Health and Care Bill

Debate between Baroness Finlay of Llandaff and Lord Patel

Committee stage & Lords Hansard - Part 1
Tuesday 11th January 2022 Lords Chamber

[Lord Patel (CB)]

My Lords, my knee-jerk reaction was going to be, “I don’t agree with what Lord Lansley says”. However, I have put my knee hammer back in my pocket, because I do agree with him about the importance of using outcomes indicators as a measure of the performance of health in patients. In that respect the outcomes framework has always been a good development. Although Clause 4 focuses on cancer—and I hope we do not change that—it is an example of how it can be used for other conditions to improve healthcare.

The noble Lord has also identified one key omission in this Bill, which I hope we can find a way to fill: who will be responsible for making sure that there is continuous improvement and development in healthcare that measures the outcomes? That is not in the Bill. I hope we might find a way to do that, whether through the mandate or other ways. That is all I have to say.

[Baroness Finlay of Llandaff (CB)]

My Lords, I must declare an interest, because a lot of the outcome measures that are now used are in place at Cardiff University. I will expand a little on and support what my noble friend Lord Patel said about outcome measures, particularly for something such as cancer. That is in part because the disease process itself is marching on all the time. It is different from many other diseases, where there might be a chronic condition and other things happen as a result of it. If you do not intervene rapidly with some cancers, you miss the boat and go from being able to cure it to a situation where you certainly will not be able to.

The other group of outcome measures that I do not think we should forget has just now been developed: family-reported outcome measures. That is the impact on the family. We know about the number of carers that there are. There are child carers and many unpaid carers. Having somebody in the family with a disease process, waiting for something to happen and seeing that disease process getting worse and worse in front of their eyes, has a major impact on the health of others and stacks up problems for the future in the health service.

That is why, when I was on the All-Party Parliamentary Group on Cancer, I strongly supported John Baron in all his efforts to look at the one-year survival times in cancer. Looking at outcomes can be far more informative than looking simply at process targets, which is what we have been looking at too much to date rather than looking at the overall impact of disease.

Agriculture Bill

Debate between Baroness Finlay of Llandaff and Lord Patel

Committee stage & Committee: 2nd sitting (Hansard) & Committee: 2nd sitting (Hansard): House of Lords
Thursday 9th July 2020 Lords Chamber

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, today’s important debates have been greatly enhanced by the pleasure of hearing the noble Lord, Lord Rooker.

My Amendment 259 is in this important group. I am grateful to my noble friends Lord Patel and Lord Wigley for their support. Chemical weapons were developed in the Second World War and then remanufactured as pesticides, now used in agriculture for around 75 years. In 2013 the Government accepted all recommendations from two important reports. The first was the Bystanders Risk Assessment Working Group of the Advisory Committee on Pesticides. The second report was from the sub-group of the Advisory Committee on Pesticides: the Pesticides Adverse Health Effects Surveillance working group. Both were scathing about the use of pesticides and laid out the dangers. Yet, although accepted, their recommendations remain largely unimplemented.

It is a worrying indictment that 70% of our land is used for farming and almost all of it, except for the 3% for organic farming, is subjected to spraying that is not dose-controlled in any way. In 2014, 17.75 million kilograms of pesticide were sprayed on the land. Carried in the wind, harmful residues have been found several miles downwind. The dangers to health are now recognised. A 2017 report by the UN special rapporteur on the right to food found that chronic exposure to agricultural pesticides was associated with several diseases and conditions, including cancers, and that those living near crop fields were particularly vulnerable to exposure.

The International Panel of Experts on Sustainable Food Systems report describes the unacceptable harm caused by the current chemical farming systems and the energy consumption in the manufacture of these chemicals. It exposes just some of the astronomical health costs externalised by the current system, and states an urgent and overwhelming case for action.

The Lancet Commission on Pollution and Health report on global deaths and chronic diseases from outdoor air pollution, including from the use of pesticides, has the lead author saying that his biggest concern is the impact of the hundreds of industrial chemicals and pesticides already widely dispersed around the world.

I remind all involved in this Bill that the effects are cumulative, because these chemicals often sit in fat stores and are not cleared. The chemicals disrupt the internal hormonal environment; they are endocrine disruptors and make cells more susceptible to mutations, abnormalities and malignancy.

I turn briefly to one of these, glyphosate, used in the weed killer Roundup, which has a large number of tumour-promoting effects on biological systems, including direct damage to DNA in sensitive cells, disruption of metabolic processes and modification to more toxic molecules. Epidemiological evidence suggests correlations between glyphosate usage on crops and a multitude of cancers that are reaching epidemic proportions, including common cancers and lymphoma. In the US, many lawsuits have been brought against the producer Monsanto, which is now part of Bayer.

The effect on the developing nervous system and on the adult neurones is not clearly known, but we must take the precautionary principle. Rats exposed to high levels of glyphosate, their offspring and the offspring’s offspring—two generations on—developed malignancy, obesity and birth abnormalities. Neurotransmitter changes occur in rats and mice exposed to glyphosate, and mice display mood and movement changes. Increased understanding of epigenetics suggests that harm experienced by the adult may be handed on by epigenetic factors to offspring not even yet conceived.

I spoke in the previous debate on the theme of future generations and I return to that now. We cannot ignore the cumulative evidence. In my amendment, I suggest an annual report to Parliament on the safety of herbicides and pesticides, taking into account evidence from the analysis of foods that should be glyphosate-free but appear to be contaminated by windborne spray. Neurotoxic effects on pollinators and the damaging effects on human health of these chemicals cannot be ignored.

As we leave Europe, we are free to produce more of our own food for our own market and ensure that our food is safe and of high nutritional quality. We must make also sure that imported food meets our new high standards. Going forward, pesticides need to be designed out of farming systems, for the environment, for health and for the market-ready production of excellent food; hence my amendment.

[Lord Patel (CB) [V]]

My Lords, I want to support the amendment of the noble Baroness, Lady Finlay. Much of what I was going to cover she has covered in great detail, so I will try not to repeat too much.

Pesticides may be metabolised, excreted, stored or bioaccumulated in body fat. The numerous negative health effects that have been associated with chemical pesticides have been mentioned in great detail by the noble Baroness. In the majority of cases, the concentrations do not exceed legislatively determined safe levels. However, these safe limits may underestimate the real health risks, as in the case of simultaneous exposure with two or more chemical substances, which occurs in real-life conditions and may have synergistic effects. Pesticide residues have also been detected in human breast milk samples, and there are concerns about prenatal exposure and health effects in children.

The noble Baroness mentioned glyphosate-based herbicides and the DNA damage that it is known to cause, which may lead to cell deaths and other conditions in cellular metabolism causing disease. Furthermore, the real-life chronic exposure in mixtures of pesticides with possible additive or synergistic effects requires in-depth research. The underlying scientific uncertainty, exposure of vulnerable groups and the fact that there are numerous possible mixtures reveal the real, complex character of the problem. The combination of substances with probably carcinogenic or endocrine-disrupting effects may produce unknown adverse health effects. Therefore, the determination of safe levels of exposure to single pesticides may underestimate the real health effects, ignoring also the chronic exposure to multiple chemical substances.