Puberty-suppressing Hormones

Baroness Bennett of Manor Castle Excerpts

Monday 16th December 2024 Lords Chamber

[Baroness Merron (Lab)]

My noble friend is right to raise the second point. It is a whole range of interventions, and that is certainly something that we have very much in mind for consideration, for the reasons that we have heard in the Chamber this evening and the points that my noble friend makes. In respect of timings, it is a planned pathway study and that includes a clinical trial component. It is, as I said, to build evidence. I am glad to say that it remains on track to commence recruitment early in 2025, but only after there has been ethical approval. When that is granted, that is when the final study protocol will be ready, and I know that noble Lords will have a lot of interest in that. We will be issuing further updates in early 2025, and if there are any particular questions, noble Lords are very welcome to raise them with me.

[Baroness Bennett of Manor Castle (GP)]

My Lords, my question follows on from that of the noble Baroness, Lady Walmsley, about the scale of the trial. I also note the report from the experts at the Council of Europe, which the noble Baroness referenced. In the other place, the Secretary of State said in response to my honourable friend Carla Denyer that the clinical trial would be “uncapped”, and the Minister repeated that word this evening. However, an article published yesterday in the Metro, arising from various freedom of information requests and headlined, “Trans Youth ‘Languishing’ While Waiting Six Years For Gender Healthcare”, said:

“If a trans young person joined the waiting list for gender-affirming healthcare on the NHS today, they would have to wait 308 weeks for a first appointment”.


In that context, I am struggling to understand where the Government will secure the resources from to run a trial to provide the resources needed to have this uncapped clinical trial allowing access to puberty blockers.

[Baroness Merron (Lab)]

In view of what the noble Baroness said, it is quite important to consider that the children and young people’s gender services waiting list currently has 6,237 people on it. I certainly agree that waiting lists for these services are too long. We are committed to changing that, which is why I outlined the timetable for the new gender services and the opening of the new centres. They will increase clinical capacity and reduce waiting times for sure. On the point the noble Baroness raised, there is a commitment to the clinical trial, and I am glad there is. As we have brought forward this legislation in an absence of evidence, it is incumbent on us, as a Government, to follow through on what the previous Government started in train, which is to use a clinical trial to provide the evidence. Otherwise, the debate would remain uninformed and not evidence-based, and that cannot be helpful.

Physician and Anaesthetist Associate Roles: Review

Baroness Bennett of Manor Castle Excerpts

Thursday 5th December 2024 Lords Chamber

Asked by

[Baroness Bennett of Manor Castle]

To ask His Majesty’s Government what the review, announced by the Secretary of State for Health and Social Care on 20 November, of the physician associate and anaesthetist associate roles will cover; and what actions they plan to take in advance of the outcome.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I thank noble Lords for staying with us late on a Thursday for this debate. I know there are many noble Lords, among them the noble Baronesses, Lady Finlay and Lady Brinton, who moved regret Motions about the statutory instrument passed under the previous Government that is behind the mess we are discussing today and who would have very much liked to take part.

I will not go over the same ground as I did in February, when I begged the then Government to pause their action, but the concerns expressed then have only grown, reflecting many of the reasons why Professor Gillian Leng has been asked to conduct the review of PA and AA roles. In the words of consultant Partha Kar, the Government’s national adviser on diabetes, we have seen

“months of heated debates, social media uproar, royal colleges in turmoil, and the reputation of many national organisations being questioned”.

Professor Kar has described this as

“the worst example of a policy implementation in the NHS I’ve seen”.

I note that just this week the Irish Medical Council concluded that it was not the appropriate body to regulate PAs, and referred to

“the potential for emerging patient safety risks arising … as observed recently because of regulation of PAs by the GMC in the UK”.

I shall ask a large number of questions. To be fair to the Minister, and to ensure that this debate is as constructive as possible, I have shared my questions with her in advance. I begin with the first part of my question, about the review itself. I have heard only respect and hopeful feelings about Professor Leng being appointed as lead, but many concerns have been expressed to me about the level of co-operation that the review will receive and the quality of information available to it. Just yesterday, the GMC wrote to medical bodies, nine days before it is due to begin registering PAs and AAs, saying that it would

“soon publish a report on the outcome of the consultation and the research; along with the final drafts of the rules, standards, and guidance”.

That report was published just two hours ago, before this debate started.

