Health and Care Bill

Baroness Lawrence of Clarendon Excerpts

Lords Hansard - Part 1 & Committee stage
Wednesday 9th February 2022 Lords Chamber

[Lord Crisp (CB)]

My Lords, I wish to speak to Amendment 292 and specifically proposed new subsection (5)(c) on the TRIPS waiver.

I was going to make a few points of context but the last two speeches—indeed all the speeches so far—have set the context extraordinarily well. As the noble Lord, Lord Howarth, has just said, Our World in Data tells us that, as of an hour ago, 66% of the world overall has had one dose but only 10% of those are in low-income countries.

When this discussion has been raised before—for example, during Questions on Monday in your Lordships’ House—the Government responded that there were practical problems with the proposal. Indeed, there are practical problems and it is not a magic bullet, but it is a first-class starting point. It is also a point that we then need to follow up with political will. I do not understand why the UK and Europe—with the exception of France, which has just said no to the proposal—have not put forward a counterproposal starting from this point. Why have they not done what some other noble Lords have talked about—something similar to what the noble Lord, Lord Campbell-Savours, has suggested? Why not use this proposal as a starting point to do something for three big reasons?

The first of those reasons is the end game here. The end game is not about intellectual property but about dealing with the next pandemic, and the one after that. It is about having the ability to manufacture and make vaccines available around the world, quickly and rapidly, whenever there is a need for that to happen. That is what we are looking at.

Secondly, the point has already been made that the UK could play a much bigger role here and in the direct interests of the UK population. We are a global power in biomedical science and technology. We have produced some help; I note, for example, during our G7 presidency, the ability to offer some scope to other countries for sequencing variants. However, much more that is being done in this country could be expanded on. I think, for example, of the global pathological analytical service being developed in Oxford, which is basically a database for the sequencing of variants around the world, and is making the data accessible to everyone, free of charge; anyone in the world can send their data to it for analysis to be provided. So there are many things that the UK could be doing and offering as part of the development of a sensible plan for the future that responds to what low and middle-income countries are asking us to do.

The other big point here is that if the UK does not respond, others will. We have already seen the process of vaccine diplomacy during the pandemic, and the positioning of China and Russia in how they have been seeking to make friends and influence people through the use of vaccines. We can also see that countries will start helping themselves, and they in turn will break away from the consensus.

I am reminded of the very different epidemic of HIV/AIDS, more than 20 years ago. It is a very different disease, and the circumstances were very different. However, some of the responses were the same. To quote Dr Peter Mugyenyi, who was head of the HIV/AIDS response in Uganda in 2000,

“despite opposition by branded drugs manufacturers, and threats of punitive reaction, we took a decision to import and use low-cost generic ARVs from … India to save the lives of our patients”.

In a way, that says it all. Countries have that responsibility to their people, and they will go and do things.

Dr Mugyenyi goes on to say in the same article that at that point, the drugs were relatively expensive for Africa, but USAID, the US development agency, would not support their use in Africa because, it said, there was no ability to provide them to the population without the necessary supply chains. In an extraordinarily insulting and racist statement, the head of USAID said in 2001 that Africans could not use ARVs because they told the time by the sun. Two years later, President Bush moved that on, and President Clinton also intervened, with the result that antiretrovirals became cheaper. There is a process that will take place, whether we are a part of it or not. We do not know where this will end, but other countries will take their action.

The really important thing here is that the UK properly engages with this proposal, and puts in the counterproposal, whatever it is. It must be about working together, something along the lines of what the noble Lord, Lord Campbell-Savours, talked about: licensing it, working with people, learning from each other and building that infrastructure around the world, which, frankly, we need for the people of the UK as well as the people of the world.

I hope that in responding to this the Minister will talk about how he sees that development happening in the longer term and how the UK will have an impact on what we all see as a shameful position where we in our richer countries have been vaccinated if we have chosen to be, but in low-income countries people have not had that opportunity.

[Baroness Lawrence of Clarendon (Lab)]

My Lords, I have added my name to the amendment in the name of the noble Baroness, Lady Chakrabarti. It has been mentioned in your Lordships’ House numerous times that no one is safe until we all are safe. We have heard it many times in today’s debate.

