Health Promotion Bill [HL]

Baroness Randerson Excerpts

2nd reading
Friday 2nd December 2022 Lords Chamber

[Baroness Randerson (LD)]

My Lords, I thank my noble friend for his work on this invaluable Bill. I concentrate on the issue of sport, and general physical activity and its importance. I want to praise the Bill’s emphasis on the importance of a cross-governmental approach.

Not surprisingly, given my remit in this House, I start with transport. It is no good encouraging people to participate in sport if they cannot access the facilities because there are poor or no public transport links. This issue applies in particular to young people. For example, at the end of the school day it is common to have sports clubs but, if you are a pupil who relies on the school bus to get home, you miss that school bus if you stay for the sports club. You then have to rely on the regular, scheduled bus service and, if it does not exist, you have no choice but to fall out of regular sport and of attending the sports club. That is one of the commonest reasons in schools why children stop participating in sport.

It is also very important that local authorities develop good, safe and active travel routes for cycling and walking. At issue is not just the existence of public transport facilities but the cost. If the bus fare is too expensive, young people and adults are not going to be able to afford it. There has to be cross-local government thinking on this.

I also emphasise the importance of location. A sports club being in the centre of a town or city is often much more important than the size of its pitches. It is where it is that is so important, rather than how big it is. I give you the example of my own home city of Cardiff which, because of a wonderful donation hundreds of years ago by the Earl of Bute, has an enormous park in the centre. There is the Sport Wales National Centre, Glamorgan Cricket Club and rugby facilities in the centre of the city, all within a short walk of the Central station and near where all the buses start and stop.

My second point relates to my time as Sports Minister for Wales from 2000 to 2003. We started work on a sports and activity strategy specifically linked to promoting good health. As part of that work, we did an analysis of grant funding from what was then called the Sports Council for Wales. On the face of it, it all looked okay. We did proper due diligence, and officials checked that the money had properly been spent, and so on. There was nothing suspect or dubious, such as VIP lanes. However, I could immediately see, at a glance, that it was badly skewed towards football, rugby and cricket—male-dominated sports—and very often to areas that were more prosperous. A proper alternative analysis showed that the vast majority of money went to men and boys’ sports clubs which were well established and had buildings, facilities and pitches of their own, and so on.

So, on equality issues, Sports Council funding failed women, girls, young people, people in poorer areas and people with disabilities. It also failed newer sports and their development—the sort of thing more likely to bring in a wider range of people. In other words, it failed the people and communities who needed it most. We therefore had to rethink the whole thing, putting equality at the centre of it and making sure that we addressed the issues of capacity to make bids and so on. We set up a small bids fund for small amounts of money, for example. I emphasise, therefore, the importance in Clause 1 of the reference to tackling discrimination. That is a key part of this Bill.

Finally, the Bill states in Clause 3 that it extends to England and Wales. I raise this question with my noble friend, because health, sport, education, transport, housing and local government are all devolved to the Welsh Government and Senedd. It is therefore important that we take into account that there is variability across Wales, and that this would need a legislative consent Motion from the Senedd if it were to become law. I will end with this thought: Wales is small enough to be a very good pilot project for this way of thinking.

Alcohol Duties

Baroness Randerson Excerpts

Tuesday 2nd November 2021 Lords Chamber

[Baroness Randerson (LD)]

My Lords, real-term cuts in the price of alcohol send the wrong message also about drink-driving. We have one of the highest drink-drive limits in the world, set more than 50 years ago and well out of date. Around 2,000 people are killed and seriously injured on the roads every year, and that figure rose by 8% in 2019 alone. The British attitudes survey reveals that 77% of people support lower limits. Do the Government intend to catch up with the rest of the world and adopt this popular policy, saving lives on the road?

[Lord Kamall (Con)]

Noble Lords will know that alcohol-related deaths are not due purely to sclerosis of the liver and other direct impacts; we also know that alcohol plays a large role in, for example, drownings, 30% of which have some alcohol connection. We know that a number of murders and cases of domestic abuse are also connected to alcohol. The most important thing is to try to incentivise drinkers to drink low-alcohol or no-alcohol products in the hope that we can do that. This is why we have reformed the taxation system in a way that is linked to the volume of alcohol in drinks.

Heathrow Airport: Border Control Passenger Safety

Baroness Randerson Excerpts

Tuesday 25th May 2021 Lords Chamber

Asked by

[Baroness Randerson]

To ask Her Majesty’s Government what steps they intend to take to improve the safety of passengers queuing at border control points at Heathrow airport.