Does the Minister consider that to be an appropriate timetable and level of transparency? Is the Minister happy with the response of the GMC to requests for information over this difficult year? Can the Minister assure me that Professor Leng will have the necessary resources and that the Government will do everything necessary to ensure that she receives full co-operation and transparency?

We have seen many different, often disturbing, localised reports about the ways in which PAs in both hospital settings and general practice have been deployed. Knowledge and concern about the deployment of PAs and AAs is growing among patients and the general population. I note that the Fire Brigades Union conference in May voted to oppose the growing use of PAs. Will Professor Leng have the resources to access those public views?

The review’s remit seems quite narrow. An obvious omission is the ask from the Royal College of Physicians that it should consider the impact of the PA role on training opportunities for resident doctors. Will the review do that? Further, will it consider the fundamental issue that the “taskification” of medicine is a massive change from previous practice and a reversal of the recent growing understanding of the need to consider the whole human, and their environment, in supporting health and tackling disease?

Our debate in February heard considerable concerns about the impact of PAs on doctors’ training. There were suggestions from all sides of the House that a major revamp of training arrangements for doctors needs to be put in place. Can the Minister write to me about what plans the Government might have in that area? I want mostly to focus what interim measures the Government plan to deal with what is clearly an untenable current situation. In February, the then Minister, the noble Lord, Lord Markham, said that PAs and AAs are

“very much a supplemental role rather than a substitute”.—[Official Report, 26/2/24; col. 912.]

Of course, that is not what has been happening, as demonstrated by a letter sent in March from NHS England to ICBs and trusts. It said that PAs

“should not be used as replacements for doctors”

on rotas, yet a detailed investigation by “Channel 4 News” in October found widespread subsequent use of such substitutions. A number of trusts indicated that they did not even keep any records of such substitutions. Does the Minister stand by that NHS England guidance? What will the Government do to ensure that it is implemented?

The Government’s announcement of the review said that it is to report in spring 2025. Your Lordships’ House knows that government definitions of seasons means that that could extend well into the year. By the time report is absorbed and action decided, realistically, we are talking about a year of a clearly untenable situation. Does the Minister agree that interim action is surely needed?

In September, the governing council of the Royal College of General Practitioners voted to oppose a role for physician associates working in general practice. Reports suggest that, as a result, PAs are being made redundant—they have my sympathy—and general practices face the risk of legal action. How will the Government deal with this situation and prevent it escalating, at great cost to NHS services?

The council of the Royal College of Physicians has agreed that there is a limited role for physician associates working in secondary care in the medical specialties, as long as they are supported by clear supervision arrangements, professional regulation and a nationally agreed scope of practice. Do the Government agree? Will they take action immediately to deliver this, at least in an interim way? Do they agree that such supervision urgently needs to be defined?

I turn to caring for our children, and highly vulnerable patients at risk of rapid deterioration in condition, an area of particular concern. The Royal College of Paediatrics and Child Health has called for an immediate pause in the recruitment of PAs. Given the very disturbing situation that arose at Alder Hey hospital, does the Minister agree that there should be such a pause?

The House may well ask where guidelines across disciplines for national scope—a ceiling of practice—for PAs and AAs might come from. I was at the launch of a detailed, carefully prepared British Medical Association outline of a PA/AA scope document. I did not hear anyone express serious concerns about the activities of PAs and AAs being safe, if they were working to that outline. Does the Minister agree?

Later this month—very soon, I think—it is expected that the Royal College of Physicians will publish draft “safe and effective practice” guidance on the supervision of PAs, alongside a definition of the PA role drafted by the RCP resident doctor committee and agreed by both the PA oversight group and the RCP council. Does the Minister agree that this should be applied?

To back to our debate in February, I suggest that the Minister misspoke in saying that the GMC is regulating. What is due to come into practice on 13 December is a registration process for which there is a two-year lead-in period, so it will in effect remain voluntary until December 2026. I respectfully suggest that, without a national scope and clear guidelines for supervision, this cannot in any way be described as “regulation”. It is purely registration. Does the Minister agree?

I turn to AAs specifically, and an issue of grave concern—including legal concern—that was recently raised with me. In the current regulations, AAs and PAs are not allowed to prescribe or order ionising radiation. How can someone acting as an anaesthetist not do so? Expert advice that I have received suggests that the tool of patient-specific directive, which are meant to allow a doctor to direct another professional in making a limited choice of drugs under very specific circumstances, is being used and possibly misused. I am told that PSDs are being used to provide an extensive list of drugs for AAs to choose from; in essence, that means that they are prescribing. Can the Minister comment on that?

