Black, Asian and Minority-Ethnic Women: Maternal Mortality Rates

Baroness Prashar Excerpts

Monday 29th July 2024 Lords Chamber

[Baroness Merron (Lab)]

I pay tribute to the noble Baroness for her work promoting good health for women and girls, and I look forward to working with her and with other noble Lords across the House. One of the first calls that I made was to the women’s health ambassador and I will certainly look to her to drive forward the change and improvements in patient safety and patient experience that we desperately need.

[Baroness Prashar (CB)]

My Lords, while I welcome the Minister’s commitment to look at all the recommendations that have been around for a pretty long time, and it is frustrating that action has not been taken, can she give a commitment that once she has considered those recommendations, and if there is a plan of action, she will report to the House on what that plan is likely to be?

[Baroness Merron (Lab)]

I will indeed be very pleased to report back to your Lordships’ House on this matter. It is something that greatly concerns me, because it cannot be acceptable that women go into childbirth, which should be a happy and safe occasion, and perhaps come away with trauma, and in some cases families experience death as well. We cannot have a situation like that. I have been very moved by the stories I have heard and will commit to working to put improvements in place, and to sharing that with noble Lords.

Covid-19

Baroness Prashar Excerpts

Thursday 15th July 2021 Lords Chamber

[Lord Bethell (Con)]

The noble Baroness obliges me to confess that, as a young man, I mastered the art of controlling my sneezing, and I am pathetically proud of this. I should be glad to share the skill with her should we have the opportunity to spend some time together.

[Baroness Prashar (CB) [V]]

I want to return to the question of masks. As we have already heard, the ending of the mandatory wearing of masks is causing anxiety and insecurity among clinically vulnerable people. Would the Minister agree that, given that the wearing of masks reduces the spread of the virus and causes no harm to the economy, it would be sensible to make it mandatory? Secondly, guidance recommends good ventilation in enclosed spaces. What assistance are the Government giving to those who need to install air filtration systems?

[Lord Bethell (Con)]

My Lords, I will be crystal clear on this matter. The noble Baroness is right: the wearing of masks is important—for yourself and other people— which is why the Government continue to recommend that people wear them. However, the question was about mandation, and, as I said earlier, it is not reasonable for the Government to mandate minute aspects of our life in perpetuity. We have made a decision on that and passed the responsibility to individuals, local leaders and those who do outbreak management. I completely understand and hear loud and clear people’s concerns, but, were we to mandate it, what is the option for the country? Are we going to issue tens of millions of fines to those who do not wear masks? If they do not wear them, will we lock them up in prison? We tried extremely hard on that policy, but I am not sure whether it had any further rope to run.

Covid-19 Update

Baroness Prashar Excerpts

Tuesday 6th July 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I wish zero Covid was possible. I wish we had never had it at all in this country, but it is a fiendishly clever virus and it gets around the measures we put in place to try to fight it. I can, very sadly, confirm that zero Covid is not something we can plan for in this country. What we can plan for is the winter. I reassure my noble friend that the NHS has extremely thoughtful and diligent plans for the winter. It has a specific winter plan and I would be happy to write to my noble friend with a copy.

[Baroness Prashar (CB) [V]]

Does the Minister agree that reliance on the good sense and responsibility of the public should be supported by clear guidance, backed by scientific evidence? If so, will he please tell the House whether the Government are planning to provide such guidance and explanation? How will it be made available in an easily accessible form?

[Lord Bethell (Con)]

My Lords, that is an extremely broad question. I reassure the noble Baroness that we have published thousands of pages of guidance, many of which have been across my desk, and it has been a privilege to read it all. We have developed better thinking on how we do guidance: I would like to think that it is now written in clearer English and in more languages, and has been made more accessible to those who have reading challenges. We have developed those important learnings over the pandemic.