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

My Lords, Heathrow Airport has extensive measures to ensure the safety and well-being of passengers and we have been working closely with it, Border Force and others to facilitate as smooth and safe a journey as possible for all passengers. In addition, Heathrow will shortly begin a trial in which direct flights from red list countries arrive into a dedicated terminal, helping to focus operational capacity and reduce mixing between passengers from red, amber, and green list countries.

[Baroness Randerson (LD)]

My Lords, there have been three-hour queues at Heathrow with passengers crammed together, yet aviation is flying at only 15% of its capacity and Border Force says that it is working at full strength. This is the latest in a catalogue of errors by the Government in their border policy. Can the Minister tell us why the Government did not properly ensure that passengers were separated out at Heathrow from the start? When will they have the additional fully trained Border Force staff to provide a safe and efficient service?

[Lord Bethell (Con)]

My Lords, I also saw the images circulating last week of queues at Heathrow Airport, and I agree with the noble Baroness that we do not want to see a repeat of those kinds of scenes. However, I do not agree with her analysis. The Managed Quarantine Service has worked extremely well, and I pay tribute to Border Force for its contribution—we have more Border Force staff working today than we did during the 2012 Olympics. It does, unavoidably, take between five and 10 minutes for Border Force personnel to process each passenger; that is an unavoidable bureaucratic burden, but we have taken the necessary steps to ensure safe travel and minimise the circulation of mixed passengers within the terminals.

Alcohol Harm Commission: Report 2020

Baroness Randerson Excerpts

Thursday 22nd April 2021 Grand Committee

[Baroness Randerson (LD) [V]]

My Lords, I declare an interest as co-chair of the All-Party Group on Liver Health, for which this is a very relevant debate. I thank the noble Baroness, Lady Finlay, for all her work in this field.

What do we need to make inroads on this problem? Obviously, first, we need better access to treatment. Secondly, Scotland’s minimum unit pricing saw a net reduction in off-trade sales by 4% to 5% in its first year. That is worth while, but it is not enough in itself.

Recent research by Cardiff University—I declare an interest as chancellor of that university—has demonstrated the link between food purchases and alcohol purchases. Buying the food for our meal literally prompts us to pick up the bottle of wine or beer from the next aisle of the supermarket. This research suggests that food and alcohol sales need to be separated and not part of the same trip to the till. Many other countries do this. I recall that in Australia the same supermarket sold both sets of items, but you went to a totally separate section and paid a separate bill for the alcohol. Finland, Sweden, Canada and some parts of the US apply similar rules. The Government should explore this.

We need further controls on the advertising of alcohol. Finally, we need more information on labels and when we buy alcohol in the pub. If we buy a lemonade or crisps or a bar of chocolate, we know the calories and contents. When we drink a glass of wine, we deserve to have access to the same information on calories and the number of units.

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

Baroness Randerson Excerpts

Friday 24th July 2020 Lords Chamber

[Baroness Randerson (LD) [V]]

My Lords, others have talked about the chaotic decision-making by government that has made delays inevitable in bringing this legislation to the House—or maybe the Government think they are being clever in trying to marginalise Parliament. Whatever the cause, it has led to contradictory government messaging, confused the public and made the police’s job very difficult. I raise a specific point that flows from this. Some 35% of fixed penalty notices issued as a result of these regulations have apparently been served on the black community, who form only 3.5% of the population. Can the Minister explain this?

Buried in here are powers to ban public gatherings of over 30 on health grounds. Can the Minister explain why gatherings of, say, 35 people indoors for elite sports coaching carry less risk than 35 people gathering outdoors in, say, Parliament Square?

Covid-19: Response

Baroness Randerson Excerpts

Tuesday 19th May 2020 Lords Chamber

[The Deputy Speaker]

I call the noble Lord, Lord Low of Dalston. I do not think he is on the call, so I call the noble Baroness, Lady Randerson.

[Baroness Randerson (LD)]

I have listened carefully to this debate, and the Minister seems to say in every answer how well the Government have done throughout this whole pandemic. If that is the case, how have we come to the point where well over 35,000 people have died? I invite the Minister to tell us now where the Government went wrong.

[Lord Bethell]

The noble Baroness is entirely reasonable. I apologise if I give the impression that I am in any way complacent or if I am unapologetic about what we have done. She is entirely right: this is an awful disease that has hit this country extremely hard and not everything we have done has worked as well as we had hoped. Undoubtedly, when we look back, it will be judged that the Government have made mistakes; of that I am absolutely sure. I approach this question with humility. I completely take on board her point that questions that resist the idea that we have made mistakes are quite wrong.

