Covid-19: Variant

Baroness Barker Excerpts

Wednesday 13th January 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the noble Lord has more medical expertise than me to be able to answer that question, but the briefing that I have is that the significant mutation in the Kent variant is not of a kind that should affect the efficacy of either a single dose or two doses of the vaccine. This comes as a significant relief to the vaccine programme. We remain on the balls of our feet, looking out for any variations that might affect vaccine deployment, but at this stage we have not found anything that poses a significant threat.

[Baroness Barker (LD)]

My Lords, the ONS data in the second week of December showed that the number of cases from all variants of the virus had rocketed. Why did the Government fail to act on that information until late December?

[Lord Bethell (Con)]

The noble Baroness is entirely right that the EpiData showed that the figures shot up in December; that is exactly why we looked extremely carefully at the genomic data from Kent and other places. As she knows, genomic data takes time to process—the tests can take a week to turn around. Looking at all the variants and matching EpiData figures with genomic data is an enormously complicated mathematical task. We moved as swiftly as possible and far faster than in many other countries.

Cannabis Oil

Baroness Barker Excerpts

Tuesday 12th January 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the noble Baroness is being a little unfair; Health Education England published a medicinal cannabis education package on 8 August 2019. But we cannot force clinicians to make prescriptions. That is not how the health service works. We need to work on clinical trials to put in place the correct authorisations and to give marketing authorisations for these important and promising drugs. That will require collaboration between government, the regulator and industry, and I call on industry to step up to that challenge.

[Baroness Barker (LD)]

My Lords, some people in England and Wales are reliant on hormone therapies produced in the EU 27. Who precisely in the NHS is responsible for ensuring continuity of supply of those therapies to patients?

[Lord Bethell (Con)]

My Lords, procurement decisions in the NHS are done by the NHS. I do not think that a specific or unique group is focused precisely on hormone therapies, but I would be glad to go back to the department and write to the noble Baroness to confirm that.

Puberty-blocker Drugs

Baroness Barker Excerpts

Thursday 10th December 2020 Lords Chamber

[Lord Bethell (Con) [V]]

I reassure the noble Baroness that patient-doctor confidentiality remains paramount and is respected. To update her, the Tavistock has immediately suspended new referrals for puberty blockers and cross-sex hormones for under-16s. In future, they will be permitted only where a court specifically authorises it. I reassure the noble Baroness that those already on the programme will continue their medication until the review has been finalised.

[Baroness Barker (LD)]

The legal team that brought the recent case has, over recent years, brought several cases designed to oppose LGBT rights and to restrict the reproductive rights of women and girls. All those actions are consistent with campaigns run by organisations including the Heritage Foundation and the Alliance Defending Freedom—extreme evangelical right-wing American organisations. Will the Minister tell the House which NHS England boards and committees approved the amendment of the gender identity service specification on 1 December, prior to the court requiring them to do so, and in the light of the fact that this judgment can and will be appealed? If he does not have that information now, will he write to me?

[Lord Bethell (Con) [V]]

Well, my Lords, it is not appropriate for me to comment on those who have brought these cases, and outstanding judicial proceedings exist and are in place at the moment, so it is not possible for me to comment from the Dispatch Box in response to the noble Baroness’s remarks. All I can say is that the NHS, NICE and the Tavistock all have the interests of patients at their heart; we are not ideological about that. We are absolutely committed to the best interests of patients, and I would be glad to write to the noble Baroness to answer in any way that I can the questions she asked.

HIV: Ending Transmissions

Baroness Barker Excerpts

Tuesday 1st December 2020 Lords Chamber

Asked by

[Baroness Barker]

To ask Her Majesty’s Government what progress they have made towards ending HIV transmissions by 2030.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, the Government remain fully committed to achieving zero new HIV transmissions in England by 2030. This is why we endorsed the HIV Commission, which was established by the Terrence Higgins Trust, the National AIDS Trust and the Elton John AIDS Foundation, and we welcome its report, published today. I reassure noble Lords that we will consider all the recommendations carefully, including an interim milestone of an 80% reduction in new HIV transmissions by 2025, and how we can expand testing. We will use the insights of the report to shape our upcoming sexual and reproductive health strategy and HIV plan.

[Baroness Barker (LD)]

I thank the Minister for that reply. I am very proud to a member of the party which, before anybody else, advocated that there be services for people with HIV and AIDS, and we will be there until this report is fully implemented and the fight against AIDS is won. Will the Government move to introduce a system of opt-out testing so that all people, including men and women from black and minority ethnic communities, can know their status, and we can get sooner to the point where they can get treatment and stop transmission?