Covid-19 Update

Baroness Prashar Excerpts

Tuesday 15th June 2021 Lords Chamber

[Lord Bethell (Con)]

I completely accept the challenge. These anomalies exist and he is entirely right to beat up the Minister for this kind of stuff. It is unbelievably difficult to write guidelines that touch so many different parts of life, and I would not pretend for a moment that there is 100% consistency in everything that is done. But I have made the point emphatically: these things are done to save lives and protect people from infection. They are done with a heavy heart, having looked at the scientific evidence, with a sense of regret that we are letting down those with a passion for singing and religious worship, and in the hope that we can get rid of them very soon. We are taking concrete steps as quickly as we can to deliver the vaccines. In terms of care homes, as he knows, there is a consultation in process and that consultation is working its way through.

[Baroness Prashar (CB) [V]]

The Prime Minister rightly says that we have to learn to live with Covid. Therefore, does the Minister agree that, while vaccinations provide protection and effective test and trace is essential, it will continue to be necessary to take sensible precautions for self-protection if we have to learn to live with this virus and its variants? Does he also agree that there is a need for continuous public education and clear, consistent guidance to explain why these precautions are necessary? If so, apart from the effective rollout of vaccinations and test and trace, what plans do the Government have in the longer run for promoting a public education health programme?

[Lord Bethell (Con)]

I am enormously grateful for the question from the noble Baroness. She gives me an opportunity to lift my head for a moment and think about a brighter future, because she is entirely right. One of the possible benefits from this awful virus is a different approach to public health that is much more effective in fighting contagious diseases, where we have much more effective tests for everything from flu to RSV to things like Covid as well, and where we can get therapeutic drugs to people the moment they test positive so that they do not fall sick. We can use this investment in public health to help level up some of the health inequalities that have beset this country so heavily.

Covid-19

Baroness Prashar Excerpts

Thursday 3rd September 2020 Lords Chamber

[Baroness Prashar (CB) [V]]

My Lords, why do we not have testing at airports yet? Leading figures in the aviation industry are expressing frustration and it is having a detrimental impact on the industry. Other countries have managed to introduce testing at airports; why are we lagging behind?

[Lord Bethell (Con)]

My Lords, I completely hear the frustrations of the airport and airlines industries about testing, but I cannot hide from them the simple epidemiological facts. If someone arrives at an airport, they may not test positive if they are harbouring the infection deep inside themselves. It may take days—up to 14 days—for that infection to manifest. I wish it were different; I wish we could set our airports free. Until we find a system that can handle that complexity, I am afraid that we will have to live with the system we have.

Medical Teaching and Learning: Ethnic Diversity

Baroness Prashar Excerpts

Tuesday 14th July 2020 Lords Chamber

[Lord Bethell]

My Lords, I completely agree with the noble Lord, Lord McColl, that complacency is our enemy. I recommend to him the NHS workforce race equality standard publication, which is very detailed in its analysis of the problem and is a guide to the challenge we face and a measure of how far we have come. I completely commend the achievements of those in the BAME community who often far outperform those of us who were born in Britain.

[Baroness Prashar (CB) [V]]

My Lords, we all know that incorporating diversity into medical school curricula is an effective way to develop culturally sensitive responses by medical practitioners. However, does the Minister agree that we need medical curricula where diversity is integral and understood in all its dimensions, including institutional and personal biases? Would he also agree that the current guidance, while welcome, is full of good intent but lacks conceptual clarity, and that more effective work is needed to develop a meaningful and more rounded curriculum and means to evaluate its efficacy?

[Lord Bethell]

The noble Baroness put her point well, although the broadband deficiencies meant that I did not get all of it. I emphasise that this area of policy work is very much the focus of the drafting of the People Plan, which will put a spotlight on a number of the areas of our human resources, including BAME people, and we look forward to the publication of that plan.

Covid-19: Care Homes

Baroness Prashar Excerpts

Wednesday 20th May 2020 Lords Chamber

[Lord Bethell]

The noble Lord is more expert on the history of public health than I am, but I do not doubt the story that he talked about. I reassure him that Covid has definitely made us all think again about the very clear priority that local public health provision must and will provide. I would like to pay testimony to those public health officials—public health directors, environmental health officers, infection control officers—who play, and are currently playing, a huge role in controlling the epidemic.