However, I want to try to convey the enormous commitment and focus that the Government, the NHS and the people who are involved in the greater project have thrown into this project. It is not a massive shambolic mess littered with political stupidity and corruption, as is implied by some of the critics of the Government. Actually it has been a venture that has had a huge amount of innovation, collaboration and good will behind it. I am afraid I cannot help but seek to salute and pay tribute to those who are involved.

Draft Human Tissue (Permitted Material: Exceptions) (England) Regulations 2020

Baroness Randerson Excerpts

Monday 18th May 2020 Lords Chamber

[Baroness Randerson (LD)]

My Lords, I declare an interest as chancellor of Cardiff University, which includes Cardiff medical school. I thank the noble Lord, Lord Hunt, and many others for all the work they have done on this important issue. I strongly welcome this debate and the fact that England is now following the lead from Wales. I was involved in the campaign for deemed consent in Wales, which started around 2008. England will be able to build on the Welsh experience as the changes are introduced. I am delighted to see that the noble Lord, Lord Bourne of Aberystwyth, will speak later as well.

In Wales, after lengthy and thorough public debate and consultation, the Act was passed in July 2013 and the actual changes in procedure were introduced in December 2015, almost two and a half years later. However, by the crucial measure of organ donation consent rates, it has undoubtedly been a success. In Wales, that statistic is now over 80%, compared with around 66% in England.

I must stress how carefully this must be introduced. Thorough training and additional capacity are key to success. A false start now could undermine the whole scheme for years to come, because public confidence is vital, and so the failure to publish the draft code of practice on the internet on the date it was laid is a more than usually worrying omission. As the Secondary Legislation Scrutiny Committee said, this is unacceptable given the sensitivity of the subject matter. Can the Minister explain how this happened, and can he provide us with reassurance that procedures have been changed so that we can have more confidence that this will be rolled out properly in the future?

I understand and accept that it is not wise to introduce such sensitive changes while the NHS is under huge pressure because of the pandemic. However, the time must be used not for stalling change but for more preparation, including adaptation to the new ways of working. The rate of transplants has fallen sharply, but people still need organ donations at the same rate. Indeed, there is a backlog of people urgently requiring donation, many of whom have become even more seriously ill while waiting for a donor. The number of organ transplants has fallen by three quarters since the start of the pandemic, as ICU units have been devoted to coronavirus patients.

I was pleased to see that the codes of practice have a strong focus on faith. This is particularly important because of the long-term shortage of BAME donors. In Wales we worked with faith leaders from the early days of the campaign and found their insight and contributions essential in developing guidance.

I understand the decision to exclude certain organs from deemed consent. However, I ask that each of these organs is treated as a separate category, rather than them being grouped together. This is so that, as surgical practice develops, there can be ongoing reconsideration of their status. What is novel in 2020 could be routine by 2025.

Diesel Emissions

Baroness Randerson Excerpts

Wednesday 5th December 2018 Lords Chamber

Asked by

[Baroness Randerson]

To ask Her Majesty’s Government what steps they are taking to raise awareness among the general public of the health impacts of emissions from diesel vehicles.

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

My Lords, the Government raise awareness of the effects of air pollution, including from diesel vehicles, via the UK Air website and through supporting activities such as the annual clean air day. Furthermore, the Department for Transport’s Road to Zero strategy contains a range of policies aimed at reducing the use of diesel in transport and therefore the harms that flow from it.

[Baroness Randerson (LD)]

My Lords, despite the work that the Minister has outlined, many people are still not aware of this problem. We are condemning young children to a lifetime of ill health because of this invisible threat, and they are particularly vulnerable to the effect of emissions during the school run. Will the Minister commit to having discussions with the Department for Transport to ensure that emission levels outside schools are tested frequently and that suitable warning signs are displayed when necessary, and will the Government introduce a ban on engine idling for vehicles waiting outside schools?

[Lord O’Shaughnessy]

I absolutely agree with the noble Baroness that this is an issue of concern. It is a concern to all of us and it is certainly a concern to those of us with school-age children in urban areas, who experience the pollution every day. First, the UK has made progress on reducing pollutants, although clearly there is a long way to go, and in specific urban areas the problem is much worse than in others. Secondly, I point the noble Baroness to the clean air strategy, which will be published at the end of this year. It will contain a range of measures aimed at reducing pollution and, as a consequence, the public health damage that comes from it. I shall certainly feed in her comments about the importance of targeting these benefits on schools.

