My Lords, I thank the noble Lord, Lord Turnberg, for introducing this important debate. It is important because there are so many concerned people who fear, with the spending cuts, that some of their vital specialised services, which are lifelines, may be severed. I hope that the noble Earl can allay some of those fears.
I must declare an interest, as I am president and founder of the Spinal Injuries Association. There is hardly anything more catastrophic than breaking one's neck and finding that you are paralysed from that point down. It is bad enough breaking one's back, but in all cases there can be complications, and specialised treatment is vital, otherwise complications occur, leading to human suffering and unnecessary costs for the NHS.
With this huge reorganisation, perhaps there is a chance to improve some front-line services and the specialised services. The White Paper states that patients should be central to the NHS. Are those just words, or will there be action? Will the Government listen to patients, patients' groups, and their doctors? There should be shared decision-making-nothing about me without me.
We were once the leading country in the world in the treatment of spinal cord injured patients. All of us with an interest in the subject would like that specialty to be returned to its former glory. Doctors, nurses and physiotherapists would come to our national centre from all over the world to train. We are concerned that, already, some expert consultants have retired, and more are to go. Therefore, I ask the Minister a few questions, which perhaps he can answer by letter.
Are there plans to reinstate spinal cord injury medicine as a speciality or subspecialty? The specialty status was lost in 1995 as a result of the alignment with European regulations. That has resulted in considerable loss of appeal and skills. Are there plans to create a national register, a database, for spinal cord patients? Do the Government know whether current trainees will be able to continue the same services offered by retiring consultants in spinal cord injuries? Is there adequate capacity to meet the readmission needs of spinal cord injured patients to spinal cord injury centres? I do not think so.
Are your Lordships aware that there are more than 9,000 new cases of tuberculosis in the United Kingdom every year? In the UK, the number of deaths from TB is 1.5 times higher than the number of deaths from HIV/AIDS. London has the highest TB rate of any major capital city in western Europe. Prevention is vital. I consider it a front-line service. The Find & Treat team, which runs the mobile x-ray unit, focuses on screening groups in London with social risk factors, especially the homeless with TB. Homelessness is a risk factor for multidrug-resistant tuberculosis. That underlines the importance of ensuring that complex cases are detected early and supported to successfully complete treatment.
The emergence of extensively drug-resistant tuberculosis threatens to make the disease untreatable. The Find & Treat team is excellent, and I hope funding can be found so that it can continue its valuable work.
Childhood cancer and leukaemia are rare conditions that require complex and highly skilled diagnostic and treatment services to achieve the best outcomes. Without specialised, centralised cancer care and excellent front-line local paediatric services, there is a risk that not all children with curable diseases will be cured. These services must be safeguarded, built on and improved.