Medicines and Medical Devices Bill

Baroness Garden of Frognal Excerpts

Committee stage & Committee: 4th sitting (Hansard) & Committee: 4th sitting (Hansard): House of Lords
Wednesday 4th November 2020 Grand Committee

[Lord Patel (CB) [V]]

My Lords, I shall curtail my remarks, as time is limited and this is very much a probing amendment. It draws attention to the need to ensure that paediatric regulation-specific measures that preside over the licensing of medicines to better protect the health of children, are reflected in future legislation regarding clinical trials in the United Kingdom.

New medicines licensed in the EU are currently subject to an EU Parliament directive that requires research about new medicines to consider babies, children and young people. The directive means that standardised procedures are in place for sponsors to plan and conduct studies. To get new medicines intended for use by children licensed for marketing in the EU, sponsors must have in place a paediatric investigation plan that aims to ensure that the necessary data are obtained through studies in children. In short, new medicines applying to be licensed for use by children must be trialled by them. It is often the case that medicines trialled in adults are then given in lower doses to children.

New medicines trialled in the United Kingdom are currently subject to this regulation. Moving on, there are clear clinical reasons why it is important for babies, children and young people, as they may show differences from adults in their response to and tolerance of medicines. To ensure that new medicines are safe for their use, they must be involved in clinical trials. That is the important point of my modest amendment.

Furthermore, there is a commitment and a key pledge in the NHS long-term plan to raise to 50% by 2025 the involvement of children and young adults in clinical trials. If there is no regulation requiring that data be collected in clinical trials with children, we will not achieve this. So all I seek is an assurance from the Minister that the Government and the MHRA are well aware of this and that the paediatric regulation will be considered whenever the clinical trials regulations are drawn up by the MHRA. I beg to move.

[The Deputy Chairman of Committees (Baroness Garden of Frognal) (LD)]

My understanding is that the noble Lord, Lord Lansley, has withdrawn, so I call the noble Baroness, Lady Jolly.

[Baroness Jolly (LD) [V]]

My Lords, since March 2011, the European Medicines Agency made available information on clinical trials in children via a public interface, the European Union Clinical Trials Register. The register is based on the information stored in EudraCT, a European database that contains information on all clinical trials with at least a site in the EEA. Can the Minister clarify whether this information will be available to researchers and paediatricians in the UK? Can he confirm whether this point has been part of EU negotiations? Can he further clarify whether there is any difference with data from joint research projects operating across the island of Ireland? Are all data equally accessible? We support the amendment.

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Clause 5, as amended, agreed.

[The Deputy Chairman of Committees (Baroness Garden of Frognal) (LD)]

We now come to the group beginning with Amendment 46, and I remind noble Lords that anyone wishing to speak after the Minister should email the clerk during the debate.

Clause 6: Emergencies

Amendment 46

Moved by

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[Lord Patel (CB) [V]]

My Lords, I support these amendments. They touch on the issues and arguments returned to in respect of amendments to Clauses 15 and 42, which set out the procedures to be followed in exercising these powers, as was mentioned by the noble Lord, Lord Hunt of Kings Heath, its unjustified use of negative procedure and this case of protocols. Clauses 6 and 15 provide that the Secretary of State can disapply certain provisions of the medicines and medical devices regulations

“in circumstances which give rise to a need to protect the public from a risk of serious harm to health.”

Such provisions may be within the Human Medicines Regulations 2012, the Medicines for Human Use (Clinical Trials) Regulations 2004, and the Medical Devices Regulations 2002. However, they also may refer to those provisions that are still to be drafted at the current time and are thus unknown and not yet subject to scrutiny.

I recognise that it is necessary to be flexible in the face of an emergency situation as in the current pandemic. However, in its present form this is another example of broad-reaching powers falling outside of that which is reasonable and proportionate. While the disapplication of certain provisions using this power can be exercised to regulations under the affirmative procedure, they may also be passed in certain circumstances by the negative procedure, and, as in these amendments, by protocol. The use of a protocol, in particular, bypasses Parliament, and therefore is unnecessary. I support these amendments.

[The Deputy Chairman of Committees (Baroness Garden of Frognal) (LD)]

The noble Lord, Lord Blunkett, has withdrawn, so I call the noble Baroness, Lady Jolly.

[Baroness Jolly (LD) [V]]

My Lords, we support these amendments, which relate to the disapplication of regulatory provisions in an emergency. As the Bill stands, the Secretary of State may make regulations about these provisions. This can be subject either to

“conditions set out in the regulations”

or in

“a protocol published by the appropriate authority.”