Finally, I turn to a couple of broader “What now?” questions. The NHS careers website’s PA/AA page, which I consulted yesterday, lists 39 universities offering courses for these roles. I have heard that several are pausing these courses. Does the Minister think it is fair to encourage students to start new PA and AA courses, given the uncertainty while the review is conducted?

I conclude by stressing that my questions to the Minister, my concerns and the mess that we are in now are not the fault of PAs and AAs who, in good faith, have signed up for service, studied and got the debt to show for it. Can the Minister assure me that the Government are committed to ensuring that a way forward will be found for them, whatever the review’s conclusions and future steps?

Mental Health Bill [HL]

Baroness Bennett of Manor Castle Excerpts

2nd reading
Monday 25th November 2024 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, as the last Back-Bench speaker in this rich and informed debate, I note that we in the Green group start our meeting each week by asking ourselves what original things we have to say, specifically as Greens, about a Bill or a debate—so it is useful to come at this particular point in the circle. As Greens, we very much agree with the need for the Bill, which virtually every noble Lord noted. We also very much agree with the need to strengthen it.

I respectfully disagree, however, with a number of noble Lords who have suggested that we are seeing an overmedicalisation of life events. Perhaps this is not quite what they meant to suggest, but it sounded like they were saying that we do not have a mental health crisis in our society. I would very much say that we do. I agree with the noble Lord, Lord Crisp, that there is a great need for more talking therapies and that, for want of those, medical professionals are very often forced to resort to pharma solutions.

We need the talking therapies, but we also need treatments because we have a mental health crisis. Behind that is not any characteristic of individuals but a deeply unhealthy society and, when we are thinking about this Bill, we have to think about it in that context. We have to think that when we compare ourselves to the societies we generally consider comparable, we have much greater health problems than them. We must ask ourselves why. This is true of mental and physical health, in so far as it makes any sense to make a division between those two. I do not think anyone this evening has yet used the phrase “the gut-brain axis”, but in the last decade there has been an explosion of understanding of the link between the microbiome and mental health. We have, particularly in the UK, a broken food system. This is of course a long way from legislation but, if we are to think systemically, it is the context in which we have to think about the Bill.

As some noble Lords have made reference to, there are also the social issues to consider, whether the levels of poverty, the insecurity of income and housing, or the pressurised jobs that treat workers like robots and make them ill. We have a loneliness epidemic, which I do not think anyone has mentioned yet, but that is very much related to our mental health epidemic. We have a huge problem with domestic violence, which is also related to mental ill-health, particularly among the victims. We need to take a public health approach to mental health. While that is not directly part of the Bill, we cannot talk about mental health without talking about all those issues.

On other areas on the Greens’ unique approach to mental health issues, we do not believe that the coercive power of the state—which is what the Bill is talking about—should ever be put into private hands; nor do we believe that healthcare should ever be run on a for-profit basis. Here, I remind us of the points made by the noble Baroness, Lady Keeley, about when the private provision of mental health care has gone horribly wrong.

A number of noble Lords have focused on the problem of stigma; perhaps we have made progress over recent decades, but we still have a long way to go. We have to think very carefully about using the rhetoric of “strivers versus skivers”, and the suggestion that all we have to do is get these people into a job and then they will be fine, because that is the underlying message we are hearing from certain very senior quarters in our society. I must mention that there has been talk of combining support for people seeking jobs and mental health care. I would not necessarily say not to do that, but it has to be done with extreme caution to ensure that it is not something that puts more pressure and stress on people, interfering with them becoming well.

More positively, I commend the Government on bringing the Bill forward so early in their term and on making it a Bill that starts in the House of Lords. I compare it to the Domestic Abuse Act, during the passage of which many noble Lords who have taken part in today’s debate also took part. There was a genuine effort from all sides of the House to make that Act better, and it has been very clear this evening that there is the same desire in this Chamber today.

Many noble Lords have made the point about the need to resource what is in the Bill—we also said that about the Domestic Abuse Bill—including, to single out a few, the noble Lords, Lord Alderdice and Lord Adebowale, and many others. There have also been some really good ideas in this debate, and here I particularly single out the noble Baroness, Lady Watkins. The idea of a safe staffing level for community services strikes me as a potentially transformative idea that is really essential. Far too often, care in the community has simply meant being abandoned in the community, being left in the hands of horribly overworked staff, who are then subject to abuse and questioning when things go wrong because they simply have not been able to handle the workload, through no fault of their own. It is really crucial that we tackle those issues.