[Lord Bethell (Con)]

The noble Baroness refers to one of the most interesting of the recommendations of the commission’s report. I took a briefing from the commission yesterday; members made that point very clearly, and their arguments were extremely persuasive. We have learned a lot during the Covid pandemic about opt-out testing; I completely understand the value of it, and I will take that recommendation to the department to look at it very closely.

Coronavirus Act 2020 (Expiry of Mental Health Provisions) (England and Wales) Regulations 2020

Baroness Barker Excerpts

Wednesday 25th November 2020 Grand Committee

[Baroness Barker (LD)]

My Lords, I warmly welcome the noble Lord, Lord Davies of Brixton, to your Lordships’ House and congratulate him on his speech. I was unaware of his professional background, but his explanation has led me to understand why there is such a sense of excitement among those Members of your Lordships’ House who are mere accountants. I look forward to the noble Lord joining the long-standing gang of Members who take a considerable interest in mental health and who often act as a bulwark against Members of the House of Commons who feel unable to take action on mental health legislation because of the grief they get from the popular press.

I declare an interest as a member of a special advisory panel for Rethink Mental Illness; I am indebted to it and to Mind for their briefings. When the Coronavirus Act went through, the mental health provisions were among the most controversial and the most feared, not only by lobby groups and patient groups—there was also a considerable amount of discomfort on the part of mental health professionals about what was being done. Under the Mental Health Act 2007, there is already a lack of patient involvement in decision-making, specifically in mental health. That is a fundamental flaw.

It was, on that basis, wrong to take away the safeguards that are the subject of these statutory instruments, and I am very glad that they have not had to be used. They have not had to be used because of the extraordinary efforts of both staff and indeed patients in the early part of this year. Both Mind and Rethink have done a considerable amount of work talking to people who were in acute services in particular. The surprising finding was the extent to which patients were deeply grateful to staff for continuing to look after them when the staff might well have been putting themselves in danger.

The extent to which patients were comfortable with incarceration during Covid was directly related to two factors: first, their ability to contact friends and family remotely and, secondly—because they are people just like the rest of us—the extent to which they were enabled to get out into the grounds and get fresh air. It is worth noting at this point that, in the recently announced hospital-building programme, only one of the new hospitals will be a mental health hospital. Given that we are likely for some considerable time to be going in and out of periods of physical restrictions because of the virus, we should do well to look at the physical estate of mental health services.

I agree with others that the £3 billion announced is very welcome, but there is a grave danger that it will be stretched way too thinly. A lot of it was earmarked before we entered the current situation. As others have said, and as the studies done by Mind and Rethink have shown, it is evident now that people are coming into community services with a greater degree of severity of mental distress and agitation. This is a clear signal that we will, in the coming months, see a much greater level of more severe illness if we do not put money now into rapidly accessible community services—patients are telling us that they cannot access those services. What efforts will be made to ensure that input of both staff and resources into a greater degree of community services?

In all the Government’s lockdown announcements, I have never seen anything acknowledging that those areas of the country that have been under severe lockdown for several months might have a greater need of mental health services than those that have not. Is that part of the analysis that the Minister’s department is undertaking? This is part of the question that I really wish to put to him. We are sitting waiting for the Government’s response to Sir Simon Wessely’s review. To what extent will the things that been learned during these last six months go into that review? For example, what have we learned about disproportionate levels of mental illness and lack of services among black and minority-ethnic communities, and what are we doing about children and young people? Can he tell us to what extent we have learned the lessons of the last six months and whether they will be in that new legislation?

Covid-19: Vaccine

Baroness Barker Excerpts

Wednesday 11th November 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Lord makes a persuasive case for those who are most vulnerable, including the itinerant and the homeless. We have seen for ourselves the impact of the disease on those who live in close quarters with each other, have health vulnerabilities or are exposed to the disease due to the nature of their circumstances. Those who are most vulnerable should surely be at the top of the list. I do not know the precise arrangements for the homeless and itinerant, but he makes an extremely good point, and I would be glad to get back to him with details.

[Baroness Barker (LD)]

My Lords, as is the case with the ordering of home testing kits, in order to prove one’s identity and access the vaccine, will UK citizens be required to share their credit rating history with US data-mining companies with which the Government have signed contracts?

[Lord Bethell (Con)]

No, they will not.

