Mesothelioma

Baroness Finlay of Llandaff Excerpts

Thursday 27th October 2016 Grand Committee

[Baroness Finlay of Llandaff (CB)]

My Lords, I am most grateful to the noble Lord, Lord Wills, for securing this important debate, and the noble Baroness, Lady Couttie, for outlining the clinical scenarios that people face, often when they are young, as they suddenly realise that they have this devastating disease. More than 2,500 cases are diagnosed each year.

I will focus initially on the iceberg effect; we are seeing just the tip because of asbestos in schools and the worry about that. Some 94% of cases of mesothelioma are effectively preventable because they are associated with chronic exposure to asbestos in one way or another, and we know that three-quarters of our schools have asbestos in place. The number of teachers dying of mesothelioma has been going up from around three a year in the early 1980s to 22 in 2012 alone. That is a marker of developing mesothelioma following chronic exposure.

The Committee on Carcinogenicity of Chemicals in Food, Consumer Products and the Environment has pointed out that we do not know whether children are intrinsically more susceptible to developing mesothelioma following asbestos exposure. However, it seems that the lifetime risk if they are exposed at the age of five is about five times that of someone aged 30 who is exposed to the same amount of asbestos. Therefore it seems that exposing children is storing up problems for the future.

I would like to coin the term “pre-mesothelioma” for the number of people in the population who will probably go on to develop mesothelioma but have no idea about it at all. If we are undertaking research, we have to get to earlier diagnosis, so we have to find ways much earlier on of picking up the markers of transformation to malignancy in the areas where asbestos fibres are stored. At the moment we do not know of any actionable drivers of the disease in order to pick up and identify early markers. There are multicentre trials, as the noble Baroness has just outlined, but the problem is that they are very disparate. That is why there is a desperate need for a single centre in the UK to co-ordinate them. That reminds me of when I was a very junior doctor and the MRC co-ordinated trials into the leukaemias, and it was from those that some advances were made. There needs to be a driver with just about everybody being recruited into a trial if that is at all possible. Currently, patients have to find out about trials and they do not really know where to go. They want to contribute because they do not want the same thing to happen to other people. The other problem is that of course while the MesobanK is in place and the cell lines are coming along, they are not there yet. We need to identify how tumour surface antigens are expressed and detect better markers of early disease.

I remind noble Lords that 60% of patients diagnosed with mesothelioma are dead within a year; in other words, they are palliative care patients. I am afraid that some clinical commissioning groups are not commissioning specialist palliative care services adequately, not at a level that allows them to be integrated with cancer and chest disease services. That is essential to provide psychosocial support as well as support for the rest of the family, and to deal with the devastating symptoms of the disease. Those groups of specialists also want to research some of the effects of the disease when it is not curable.

Lastly, we need data. I declare an interest as chairman of the National Council for Palliative Care. I was very concerned to discover that Public Health England does not plan to carry on collecting a minimum dataset from specialist palliative care services. Without that data we will not know whether what we are doing is improving services for patients. It would cost only £200,000 to refresh the collection and data management process, which in the greater order of things is nothing. Without good data on the number of patients, the people who transform from what I would call pre-mesothelioma into mesothelioma, and the numbers that need palliative care services, we will have no idea whether we are improving.

Breast Cancer: Innovative Drugs

Baroness Finlay of Llandaff Excerpts

Monday 24th October 2016 Lords Chamber

[Lord Prior of Brampton]

My noble friend makes a perceptive point. There is always going to be tension between new drugs and affordability, although there are new drugs and new medical devices that can, in the long run, actually save money. The whole purpose of the Accelerated Access Review is to try to square the circle. There are three factors that we have to consider: first, we want a strong and vibrant life sciences industry in this country; secondly, we want to bring forward new drugs as soon as possible if there are big patient benefits; and thirdly, it must be affordable.

[Baroness Finlay of Llandaff (CB)]

Following the statement of the Academy of Medical Royal Colleges this morning urging caution over chemotherapy in advanced cancer, does the Minister agree that it is very important that, at the time of diagnosis, patients have a serious illness conversation and are prepared for what might come so that they are not hanging on with false hopes for drugs which might not be of benefit to them but can have treatments that are appropriately targeted to the individual patient and their needs?

[Lord Prior of Brampton]

The noble Baroness is describing good clinical practice. One would hope that that conversation would take place between a doctor and patient. What was disturbing about the report from the Academy of Medical Royal Colleges was its overall estimate that £2 billion a year was being wasted on unnecessary tests, drugs and the like. The issue that the noble Baroness raises is where people’s lives are prolonged right at the end but they are not given any quality of life at the same time.