As the protocol is not subject to parliamentary scrutiny, the amendment in the names of the noble Baroness, Lady Thornton, and the noble Lords, Lord Hunt of Kings Heath and Lord Patel, would remove this provision from the Bill so that, as the noble Baroness, Lady Wheeler, said, conditions would have to be set by regulations alone.

[Lord Bethell (Con)]

My Lords, the lockdown debate later this afternoon brings home the significance of an emergency like Covid. It requires swift, dramatic change to protect public health. Clauses 6 and 15 are essential. They would allow us to make provisions about the disapplication of a medicine or medical devices provision where there is a need to protect the public from a serious risk to health. We would need regulations to do this, because to act in breach of an otherwise applicable provision would be an offence.

Medicines is a highly regulated area. Regulations apply from development of medicines to delivery, right the way down to the pharmacy. It is a complex and overlapping system, designed to protect the end-user, the patient. But there are times when we need to switch off a circuit of the system to respond to an emergency. This is most vividly apparent when we speak of a Covid vaccine. This is end to end, from port arrival, to the logistics of its delivery, to who may administer it. We need to be able to pick this circuit out of the whole and isolate it. Otherwise, to disapply regulation without being highly specific is to disapply regulation not just from the vaccine but from other medicines as well.

This is the point of conditions that go alongside the disapplication. Where we know what the conditions will be, of course it should be in the regulations. But often we cannot know what the specific conditions are. That is where the protocol comes in that the noble Baroness, Lady Thornton, with her Amendments 46, 47, 93 and 94, would like to remove. I acknowledge that the Delegated Powers and Regulatory Reform Committee objected to the use of a protocol. I note that its condemnation was not limited to this Bill but was a broader point about other legislation as well. I hope that I can explain why such a protocol is necessary here.

Protocols are a last resort in any emergency that provides critical flexibility in highly regulated areas. They would be time limited to provide flexibility and administrative detail, tailored to the professional audience that requires it and in language which they are familiar with. A protocol will be used only where it is not be possible to determine all the necessary conditions of disapplication at the pace needed to deal with an urgent threat. The protocol allows for the finer details to be sketched in, while giving Parliament the structure of the regulations to consider. We can debate the principle of disapplying certain provisions of the regulations, without always having the specific names of medicines or vaccines in front of us.

There are existing provisions in the Human Medicines Regulations 2012 that allow for the disapplication of regulatory provisions on how prescription, pharmacy and over-the-counter medicines may lawfully be supplied. These are limited to circumstances in the event or anticipation of a pandemic disease. This formed part of the response to the swine flu pandemic in 2009. Six protocols were issued in relation to specific antivirals for the treatment of swine flu, enabling them to be supplied by authorised staff who would not normally be able to supply prescription-only medicines. This involved separate protocols for different strengths of oseltamivir, a demonstration of just how specific we would expect the protocols to be.

We have made an SI this month introducing provision for the use of protocols in relation to coronavirus and influenza vaccinations. That SI seeks to anticipate the certain flexibilities that might be needed but it is not possible to cover all eventualities. It anticipates the need for rapid supply and the potential mass administration of medicines, since the anticipated vaccine may be delivered by injection.

However, until we are presented with a vaccine, we cannot know how many injections are required, for example. That is a finer point of detail that has implications for the scale of operation required. The SI makes clear that the disapplication of existing regulatory provisions about supply and administration of medicines will be subject to conditions set out in the protocol. These conditions of disapplication will include specifics around the class of persons permitted to administer the vaccines, and the protocol would specify the process by which a person in that class is designated as a person authorised to do so. It will provide for supervision and recording requirements that must be met when the vaccine is administered. These requirements will change depending on the necessities of the specific vaccine. Parliament can debate the regulation, but until we know the detail of that vaccine, we simply cannot establish how this operation will run.

The emergency powers allow us to go broader in terms of disapplications than what is currently available, a reflection of the type of emergency we face. In the illustrative SI published on introduction we have provided some clarity on our intent. It gives an example of what might be needed to ensure the disapplication could be relied upon in response to other circumstances, including a spread of toxins, pathogenic agents, and so on, that give rise to the risk of serious harm to health. This too would operate alongside a protocol.

Amendments 93 and 97 in the name of the noble Baroness, Lady Thornton, relate to emergencies involving medical devices. Provisions already exist in the Medical Devices Regulations 2002. These provisions allow particular devices to be put into service without being subject to CE marking, following a duly justified request if the Secretary of State considers this to be in the interests of the protection of health.

