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Tuesday, 13 October 2009.
2.30 pm
Prayers-read by the Lord Bishop of Liverpool.
Introduction: Lord Martin of Springburn
The right honourable Michael John Martin, having been created Baron Martin of Springburn, of Port Dundas in the City of Glasgow, was introduced and took the oath, supported by Lord Falconer of Thoroton and Lord Foulkes of Cumnock.
Health: Stroke
Question
2.43 pm
Asked By Baroness Gardner of Parkes
To ask Her Majesty's Government whether, in announcing eight hyper-acute stroke units for London, they will give further consideration to the policy that all suspected stroke cases will be sent in the first instance to those units for three days and then transferred to their local stroke centre.
Baroness Thornton: My Lords, after consultation with patients, clinicians and healthcare workers, on 20 July a joint committee of London's primary care trusts endorsed plans to establish eight hyper-acute stroke units in the capital. These will admit stroke patients who, once stabilised, will be treated at one of the 24 supporting units throughout the capital. As this plan has just been established, it is not anticipated that this will be reconsidered.
Baroness Gardner of Parkes: My Lords, I thank the Minister. I declare an interest in that my husband and I have both been patients of the Chelsea and Westminster, which is not one of the eight but is one of the 24. Is she aware that there is only a three-hour opportunity during which thrombolysis or clot-busting can work? Most of the other stroke units, which are not hyper-acute classified, ask what the point is of taking someone who is beyond that stage to the hyper-acute unit when they could more conveniently and less expensively be treated at their local stroke unit.
Baroness Thornton: Of the 11,500 people who suffer from stroke in the capital each year, only 1,000 of those, it is estimated, would need thrombolysis. However, many of the others would need rapid action to diagnose and treat their stroke. But the noble Baroness raises an important point about those people who present having had a stroke perhaps a day or several days before. At that point, when a patient visits their doctor or a local stroke unit with those symptoms, an assessment would be made whether it was appropriate to send them to one of the hyper-acute units or to keep them and treat them in their local hospital.
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Lord Walton of Detchant: My Lords, does the Minister agree that the necessary services for strokes and their acute treatment have been delayed for an excessively long time? The establishment of these eight hyper-acute units is therefore very welcome. However, what action are the Government taking to advise the emergency services, and members of the public at large, to recognise that stroke is an emergency? The three-hour window of opportunity in which it is necessary for individuals to have a scan, before those who have had a stroke due to a reduction in blood supply rather than a haemorrhage can be treated with these clot-busting drugs, is crucial. It is a matter of fundamental importance: stroke is an emergency.
Baroness Thornton: The noble Lord is absolutely right. In a Question in February, I demonstrated the FAST message to your Lordships' House, which is the way in which all of us can diagnose stroke with the face, arms and speech test. This has been promoted by the Stroke Association with the support of the department. The emergency services are part of the strategy in London and are being geared up to take patients with threatened stroke to the new acute centres.
Baroness Pitkeathley: My Lords, is my noble friend aware of the rather depressing news this morning that only a small proportion of the budget allocated for carers' breaks is in fact reaching them? In view of this, will she take account of the extra cost for families of visiting other than in their local area when someone has had a stroke?
Baroness Thornton: I will certainly take note of that. The idea is that the person would be stabilised in the hyper-acute unit and, as soon as they were stabilised, moved to a local unit for precisely the reasons that my noble friend has outlined.
The Earl of Mar and Kellie: My Lords, will all accident and emergency departments retain staff with the skills to diagnose a stroke?
Baroness Thornton: All the staff in our accident and emergency departments should be able to diagnose stroke.
Baroness Masham of Ilton: My Lords, will there be any hyper-acute stroke units outside London? Does she agree that there are many people at risk of stroke who live outside London?
Baroness Thornton: The stroke networks for London are designed to ensure that those living within this region should be able to reach a hyper-acute unit within 30 minutes. The strategic authorities outside London, I am pleased to say, are developing their own units. In the east of England region, for example, there are new 24/7-that is a terrible term; rather, 24-hour services offering thrombolysis services for stroke patients. The same is happening in the south central region, where there are 14 acute combined stroke units. Each area is developing its own strategy.
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Baroness Sharples: Are there delays in follow-up treatment due to the shortage of therapists?
Baroness Thornton: Part of the strategy, both nationally and regionally in London, is about recruiting and training therapists. Resources are being made available for that. It is specialist nurses and therapists whom we need to recruit and train to ensure that the 24 stroke centres are properly equipped. I am not going to pretend that all the centres are as we would wish them to be right now.
Lord Davies of Coity: My Lords, is the Minister confident that there is sufficient evidence to ensure that the London Ambulance Service can reach these units on time?
Baroness Thornton: That is a very important question, as the whole strategy would fall down if that were not the case. We are confident that the service can reach all the centres within 30 minutes. The London Ambulance Service already has an impressive track record in getting heart-attack patients to the centres of excellence that exist to treat them. We are therefore confident that it has the experience to be able to diagnose and get people to the centres on time.