I will quickly whizz through some specific points of the Bill, particularly focusing on things that other people have not said. I have not heard a great deal of discussion of the idea, as recommended by the Joint Committee on the Draft Mental Health Bill, that we have a mental health commissioner. The briefing from the Centre for Mental Health draws a parallel with the powerful impact of the Children’s Commissioner; I would also add the impact of the Patient Safety Commissioner, on which I worked with the noble Baroness, Lady Cumberlege, over many years. Again, that was a case in which your Lordships’ House was very powerful in pushing to create that position. Having the Patient Safety Commissioner has made a real difference, and having a new statutory role to champion mental health across government and speak up for people with mental illness is something we really should be including in the Bill.

Very briefly, I agree with the noble Baroness, Lady Fox, on community treatment orders. The Bill still allows these to be continued indefinitely rather than placing a time limit on them with an option for a new one if needed. These should not be renewed without proof of necessity and proportionality.

I will use my remaining time to focus particularly on the importance of children and young people. Many other noble Lords have addressed and given us statistics on how our mental health services are failing young people. I want to draw another parallel with another element of what the Government are doing and which I have praised. A couple of nights ago, rather late in your Lordships’ House—about this sort of time, actually—we were discussing the Government’s plan for a new youth strategy and their plan to make sure that there is really strong consultation on it with young people. The one direct question I will put to the Minister is: I am sure the noble Baroness is aware of the phrase “Nothing about us without us”. What is being done to ensure that there is a real say for young people, particularly young people with experience of the mental health system, to ensure they actually have the chance to be involved in the Bill?

I will rush into one final, technical point. The Bill introduces the new statutory care and treatment plans for all patients. That is welcome, but many under-18s are admitted on an informal basis, so they will not be covered by this. How will that be dealt with?

One final rushed point is that the noble Lord, Lord Alderdice, and others, have talked about how we can learn from other parts of the UK. The mental health Act in Wales includes a measure to give people the right to have a mental health assessment if they request help. That is surely something we could learn from and include in the Bill.

Government Policy on Health

Baroness Bennett of Manor Castle Excerpts

Tuesday 10th September 2024 Lords Chamber

[Baroness Merron (Lab)]

I thank the noble Baroness for sharing her experience of consulting widely. It is certainly entirely legitimate for government departments to do just that. However, those who do not have a formal role are not required to declare interests; it is different for those who have a formal role. Requiring them to do so would mean, for example, us sending forms in advance to Cancer Research UK before it comes in to talk to us about cancer and to assist us. Would we want that? We would not. Of course, where there is a formal role, we absolutely do that.

It is probably worth saying that a particularly high-profile invitation went from the Secretary of State to the noble Lord, Lord Darzi. He will report shortly on the true state of the National Health Service. He does not have a specific role in the department but he has been invited by the Secretary of State to assist; I believe that he will assist both your Lordships’ House and the other place.

[Baroness Bennett of Manor Castle (GP)]

My Lords, when the Green Party consults on health policy, among the organisations it consults are the Socialist Health Association, Keep Our NHS Public and 999 Call for the NHS—all organisations that are greatly concerned about the continuing privatisation of the NHS. Can the Minister tell me whether the Secretary of State or she herself have had meetings with any of those three organisations since coming into government?

[Baroness Merron (Lab)]

I cannot answer that, I am afraid. I would be very happy to look at it for the noble Baroness.

Vaginal Mesh Implants: Compensation

Baroness Bennett of Manor Castle Excerpts

Thursday 5th September 2024 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I join what I am sure will be a chorus of praise for the noble Baroness, Lady Cumberlege, both for securing this debate and for her brilliant work over many years on these issues, particularly that of vaginal mesh. I started working with the noble Baroness during the passage of the Medicines and Medical Devices Act. If we think back, many of the things the noble Baroness was pushing for have since been achieved. However, today we are addressing some of the things that still desperately need to be dealt with.

One of the noble Baroness’s achievements was the appointment of a Patient Safety Commissioner. Dr Henrietta Hughes is doing a brilliant job and, as has already been referred to, brought out a report in February urging that the compensation schemes for both sodium valproate and vaginal mesh be brought in as soon as possible. I will just do a little bit of advertising for Dr Hughes. She still has a consultation open on the principles of better patient safety and there is one more day for a chance to respond to that, if anyone would like to do so. It is such important work that it deserves to be highlighted.