The ventilator challenge allowed us to fulfil the clinical need for ventilators through a combination of CE-marked devices, and devices which were granted an exemption from the requirement. They were required to conform to bespoke technical specifications as a condition of the exemption being granted, and the technical specifications evolved as they needed to. That ensured that the only devices in service without a CE mark were those that met the highest possible standards.

Online publication will also support dissemination to the required audience, to whom it will be targeted, such as operators in the supply chain, enabling conditions to be quickly understood by those who must use them, referring to concepts, processes and so on that they are familiar with from their field.

Protocols are a last-resort power. Where we can anticipate what the conditions of disapplication will be, we will put these into regulations, but I cannot say now how many injections will be required for a Covid vaccine or how many staff will be needed to deliver it. Parliament has our intent, our plans and our proactive preparations now, but not technical specifications—nor do we. I commend the noble Baroness, Lady Thornton, and her team for all they do to hold us to account. It is right that they look at how we can write good legislation, although we need legislation that allows for practicality in a crisis. Therefore, I hope I have provided enough assurances for her to feel able to withdraw her amendment.

[The Deputy Chairman of Committees (Baroness Garden of Frognal) (LD)]

My Lords, I have received a request to speak after the Minister from the noble Lord, Lord Patel.

[Lord Patel (CB) [V]]

My Lords, I say respectfully to my friend the Minister that he is putting up smokescreens. As he mentioned, he already has the power under the 2012 Act to do much of what he wants to do. Furthermore, the arguments used all relate to the Covid emergency. He alluded to this afternoon’s debate and the measures that are about to be taken, but he already has those powers, otherwise he would not be able to do it. We have emergency legislation related to Covid, which includes immunisation through vaccines. By the way, how many doses would be required? It is not necessary to have that in legislation: it is a clinical decision based on the effectiveness of a vaccine. I do not require legislation to tell me how many tablets I should prescribe to my patients for any disease, so I fear that these are smokescreens. He already has powers of disapplication in an emergency, and I continue to support the amendment.

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Amendment 48 agreed.

[The Deputy Chairman of Committees (Baroness Garden of Frognal) (LD)]

That concludes the work of the Committee this afternoon. I remind Members to sanitise their desks and chairs before leaving the Room.

Committee adjourned at 4.15 pm.

Health Protection (Coronavirus, Restrictions on Gatherings) (North of England) Regulations 2020

Baroness Garden of Frognal Excerpts

Friday 25th September 2020 Lords Chamber

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

The noble Lord, Lord Mann, has withdrawn, so I now call the noble Lord, Lord Singh of Wimbledon.

Medicines and Medical Devices Bill

Baroness Garden of Frognal Excerpts

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Wednesday 2nd September 2020 Lords Chamber

[Baroness Redfern (Con) [V]]

I congratulate the Minister on introducing this important Bill and the review team, led by my noble friend Lady Cumberlege, on its commitment to patient safety.

This Bill delivers an extensive programme for the regulation of medicines, veterinary medicines and medical devices in the UK, and provides for a high standard of safety. To capture the fast pace of innovation in these areas within a regulatory legal framework, it is important to share vital information and be responsive and flexible, while being less complex and unwieldy, with data central to effectiveness. Can the Minister say how the duty to consult on regulations about human medicines will be carried out and which stakeholders will be involved?

I am pleased to see the Bill upholding and enhancing of the attractiveness of UK life sciences, as mentioned by previous noble Lords, while not hindering its ability to continue to provide for these important innovations for patients. It demonstrates a wish to make clear the importance of commitment to the life sciences sector, which is worth over £75 billion to our economy. We all know and acknowledge that enhancing continued collaboration of technical and scientific expertise is of significant importance to the UK going forward, but it should not be put before patient and user safety.

There is also a government commitment to a world- leading regulatory system, enhancing us as an attractive destination for clinical trials; to allowing strong collaboration, not just across the EU but maintaining alignment with global standards on the different routes to accessing innovation; to supporting patients’ access to innovation, creating more opportunities as we leave the EU; to maintaining and strengthening our position as a global player in the world of R&D; to allowing the removal of barriers to hub and spoke dispensing, giving smaller community pharmacies the same opportunities as large pharmacies; and to extending low-risk drug prescribing to other healthcare professionals.

An area of concern in the dispensing of medicines is oversupply, particularly in repeat prescriptions. Unused medicines have an environmental impact, so I would like to know how that can be responded to. How, too, can regulations be made to provide for a database of information on medical devices, to be established and managed by the Health and Social Care Information Centre?