[Baroness Prashar (CB)]

My Lords, the Statement is encouraging on one level but very disappointing on another, since it does not recognise that initially there were delays and problems. Consequently, care workers in those homes were working in very difficult and distressing circumstances, often without PPE and on low pay, in many cases below the real living wage. Will the Minister agree that they deserve not just applause but proper protection and a real living wage?

[Lord Bethell]

My Lords, we ensure that the social care system is funded so that providers can pay the national minimum and living wages to care workers. Since the introduction of the national living wage in 2016, care worker pay has increased at a faster rate than before. I share the noble Baroness’s praise for care workers. As a group, our million-plus care workers have massively delivered for the country. They deserve our praise, our thanks and a tribute from this House.

Alcohol Strategy (EUC Report)

Baroness Prashar Excerpts

Wednesday 10th February 2016 Grand Committee

Moved by

[Baroness Prashar]

That the Grand Committee takes note of the Report from the European Union Committee, A New EU Alcohol Strategy? (8th Report, Session 2014–15, HL Paper 123).

[Baroness Prashar (CB)]

My Lords, I move this Motion as chairman of the European Union Sub-Committee on Home Affairs, Health and Education, which prepared the report to which this Motion relates. Before I get into the substance, I thank the current and former members of the committee, the former clerk to the committee, Michael Collon, and its policy analyst, Lena Donner, for their assistance with the preparation of the report.

As your Lordships all know, alcohol is a major contributor to loss of life and to the burden of disease in Europe. Harmful and hazardous, alcohol use is associated with a wide range of physical, psychological and social harms. The costs to individuals, communities and society are widely recognised. Europe has the highest per capita alcohol consumption of any region in the world. In 2004, the World Health Organization estimated that in the European Union, 11.8% of deaths of people aged 15 to 64 had causes attributable to alcohol. Alcohol also causes harm to others, through drink-driving or domestic violence, while heavy drinking can cause harm to unborn children. To address these problems, in 2006 the European Commission adopted an EU strategy to support member states in reducing alcohol-related harm. This strategy had five priorities: to protect young people, children and unborn children; to reduce deaths and injuries from alcohol-related road accidents; to reduce alcohol-related harm among adults; to increase education and awareness; and to develop and maintain a common evidence base. This strategy expired in 2012 and so far, it has not been renewed.

The sub-committee on home affairs, with its joint responsibility for health and crime, undertook an inquiry which started in July 2014 and was completed in March 2015. Our aim was to assess the 2006 to 2012 alcohol strategy and in part to determine whether there was any value in further EU action in this area. We took evidence from academics, medical professions, non-governmental organisations and industry representatives. Not surprisingly, the evidence was highly polarised and there was no meeting of minds between the public sector professionals and the alcohol industry. But in assessing the first strategy, it was clear that it is difficult to attribute outcomes accurately to any one policy measure or strategy. This difficulty was compounded by the complexity of the cultural, economic and social differences across member states. Furthermore, we found that there was a lack of research indicators, standardised data collection systems and evaluation mechanisms. The strategy has notably failed in achieving one of its key priorities: to develop a common evidence base.

Another fundamental problem was that the EU has only limited competence in health and that the strategy concentrated on matters where the EU could do no more than encourage action by other member states. It ignored a number of areas where it has competence to take action—for example, on EU alcohol taxation regimes or EU rules on food labelling.

Our witnesses said that there should be further action at EU level and that this should take the form of a new strategy. The public health lobby favoured much more action to combat alcohol abuse, although much of it is outside the competence of the EU. Manufacturers, retailers and advertisers of alcoholic drinks nearly all favour the continuation of the same strategy, but our conclusion was that action is worth formulating at the EU level only to the extent that it supplements and supports what member states do independently.

There is in fact considerable scope for action at EU level that is within the competence of the EU. Our conclusion was that action should not be confined to policies dealing specifically with alcohol misuse, though there should be what is called a “health in all policies” approach in related areas such as food labelling, cross-border marketing and taxation. This would bring greater coherence across EU policy areas while respecting the competence of member states in health matters. We also concluded that action is more effective if targeted at specific populations. Accordingly, EU-level measures should be flexible enough to allow members to adapt them to the national context.

