pretty widely that there is a loophole in our legislation and has therefore made the risk of this country being seen as a safe haven for these people considerably greater? There is therefore surely great urgency to the Government making up their mind and using legislation currently before this House as a means of blocking that loophole.

Lord Brett: My Lords, I agree with the noble Lord that the result in the High Court is likely to be a form of encouragement for some; we are seeking for our screening to be a deterrent for others. However, as the noble Lord said, there are amendments to the Coroners and Justice Bill to be discussed next week which will encourage debate around this whole subject. I am sure that it will be both educational and informative.

Lord Vinson: My Lords, does the Minister think that the Human Rights Act might have some bearing on the interpretation of these cases and, if this is the case, was it ever envisaged that the Human Rights Act could be used in this way?

Lord Brett: My Lords, the Human Rights Act is a very valuable piece of legislation which we conform to. It occasionally provides judgments which we might not find politically convenient or in the best interests of ourselves as a single nation. They are, however, judgments in the best interests of humanity. As the Human Rights Act protects people in law, I do not believe we should disagree with it.

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