As with human medicines regulations, the framework in the Veterinary Medicines Regulations 2013 upholds the safety of veterinary medicines by having a robust system for their availability, development and supply. Changes making prescribing professionals for veterinary medicines as accessible as possible, without compromising animal safety and while ensuring that the person administering the medicine is protected, are to be welcomed.

The Bill is an important piece of legislation for the regulatory system for medicines and medical devices, and for enabling new developments, but it must always display safety front and centre. The Government have stipulated that they do not intend to make any bold policy changes without full consultation, and that is to be welcomed.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

The noble Lord, Lord Gadhia, has withdrawn from the debate, so I now call the noble Baroness, Lady Sheehan.

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[Baroness Morgan of Drefelin (CB) [V]]

My Lords, I declare an interest as chief executive of the research and care charity Breast Cancer Now and as chair of the National Cancer Research Institute.

I would like to start by congratulating the noble Baroness, Lady Cumberlege, and her colleagues on her committee, for her report and her compelling contribution today; it was incredibly moving. I, too, will be supporting steps to see this Bill serve as a vehicle for the implementation of her recommendations, most notably, as so many Peers have commented today, the establishment of a patient safety commissioner.

This Bill covers two areas of particular concern to cancer patients that I wish to emphasise today, which others have touched on, too. These are access to clinical trials and speed of access to newly licensed medicines. For the estimated 35,000 women living with incurable secondary breast cancer in the UK, clinical trials can provide early access to potential new treatments which might extend the time before their disease progresses, which might extend their lives and which can improve quality of life. These women often have few treatment options available to them, and clinical trials really do offer people with incurable secondary breast cancer and other cancers hope for the future. I do not want us to underestimate the value of that in these debates.

Research is, as we have heard, underpinned by pan-European and international collaboration. As an example, over 4,800 EU clinical trials involved the UK between 2004 and 2016. That is a significant number of important trials. The new EU clinical trials regulation, which we have already heard about today, will improve patient safety and streamline the process for setting up new trials, and this is vital. The Government made an extremely welcome commitment in 2018 to align as closely as possible with the new regulation, and it is essential that this commitment is restated and honoured. Today is an opportunity for that. However, without access to the infrastructure that clinical trials require, such as the portal and the database to support the regulation system, it will become much more difficult to run clinical trials across borders; that has already been talked about today.

Where trials show that medicines are safe and effective, it is vital that they are licensed and made available to patients as quickly as possible. We have heard today that the EMEA area represents 25% of global pharmaceutical sales and the UK just 3%. These are important numbers to bear in mind. If the pharmaceutical companies have to make a separate application to the MHRA, and incur additional costs, to license their medicines, delays are likely in those medicines becoming available in the UK. This is a threat to timely access for patients to new medicines, and its importance should not be underestimated.

We are also particularly concerned about access to medicines developed by small pharmaceutical companies. Can the Minister give some reassurance to patients with secondary breast cancer and other incurable cancers that access to clinical trials and newly licensed medicines will not be adversely impacted by the effects of this Bill? I look forward to hearing from the Minister.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

The noble Lord, Lord Darzi, has withdrawn, so I now call the noble Lord, Lord Freyberg.

Covid-19: Response

Baroness Garden of Frognal Excerpts

Monday 27th July 2020 Lords Chamber

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

My Lords, I thank the noble Baronesses, Lady Thornton and Lady Brinton, for their detailed questions, which I will go through as speedily and thoroughly as I can.

On accountability during the Recess, there are long-standing precedents on this and we will obey them, as is normal.

On the arrangements for Spain, I reassure the noble Baroness, Lady Thornton, that there is a very thorough system of regular meetings to assess the exemptions on travel. This is done at several levels of government and detailed intelligence from the front line is provided to those meetings. However, the situation in many countries is fast changing, and the Spanish situation is a good example. The information we had at the beginning of last week was quite different from the information we had by the end of the week. Fast turnaround decisions are not a sign of panic or weakness; they are a sign that the system works and is working well. We are trying to be as flexible as we can and we respect the country’s desire to travel, but when the infection rate in overseas countries moves, we have to move quickly as well. Within individual countries, there is no way for us to control intra-country transport. It is therefore very difficult and challenging to have a regional exemption list. That is why we have not been able to give exemptions to the Balearics, and I say that with a personal interest in the matter.

Our guidance on face masks is based on trust. There is no compulsion and they are not mandatory. In some countries they are mandatory, but not in this country. That is why the science is so important to us, and it is one reasons that we may have moved behind some other countries. The guidance we now have on face masks is extremely clear. I pay tribute to the large and growing number of people wearing them. I believe this country is moving in the right direction.