Lord Campbell of Alloway: Is the policy proposed by my noble friend really necessary? I speak as one of those suspected stroke cases. The provision that was given to me by the doctor was, "Well, you're over 90. You'd better have a check". So I was sent around, had a check and they said, "Yes, for heaven's sake, look at what you drink and what you eat"-I shall not describe it. You just change it, and I am no longer a suspected case.
Baroness Thornton: I am very pleased to hear that, but every year 110,000 people in England have a stroke; it is the third biggest cause of death. I am very pleased to hear that the noble Lord is in great health.
Baroness Nicholson of Winterbourne: The Minister is more aware than I am of the necessity of follow-up treatment. Is she able to reassure this House that the follow-up treatment in the local stroke units will be as good as or better than that provided by the Oxford Centre for Enablement, which is primus inter pares as far as I am aware?
Baroness Thornton: I am sure that that is the case. I think that I have already said that we accept that the level of rehabilitation and community care is crucial. We are addressing the recruitment and training of therapists and specialist nurses.
Disabled People: Benefits
Question
2.51 pm
To ask Her Majesty's Government which elements of disability benefit they are considering integrating into the wider social care budget in England.
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The Parliamentary Under-Secretary of State, Department for Communities and Local Government & Department for Work and Pensions (Lord McKenzie of Luton): My Lords, the Green Paper, Shaping the Future of Care Together, proposed that one way to deal with the challenge of an ageing society may be to bring some disability benefits and the new care and support system together into a single system as a better way of providing support. At this stage, we do not want to rule out any options and so are considering all disability benefits.
Lord Ashley of Stoke: I thank my noble friend for that reply. Is he aware that any attempt by the Government to withdraw these benefits, or any benefits at all, will be very strongly resisted by disabled people, by their organisations and by many Members of both Houses of Parliament?
Lord McKenzie of Luton: My Lords, I reiterate that no decision has been made on this matter-it is a consultation-and I acknowledge the benefit that many disabled people see in the current benefit structure, particularly DLA and attendance allowance. However, there is a case for bringing some disability benefits and the adult social care system together to provide better support through a new national care service. We should remember that the social care system and disability benefit system have in many ways developed in isolation from each other-they are separately assessed and have separate applications-and there may be benefits for individuals in bringing them together. However, we have made clear in the Green Paper that should we make a change in this direction, individuals receiving the relevant benefits at the time of the reform will continue to receive an equivalent level of support and protection.
Perhaps I may illustrate the nature of the challenge that we face. There are currently 1.26 million adults who get their care and support needs addressed. Over the next 20 years, 1.7 million more adults will need to be supported. Currently, 20 per cent of cases cost less than £1,000 a year and 20 per cent cost more than £50,000 a year.
Baroness Wilkins: My Lords, does my noble friend consider it acceptable that if attendance allowance were absorbed into the social care fund in future, many thousands of disabled people who get the benefit now, such as visually impaired people who fall outside the fair-access-to-care criteria, would no longer get any help with the extra costs of disability?
Lord McKenzie of Luton: My Lords, these are exactly the points that need to be fed into the consultation so that they can be taken fully into account. Currently, there is a considerable degree of overlap between the social care support system and attendance allowance, in particular, and many claimants of attendance allowance effectively have a significant loss of their benefit in the assessment for social care.
Baroness Thomas of Winchester: My Lords, I declare an interest in that I receive a disability benefit. Is the Minister aware of the very real fear that has been engendered among disabled people at the possibility of attendance allowance, and possibly the care element of disability living allowance, being swept into the
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Lord McKenzie of Luton: Indeed. I can absolutely reassure the noble Baroness and the whole House on that issue. This is a Green Paper. It is a consultation and we need fully to take account of people's views. There is no prospect of people simply having their disability benefits removed overnight. That is no way in contemplation.
Lord Freud: My Lords, on this proposition of subsuming various allowances, including attendance allowance, is this moving away from the principles of right to control which are being included in the Welfare Reform Bill?
Lord McKenzie of Luton: It is very much to the contrary. It is a clear thrust of the Green Paper that when we establish the national care service, some of its key components will be prevention services and information and advice, and personalised choice and control will be at the centre of those proposals. In a sense, this is being reinforced by the Welfare Reform Bill at the moment.
Lord Low of Dalston: My Lords, notwithstanding what the Minister has said about all disability benefits being up for consideration, and given the reported statement by the Minister for Care Services that disability living allowance is not under threat, can the Minister confirm that neither component of the disability living allowance, whether paid to present or future recipients over as well as under 65, is being considered as a possible source of funding for social care?
Lord McKenzie of Luton: My Lords, as I said in answer to the first Question, currently no particular benefit is ruled out of consideration. We are conscious of the fact that DLA is overwhelmingly used by people who are under 65, and obviously care needs are overwhelmingly for people who are older.
Gulf War 1990-91: Nerve Agent Pre-treatment Tablets
Question
2.58 pm
Asked By Lord Lloyd of Berwick
To ask Her Majesty's Government what is their response to the decision of the Pensions Appeal Tribunal in Edinburgh on 29 August in the case of Michael John Kozac that his death in October 2003 was directly attributable to high blood pressure caused by the consumption of nerve agent pre-treatment tablets, which he was required to take during his service in the Gulf in 1990-91.