Covid-19: Contracts and Mass Testing Programme

Baroness Barker Excerpts

Wednesday 4th November 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, the circumstances of the pandemic were exceptional, and I am not sure that any large company had any experience of putting together a national test and trace programme. The firms to which the noble Lord refers have considerable consulting experience and the capacity to support the national rollout of a large organisation such as NHS Test and Trace. They have provided invaluable support to the country at a time of need. All our contracts are scrutinised extremely closely by the finance function in the DHSC, and we are supported in that by the government legal service and finance staff from the MoD and the Cabinet Office, for which we are enormously grateful.

[Baroness Barker (LD)]

My Lords, in July, a company called Topham Guerin was given a £3 million contract, without any tender process, to test public understanding of health messages relating to Covid. It did not have any experience in health messaging; those running the company appeared to be friends of Dominic Cummings and Michael Gove. Will the Government now publish the tender that has subsequently been issued, the research findings and the evaluation relating to this contract? As the country goes into lockdown, it is fair that taxpayers know whether we are paying money for old rope.

[Lord Bethell (Con)]

My Lords, the insight into how the public react to key messages associated with our healthcare and health advice has been absolutely critical. Behavioural change and asking the public to step up to extremely challenging requests from the Government require a huge amount of analysis and study. The support from our own communications team has been supplemented by agency support, which has both the capacity and the expertise to provide the necessary insight. That insight has been critical to the success of our messaging.

Blood Safety and Quality (Amendment) (EU Exit) Regulations 2020

Baroness Barker Excerpts

Monday 2nd November 2020 Grand Committee

[Baroness Barker (LD)]

My Lords, I thank the Minister for introducing these regulations. Indeed, I remember taking part in that debate in January 2019—I am looking at the noble Baroness, Lady Thornton, and clearly she does, too. Although much time has passed, little has changed. We are still facing a situation in which we live under the threat of leaving with no deal and therefore being a third country in terms of EU regulation. These matters are of immense importance. We are, as the noble Lord, Lord Lansley, said, talking about tissues and materials and so on which are in high demand and of which there is not a great surfeit.

It is important now to realise that we are talking in these regulations simply about the circumstances under which we would import such materials from the EU into Northern Ireland and into Great Britain. I will say one thing for Brexit: it has educated the British public in what the United Kingdom is and what Great Britain is and what the differences are between the two. Some of us who were brought up in Scotland have long known the difference.

I understand what the Minister says about these regulations being important in order to enable the current regime, or congruence of regimes, to continue. However, we are still talking about these regulations applying only for a transitional period of six months. The noble Lord, Lord Lansley, is absolutely right that we will face the prospect very shortly of having part of the United Kingdom under a regulatory environment into the terms of which the UK Government have had no input. I happen to think that that is an inevitable part of Brexit, and I am not surprised that that was never put on the side of a bus. None the less, it has important consequences for people in Northern Ireland and for the rest of us in the United Kingdom.

Can the Minister say who will have the responsibility for keeping under review the regulatory burden and costs of operating two different systems within the United Kingdom, and who will be responsible for the long-term monitoring of issues such as the availability of organs and tissues within Great Britain on a long-term basis? My noble friend Lady Walmsley is right: there is a degree of danger here to the supply of these necessary items.

When we debated these regulations in 2019, I did not get a satisfactory answer on inspection of premises and what would be the responsibility of both the British authorities and others to notify serious incidents within 24 hours. Perhaps in his response the Minister might take that up.

I also think that the noble Lord, Lord Lansley, is absolutely right that Clauses 42 and 43 of the United Kingdom Internal Market Bill have no place on our statute book. They certainly have no place in relation to the importation of these materials from the EU.

So politically we are no further on, but perhaps the Minister might be able to enlighten us with a bit more detail than was the case back in January 2019.

Covid-19: Intensive Care Treatment

Baroness Barker Excerpts

Thursday 29th October 2020 Lords Chamber

[Lord Bethell (Con)]

We go into the second wave in much better shape in relation to coronavirus because we know so much more about the virus. In terms of medicines, the therapeutics, the practices, the training, the configuration of our wards and the building of the Nightingales, there is a huge amount of skill, learning and capacity in the NHS to ensure that everyone has the opportunity to receive the best possible care. I remind noble Lords that these claims not only worry patients, they are deeply offensive to NHS doctors, nurses and therapists who have cared for more than 100,000 Covid patients to date in hospital settings and are committed to providing the best possible care in a second wave.