We are concerned about shopworkers. USDAW makes a good case for the need to protect shopworkers who may be put in an awkward situation. That is why we work closely with the police to ensure that the right protections are in place.

I say a profound thank you to the people of Leicester, who have done an incredible amount in a difficult situation. The signs are that the prevalence of the disease has come down a long way in Leicester thanks to their commitment. The lessons we have learned include some of the most obvious lessons you could learn, but there is no replacement for local contacts and the involvement of local communities. However, there are hard-to-reach communities where our message has not got through and we need to do more to reach them. In particular, I am grateful to faith leaders in Leicester who are working with us on preparing for Eid and ensuring that the message on social distancing gets through in time for that important celebration.

Full details of the budget for NHS Test and Trace will be published when the time is right, and when that time arrives I will be glad to place a copy in the Library as requested.

I completely agree with the noble Baroness. Having an equitable distribution of the vaccine in this country and overseas is key to the Government’s policy. That is why we are working hard with the World Health Organization, GAVI and others to ensure that vaccines are shared as a global resource. We hope that a vaccine can be found, and the indications from Oxford are encouraging, but we recognise that vaccines for coronaviruses, particularly those affecting the respiratory system, are difficult. That is why we are making a massive investment in the test-and-trace programme and in therapeutics and why we remain vigilant over local lockdowns—to rid this country of this horrible disease.

Both noble Baronesses spoke about social care. I do not recognise the phrase used by the noble Baroness, Lady Brinton, that the care sector has been “thrown to the wolves”. I find that an unhelpful characterisation. I say yes to regular testing, yes to PPE and yes to financial support—we have given £3.7 billion to local authorities to help them pay for the cost of Covid-19, and on 2 July we gave a further £500 million to the social care sector. We remain vigilant with regard to the financial resilience of the social care system and we are working very closely with social care providers on the ongoing costs of both testing and PPE, as well as the financial resilience of the entire sector.

On shielders, the noble Baroness, Lady Brinton, makes a very good case. The handling of those who need shielding is one of the most delicate challenges that we face. Those who through no fault of their own are particularly vulnerable to the effects of the disease are put in an invidious situation, and we are extremely grateful to all those who have gone through the hardship of extreme shielding during this long and difficult time. I take on board all her comments and extend my profound thanks to all those concerned. I will look into the question of the parcels that she raised in the debate last week. My inquiries are ongoing on that, and I will respond to her, as I promised to last week.

On the arrangements for travel, it is true that the current medical advice is that we are currently sceptical whether temperature testing is effective and therefore we have not imposed it.

On testing, it is a frustrating but unavoidable truth that a test today does not necessarily mean that you do not have Covid and that you may not display both the symptoms and contagiousness of Covid in the days ahead. That is why snap testing at airports cannot be a sure-fire and safe route for protecting the country, which is why we have to look at isolation as a way of protecting the country.

On the mandation of isolation, as in other matters to do with Covid, we apply a voluntary principle because we believe that trust is the best way to keep the public on side, and we have neither the legal nor the other resources necessary to impose mandation.

On the questions from the noble Baroness, Lady Brinton, about the state of the testing programme, I reassure her that testing at home is not stopping and that NHS staff are regularly tested. There is a very clear plan, that plan is heavily resourced and we are continuing to invest in it with innovation, manpower and legal support where necessary.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

We now come to the 40 minutes allocated for Back-Bench questions. I ask that both questions and answers be brief so that I can call the maximum number of speakers.

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[Lord Bethell [V]]

The Secretary of State has asked Public Health England to review the logging of death statistics; we await the review’s results.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

Lord Rogan? We will move quickly on to the noble Lord, Lord Balfe.

[Lord Balfe (Con) [V]]

My Lords, on three occasions today the Minister has said that, if you have a Covid test today, you are not guaranteed to not have the disease tomorrow. In that case, what on earth is the purpose of having the test system at all? Secondly, the NHS is not functioning properly. Bearing in mind the precedents of my noble friends Lord Deighton and Lady Harding, would it be a good idea for the Minister’s department to appoint a specific person to get the NHS up and running again, as foreseen by my noble friend Lord Ribeiro in his perceptive question?

[Lord Bethell [V]]

My Lords, we use the tests we have got because they are the tests we have got. The way in which the disease manifests itself is not, I am afraid, something that I can negotiate with. We do what we can, but I emphasise that an unfortunate feature of this disease—and many others—is that it harbours itself silently in our bodies and manifests itself both to infect and be diagnosed only when it is ready. That is a simple fact of life. However, the testing regime has a profound impact on the spread of the disease by identifying those who have some form of symptom, even if it is a quiet one. I pay tribute to Sir Simon Stevens, who is working hard to get the NHS back to business as usual and is having a profound impact on the issue.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

My Lords, the time allowed for this business has now elapsed. I apologise to the four speakers who did not have time to put their questions.

