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House of Lords

Tuesday 3 November 2009

2.30 pm

Prayers-read by the Lord Bishop of Wakefield.

Introduction: The Lord Bishop of Lichfield


Jonathan Michael, Lord Bishop of Lichfield, was introduced and took the oath, supported by the Bishop of Ripon and Leeds and the Bishop of Wakefield.

Death of a Member: Lord Steinberg


2.40 pm

The Lord Speaker (Baroness Hayman): My Lords, I regret that I have to inform the House of the death last night of Lord Steinberg. On behalf of the House, I extend our condolences to his family and friends.

Health: Side Effects of Medication


2.41 pm

Asked By The Earl of Sandwich

Baroness Thornton: My Lords, the Government are aware of concerns around prescribing these medicines, particularly after the report of the All-Party Parliamentary Group on Drugs Misuse. The Department of Health is undertaking a review of addiction to medicines which is due to report next year, and of course the Medicines and Healthcare Products Regulatory Agency continuously monitors the safety of medicines on the UK market and issues advice to raise awareness of the potential for side effects.

The Earl of Sandwich: My Lords, I thank the Minister for her reply and I welcome the review. Can she confirm that there are approximately 1.5 million people in the UK who are addicted to prescribed drugs such as benzodiazepines? I declare an interest. A member of my family is confined to his room; he is trying to withdraw from one of these drugs. He cannot work or take the children to school. There is no government benefit or assistance for people in his situation. Can the Government confirm that they are getting on with a proper NHS network of support for these patients?

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Baroness Thornton: The noble Earl is, I fear, not alone in direct experience of what can happen to people who suffer from withdrawal reactions to these drugs. There are support services available in some areas of the country which have a good success rate in helping people to withdraw from medicines to which they have become inadvertently addicted, but we recognise that the availability of these services is variable and patchy. Our review will seek to identify what needs to be done to better support people experiencing these problems. We will also review the services that are currently provided in order to gauge the level of support available, and draw on best practice to ensure that we get full cover and support for people in these situations.

Lord Ashley of Stoke: My Lords, have the Government made their own special study of the effects of these tranquillisers? Are they able to impose their views on doctors and pharmaceutical companies? Does the Minister agree that pharmaceutical companies can be far more resistant to pressure from the Government than doctors and that it will require much stronger pressure on the companies than on the medical professions?

Baroness Thornton: My noble friend asks a very pertinent question. Product warnings are kept under close review. One example of this relates to products containing codeine, where new, hard-hitting warnings such as "can cause addiction" and "for three-day use only" on the front of the pack will be introduced next year. Guidance to the healthcare professions will be considered as part of the review that is taking place.

Lord Williamson of Horton: My Lords, I declare an interest as a patron of Rethink, the mental health charity, which does excellent work. There is also the medication helpline of the Maudsley Hospital.

Will the Minister consider whether there could be improvements in the information available to those who suffer from mental health problems as the result of withdrawal from prescription drugs? There may be a gap there that we could help to fill.

Baroness Thornton: The noble Lord makes an important point, and the review will be looking at that. There are examples in Liverpool and Bristol of counselling information, education and advice being made available to people, but the noble Lord points to the importance of telling people who are being prescribed these drugs what the side effects might be.

Lord Elton: My Lords, will the inquiry bear in mind the advisability of advising doctors not merely on the dangers of addiction but on the method of keeping in view the condition of people for whom they prescribe these drugs long-term, and who will become addicted without their own knowledge unless they are carefully monitored?

Baroness Thornton: There is a great deal of information available to prescribers of these drugs: the British National Formulary; product information; the National Prescribing Centre, which has an excellent record; and-for the treatment of depression, for example-NICE

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guidance talks not only about the effect of prescribing but about the need to provide other therapies to people who are suffering from depression.

Baroness Barker: Does the Minister agree that it would be beneficial if all pharmaceutical companies were required to print information about the half-life of tranquillisers and anti-depressant drugs, so that individuals trying to manage the process of coming off them could do so knowing what the effects were likely to be over a short period?

Baroness Thornton: In answer to a Question put by my honourable friend Jim Dobbin, the Minister said that:

"The half-life of a drug intended for use as a sleeping tablet is only one of many factors that influences the safe use of a medicine. Information to aid ... safe use ... is provided in the product information which consists of the Summary of Product Characteristics ... and the Patient Information Leaflet".-[Official Report, Commons, 20/5/09; col. 1435W.]

The key point is that those resources are used at the right time.

Lord Crisp: My Lords, in setting up the review, will the Minister ensure that it takes full account of implementation? She will know as well as I do that there is a difference between policy and implementation. Does she have any thoughts about how to ensure that this policy, which needs to be a very personal one to every member of the primary care team, is disseminated so that people are not only aware of it but follow it in practice in all the individual cases that we are talking about?