[Baroness Barker (LD)]

My Lords, triage is a necessary part of emergency medicine, and it will continue to be. Can the Minister say what has been learned in emergency departments in areas that have been in lockdown, such as Leicester, Bolton and Oldham? What learning has there been in those areas that can be sent to other areas to inform what will continue to be a necessary practice and part of good medicine?

[Lord Bethell (Con)]

Our learning has come a long way. Practices within ICU units have changed as a result of what we have learned in relation to the way that oxygen is administered, the range of drugs available and the turning of patients. To date, triage has not been necessary because the NHS is so good at load management that patients can be dispersed and deployed through the system, which has not been placed under pressure. We expect to be in good shape for the second wave. The principle remains as the national medical director, Stephen Powis, stated in his letter of 7 April:

“The key principle is that each person is an individual whose needs and preferences must be taken account of individually.”


That remains our principle.

Medicines and Medical Devices Bill

Baroness Barker Excerpts

Committee stage & Committee: 3rd sitting (Hansard) & Committee: 3rd sitting (Hansard): House of Lords
Wednesday 28th October 2020 Grand Committee

[Lord Sharkey (LD) [V]]

My Lords, it is a pleasure to follow my noble friend Lord Stunell. As my noble friend Lady Sheehan so clearly and compellingly explained on Monday, this amendment deals with the key question of access to medicines and is particularly relevant as we find ourselves swept along by wave 2 of the global pandemic. It is clear that, at least initially and perhaps for much longer, supply of any Covid-19 vaccines will fall behind demand. This raises the urgent question of who should receive priority access to these vaccines. Who should get them first, here and internationally? How should equitable access be decided?

The Government appear to be adopting two contrasting approaches to this question. On the one hand, we have Gavin Williamson saying:

“It’s the right thing to be doing to be at the absolute front of the queue to make sure we’re in a position to get those vaccines first when they become available”—


and that does seem to be what we are doing. As of August, the United Kingdom was the world’s highest per caput buyer, as the noble Lord, Lord Alton, mentioned on Monday. The vaccine taskforce has placed orders for six unproven vaccines, taking its potential stockpile to 340 million doses. Of course, we do not yet know to what extent, if at all, these vaccines might work, so some duplication is obviously prudent. But on the other hand, and while securing our place at the front of the queue as Mr Williamson recommends, we are also involved in trying to work out, under the auspices of the WHO, an equitable access scheme. The rationale for that is pretty obvious. Unless we have such a scheme, rich countries will end up vaccinated well in front of poor countries. In the face of a global pandemic, that approach carries obvious risk. It also carries moral risk.

The Government have committed £60 million to the WHO COVAX facility—the Covid-19 Vaccine Global Access Facility mentioned by my noble friend Lady Sheehan on Monday. COVAX seeks to enable global collaboration and equitable access to vaccines. It views this model of pooled procurement as preferable to rich countries doing bilateral deals. We have also joined 150 countries in expressing an interest in participating in COVAX for our own vaccine purchases. But there is clearly a risk that the bilateral purchasing of vaccines by the United Kingdom and other rich nations could undermine the work of COVAX. Could I ask the Minister how we balance our Williamson approach with our COVAX approach? How are these approaches prioritised? How much should we try to secure for ourselves and how much should we share? What criteria will be used to decide what access means in practice? We know something of what people in the UK think about the issue. Some 96% of the UK public supported the idea that national Governments should work together to ensure that treatments and vaccines can be manufactured in as many countries as possible and distributed globally to everyone who needs them.

My noble friend’s amendment also raises the issue of Crown use licences. We have previously used or threatened to use these licences in our negotiations with pharma. Can the Government confirm their willingness to use these licences if price negotiations on Covid-19 vaccines fail to reach a satisfactory conclusion?

I urge the Minister to give very serious consideration to the issues raised by this amendment. I will listen to his reply with great interest.

[Baroness Barker (LD)]

I thank my noble friend Lady Sheehan for her introduction to this amendment and the noble Lord, Lord Alton, for the detail that he added to that.

My interest in this matter stems back to 2013, when I was part of the All-Party Parliamentary Group on HIV and AIDS, which produced a report called Access Denied. It was about barriers to access to antiretroviral drugs for HIV and AIDS in low and middle-income countries. In the course of our research work for that report, we held a number of hearings with all sorts of representatives from a number of international research groups based in the United Kingdom but which worked across Africa and Asia. We met user and patient groups and also included representatives from the pharmaceutical companies.