Covid-19

Baroness Garden of Frognal Excerpts

Wednesday 8th July 2020 Lords Chamber

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

My Lords, the time allowed for this Question has now elapsed. I apologise to the noble Lords, Lord Balfe and Lord Rogan, that there was not time to fit them in.

Health Protection (Coronavirus, Restrictions) (England) (Amendment) (No. 2) Regulations 2020

Baroness Garden of Frognal Excerpts

Monday 15th June 2020 Lords Chamber

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

As regulations change rapidly, I want to focus on PPE, particularly the supply of FFP3 high-level protection masks for clinical staff. The Royal College of Physicians—I declare my interest as a fellow—has conducted four surveys of members about their continuing experiences, and the latest, on 3-4 June, has shown welcome improvements, but problems persist. Just 10% feel ready for services to return to normal, while 31% think it would take a year to 18 months for the NHS to get back on an even keel. Access to PPE and testing have improved but 16% of doctors still report being unable to access the PPE they need for managing patients with Covid-19, and almost a third report not having been properly fit-tested. Shortages continue: 11% found themselves in the last two weeks unable on occasion to access the PPE that Public Health England advises. Only 26% have had access to antibody testing, and of those, 30% report the results as positive.

As Test and Trace gets established, the requirement for contacts to self-isolate for two weeks risks returning to the pressures of staff absences. Current guidance about PPE is that staff should always wear a mask, which decreases the risk of asymptomatic spreaders and protects the patients. But staff are not adequately protected. An FFP3 mask is only allowed in high-risk areas and for certain procedures. Patients on ordinary wards, waiting for admission and on whom results of tests are not yet back, often cough, splutter or vomit and it is inevitable that clinical staff are showered with droplets. Can the Minister say how secure are supplies of FFP3 masks, are we now producing them in the UK, and will they be issued to all front-line clinicians to try to ensure that a second peak does not pull down staffing numbers to critical levels as the lockdown eases? As people move around more, the risks to those shielding or with visual difficulties will make them more anxious. Will the Minister explore with me the idea of Dr Iliff, an anaesthetics Bevan Health Technology Exemplar trainee in Wales, for a lapel badge that those who need more protection can wear to make them visible to others when in public places, and which could go on a lanyard?

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

I understand that the noble Baroness, Lady Hussein-Ece, has scratched, so I call the noble Lord, Lord Holmes of Richmond.

[Lord Holmes of Richmond (Con) [V]]

My Lords, we owe all our front-line workers, not least those in the NHS and in care homes, an enduring debt of gratitude. To that end, can my noble friend say what is the current situation with PPE? Do the NHS and our care home workers have all the PPE that they require, and is it all now in date? Similarly, it may be beyond my noble friend’s brief, but of the supermarkets that opened up early sessions for NHS workers specifically to come first thing in the morning, how many are still running those sessions, and how many of them are now simply letting all members of the public come in, denying NHS workers that key opportunity to get their shopping when they are off shift?

At the beginning of this pandemic, the WHO said that a safe social distance was one metre, and it has stuck to that throughout. To that end, will my noble friend announce to the House tonight that it is time to end two metres and go to one metre, not least combining it with the use of masks so that we can transition to this state safely and securely? Bars and restaurants have said that at two metres, they can add 30% of custom, and at one metre over 70%—which is where an efficient and effective business can be run.

Can my noble friend tell the House that we will end this quarantine situation, which makes no sense at this time at all? Similarly, how is it possible to get on a domestic airliner from London to Glasgow and sit next to your fellow passengers with no social distancing, yet we cannot go to places of worship together with safe social distancing? You can get on that plane and sit right next to fellow passengers, yet we cannot get our young people back to school. Does my noble friend agree that if we end the quarantine period and reduce social distancing from two metres to one metre, we will be able to have a safe and social summer, in which we will be able to educate our young people, get our economy back on track, and return to some form of society?

[The Deputy Speaker]

I understand that the noble Lord, Lord Wei, has scratched, so I call the noble Lord, Lord Rennard.