The EU alcohol taxation regime is illogical. While beer is taxed based on its alcohol content, wines and ciders may be taxed only according to the volume of the finished product. This prevents member states imposing duty in accordance with alcohol strength, thereby reflecting the public health risk associated with the product.

Minimum unit pricing, as we all know, is a highly controversial topic and views on it are sharply divided. In spite of the commitment to bring forward such a measure in 2012, the Government have so far only introduced a ban on selling drinks below the cost price —that is, they may not be sold at a loss to the retailer. The Scottish Parliament, by contrast, passed an Act in 2012 to set an absolute minimum price of 50p per unit of alcohol. However, this law was not brought into force because it was challenged in the Court of Justice of the European Union, and in December 2015 the court gave a preliminary ruling that such a measure would be unlawful. Part of the court’s reasoning was that the minimum unit pricing objective of protecting health and life could effectively be achieved through taxation. This neglects the point that the aim of the measure was to target those with the most serious alcohol addictions, and that taxation cannot be easily imposed because of the rigidity of the EU tax structure to which I have referred.

Following this judgment, I understand that the Ministers of the Scottish and Irish Governments have said they are committed to bringing about minimum unit pricing measures. What steps are the UK Government taking to investigate the implications of that judgment? Will they follow the example set by Scotland in pursuing minimum unit pricing measures? Does this judgment have implications for the UK’s existing ban on sale below cost price?

On the other hand, I am encouraged to see that the Commission has undertaken a public consultation on the law concerning the marketing of alcohol. The labelling of alcoholic beverages, however, remains a concern. We recommended that the Government should press the Commission to propose amendments to the food labelling regulations to include information on strength and calorie content, guidance on safe drinking, and to warn of the dangers of drinking during pregnancy. So far, I have seen no evidence that the Government have done so. The regulations are already sufficiently flexible to allow member states to impose such rules domestically, and France has done so. The Government have responded, saying they are concerned about the additional burdens this would place on businesses. Given that labelling is already required, it is difficult to see that that burden would be great.

We also need further cross-border research on alcohol and its effects, and what works. A more strategic approach is needed in the selection of topics for research and how it is commissioned.

Having published our report in March 2014, we granted the Government a two-month extension to the standard two-month deadline to respond to our recommendations. Even with that leeway, however, the Government took almost six months to respond and this debate has taken almost a year to be scheduled.

We recommended that action on specific topics should be taken at EU level. Whether or not this is called a strategy is irrelevant. Since the publication of our report, civil society and member states have called for the renewal of the strategy and the Council, in particular, has called on the Commission to do so by the end of 2016. So far, however, the Commission has not brought forward a new strategy to combat alcohol-related harm or taken any significant action in this area.

In their response the Government said they were broadly supportive of our recommendations, but it was less than clear what precise steps they have taken to encourage the Commission to bring forward further EU action in line with our recommendations. What steps have the Government taken, and what steps are they taking, to bring this about?

While the Commission and the Government were pondering at excessive length their responses to our report, it was receiving a welcome from the Latvian Ministry of Health. Last April, during the Latvian presidency, an informal council was held in Riga and the discussion paper put before the council summarised and endorsed the conclusions of our report. This is a welcome example of the attention that foreign countries give to the reports of this House. I beg to move.

--- Later in debate ---

[Baroness Prashar]

My Lords, I thank the Minister for a very full response. I also thank noble Lords who took part in this debate. In producing the report, we were very conscious of the fact that we did not wish it to be a killjoy report but that we had to take a very balanced and informed approach to the issue. It is very gratifying that all noble Lords who have taken part in this debate have reinforced the recommendations that we made. Therefore, it is encouraging to note that we were obviously moving in the right direction.

I listened carefully to the Minister’s response and wish to highlight two points. On the minimum unit pricing, it would be useful if the Minister would write to me informing me of the implications of the European Union judgment for the UK. On labelling, I know that the Minister mentioned doing this voluntarily, but I still think that it should be mandatory because the voluntary approach is not sufficient. Having said that, we did not have a large quantity of noble Lords speaking in this debate but its quality was very good. I think that all the points have been covered. I again thank all noble Lords and the Minister for his response.

Motion agreed.