I want to put this in the broader context of where we are now. We seem to be hearing weekly about a cascade of official and government failures: the Grenfell Tower tragedy, the Horizon scandal, the infected blood disaster and the Hillsborough tragedy. Obviously, we have a new Government and they do not bear direct responsibility for any of those circumstances, but it presents them with an enormous challenge: the challenge to respond sensitively, appropriately and at sufficient speed to do everything possible to ameliorate the circumstances of the victims.

These cases also throw up the challenge of acknowledging that the talk about “cutting red tape” that we have been hearing for so many years is a deeply dangerous approach. We need rules, regulations and controls to keep us safe. As the noble Baroness, Lady Sugg, drew attention to, we need to keep under control what those who make profits are doing to increase them.

We also need to listen to the people who are adversely affected when things start to go wrong. The reality is that so often—we know this is particularly the case with female patients—for years and years people said, “There’s a problem here”, and officialdom said, “No, nothing to see here; it’s all fine”, sometimes even saying that it was all in their head. The Government really need to stamp on that tendency.

I understand that it is early days for the new Government, but I have noticed—this is not directed at the Minister in particular, but at the Government more generally—that when I put down Written Questions and get the Answers, I seem to get essentially the same Answers as I got a few months ago under the previous Government. I urge Ministers, both individually and collectively, to please be curious and challenging. If an Answer was given six or 12 months, or two years, ago, ask if it is still the right one, if indeed it was the right one in the first place.

I have some specific points. A number of people referred to the recent settlement in the court case against the manufacturers. One of the issues that raised was the fact that hundreds of women were unable to make a claim due to a strict 10-year time limit from the date that the product was manufactured. Are the Government planning to do something about that?

I join the noble Baroness, Lady Sugg, in paying great tribute to Sling The Mesh and other similar campaigners. Is the Minister ensuring that her door is open not only to that group but to many other campaigning groups? It would be great to hear that that is the case.

A further point is that Dr Hughes recommended at least an interim payment scheme for vaginal mesh and sodium valproate. The question everyone is asking is, when are we going to hear about that?

The Independent reports that June Dunne, a 64 year-old, has been waiting for corrective surgery since 2019. What are the waiting lists now like?

Finally, the official government figures say that there are 127,000 mesh implants. The campaigners say there may have been many more. Are the Government looking into making sure that they have the proper records of all people affected?

Vaping Products: Usage by Children

Baroness Bennett of Manor Castle Excerpts

Monday 2nd September 2024 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Walmsley, and to thank the noble Lord, Lord Storey, for securing this very important debate and reminding me that I should declare my position as a vice-president of the Local Government Association.

Seeing this on the Order Paper took me back to a moment when I really saw how much of an issue vaping is becoming. I was on a local train in the West Midlands when a young woman, maybe 18, was chatting on her phone to her friend. I remember the vehemence of the sentence that she stated then, talking about vaping: “You just need it so desperately; it’s much worse than cigarettes”. That point of addiction in the way that vaping is experienced by young people was driven home to me by that individual circumstance. This is a significant health issue.

It is worth looking at the fact that behind this is a semi-success story. The indoor smoking ban that came in in 2007, fairly strong labelling laws, education, and provision of cessation help have had a big impact. However, as the noble Lord, Lord Bethell, says, we seem to have hit a brick wall in making progress.

What has happened, as happens so often when regulating big business, is that an escape clause was levered out: vaping. It has become a new method of keeping big tobacco in business. All bar one of the giant tobacco companies have made substantial investments, as outlined by the Tobacco Tactics project of the University of Bath. I must ask the Minister a question here: are the Government concerned about the potential lobbying impacts of big tobacco on the operations of Government and Parliament? Do they intend to act on that level of influence, which is a threat to future action?

The noble Lord, Lord Winston, accurately said that there is a huge amount of uncertainty and that future research is needed. I was looking at a 2022 state-of-the-art review from the British Medical Journal, by Andrea Jonas, titled the “Impact of Vaping on Respiratory Health”. A sentence in it really struck me:

“The public health consequences of widespread vaping remain to be seen”.


We need to apply a precautionary principle, as was said by the noble Baroness, Lady Walmsley. Young people, who still have underdeveloped lungs, are taking who knows what substances into their lungs—certainly the Government do not know; no one really knows. Basic common sense says that this will certainly not be good.