Covid-19: Masks

Baroness Garden of Frognal Excerpts

Thursday 11th June 2020 Lords Chamber

[Lord Kirkham (Con) [V]]

My Lords, I grew up in a world where the only wearers of face masks were bank robbers, sexual deviants and the Lone Ranger, in a mining community where the underground workforce would have benefitted from wearing face masks, but did not, and paid the price. It seems now that, in many situations, masks will be mandatory, yet not long ago, we were informed by Public Health England that face masks were worse than useless outside of clinical settings. The subsequent volte-face, inconsistency across the devolved Administrations, and publicity given to more draconian recommendations by the World Health Organization are confusing and damaging to essential credibility and trust. Whatever the veracity of the mask concept, if we want the public to take our advice, then the message needs to be bold, clear and, above all, consistent until the pandemic is over. At that time, I trust that non-clinical masks will be worn only as a fashion accessory, and by those with unusual hobbies.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

My Lords, I understand that the noble Lords, Lord Pendry and Lord Wei, have withdrawn, so I call the noble Baroness, Lady Barker.

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[Lord Truscott (Ind Lab) [V]]

My Lords, as we have heard, the Government’s policy on wearing face masks has been shambolic, like much of their response to Covid-19. My wife and I went into voluntary lockdown on 14 March, and if the Government had brought lockdown forward similarly, tens of thousands of lives would have been saved. The president of the Royal Society has pointed out that mask-wearing countries have a much lower rate of transmission of Covid-19, as has been mentioned. The evidence for wearing masks is now overwhelming. I shall ask the Minister two questions. First, where does he expect people to buy the masks required to travel on public transport et cetera? Secondly, will Her Majesty’s Government, like some other countries, be handing out free masks at railway stations and shopping outlets, as some noble Lords have suggested?

[The Deputy Speaker]

Lord Rennard? I apologise, but we cannot hear the noble Lord. Baroness Thornton?

[Baroness Thornton (Lab) [V]]

My Lords, a speed dating debate such as this one at least ensures brevity. I congratulate noble Lords. There is a theme to the questions: our regret at another issue that exemplifies the Government being slow to act. Is this yet another policy announced without discussion with the devolved Administrations?

Two months ago, Labour backed the Mayor of London’s call for face masks on public transport to be compulsory. Two months ago, we raised the issue of bus drivers needing PPE, and asked whether buses should still run if there is not sufficient PPE. Does the Minister know the answers to these questions, and is he aware of the vulnerability and risk to bus drivers? We must wear masks on public transport from Monday, but who will enforce this policy, and who will help those who forget to bring their masks, forget to put them on, or cannot afford them? We need a comprehensive transport policy, to get our public transport moving, to protect staff and to protect passengers.

[The Deputy Speaker]

My Lords, may I just see whether the noble Lord, Lord Rennard, is available before we come to the Minister? No, I think he is not. In that case, I call the Minister.

Covid-19: Cancelled Medical Operations

Baroness Garden of Frognal Excerpts

Wednesday 10th June 2020 Lords Chamber

[Lord Bethell [V]]

The work of my noble friend Lady Blackwood on rare diseases is well known and acknowledged in the House. Those with rare diseases are in exactly in the kind of vulnerable groups that are being hard hit by Covid. They are given particular access to local support systems and they should have access to home testing services if they feel vulnerable to the effects of Covid. Further, I am happy to undertake a commitment to meet with the relevant stakeholder groups to discuss how we could be working harder to support them.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

We do not seem to be able to hear the noble Lord, Lord Patel.

[Lord Patel (CB) [V]]

My Lords, I have unmuted my microphone and I hope that my voice is coming through. I am sorry for the delay.

As the Minister will know, several million patients are on waiting lists for surgery. Given the increased levels of hygiene safety that will be required, it is inevitable that productivity will be down. This means that there will be a need for the prioritisation of cases. Does he agree that the professional organisations should draw up advisory guidelines for clinicians, rather than leaving it to the individuals?

--- Later in debate ---

[Lord Bethell [V]]

The noble Baroness is right to raise this concern. The bigger focus is less on the operational restraints, because the NHS has in fact done extremely well to keep the flow of operations going during this period. It is actually on demand. What we are most deeply concerned about is that patients return to hospitals and that their confidence in undertaking procedures is restored. That is why we have put a huge amount of emphasis on the marketing side of things. That is not to understate the importance of the operational side, but it is patient confidence that is our focus at the moment.

[The Deputy Speaker]

My Lords, the time allowed for this Question has elapsed and I apologise to the noble Lord, Lord Dobbs, and the noble Baroness, Lady Barker, that we have not been able to take their questions.

Queen’s Speech

Baroness Garden of Frognal Excerpts

Tuesday 22nd October 2019 Lords Chamber

[Baroness Garden of Frognal (LD)]

My Lords, I shall speak on education, although this is stretching the Queen’s Speech way beyond its content. As my noble friend Lord Storey and others have said, the only mention of it is:

“My Ministers will ensure that all young people have access to an excellent education, unlocking their full potential and preparing them for the world of work”.