I have voiced my concerns many times about the monopolies upheld by high-income countries that have chosen to retain scientific innovation and expansion by withholding the IP of the Covid vaccine. Low-income countries are in the position where they can manufacture their own vaccines, as there are more than 100 potential mRNA manufacturers across these countries ready to develop a vaccine, if they had access to the IP and the manufacturing know-how.

Too often the agendas of pharmaceutical companies are not aligned with positive public health outcomes. The public health condition aspect of Amendment 292 will help guide the Government to tighter stewardship around public funding to ensure that at the end of the development process, health treatments are both affordable and accessible to all concerned. I stand by the amendment in the name of the noble Baroness, Lady Chakrabarti, for this very reason, as its primary objective is to address the barriers that prevent poorer nations having adequate access to medicines at an affordable rate. We have heard many of your Lordships in the Committee today seeking to make the Government understand what is happening in lower-income countries and to support them and to ensure that action is taken when we say that no one is safe until all of us are safe.

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

Baroness Lawrence of Clarendon Excerpts

Friday 25th September 2020 Lords Chamber

[Baroness Lawrence of Clarendon (Lab)]

My Lords, one thing that has to be said about the statutory instruments being discussed today is that, whatever their good intentions, they are certainly complicated. Obviously the author felt a duty to be both precise and comprehensive, otherwise we would not have in Statutory Instrument No. 828 the laborious definition of an “elite sportsperson” or of all that the word “vessel” can mean—although the sub-paragraph does not refer to the old proverb about empty vessels.

As we look back over the months and survey the statutory instruments produced by the Government on restrictions on gatherings, we have concluded that the whole policy has become an unholy mess, a confusion of mixed messages and tentative, half-baked decisions. Any scan of media cuttings from the north of England in the past few days will expose just how much bewilderment there is among the local population about what is or is not permissible and what is or is not wise. The spate of legalisms contained in the statutory instruments is directly responsible for that state of affairs. We need more clarity for people, not more jobs for lawyers.

One has to wonder whether we would be in a happier situation if greater flexibility were to be embedded in the legislative process here. I think we might all agree that each statutory instrument before us today is a cumbersome and unwieldy tool—a perfect metaphor for the Government’s utterances on social gatherings since the very first version of lockdown.

Covid-19: Rise of Positive Tests

Baroness Lawrence of Clarendon Excerpts

Wednesday 9th September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, the impact on R is not entirely clear at the moment. ONS and REACT figures will be published shortly, and they will have the statistical analysis that the noble Baroness asks for. However, it is safe to say that R is up. With regard to schools, the Government have made it clear that our support for the return to schools is completely emphatic. However, I remind the noble Baroness that the average distance travelled for tests, even at this stage, remains 6.4 miles. Ninety per cent of people who book a test travel less than 23 miles, and 90% of tests undertaken in our mobile sites are still converted in 24 hours.

[Baroness Lawrence of Clarendon (Lab)]

My Lords, the Government have imposed 14 days’ isolation on people travelling from certain countries where the virus is increasing. What steps have Her Majesty’s Government taken to ensure that children travelling back with their parents are not returning to schools—so that a child with the virus goes to school on day one and the children then have to be isolated?

[Lord Bethell (Con)]

My Lords, the quarantine arrangements we have put in place are essential for containing the spread of the disease. We completely sympathise with parents who have found themselves caught overseas. However, we implore them to abide by the quarantine arrangements and return their children to school once the 14-day quarantine has passed.

Covid-19: BAME NHS Staff

Baroness Lawrence of Clarendon Excerpts

Tuesday 19th May 2020 Lords Chamber

Asked by

[Baroness Lawrence of Clarendon]

To ask Her Majesty’s Government what assessment they have made of the impact of COVID-19 on black, Asian and minority ethnic frontline staff working in NHS hospitals.

The Question was considered in a Virtual Proceeding via video call.