Organ Donation (Deemed Consent) Bill

Baroness Randerson Excerpts

2nd reading (Hansard): House of Lords
Friday 23rd November 2018 Lords Chamber

[Baroness Randerson (LD)]

My Lords, I thank the noble Lord, Lord Hunt of Kings Heath, for bringing this Bill forward, and for his excellent speech. We have heard moving contributions from across the House this morning. I want to thank the Government for their indication of support for the Bill. I also thank the noble Lords who chose to say kind words about me.

Of course, the important thing is that the greatest tributes must be paid to the donors and their families. There is, however, rare cross-party unity on this issue. That, you may think, is not surprising, because 80% of people say they would consider donation, but only 37% are on the donor register. Importantly, the percentage on the register from ethnic minority groups is a lot lower than that, and yet some of these groups face a greater than average likelihood of developing some of the illnesses that lead to the need for a transplant.

My party has supported this policy since 2002. At a personal level, I believe passionately that a system of presumed consent, a soft opt-out system, is the answer to addressing the gap between the number of donated organs and the number that we really need to save as many lives as possible. As the noble Lord, Lord Hunt of Kings Heath, indicated, I have some experience of this issue. As an Assembly Member in Wales, I was a member of the Health Committee. I was also spokesperson for my party on health issues in 2008 when the Kidney Wales Foundation and the BMA, together with other health groups, started to campaign for a system of presumed consent. I should declare that I was a trustee of the Kidney Wales Foundation from 2010 to 2012.

There was a well-co-ordinated campaign which had an impact on civic debate in Wales and on politicians in the Assembly. It led to the Health Committee deciding to do an inquiry. As part of that, we looked at evidence from across the world. We have heard a lot of statistics today but if you look at the evidence from across the world you will see that rates of donation vary considerably. But one thing you can draw out of it is that in countries with presumed consent, the rates tend to be higher than in countries without. When presumed consent is introduced, the number of donations increases over time as a percentage of the population.

As part of our inquiry, we also visited Madrid. Spain has been mentioned several times in this debate. There, we learned how soft consent works. We also learned that, as well as the legislation, you need the infrastructure to develop the system properly. You need improved training for staff as well as the best equipment. Meeting the clinicians, nurses and counsellors involved in the process in Spain had a huge impact and made us aware of the issues that we needed to tackle. In due course, after taking evidence from many groups, including patients and health campaigners, the Health Committee in the Assembly produced a report, which in fact at that point did not recommend a move to a soft opt-out system because some members were concerned that it might not be within the powers of the Assembly. These were early days for the Assembly and it was feeling its way.

Therefore, along with some other Assembly Members, we produced a minority report supporting a change to a soft opt-out system. Fortunately, the Health Minister at the time, Edwina Hart, was a lot bolder than some Assembly Members and decided to support the change, and she did excellent work in making it happen. It took a long time and years of consultation to get it right. The new Human Transplantation (Wales) Act was passed in 2013 but, even then, preparations took until December 2015, when the new system was eventually introduced.

I have some observations to make about that process. At the time, I was surprised at the extent to which the establishment—some in government and even some health organisations involved—closed ranks against the idea that the new Welsh Assembly could take such a radical path. It is a measure of how the debate has moved on—and I strongly welcome that—so that the Government now welcome it. In 2008, the Government’s Organ Donation Task Force, in its second report, unanimously opposed a change in the law. The UK Government have now accepted that the Welsh Government did indeed have competence to change the law. That happened during the coalition Government, when I was in the Wales Office, and it was not challenged.

In our original debates we were bolstered by the extent of the support from many faith communities. There were thoughtful contributions to the debate and overall support from faith communities. I very much hope that the right reverend Prelate the Bishop of Carlisle will study the Welsh experience in detail and look at exactly how much care was taken on the key and very important issues that he raised. The noble Lord, Lord Carlile of Berriew, is right that devolution in Wales made this a manageable initiative, with Wales being the first part of the UK to adopt the system. The noble Baroness, Lady Finlay, was right to emphasise the extensive public information campaign, and there has been no backlash, as some predicted. In addition, I emphasise that the public information campaign came not just from the Government but from third sector organisations, so it involved not just public money.