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The Minister for International Defence and Security (Baroness Taylor of Bolton): My Lords, the decision of the Pensions Appeal Tribunal was based on the coroner's verdict that Mr Kozac's death was due to natural causes to which his military service in the Gulf campaign and an assault on 31 August 2000 were contributing factors. The coroner did not say that his death was directly attributable to the consumption of NAPS tablets, and the overwhelming evidence from scientific research shows no adverse effects from NAPS tablets.
Lord Lloyd of Berwick: My Lords, I thank the noble Baroness for that Answer. As she will know, Mr Kozac died in hospital after an operation. Mrs Kozac then had to wait four years for an inquest. The coroner found that his death was attributable in part to his war service but the department refused to accept that finding, so Mrs Kozac appealed. The department fought the appeal and lost. How does that history square with what the noble Baroness was saying yesterday in answer to my noble and gallant friend Lord Bramall about the importance of providing for the families of deceased and injured veterans?
Baroness Taylor of Bolton: My Lords, it did indeed take four years before this inquest was held. That had nothing to do with the Ministry of Defence. Indeed, when the inquest took place, the Ministry of Defence was not represented. The coroner said that the assault which led to Mr Kozac having a dissection of his aorta had been a contributing factor. It is regrettable that anybody has to suffer any ill effects, but the question of Gulf War syndrome-which we have discussed at length in this House and which I know the noble and learned Lord has a great interest in-is something to which the department has given great resources. Indeed, those who suffer from the syndrome get financial support, depending on the nature of their disability.
Lord Morris of Manchester: My Lords, I too thank my noble friend. Is she aware that this decision is seen as one of landmark importance by the ex-service community? Recalling the admiration felt across the House yesterday for British troops killed and maimed in our service, what action is the MoD taking to identify other veterans and bereaved families who could benefit from the implications of the tribunal's decision?
Baroness Taylor of Bolton: My Lords, I think my noble friend will be aware that any decision of the Pensions Appeal Tribunal is not a precedent. That is an important fact. The Ministry of Defence cannot appeal, except on a point of law. Disagreeing with the evidence, and indeed the suggestions made about the cause of death, is not a basis for appeal, so I do not think it is a landmark decision in that respect. As far as yesterday's decision is concerned, Lord Justice Carnwath said that the Secretary of State was,
Those issues are complex. I remind the House that we have only had the compensation scheme since 2005 and it is, of course, subject to review by the noble and gallant Lord, Lord Boyce.
13 Oct 2009 : Column 115
Lord Tyler: My Lords, can the Minister at least accept that veterans will think that this has important implications for others who may have suffered severe ill health as a result of their service in the Gulf War? As a member of the Royal British Legion Gulf War Group, I am very conscious of the extent to which veterans have been looking at tribunal decisions of this sort and assuming that they have implications for others. Will the Minister give us at least the assurance that, if others come forward who appear to have illnesses of a nature similar to that of Mr Kozac, they will be dealt with speedily and not delayed in the way that, unfortunately, has happened in this case? I accept that it is not the fault of the Ministry of Defence.
Baroness Taylor of Bolton: My Lords, I welcome the noble Lord's last point-that he accepts that the delay was not due to the department. Perhaps I can remind the House of exactly what the verdict was. Death was due to natural causes, to which Mr Kozac's military service in the Gulf campaign and an assault on 31 August 2000 were contributing factors. Indeed, the coroner said, when explaining the verdict to the widow, that the evidence,
- "goes no more than to suggest that that may be an explanation on the balance as to why his blood pressure was",
high. That was considered to be a contributing factor. We should be careful not to mislead others into thinking that there are more implications in this decision than perhaps there are.
Lord Astor of Hever: My Lords, could the Minister inform the House of the outcomes of the important discussions between government officials and the US Department of Veterans Affairs?
Baroness Taylor of Bolton: My Lords, I return to this subject, but with nothing new to say. We have made it clear that we are awaiting the outcome of the Institute of Medicine's review. It is now looking at the report that was prepared. We have discussed it in this House. The report is due, I understand, in February. Lawrence Deyton, the chief public health and environmental hazard officer at the Department of Veterans Affairs, reconfirmed on 19 May that the Institute of Medicine is looking at the review that took place last year. Until that work is completed, it is not the intention of the Ministry of Defence to make any more comments on that research.
Earl Attlee: My Lords, will the Minister remind the House what are the benefits of nerve agent pre-treatment sets when engaged in chemical warfare or where there is a chemical warfare threat?
Baroness Taylor of Bolton: My Lords, I think it was clear in the Gulf War that there was a real concern about the threat of the use of chemical and potentially biological weapons. Those who took these tablets did so to protect themselves in what could have been extremely hazardous circumstances. It would have been negligent of the Ministry of Defence not to consider how best to protect our troops at that time.
Lord Campbell of Alloway: Is it not time that we knew the approach of the Government to this question in principle, I respectfully ask?
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