It is worth looking at the figures. I am relying on the extensive briefing from the British Medical Association, which I am sure most noble Lords have received: 7.6% of 11 to 17 year-olds are vaping regularly or occasionally. That compares to 1.3% 10 years ago, so this really deserves the term “epidemic”. The YouGov survey quoted in the very useful Library briefing shows that 18% of 11 to 17 year-olds have tried vaping. That is nearly 1 million children. This is not a fringe concern.

As other noble Lords have said, many children are buying these products from shops illegally. This is very clear. It is also clear that many products are sold that do not meet health regulations. It is worth looking at the context in which this operates. I note a recent interview with the chief executive of the Chartered Trading Standards Institute, in which he pointed out that trading standards are not protected in local government budgets in the way that adult social care and children’s services are. Those two elements make up 80% of the budgets of many local councils. Trading standards are just one of the many essentials that have been squeezed and squeezed again.

This is a really useful case study in taking on the rhetoric that we hear all too often about how terrible red tape is. Protecting our children from dangerous substances and making sure that the law is enforced in shops is what some would call red tape, but I say that they need to be properly funded and supported. Among the many briefings that we have received is one from the Association of Convenience Stores stressing the cost of fully enforcing vape legislation. I was not entirely clear about where it was coming from, but it makes the point that, if we are going to do anything about this, we cannot just pass laws; we also need to fund their enforcement.

I noted in the King’s Speech in July that a tobacco and vapes Bill would be reintroduced. Can the Minister indicate whether that will include the promise of enforcement for whatever that Bill contains?

I pick up the point made by the noble Lord, Lord Bethell, about the need to future-proof that Bill. We are already seeing, in expectation of restrictions and controls coming in particularly on single-use vapes, that companies are adapting. We are seeing reusable replacements for these disposable single-use vapes already on the market, carrying the same brand name and looking very similar in product design. It is very hard to tell the difference between the single-use and the reusable. This is one of the ways in which people are attempting to intervene before the restrictions come in.

Another area that we need to look at very closely is nicotine pouches. Usage in the UK is relatively low compared to some other countries, but people in the social media world tell me that this area is exploding. We need to look at what restrictions might be placed on those products and how we stop creating an open door to be driven through.

As a Green, I feel that I must finally pick up a point made in the introduction by the noble Lord, Lord Storey, about environmental impacts, particularly of single-use vapes. We are talking about children’s health, but plastic in the environment is significant to the health of all of us, particularly children. I point to a recent study; I urge noble Lords to look it up if they have not seen it. A study of a sample of human brains found that they consisted of 0.5% plastic. Microplastics are everywhere: they are in testes, placentas, breast milk and brains.

Think about the world in which our young people live. In the UK, 1.3 million of these battery-powered devices, usually plastic, are discarded every week. Some 10 tonnes of lithium are thrown into the environment, which is sufficient to manufacture 1,200 electric car batteries a year. As with so many issues, this is a public health issue, an individual health issue and an environmental health issue. We need to look holistically at many of these issues from that one-health frame.

Coronavirus: UK Deaths

Baroness Bennett of Manor Castle Excerpts

Monday 29th July 2024 Lords Chamber

[Lord Lilley (Con)]

My Lords—

[Baroness Bennett of Manor Castle (GP)]

My Lords—

[Lord Kennedy of Southwark (Lab Co-op)]

My Lords, we have not heard from the Green Benches yet.

[Baroness Bennett of Manor Castle (GP)]

I thank noble Lords. Following on from the question from the noble Earl, Lord Clancarty, about long Covid, and of course continuing new cases are arising even from apparently initially mild infections, we also face the threat that I hope the Government are watching closely of H5N1 in terms of other respiratory diseases, and we know it is only a matter of time before another respiratory pandemic faces us. What steps are the Government taking to look at air filtration and ventilation systems to provide a better public health system that is more resistant to future diseases in schools and other public buildings and perhaps to provide ways for people to assess in premises they visit how good the ventilation and filtration is for them to be able to go into those environments?

[Baroness Merron (Lab)]

The noble Baroness offers some helpful suggestions as to areas that we can be looking at, but this for me all comes under the headline of resilience and certainly we are monitoring potential emergencies, including the one that the noble Baroness refers to. I can assure her also that preparedness will not just focus on respiratory means of passing on disease but will now look at all of the five routes of transmission, and I feel that will make us a much more resilient country.

Cass Review

Baroness Bennett of Manor Castle Excerpts

Wednesday 17th April 2024 Lords Chamber

[Lord Markham (Con)]

To take the second point first—it was also made by the noble Baroness opposite—that is absolutely right; it can be a real danger. People with English as a second language might not understand that a “person with ovaries” refers to them. It needs to be very clear. It is fundamental that the first description has to be “male” or “female”; you can then put additional parentheses after that.