That is hardly controversial, but it would be good to know just how the Government think they are preparing young people for the world of work with their constant focus on academic GCSE and A-level results at the expense of vocationally talented and motivated learners. Do the Government never make the connection between the growth in gangs and violent crime among young people and the fact that their compulsory education has left them alienated from learning, with a lack of self-confidence and self-respect because Shakespeare and algebra were not their skill set? Had there been encouragement and opportunity to work on cars, plumbing, construction, catering, hairdressing, caring or the arts, how different their lives after school might have been, but schools are not measured on practical achievements.

I declare interests as a fellow of Birkbeck, which has adult and lifelong learning at its heart, and as a vice-president of City & Guilds, which for more than 140 years has provided highly respected and well-understood employer-led vocational qualifications.

Preparation for the world of work depends on careers information and guidance at the earliest stage—certainly at primary school. The country faces a critical skills shortage and all the encouragement we can muster should be going to those young people whose motivation and talents lie in areas where GCSEs will be, to a great extent, irrelevant. What are the Government doing to motivate those young people? They may gain no credits for their schools in the narrow definition of education against which schools are judged. They may wish to embark on apprenticeships, often in the teeth of the opposition of schools and parents who fail to understand just how important a skilled workforce may be, even if they cannot pass GCSE English and maths in the approved fashion.

Where is the Government’s encouragement for lifelong learning? We certainly need the skills of adults to make up for the shortfall in younger skilled people. The Augar report, which seems to have been conveniently parked, recommended much better funding and support for further education for adults and work-based education. I endorse all that the noble Lord, Lord Lingfield, said on this subject. Love Our Colleges has been an active campaign, because for too long colleges have been the Cinderella service of our education system, with lower funding and lower pay for staff than for school teachers, but with huge responsibilities put on their shoulders. This has to be wrong.

As Liberal Democrats, we would aim to rectify this and to extend the pupil premium to the age of 19, because deprivation does not stop at 16. The £400 million that the Government have announced marks the first meaningful investment in further education for 16 to 19 year-olds for more than 10 years. It is not enough to reverse the decade of cuts, nor to properly stabilise the sector for the future, but it is a good start. We would introduce a personal education skills allowance to give motivation and funding to adults to retrain and reskill at key points in their working life. We would encourage support for those who take Open University degrees, who are motivated by learning but deterred by funding.

Given my portfolio, I must address the dreaded T-levels. I echo all that the noble Lord, Lord Willetts, said. This innovation is mistimed, mistaken and flawed. Instead of building on BTEC and City & Guilds qualifications, which have long been the benchmarks for industry, the Government threaten to undermine such tried and tested qualifications in favour of untried, untested T-levels. The noble Baroness, Lady Barran, repeated the mantra that by renaming vocational qualifications as technical qualifications we would, at a stroke, solve the academic and vocational divide. If only life were that simple.

This Government will not be forgiven if, in pursuit of this latest initiative—which might well be one of many that founders in the course of time—they withdraw funding and support from technical, craft and vocational qualifications that have long served employers so well. I therefore appeal to the Government to think again on T-levels, to give more time to pilots and, meanwhile, to ensure that existing qualifications remain available and supported to work-based learners. I will not hold my breath for a response today as we do not have an education Minister here to reply, but the education team on these Benches will keep pressing the Government for action on further education and lifelong learning and for recognition of the very real value of practical work-based achievement.

We face huge skills shortages in this country: in construction, engineering, hospitality and the creative industries. We deserve an education system that meets the needs of learners and of the economy. Yes, of course we need to support our brilliant universities, but for the 50% or more who do not go to universities, let us celebrate their talents and the skills that they acquire that meet the needs of employers.

Healthcare (International Arrangements) Bill

Baroness Garden of Frognal Excerpts

Report stage (Hansard): House of Lords
Tuesday 12th March 2019 Lords Chamber

4: Clause 2, page 1, line 11, leave out subsections (2) to (4) and insert—
“(2) Regulations under subsection (1) may be used only to the extent necessary to replicate so far as possible the model of reciprocal healthcare for the European Union, the European Economic Area and Switzerland in place before the withdrawal of the United Kingdom from the European Union.”

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

Amendment 4 is, I think, consequential on Amendment 1.

[Lord Marks of Henley-on-Thames]

I am not sure that Amendment 4 is entirely consequential, so it is probably better if I do not move it, now that Amendment 1 has been agreed.