I vividly remember sitting in a room in Portcullis House during one of our question and answer sessions and putting a question to a representative of a pharmaceutical company that has cropped up in our discussions in the last couple of days. I asked him a simple question—whether there was a direct correlation between the R&D costs of a drug and the price. With disarming candour, he said, “No”. Once people’s jaws had ceased to drop, we had the revelation that actually there is no transparency about pricing in the pharmaceutical industry or about the extent to which public and private funding goes into the development of new medicines—and, in effect, an admission that the overstatement by pharmaceutical companies of the need to charge excessive prices in some markets to maintain their viability is not substantiated.

I am not an anti-pharma campaigner. I believe that human and animal welfare rests very much on the development of pharmaceutical knowledge and science, and I am all in favour of extension of research and development of new drugs. However, for far too long Governments of all sorts have been held over a barrel by pharmaceutical companies, and that should stop.

I say this as someone who has had a long-standing interest in HIV. To see some patient groups in some parts of the world continue to become infected and, perhaps, have threats to their lives that would not occur if they had simply been born in another country is devastating. For example, in the world of HIV, very little work is being done on development of antiretroviral drugs for paediatrics because there is very little call for that in western developed nations, whereas there is a very big need for it in sub-Saharan Africa. Our involvement in these matters has a direct bearing on the lives of people across the world and on our standing not only as one of the major governmental funders through the different international funds but as a country in which research into new and emerging transmissible diseases is second to none because of our long-standing history.

For all those reasons, I very much support my noble friend Lady Sheehan, and I await with interest the answer to the question that my noble friend Lord Stunell put, which was the one I was going to ask, about proposed new paragraph (d) in my noble friend’s amendment.

[Baroness Thornton (Lab)]

The Committee owes the noble Baroness, Lady Sheehan, a debt of gratitude for bringing forward this amendment. I very much enjoyed her opening speech—and, indeed, those of the noble Lords, Lord Alton and Lord Crisp, both of whom are so well qualified to speak about international health responsibilities.

What this debate does is to remind us of how privileged we are to live in a country with free access to new medicines and innovations. However, we are now entering choppier international waters. We have been sheltered, as it were, over 40-odd years or so by the European Union’s heft and regulatory framework. So we need to take notice of the need for greater co-operation, as has been outlined by the noble Lord, Lord Patel.

I was very struck by the mention of things like price gouging by the noble Baroness, Lady Sheehan, and their dangers for those less fortunate than ourselves. On the immediate responsibilities and dangers around the Covid vaccination, which we so desperately need, the World Health Organization says that it is working on a plan to ensure equitable distribution of vaccines, but how that would be enforced in practice is not clear. Professor Mariana Mazzucato, who heads the University College London’s Institute for Innovation and Public Purpose, says:

“In a pandemic, the last thing we want is for vaccines to be exclusively accessed by countries that make them and not be universally available.”


That is absolutely right.

However, as the noble Lord, Lord Crisp, said, we need to pay attention to what is happening in the UK and what the effect of Brexit might be—and, goodness me, we are all on tenterhooks as to whether we get a deal or not. Rick Greville, the director with responsibility for supply chain at the Association of the British Pharmaceutical Industry said, in the run-up to a no-deal Brexit—the last time this happened—that there could be currency fluctuations, including a fall in the value of the pound. He said:

“You can imagine in that situation that exporting medicines into Europe would become even more profitable. It may be that”


drugs

“that currently aren’t being exported suddenly become attractive to export, driven entirely by profit”.

The UK is not invulnerable to what might happen next, and I would like the Minister’s observations on that.

Launched earlier this year, COVAX wants wealthy nations to pool funds that together can be used to develop and scale up vaccine production. In return, rich countries would have a guaranteed supply for about 10% and 15% of their population. I would also like the Minister’s answer to that, because several noble Lords have raised that question.

This is one of those debates in which one feels that so many people are better qualified to speak than oneself. I finish by quoting the noble Lord, Lord Crisp, and what he said on Monday. He said:

“This amendment is absolutely right in asserting that the UK should reaffirm its position and its rights to protect the health of its population. We should adopt it. The future will be difficult, as will the negotiations on this issue, but no one should be in any doubt about the UK’s firm position. We should support not just the UK’s position for the population of the UK directly but a global effort to deal with these important matters.”—[Official Report, 26/10/2020; col. GC 71.]


I could not have put it better myself.