The noble Baroness’s first point is exactly right. Until young people are through the age of puberty and its effects, they are not in a real position to make up their own minds. That does not mean that they should not be supported during that process, but it does mean that we should not be doing anything irreversible.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I watched the Secretary of State’s introduction to this Statement on Monday, live from my office. She asked the other place to

“bear the sensitivities of this debate in mind”.—[Official Report, Commons, 15/4/24; col. 55.]

I am afraid that it is clear from the printed record before us, and was even clearer watching the Secretary of State speaking, that it was delivered in a triumphalist, dogmatic tone, which meant that she did not follow her own prescription.

The Statement speaks of “myths” but fails to acknowledge the agency and lived experience of children and young people. I have two questions for the Minister. Can he reassure me that we are not going to lose, in this ideological debate, the need for massively more investment in services for children and young people in the NHS? The noble Baroness, Lady Burt, referred to the huge waiting lists that are behind the report we are discussing today.

The Statement also did not mention—and I think we have to acknowledge this—that hate crime against transgender people hit a record high in figures out last October. I hope that the Minister will agree with me that children and young people seeking gender identity services should not have to live in a society where their experiences are used as a political football. They should not be treated as a weapon in the culture war. They should not have to live in a hostile society.

[Lord Markham (Con)]

First, I think I speak for the whole House in agreeing that no one, under any circumstances, should feel that they live in a hostile society —whatever case it is, whether it is transgender, race, sex or whatever. I totally agree with the noble Baroness there. I will absolutely clarify this in the follow-up in writing, but I know that, in this specific area, the NHS has already committed £18 million in this space. Of course, this is quite separate from the £2.3 billion that I mentioned before in the mental health space generally, which, from memory—and I will absolutely clarify this—is the provision of 350,000 extra places for young people, because we know how much the demand is out there.

Sodium Valproate and Pelvic Mesh

Baroness Bennett of Manor Castle Excerpts

Monday 25th March 2024 Lords Chamber

[Lord Markham (Con)]

That is precisely what I put to Minister Caulfield this morning. She commissioned the review because her feeling was that the period from when my noble friend’s initial report came in until when Maria Caulfield was in post was too long. So it was absolutely she who commissioned it last year, and it is absolutely she who very much said that she is determined that there should be a substantive reply from us in the next few months.

[Baroness Bennett of Manor Castle (GP)]

My Lords, at the launch of the Patient Safety Commissioner’s report the victims of the Primodos scandal expressed great distress as they felt that they had been airbrushed out. Of course, the noble Baroness, Lady Cumberlege, recommended that they should receive redress, and they were treated the same way in the report as the sodium valproate and vaginal mesh victims. Can the Minister tell me what will be done to provide redress and ensure that there is appropriate treatment for the victims of Primodos?

[Lord Markham (Con)]

Again, these are difficult areas. My understanding is that we are working from the conclusions of the expert working group in 2017, and its review of all the evidence was that it could not find a causal link between Primodos and the impact it had during pregnancy. This was again reviewed by the MHRA when more information was brought up in the last year. So I am afraid that, as we stand today, the evidence is not there that suggests that causal link.

Sexual and Reproductive Healthcare

Baroness Bennett of Manor Castle Excerpts

Tuesday 19th March 2024 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I sincerely thank the noble Baroness, Lady Barker, for securing this debate. I thank her slightly less for the fact I have had to throw half of my speech out because she has covered it so comprehensively already, but it was a great introduction that set out the issue of work- force that the subject directly addresses but also the true crisis in sexual health. I echo the reflections from the noble Baroness, Lady Barker, about the importance of relationships and sex education. That is the foundation of prevention; it is clearly not being delivered to anything like the standard it should be to our young people. That means we are utterly failing them.

It is a pleasure to follow the noble Lord, Lord Hunt; he and I have had our disagreements in recent times, but I entirely agree with everything he just said. I echo his comments about public health, and that this Government have essentially abandoned public health as a way of ensuring that we have a healthy society that enables the people in it to thrive and live to their full potential. There is the failure to tackle the issue of ultra-processed foods—our broken food system—as well as issues around alcohol; I would add the failure to restrict gambling advertising and allowing the gambling industry to go totally out of control, which presents a great threat to many people.

