Biosecurity and Infectious Diseases

Baroness Murphy Excerpts

Thursday 18th January 2024 Lords Chamber

[Baroness Murphy (CB)]

My Lords, the House has not seen much of me this last year, because last year I was one of the 100,000 people to be admitted to hospital in the UK with cellulitis, going on to septicaemia, which then progressed very rapidly to sepsis. I owe my life, or at least my legs, to flucloxacillin. So I thought I would talk about antimicrobial resistance today. I am perfectly well now, by the way, so no worries for the future.

First, antimicrobial resistance in humans is due to inappropriate or excessive prescribing by doctors, of whom I am one, not just in the UK but worldwide. Some 58,000 people in England were reported to the UK Health Security Agency—probably an underestimate, of course—to have had a resistant infection in 2022; that was a rise of 4% in a single year. With Klebsiella pneumoniae, for example, which is a very common cause of sepsis in this country, 30% of the bug’s subtypes are now resistant.

Pre-pandemic, there was a very healthy drop in prescriptions, which was due to doctors’ efforts to reduce the number of inappropriate antibiotic prescriptions, which are usually given out for very mild virus disorders, of course. But this has not been maintained after the Covid pandemic; in fact, they are on the rise again, and we need another big effort. What are the Government doing? I realise that I am asking for some Department of Health wisdom here, as well as the Minister’s own.

The second issue, of course, is, as we have heard from everybody, the global impact of antibiotic resistance, which is brought by travellers from abroad. At the moment, Asian and Asian British ethnic groups have almost double the proportion of antibiotic resistant infections—35%—compared with only 19% in white British ethnic groups. This is probably because of antibiotic overuse in south-east Asia.

I was sceptical about this—I thought it could not be happening that quickly—but recently an elegant study looked at subtypes of enterobacteria causing dysentery that are currently found in India and Pakistan, and you can map the progress of the subtypes cropping up all over the UK, so it is due to international travel. The Hospital for Tropical Diseases recently reported 92 travellers arriving in Britain from south Asia and Nigeria with enteric fever caused by salmonella and found that 30% were multiple drug resistant.

Globally, the financial costs of resistant strains of malaria, HIV and TB are directly related to poor prescribing and inadequate courses of treatment. In this age of global travel, as we have heard from others, the transmission of resistant strains of tropical diseases is of increasing importance. The ill-educated beliefs of patients impact very much on doctors’ prescribing habits. We know that GPs who do not prescribe antibiotics tend to be less highly rated and less popular. In Romania, Greece and Hungary most people buy their antibiotics over the counter and there is very little control indeed. In Cyprus, Estonia, Italy and Spain, most patients get antibiotics left over from previous courses—and I bet there is not anyone in this House who has not done the same. We use antibiotics from last year if we think we have something that we need to use them for. We need a real effort to reduce these.

Finally, I want to mention the issue of antibiotics in livestock. The noble Baroness, Lady Bennett, has brough the issue of fish farming to our attention because it is one area where we are not making progress. I thank the noble Lord, Lord Trees, for his brilliant personal briefing on this. We are making good progress on tackling resistance in animals by the improvement of their environments so they do not get infections in the first place, the control of veterinary medicines and the excellent work done by vets in the UK. However, as we have heard, that is not necessarily the case in other countries. We have achieved a 42% reduction in fluoroquinolones and reductions in other important drugs, such as cephalosporins, that are important to human beings.

So we are making good progress. We probably do not need to make it statutory by banning things; it is always better to do it with the co-operation of the agencies, individual professionals and farmers involved. However, we need to make greater progress on antimicrobial resistance. I know the Government were negotiating with the pharmaceutical industry to see what could be done. Can the Minister tell us how far have we got on our project there?

Brexit: Agriculture and Farm Animal Welfare (European Union Committee Report)

Baroness Murphy Excerpts

Tuesday 17th October 2017 Lords Chamber

[Baroness Murphy (CB)]

My Lords, I speak with no more expertise in agriculture than being resident in rural south Norfolk, so I am rather like my noble and learned friend Lord Hope in that respect; I am surrounded by fields. The county of Norfolk has the largest agricultural sector of any English county and contributes 7% of English food production. I am a psychiatrist first and a historian second. I do not think that my first skill will be useful in this debate but perhaps the second will be.

I congratulate the committee chaired by the noble Lord, Lord Teverson, on identifying in no uncertain terms the serious risks to which the Government are exposing our rural community. Leaving the European Union is of course a political decision, not an economic one, but in my view possibly the most foolish political decision a UK Government have taken in my lifetime. I do not blame the British public. If you ask them a foolish question, you will get a foolish answer. There is no escaping it, however, because apart from the Lib Dems, the main political parties are intent on hurtling over the cliff like lemmings. By the way, lemmings are not committing suicide; they are simply misjudging the distance they have to jump across the water to find a new habitat—a rather better analogy for the Brexiteers, I think.

Our rural economy is kept afloat by the £3 billion that flows into rural areas from the EU, and while there is a commitment to the continuity of mainstream CAP funding over a brief transition period, history tells us that the Government will almost certainly pull the plug on farming subsidies quite quickly. There seems to have been very little in the way of learning from history of how previous subsidies developed over a longer historical period. I will not go back to the support for wheat producers through the Corn Laws that went on for 30 years after the Napoleonic wars, as the noble Lord, Lord Jopling, did, but I will refer to 1917 as the Atlantic blockades began to bite during the First World War. The Corn Production Act 1917 and Agriculture Act 1920 ensured that the last years of the Great War were profitable ones for farmers, but those Acts which protected farm wages and corn prices were repealed in 1921—just three years of peacetime for the Government to lose interest in farming. In 1921 the Government were facing a potential £20 million subsidy bill for the agricultural sector when other parts of the economy had no such protection and high food prices were resented by a predominantly urban electorate. We are, and remain, a nation of townies. The result was a rapid reduction in agricultural wages, by about 40% in the first year, and the increased indebtedness of farmers, which did not improve until subsidies were re-introduced in the Second World War. Then it started all over again. Indeed, subsidies were withdrawn again after the Second World War, apart from support for some important food products we were short of.

What will be different this time round? Perhaps the Minister will tell me. Will the urban public be happy to see £3 billion go into a sector that produces only £9 billion of GDP? That seems unlikely. As the economic disaster of Brexit impacts on the rest of industry and our public services, the Treasury will surely look to that £3 billion pot to start funding its other priorities—and I might vote for it too. That is a threat to the very fabric of rural Britain, not only to our home-grown food production capacity but to the environment, landscape and wildlife. I thought the noble Baroness, Lady Miller of Chilthorne Domer, would say what she has said before: that it would be ironic if the old Britain that the Brexiteers are so nostalgic for is wiped out by Brexit itself.

Of course, if we get a common market free trade deal with Europe and a continuing customs union, all will not be so doom and gloom, and there could be a new settlement for agriculture and the environment. No one doubts that the common agricultural policy system is inefficient and has rewarded the wrong things. Indeed, I carry no candle for the great wheat barons of Cambridgeshire; I hope one is not sitting in the Chamber. It would be nice to see more-focused support for the type of sustainable but efficient food farming that produces goods that are attractive to consumers all over the world without ruining our landscape. However, if we leave with no deal, as some deluded folk seem to think we can with equanimity, then, as we have heard so often here, our farming communities will become theme parks, perhaps for foreign investors chasing nice houses. Will the Minister assure us—I am asking a lot—that the Government will not leave the EU without a realistic trade and customs deal sealed, and will create a mechanism to support the public benefit that farming can have for us all?