Baroness Thornton: The review will be completed next year, with a report published later in the spring. We are doing a counting exercise, reviewing evidence of the prevalence of addiction, effective treatment and the long-term effects of the use of a range of antidepressants, sleeping pills and codeine-based painkillers. That will influence future policy. The noble Lord is right, though, that the policy leadership within the department has to address how to ensure that this is rolled out and how to use the machinery and levers that we have to ensure that it is implemented.

Baroness Gardner of Parkes: My Lords, does the Minister agree that these drugs are obviously very complicated and must be of benefit to a number of patients or they would not be in such common use? Does she have any figures on the percentage of people who become addicted?

Baroness Thornton: I do not have any figures on the percentage of people who become addicted. That is part of the exercise that we are undergoing. The noble Baroness is right that we must not forget the impact of depression, for example, on sufferers, and that depressive illness is a debilitating condition. One in four women and one in 10 men in the UK is likely to suffer from depression at some point in their lives, and these drugs will help to transform their lives and enable them to cope and recover.

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Lord Acton: My Lords, does my noble friend agree that "next year" is a rather long and elastic time? Could the review not be tightened up a bit?

Baroness Thornton: We are moving with all speed because we know that this is important, but I promise my noble friend that I will take his views back to the department and see if there is any way that we can hurry up.

Health: Walton Report


2.49 pm

Asked By Baroness Thomas of Winchester

Baroness Thornton: The department welcomes the Walton report into services for those living with muscular dystrophy. Following the publication of the National Service Framework for Long Term Conditions in 2005 to improve health and social care services for those with muscular dystrophy, progress to improve services has been made. However, in some parts of the country, services are not meeting the expected standards. The department is committed to working with stakeholders to improve overall standards.

Baroness Thomas of Winchester: I thank the Minister for that reply, especially the last bit about improving standards. Will the Government take urgent action to address the disturbing fact revealed in the report that the life expectancy of boys with Duchenne muscular dystrophy living in areas of Britain with poor specialised services is only 18 years, while in other regions with better specialised services it is now over 30? Will the Government in particular encourage the 10 national specialised commissioning groups to ensure that there is co-ordinated multidisciplinary specialist care throughout the country for boys in that situation?

Baroness Thornton: I thank the noble Baroness for drawing this issue to my attention. We have enormous sympathy for people living with muscular dystrophy-and their families and carers-particularly those with Duchenne, a very severe disease with which about 100 boys are born every year. We are very concerned that life expectancy is shorter in some areas than in others. We are aware that in some parts of the country-for example, in the south-west and West Midlands-specialist services have been redefined and redesigned. We need to learn from that. I have asked Steve Collins, who is the deputy director for commissioning, to look at how other regions might learn from the south-west and West Midlands. I am happy to offer the National Specialised Commissioning Team to work with the muscular dystrophy association to set up the best practice commissioning workshop in the new year.

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Lord Walton of Detchant: My Lords, I am deeply honoured by the fact that the all-party group should have decided, at a meeting at which I was not present, to attach my name to this report. Is the Minister aware that the most recent evidence from the highly specialised centres in Hammersmith Hospital, Oxford, Oswestry and Newcastle upon Tyne has been able to demonstrate that, for boys with Duchenne muscular dystrophy, the average age of death is now in the 30s, with a few boys now living into their 40s? To ensure that there is stronger national leadership and clearer accountability for the development of specialist health services for neuromuscular diseases, will the Government instruct the NHS National Specialised Commissioning Group to appoint a national named lead, who will be responsible for the development and co-ordination of specialised commissioning for these patients?

Baroness Thornton: I have to say-I am sure that the House will join me in this-that I am not surprised that the report was named after the noble Lord, given his record and work in this area. For those with rare neuromuscular diseases whose services are commissioned by the National Commissioning Group, there is already in place a named commissioning manager, medical adviser and finance leader, who have responsibility to commission these services. However, of course this varies across the 10 SHAs and groups, depending on the type of commissioning that they are doing. I should like to take the noble Lord's question back and ask again whether we will be looking for a named lead responsible for those services. I suspect that, given his intervention, the answer will probably be yes.

Baroness Campbell of Surbiton: My Lords, what progress has been made in embedding in the NHS the vital posts of neuromuscular care co-ordinators in the UK, several of which are reliant on charitable funding? All of them are vital in maintaining equal access to healthcare for people with muscular dystrophy and other neuromuscular conditions. Does the Minister realise that this is an equality issue, not just a health one?