Returning to the specific issue we are talking about, when I was reading the briefings, I came across the term “neonatal syphilis”. What I knew about neonatal syphilis before this came from reading the history of Georgian and Victorian England. If we read some of the novels of that era, we find some very vivid descriptions—they might not have known the cause, but they could describe the effect. I went and looked, and I came across the website for the Centers for Disease Control and Prevention in America setting out the reality of neonatal syphilis, which is frequently

“stillbirth, miscarriage, or neonatal death”.

If the baby survives, among the effects are

“blindness, deafness, developmental delay, or skeletal abnormalities”.

It is interesting that there is a parallel between what is happening here in the UK, with different structures, and what is happening in the US, because the US, as the CDCP says, has an acute failure in terms of neonatal syphilis—the number of babies born with neonatal syphilis in 2022 was 10 times greater than in 2012. The CDCP says that testing and treatment during pregnancy could have stopped 88% of those cases.

I reflect on those US figures because we are seeing increasingly an Americanisation of our healthcare system: a copy of the US healthcare system’s models; an import of US companies; and an import of people with professional experience, particularly managerial experience, of the US system. This is a system that the CDCP, citing the syphilis figures, says is a total failure. That is something we should really reflect on.

I should probably declare my position as a vice-president of the Local Government Association. I will pick up figures that have already been mentioned, but that have to be highlighted. Among the largest reductions in public health spend since 2015 has been spend on sexual health services—29%—yet at the same time, there has been a significant increase in demand for sexual health services: nearly 4.5 million consultations in 2022, up by a third in a decade.

Of course, we are always hearing elsewhere in your Lordships’ House about rising costs. Sexual health clinics and services are no more immune from the costs of rising energy prices and rising staff costs, et cetera, than anywhere else. The funding is falling and the demand is increasing, so of course the needs are not being met. I reflect back on the debate earlier this week on the Budget. Member after Member of your Lordships’ House got up and spoke about “broken Britain” and our broken services. The noble Baroness, Lady Vere, for the Government, said at the end: “Oh, I think you’re all being too gloomy”. Well, I am afraid that if we look at the state of our sexual health services, we see that the phrase “broken Britain” is sadly appropriate.

I acknowledge having drawn on the excellent briefings we have received, and I now turn to training. We have received demands, which seem perfectly fair and reasonable, that all sexual health medical training posts be 100% funded through the NHSE, in the same way that posts in primary care, oncology and public health are funded, and that the NHSE be accountable for ensuring that some of the recruitment gaps that the noble Lord, Lord Hunt, referred to are filled in. This is important and relates to some of the other debates we have had about the importance of expertise and of proper, full medical expertise being involved at all levels of the health service. No service should be allowed to operate without a genitourinary consultant, and meetings of organisations and commissioners must include them.

I come to two more specific asks. We have a contrast in asks from the briefings. The Terrence Higgins Trust calls for a high-level sexual health commission to address these issues, while the National AIDS Trust calls for a national sexual health strategy. I do not have a particularly strong position on which of those is the right way to approach the crisis, as all these organisations are saying, in different words, are the Government going to take serious, significant action? They may not have very long to go as a Government, but this really cannot wait until we have had an election—whenever that is.

I come back to an issue I have raised a number of times before in the House: the patchy provision of postal STI and HIV testing across England. Only during one special week, the national HIV testing week, can everyone access this testing from a single service. That makes England an outlier. Wales and Scotland already have national HIV postal testing services. In Wales, that also includes STIs, and the Scottish Government are also moving in that direction. It would surely be cost-efficient and cost-effective to make available to everyone in England a national HIV and STI testing service. It would be an extremely good way to spend government money.

I also want briefly to raise the issue of chlamydia testing. We had a full national chlamydia screening programme that included both young men and women, but that was cut back in 2021 from preventing chlamydia infection to reducing the harms of untreated chlamydia. As a result, chlamydia has come to be seen as a women’s issue. Of course, infection occurs in both sexes, but that is not being drawn to the attention young men in particular. Will the Government reverse that change and reinstate the full national chlamydia screening programme service?

The final thing I want to address is people living with HIV who are no longer engaged with services. The Government estimate that some 14,000 people have not been seen at their HIV clinic for at least a year. That is a real risk to the health of people living with HIV and a significant threat to the Government’s goal of ending new HIV cases by 2030. Of course, this issue relates to many other policy areas that the Minister cannot deal with, such as poverty and homelessness, but surely there should be within health a programme to re-engage people with HIV, who should be being cared for not only in their own interests but in the interests of the health of the nation and the whole of society.