Dermatology Debate in the House of Lords (December 2014)

On the 17th December, a short debate on dermatology services was initiated by Lord Kennedy of Southwalk. The transcript of the debate can be read below:

Asked by Lord Kennedy of Southwark

To ask Her Majesty’s Government what action they are taking to improve dermatology services in the National Health Service.

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con): My Lords, we want all patients with dermatological conditions to have access to high-quality, patient-centred services wherever they live. NHS England has set national standards to ensure that the needs of patients with the rarest skin conditions are met, the National Institute for Health and Care Excellence has published clinical guidance and quality standards to drive improvement for common conditions, and we are currently investing more than £9 million in dermatology research.

Lord Kennedy of Southwark (Lab): My Lords, does the noble Earl believe that we have the balance right between the training that doctors and other healthcare professionals receive and the people they have to deal with, who have conditions ranging from minor skin complaints to serious skin cancers? If we do not have the balance right, what appropriate changes have to be made to make sure that patients are provided with the best possible care?

Earl Howe: My Lords, the Government have mandated Health Education England to provide national leadership on education, training and workforce development. Dermatology is currently a key part of the generalist undergraduate medical curriculum and a component of GP training. The General Medical Council requires that the undergraduate medical curriculum should provide enough structured clinical placements to enable students to demonstrate the outcomes for graduates across a range of clinical specialties, including dermatology.

Baroness Gardner of Parkes (Con): My Lords, with my typical Australian fair skin and the strong sunlight there, I had a skin cancer some years ago. I have to go back and be checked and I consider that I am being looked after very well. However, the one thing that the consultant always says when he sees me on this annual basis is that there is a lot of unhappiness about the research money. When people apply for research funding, it tends not to go to those who are actually doing the work, but to someone who carries the name of being the research officer in the department. The money is spent on administration rather than on actual research. Can my noble friend tell me whether that has improved since I last raised this point, which must be about two years ago?

Earl Howe: My Lords, the National Institute for Health Research’s clinical research network is currently recruiting patients to more than 60 studies in dermatology. Specifically, it funds a wide range of research on skin cancer. It has awarded £1 million for research on GP

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and patient interventions to improve early diagnosis of malignant melanoma in primary care. Another NIHR award is on understanding the experiences and support needs of patients with melanoma and their carers, and patients are being recruited to 18 melanoma studies. I will take away my noble friend’s point about administrative costs but clearly any research project carries such costs, which must be covered somehow. Unless the balance is wholly wrong, I do not think we should be worried that some funding goes towards administration.

Lord Walton of Detchant: My Lords, it is a truism in medicine that one of the greatest stimuli towards the recruitment of doctors into a particular specialty is the example that they respect from their teachers. Many years ago when I was dean of medicine in Newcastle, the standard of dermatological services in the area was relatively poor. The appointment of a new professor who had a stimulating effect on teaching and recruitment made an immense difference. What are the Government doing to encourage Universities UK to recruit new professors in dermatology?

Earl Howe: My Lords, I will have to write to the noble Lord on that issue. I know that there is not an issue in relation to the number of dermatologists serving in the health service. We believe that number to be satisfactory. But as regards the emergence of leaders in the sense that he has described, I shall have to take advice and let him know.

Baroness Barker (LD): My Lords, NHS England has set the objective of all patients receiving a timely and accurate diagnosis within three months of referral. Is that objective being met?

Earl Howe: My Lords, as my noble friend has said, there are clear standards in any referral to treatment situation. That includes dermatology. Where those standards are being breached, we expect commissioners to monitor that and bear down on the failure.

Lord Bradley (Lab): My Lords, I am sure the Minister is aware that the psychological and social impact of skin disease, such as psoriasis, can be devastating. But is he aware of the 2011 survey by Dr Anthony Bewley, which found that of 127 hospitals across the UK only one had a dedicated dermatology psychiatric clinic, only seven had a psychodermatology service, and only one had a children and adolescent psychodermatology service? What action will the Government take significantly to improve psychodermatology services across the country?

Earl Howe: I was not aware of that survey but the noble Lord’s point is well made. Guidance for the management of both common and complex skin conditions set out by NICE and NHS England makes it very clear that access to psychological services for patients should be considered where appropriate. Through the IAPT—Improving Access to Psychological Therapies —programme, NHS England is looking at how best to support people with psychological problems arising from their physical problems, including, very significantly, skin conditions.