Mental Health: Young People

Baroness Finlay of Llandaff Excerpts

Tuesday 11th October 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I am obviously disappointed to hear what the noble Lord says about Merseyside; I cannot answer specifically on Merseyside today. We have the Future in Mind strategy, which pledged £1.4 billion of extra spending over the lifetime of this Parliament for children and young people. If it is not reaching the front line in Merseyside, we should look at that.

[Baroness Finlay of Llandaff (CB)]

Can the Government provide assurance that the phenomenon of suicide contagion is now being recognised? That is contagion both from personal contact with somebody who has attempted or committed suicide and through media reporting, where the higher the profile in the media, the more likely there is to be suicide contagion. That appears to be a linear relationship. Do the Government recognise that the best way to deal with the complex problem of suicide contagion among children and adolescents at school is to provide suicide screening within schools—for the precise reason that the Minister outlined, which is that many of these people are below what you might call the healthcare radar?

[Lord Prior of Brampton]

My Lords, the issue of suicide clusters and contagion is serious and real. By 2017, as recommended by the Five-Year Forward View on Mental Health prepared by Paul Farmer, every authority will have a multiagency plan addressing that issue. I agree with the noble Baroness that we need to do a lot more in schools. Interestingly, 255 schools are now part of a pilot scheme where there is a single point of contact within the school, so that when a child is feeling suicidal or has mental health problems, it is at least clear who they should go to to seek advice.

NHS: Junior Doctors’ Contract

Baroness Finlay of Llandaff Excerpts

Wednesday 6th July 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, 40% of junior doctors voted against this contract. That is a fact, but it does not alter the fact that it is disappointing and sad that so many junior doctors feel obliged to vote against. I am not downgrading that at all. I have not heard it said that it is not democratic. A significant minority of junior doctors have voted against the contract. We have a huge need to rebuild trust between the Government and the junior doctors. The vast majority of junior doctors are committed to their profession and the NHS and we want to rebuild with them the level of trust that always existed in the past.

[Baroness Finlay of Llandaff (CB)]

Do the Government recognise that the unrelenting pressures on junior doctors are reflected in this vote and that it is essential to restore relationships and demonstrate outreach to restore some trust, and therefore that an open mind towards negotiating even minor areas of adjustment such as timetabling of introduction would go a long way to restore deeply damaged and fractured relationships?

[Lord Prior of Brampton]

It is worth noting that the Royal College of Surgeons and the Royal College of Physicians, and I think most of the other royal colleges, have supported this contract. Many of the leaders of the BMA supported this contract. As I said, the Secretary of State has specifically said in a statement today that his door is always open when it comes to issues around implementation. The plan is to implement this contract after the first foundation year 1, when doctors complete their first four-month rotation in October and November.

Health: HIV

Baroness Finlay of Llandaff Excerpts

Monday 4th July 2016 Lords Chamber

[Lord Prior of Brampton]

The critical issue is: to whom do we provide it? The whole purpose of the trials that NHS England is now funding is to ensure that when we provide PrEP, we do so for those who can most benefit from it.

[Baroness Finlay of Llandaff (CB)]

Do the Government recognise that the number of new cases in London is not falling, despite all the public health measures, and that there is therefore an urgent need to address the continuing at-risk behaviours? Will the Government also consider a trial of PrEP in the prostitute population, in which heterosexual transmission can occur and who are often not spoken about in relation to HIV, partly because all their activities are underground?

Health: Diabetes and Obesity

Baroness Finlay of Llandaff Excerpts

Thursday 30th June 2016 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness is clearly right that weight reduction can reverse diabetes. My father, for example, has lost weight and his diabetes has, effectively, been put into remission. There is no question that it works. However, it is very difficult to lose weight once you are overweight. The figure is that only one in 210 people with a BMI of over 30 can reduce it to a normal level; hence the emphasis that the Government are putting on explaining this to children and young people before they get fat. That is the critical place to aim. However, I entirely agree that greater access to structured education programmes is very important.

[Baroness Finlay of Llandaff (CB)]

I fully endorse that reply from the Minister, but will he also ensure that the guidance includes recognition of emerging research that children, if they never become obese, have a different type of fat—brown fat—which maintains a higher metabolic rate and therefore decreases their long-term risk of diabetes? The importance of avoiding obesity in the first place, particularly in children and in women, in pregnancy and post pregnancy, is the only way that we will stop this ever-growing curve of diabetes associated with adult obesity.

[Lord Prior of Brampton]

I entirely endorse the words of the noble Baroness, which I am sure will be reiterated in the obesity strategy when it is announced later in the summer.