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

My Lords, the Government are deeply concerned about these groups. That is why we have asked Public Health England to review the evidence. In advance of PHE’s recommendations, NHS England has written to NHS services so that, on a precautionary basis, employers can risk-assess staff at potentially greater risk and make appropriate arrangements accordingly.

[Baroness Lawrence of Clarendon (Lab)]

I thank the Minister for that Answer. I have been asked by the Labour leader to conduct a review into the effects of Covid-19 on the BAME community. Are the NHS and Government making sure that BAME nurses are properly shielded with adequate PPE? Have they considered taking BAME nurses and staff off the front line, as they are overrepresented in the death toll of the virus?

[Lord Bethell]

As I mentioned in my previous Answer, arrangements have been put in place for local trusts to risk-assess all employees, including BAME nurses, and to assess whether they are at a higher risk and, if necessary, to change their rotas and staffing arrangements accordingly. I understand that some trusts have already taken these measures.

Mental Health Services: Children and Adolescents

Baroness Lawrence of Clarendon Excerpts

Monday 17th July 2017 Lords Chamber

Asked by

[Baroness Lawrence of Clarendon]

To ask Her Majesty’s Government when they intend to bring forward proposals to reform Child and Adolescent Mental Health Services as outlined in their 2017 manifesto.

[The Parliamentary Under-Secretary of State, Department of Health (Lord O'Shaughnessy) (Con)]

My Lords, the Government are committed to delivering their manifesto pledge to reform child and adolescent mental health services so that children and young people with serious conditions are seen in a timely manner and no child has to leave their local area and family to receive normal treatment. We will set out proposals in the Green Paper for children and young people’s mental health later this year.

[Baroness Lawrence of Clarendon (Lab)]

My Lords, I thank the Minister for his Answer. In a report published on 5 November 2014, the Health Select Committee came up with a series of deep-rooted complications in the provision of child and adolescent mental health services. With 75% of mental health problems starting before the age of 18 but only 8% of mental health funding currently spent on children and adolescents, questions must again be raised. Will the Minister consider ring-fencing funding for young people with mental health problems and ensure that it reaches front-line services, so they do not have to wait for another report to be published?

[Lord O'Shaughnessy]

I thank the noble Baroness for highlighting this very important issue. She will know that ring-fencing funding for mental health comes up a lot. There has been increased funding for mental health, but there is more than one reason why ring-fencing is not used for clinical commissioning groups, including honouring the principle of clinical autonomy, and we do not ring-fence around particular disease areas. I should point out that CCGs are being monitored now to ensure that they are increasing spending on mental health, year on year, in line with the increases in funding they are receiving, which is £1.4 billion over the coming years. The noble Baroness is of course quite right in what she said about the specific issue of children under the age of 18. That is why, among other things, we have committed to introducing mental health first aid in all secondary schools.

Queen’s Speech

Baroness Lawrence of Clarendon Excerpts

Thursday 29th June 2017 Lords Chamber

[Baroness Lawrence of Clarendon (Lab)]

My Lords, the decisions on grammar schools and higher education were omitted from the gracious Speech, as was positively noted by many noble Lords. However, my focus today will be on higher education and, in particular, on the positive impact of international students who study in the UK. I declare my interest as chancellor of De Montfort University.

It is fair to say that following the Brexit result a high degree of negativity has been centred on immigration, with a significant part of it emphasising international students. Therefore, I want to convey the benefits of having international students as part of our global society. We too often hear of the negatives and rarely come across the positives. To endorse this, I shall set out some findings from a survey conducted by Oxford Economics for Universities UK in 2014-15 which gave a clear indication of why it is so important for the UK, as a world leader in global education and research, to maintain a lead in bringing in international students.

The UK has been the second most popular global destination for international students after America. However, this number has declined recently, given that other English-speaking countries, such as Australia, New Zealand and Canada, and Europe have increased their number of overseas students. The basis for the decline has been attributed to factors such as changes in student visa arrangements, the net migration target and, more recently, Brexit, although the actual impact of Brexit on EU students in the UK remains unknown. For the moment, the Government have guaranteed to continue to fund EU students until 2019.