The fundamental objection is the fear of coercion. That has to be addressed through thorough information and careful explanation. It is called a soft opt-out system for a reason. By convention in this country we have always put the wishes of the deceased and their next of kin at the forefront so, whatever the legislation in this situation, it is important that that care over the wishes of the deceased and their relatives continues. You cannot rely on the law alone; you need a big investment in intensive treatment units and many more trained nurse counsellors. The conversation prior to or at the point of death is difficult but crucial. We cannot expect clinicians to do it as an adjunct to their work. Their mission is to save lives. It is very difficult for clinicians to be working to save a life at the same time as talking to the family about the point after death.

Difficult conversations need to be had as well in preparation in advance of death, where that is possible. Along with this approach to individual cases, you need, as several people have mentioned, a big national conversation, a campaign to encourage people to tell their loved ones what they want to happen to their body after death. I do not know if noble Lords have had those conversations. My son came out and told me that he wanted to donate his organs but I found it very much more difficult emotionally to raise that issue with my daughter, and it was the public information campaign in Wales that made me feel that I had a duty to discuss these issues within the family. So the open conversation is really important.

Evidence from Wales is also there to say that people also talk about not allowing cardiopulmonary resuscitation, which is often something on which there is confusion. Our system in Wales is being widely commended within the medical world, and we have evidence of overwhelming change in that too.

I want to spend a moment or two on the outcome because it is difficult to keep up when the situation is changing so fast. The Wales studies, prior to legislation, allowed for a 19% opt-out rate. In fact, as we have heard, it has been very much lower at 6%. At the same time consent rates in Wales have increased from 58% in 2015 to 72% in 2017, compared with 65% in England. Specifically, consent rates for brain-dead donors are now 89%, and for donors after circulatory death, donation rates have increased from 53% in 2015 to 68% in 2018.

The donation of eyes is always a particularly sensitive issue, and there is worldwide evidence to show lower rates of donation on those. The deficit between the number of corneas being donated and the number of transplants needed is increasing rapidly; it has gone up by 157% in five years. However, by increasing the donor pool across the UK we should be able in the long term to address that shortage.

Overall Wales now has the highest rate of consent for organ donation in the UK. There is also a hidden factor here that I draw to noble Lords’ attention: organs cross borders. There is anecdotal evidence in Wales that additional donations have helped in England, Scotland and Northern Ireland, and indeed beyond, in the EU, to produce better outcomes. The number of organ donors has gone up, from 60 in 2015 to 74 last year, and 44 in the first six months of this year. Wales has a population of only 3 million, so the numbers are necessarily small.

It takes time to build the new system but I am delighted that it looks now that, thanks to the change in Wales, things have improved there. I am very pleased indeed that it now looks as though, thanks to this Bill, England has the chance of following in the footsteps of Wales. I urge those who will, I hope, have the responsibility of introducing a new system to look carefully at the procedures and experience in Wales. As several of your Lordships have said, deemed consent is not the whole answer, but it is the golden key to unlock the door. This is an excellent Bill because, most importantly, it retains the key principle that organ donation is a gift, and it must remain freely given.

Hepatitis C

Baroness Randerson Excerpts

Monday 9th July 2018 Lords Chamber

Asked by

[Baroness Randerson]

To ask Her Majesty’s Government what plans, if any, they have to publish a strategy for the elimination of hepatitis C.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O’Shaughnessy)]

My Lords, the Government are committed to meeting the World Health Organization’s target of eliminating hepatitis C as a major public health threat. While there are currently no plans to publish a strategy, my department is working closely with NHS England and Public Health England to deliver a highly ambitious, whole-system approach that would achieve elimination in 2025—five years ahead of the WHO target.

[Baroness Randerson (LD)]

I thank the Minister for his positive approach. I declare an interest as co-chair of the All-Party Group on Liver Health. In our recent inquiry, we demonstrated that hepatitis C specialists do not believe that the NHS is geared up to achieve the Government’s ambition, which the Minister has just outlined. Some 40% to 50% of those with hepatitis C remain undiagnosed. Do the Government intend to introduce a national campaign to raise public awareness of hepatitis C, thus encouraging more people to seek treatment?

[Lord O'Shaughnessy]

First, I applaud the noble Baroness for her work on this. We know that hepatitis C is a truly horrible disease that affects some of the most vulnerable people in our society, which is why we want to eliminate it. In terms of the NHS being geared up, we are on track to treat 70,000 people by 2020. We need to keep finding people, and, of course, they become harder and harder to find. She is quite right about the need to raise awareness. We are doing other things as well, such as reaching into hard-to-reach communities. To give one example, there is now a 100% opt-out testing offer for people entering the prison estate, which is one of the areas where hepatitis C tends to be transmitted. There is clearly a need to do more, but we are looking at how to reach those hard-to-reach communities.