National Clinical Director of Adult Neurology

Baroness Finlay of Llandaff Excerpts

Thursday 9th June 2016 Lords Chamber

[Lord Prior of Brampton]

I do not think that anyone is saying that the system was not working well enough. The argument that NHS England put was that it had to focus its resources on a smaller number of key national priorities—for example, mental health, cancer and learning disabilities—and that is what it is doing. It is poking the resource into a smaller number of well-focused and well-defined areas, but it can still get all the advice that it needs on neurology from the clinical reference groups and other sources.

[Baroness Finlay of Llandaff (CB)]

Do the Government recognise that the UK has only one-sixth of the number of neurologists that the rest of Europe has, which accounts for delays in diagnosis, poor outcomes for patients and wide variation in services? That needs to be addressed urgently for patients to have earlier diagnosis and better outcomes, and for their families to be better supported. Co-ordination of clinical and research efforts needs to be across the UK. I declare an interest at Cardiff University, where the amazing CUBRIC has just been opened by Her Majesty the Queen. It has the potential to transform neurological diagnosis in the UK, but there needs to be UK-wide effort.

[Lord Prior of Brampton]

Health is of course a devolved matter in the UK, but there is absolutely nothing to stop the devolved parts of the UK—Scotland, Wales, Northern Ireland and England—from working closely together on these issues. I do not think that the lack of a national clinical director prevents us in any way from doing that.

NHS England: Pre-exposure Prophylaxis for People at Risk of HIV

Baroness Finlay of Llandaff Excerpts

Tuesday 7th June 2016 Lords Chamber

[Lord Prior of Brampton]

All I can say in response is that NHS England has had independent legal advice that it does not have the power to commission this particular drug for this particular purpose, and for this purpose the drug itself is not yet licensed. It is not to do with any decision made on efficacy grounds for this drug; it is purely that they have received independent legal advice.

[Baroness Finlay of Llandaff (CB)]

Can the Minister confirm that that legal advice, as I understood it on reading it through, points out that there is weak evidence that NHS England does not have the power to commission PrEP? It says that NHS England does not have the power to fund PrEP but points out that under Section 7A, the Secretary of State has the power to delegate the commissioning of PrEP. Can the Minister therefore explain why, in the face of the evidence that has come through from the PROUD study and internationally, the Secretary of State has not used Section 7A to support NHS England? Is there a dispute going on between NHS England and Public Health England, and is this a fallout from the Health and Social Care Act?

[Lord Prior of Brampton]

I do not think that it is a fallout from the Health and Social Care Act. It is purely that the NHS specialist commissioning committee within NHS England has received clear independent legal advice, as I understand it, saying that it does not have the power to commission this product. That position may well be challenged legally, in which case it will be resolved one way or the other.

Obesity

Baroness Finlay of Llandaff Excerpts

Thursday 26th May 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, of course my noble friend is right that individual responsibility is critical to this. But we have to make it easy for people to make the right choices by providing the right information. Particularly for children, we have to make it easier for them and their parents to make the right choice.

[Baroness Finlay of Llandaff (CB)]

Has the Minister asked NHS England to tackle the problem of obesity among healthcare staff? It is very difficult for the public to get a public health message about losing weight from a member of staff who is, frankly, obese.

[Lord Prior of Brampton]

The noble Baroness makes a very important point. That is what lies behind the chief executive of NHS England’s decision to address the presence of unhealthy food and drinks on NHS properties, and to encourage staff to live a much healthier lifestyle.

Health: Alcohol

Baroness Finlay of Llandaff Excerpts

Thursday 12th May 2016 Lords Chamber

[Lord Prior of Brampton]

Thinking very quickly, my Lords, our position is that alcohol is not safe but it is low risk depending on how you drink. It is a low-risk activity at a level of about 14 units spread evenly across the week. I am sure that the noble Lord will adhere strictly to that guideline.

[Baroness Finlay of Llandaff (CB)]

My Lords—

[Baroness Massey of Darwen (Lab)]

My Lords, does the Minister agree that attempts to alert the general public are often too little, too late?

[The Lord Privy Seal (Baroness Stowell of Beeston) (Con)]

My Lords, it is the turn of the Cross Benches.

[Baroness Finlay of Llandaff]

In the review to which the Minister referred, is the cost of accidents through alcohol-related driving and road accidents being costed? Is consideration being given to lowering the drink-driving limit, perhaps even to almost zero, as in some countries?

[Lord Prior of Brampton]

My Lords, traffic accidents caused by alcohol have been costed. I cannot give the noble Baroness that figure today but I will write to her with it. I do not believe that we are currently reviewing the alcohol limit for driving, although I know that in Scotland it has recently been reduced.