Baroness Thornton: The noble Baroness points to the very important work that neuromuscular care co-ordinators do and we are aware that several of them are reliant on charitable funding. The local health authorities are responsible for ensuring that they have the correct mix of health and social care professionals to meet the needs of their local population who live with muscular dystrophy. PCT commissioners should consult the local stakeholders on their plans for commissioning.

The Lord Bishop of Chester: My Lords, I declare an interest as a supporter of the NeuroMuscular Centre in Cheshire, one of the flagship providers in the charitable sector for people with serious muscle-wasting diseases. The well named Walton report refers to a lack of clarity and responsibility in the NHS for supporting services for people with these diseases. What pressures can be brought to bear on the one-third of primary care trusts in the north-west that refuse to provide any

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support to the NeuroMuscular Centre for the work that it does on behalf of their patients, while the other two-thirds of the PCTs are glad to do so?

Baroness Thornton: The right reverend Prelate points to where we started with this Question, which is the patchy nature of some of the services. I am hopeful that, if our National Specialised Commissioning Team will work to set up the best practice commissioning workshop, we will attract people from across the country who are dealing with this issue and that we can encourage them to use the best practice.

Lord Judd: Does my noble friend accept that there is a widespread problem of access to these services? There has been reference to the centre of excellence at Newcastle upon Tyne, which certainly is a centre of excellence. However, is she aware that those living on the west coast of Cumbria, for example, have to travel right across the United Kingdom to Newcastle to have access to those services? Is that really satisfactory?

Baroness Thornton: I think that it is probably absolutely not satisfactory, which is why we have to attend to reviewing this and are calling on our local services to make sure that they provide local care at local level.

Armed Forces: Political Activity


2.57 pm

Asked By Lord Razzall

The Minister for International Defence and Security (Baroness Taylor of Bolton): My Lords, regular service personnel are free to join political parties. They are not permitted to take an active part in political activities during their service with the Armed Forces.

Lord Razzall: My Lords, in thanking the noble Baroness for that Answer, I am sure that the House will appreciate that my Question has been provoked by the announcement that General Dannatt is to become a Tory adviser on defence. First, does the noble Baroness think it appropriate for a senior officer who is still being paid to be paraded in this way by a political party? Secondly, does she agree that, to ensure that senior officers are not seen as party political, it would be better for there to be a significant gap before the Chief of the General Staff, after his resignation, joins a political party? Thirdly, does she agree that in the event of a change of Government, were that to happen, General Dannatt's replacement as CGS will be placed in an impossible position if his advice to the Prime Minister is countermanded by his immediate predecessor?

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Baroness Taylor of Bolton: My Lords, the noble Lord raises some interesting speculation about what might happen on some future hypothetical occasion should there be a change of Government. Queen's Regulations give very clear guidance on what should happen when members of the Armed Forces seek to participate in politics. As I mentioned, it is possible to be a member of a party but not to be active in it. There are also rules about gaps between leaving service and taking paid employment. As for who should sit on the current Opposition Front Bench, or on any future Government Front Bench that is not from my political party, I would not dream of speculating.

Baroness Knight of Collingtree: My Lords, does the Minister consider that, in this context, a pension counts as remuneration?

Baroness Taylor of Bolton: My Lords, the pensions of those who serve in our Armed Forces at senior levels come into play as soon as they leave the service and they are significant. They are something that people work for and pay for. I think that those who leave senior positions in any area of life have to be extremely careful about what responsibilities they take on subsequently.

Baroness Symons of Vernham Dean: My Lords, as I understand it, this appointment is being made in the period that is known as the period of terminal leave, which is a paid period. Can my noble friend tell us, as a matter of fact, whether there are any restrictions on the political activity of former members of the Armed Forces during the terminal leave period? Also, given the serious disquiet that there has been in some quarters about this appointment, not least in the MoD, can she tell us whether there have been any formal complaints to Her Majesty's Government and whether she has received any informal representations?

Baroness Taylor of Bolton: My Lords, I do not wish to talk about informal representations from the Dispatch Box, and, of course, any formal complaints would not come to Ministers because Queen's Regulations are enforced by the Army itself and not by Ministers. My noble friend is right that this is the terminal leave period. The former CGS stood down from his responsibilities on 28 August and does not leave the Armed Forces until 22 November. Queen's Regulations state what should happen when people want to take up paid employment. They actually say that a candidate must take all steps within his power to ensure that no public announcement is made before he has retired or resigned. However, I think that the leak may not have come from the individual but perhaps from a party leader of a particular persuasion.

Lord McNally: Does the Minister not have some sympathy for General Dannatt? When he was appointed, he specifically said that he was taking up this appointment because of the lack of expertise on the Tory Front Bench in this matter.

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