In terms of benefits, what are we actually looking at? International students have very much been part of the essence of university life culturally and socially, and the students have always been essential to the UK’s higher education sector and to the country more widely. International students contribute more than £7 billion to the UK economy, and spending by international students supported 206,600 jobs in university towns and cities across the UK. In 2014-15, 437,000 international students, EU and non-EU, made up 19% of all students registered at UK universities. Their contribution to on and off-campus spending has generated £25.8 billion in gross output for the UK’s economy. International students are necessary for the British economy as a whole, being responsible for £10.8 billion of UK export earnings. They also boost other British industries. For example, they add £750 million to the UK transport industry and £690 million to the retail industry.

In my role as chancellor of De Montfort University, I have obtained some facts, and I would like to share with the House a case study on De Montfort students’ impact on the local community via DMU Square Mile. One-fifth—560—of its 2,800 student volunteers are international students. They have done more than 5,000 hours of work in the community this year. Nabeelah Omarjee is from South Africa. Nabeelah’s enthusiasm has seen her benefit hundreds of people by volunteering on a variety of projects in Leicester and abroad. By taking part in projects around cancer, refugee support, diabetes and more, Nabeelah has always been available to give anyone a helping hand. DMU Global is De Montfort’s pioneering international student experience programme, and demonstrates that DMU is committed to ensuring that its students have a global outlook. I must not forget the DMU Love International campaign, which has celebrated the value that international students and staff bring to the UK.

It is very concerning, therefore, that following several reforms made to the immigration system, the UK’s higher education sector as a whole has experienced two consecutive years of falling overseas entrants: 2011-12 and 2012-13. This is not regarded as a dramatic drop in enrolments, but this recent trend challenges the levels of growth witnessed pre-2010. While demand has continued to increase from countries such as China, the number of Indian students commencing courses in the UK has almost halved in two years. The higher education sector as a whole now sources around one-eighth of its income from international students’ tuition fees. Fluctuating demand from prospective students overseas can therefore leave institutions vulnerable or affect their ability to plan strategically in the long term. Therefore, I ask Her Majesty’s Government to recognise that international students are of real and great importance to the UK’s higher education sector and to the country regionally. Although there have been suggestions that a more positive picture is emerging, it is key that an encouraging approach is maintained and narrated to the global society which demonstrates the values and commitment made by the UK to enhance and develop further the huge opportunities available to young people all over the world.

Health: Black and Minority Ethnic Psychiatric Patients

Baroness Lawrence of Clarendon Excerpts

Monday 29th February 2016 Lords Chamber

Asked by

[Baroness Lawrence of Clarendon]

To ask Her Majesty’s Government what steps they are taking to reassure black and minority ethnic patients, carers and users of mental health services that they are not being prescribed higher levels of psychiatric medication than those from other community groups.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, improving the experience, access and outcomes of mental health services for people from black and minority ethnic communities is a government priority. The Five Year Forward View of mental health services recommended the appointment of a new equalities champion. The Government have accepted the recommendations for the NHS and agree with the task force’s vision for the future.

[Baroness Lawrence of Clarendon (Lab)]

I thank the Minister for his reply. In the last month there has been a government announcement on mental health. There is always a broad-brush approach to this subject. What we need to remember is that no two people are the same and that there are different cultures. People from the black and minority ethnic communities are treated differently when it comes to treatment and institutions where they are placed. That is a fact. There are more treatment options becoming relevant for people with severe, enduring mental health problems and it is not clear whether BME patients are getting access to these—for example, talking therapy. BME patients are more likely to be given higher doses of psychiatric medication. My question to the Minister is: what are the Government doing to ensure that BME patients are offered the same access to treatment options as their white counterparts, and not just psychiatric medication?

[Lord Prior of Brampton]

My Lords, although there is evidence that gender and ethnicity affect the efficacy and tolerability of some medicines, there is no evidence that people from black and minority ethnic backgrounds are prescribed a higher dose of antipsychotics. On the other hand, there is considerable evidence that many people from BME backgrounds are detained more, spend more time in in-patient psychiatric facilities and suffer greater seclusion, and that other aspects of mental health treatment for black and minority ethnic people are entirely unsatisfactory.