Health: RSV Immunisation

Baroness Ritchie of Downpatrick Excerpts

Wednesday 17th January 2024 Lords Chamber

Asked by

[Baroness Ritchie of Downpatrick]

To ask His Majesty’s Government what steps are being taken to ensure that appropriate funding is in place to deliver immunisation programmes for respiratory syncytial virus by the 2024/25 winter season, and when an implementation plan will be published.

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

The Government published a prior information notice on 27 November 2023 outlining the market’s intention to tender against its requirements for infant and adult RSV programmes in 2024. Following the tender and the confirmed potential budget implications, a final decision on programme designs will be taken alongside an implementation plan for autumn 2024.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, I thank the Minister for his Answer. For the avoidance of doubt, can he explain to your Lordships’ House what funding has been allocated to the national immunisation programme for the 2024-25 winter season; what proportion of that funding has been allocated for immunisation programmes for adult, infant and neonate RSV; and what conversations have been held with NHS England regarding readiness to implement the RSV immunisation programme, as advised by the JCVI?

[Lord Markham (Con)]

First, I thank the noble Baroness. She has been a tireless campaigner on this issue and very good—quite rightly—at holding our feet to the fire. The exciting news is that the new vaccines that are coming along for both mothers and infants, as well as the over-75s, are now cost effective; that was recognised in the JCVI’s analysis. As part of that, we have plans to fund the programme, as mentioned. I would rather not go into the details of the actual budgets, because they depend on the tender and I do not want to give that information out to the market—but I can reassure the noble Baroness that plans are in place.

Cancer Research UK Report

Baroness Ritchie of Downpatrick Excerpts

Tuesday 5th December 2023 Lords Chamber

Asked by

[Baroness Ritchie of Downpatrick]

To ask His Majesty’s Government what assessment they have made of the report Longer, Better Lives: A Manifesto for Cancer Research and Care, published by Cancer Research UK on 28 November, regarding their priorities for investment in clinical research and innovation.

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

The Government welcome the Cancer Research UK report Longer, Better Lives, which rightly highlights progress made against cancer. We have invested over £100 million in cancer research in 2021-22 through the National Institute for Health and Care Research. We are working closely with research partners in all sectors, and I am confident that the Government’s continued commitment to cancer research will help us to build on that progress, leading to continued improvement for all cancer patients.

[Baroness Ritchie of Downpatrick (Lab)]

I thank the Minister for his Answer. The CRUK manifesto clearly highlights the priorities required for tackling rising cancer rates with a growing ageing population, including the need for more investment in research, greater disease prevention, earlier diagnosis through screening, better tests and treatments, as well as cutting NHS waiting lists and investing in more staff. Can the Minister outline what steps the Government will take to implement this strategy, allied with resources and updated infra- structure in all hospitals?

[Lord Markham (Con)]

Absolutely. I thank the noble Baroness for the work that she does in this field. I welcome the manifesto, specifically on rebuilding the global position in research. We have done a good job on that: we have gone from a position of 26% of the clinical trial responses being in time to international standards to over 80%. The biggest prevention method that anyone could take is to stop smoking because, as we know, that is the biggest cause of lung cancer, so we are introducing steps to prevent smoking. On early diagnosis, we have introduced an excellent example in lung cancer. Some 60% of people used not to be detected until they were stage 4, which is often too late. Now, through the mobile lung cancer units, we are detecting 70% at stage 1 or 2, where they have a 60% chance of survival. Across the field, we are doing a lot on this that we can feel proud of.

Respiratory Syncytial Virus

Baroness Ritchie of Downpatrick Excerpts

Tuesday 25th July 2023 Lords Chamber

Asked by

[Baroness Ritchie of Downpatrick]

To ask His Majesty’s Government, following advice issued by the Joint Committee on Vaccination and Immunisation on 7 June, whether they are planning to undertake an immunisation programme against respiratory syncytial virus before winter; and if not, what are the barriers to doing so.

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

My Lords, officials are currently developing policy options based on Joint Committee on Vaccination and Immunisation, or JCVI, advice regarding an expanded RSV vaccination programme for infants and older children. While officials are working at speed, challenges such as procurement negotiations, system readiness and delivery capacity mean that a universal programme in time for this winter is not possible. The department is working with partners to mitigate those challenges and to support implementation as soon as possible.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, I thank the Minister for his Answer, albeit a little disappointing. When will that policy position on the introduction of the RSV immunisation programme be submitted to Ministers? When will the business case, including funding priorities, for the introduction of such an RSV immunisation programme be developed and put to the Treasury? Does the Department of Health plan to accept the joint industry offer to work with manufacturers to overcome barriers to rapid implementation?

[Lord Markham (Con)]

I thank the noble Baroness. The issue is that the current jab, palivizumab, is very expensive and lasts for only one month at a time, so it is logistically quite difficult. Promisingly, a new jab, nirsevimab, has just been agreed by the JCVI. It offers six months’ protection, is more effective and is lower in cost, so that is the one we are looking to roll out to more people. At the same time, there is a promising Pfizer jab which can be given to mothers. There are good new vaccines coming along; the issue is whether they are going to be licensed in time for us to be able to use them this winter.

--- Later in debate ---

[Lord Markham (Con)]

First, I thank noble Lord. That is the nicest thing anybody has ever said to me; I think I want to go on holiday at this point. This is a devolved matter, but it is something on which we are working very closely with the devolved Administrations. I must admit, as we discussed yesterday, that there is concern about the Northern Ireland Administration. Obviously, the Executive and Assembly not meeting at the moment makes some areas more difficult. We had examples of that yesterday, and we are about to have one in a minute when we talk about the fortification of bread. However, where we can, we are working closely with our colleagues.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, in his initial response to me, the Minister indicated that the policy papers were being drawn up. What policy options are being considered?

[Lord Markham (Con)]

The hope is that there will be two effective and cost-effective vaccines, nirsevimab and the Pfizer maternal jab. Those are much more effective and give longer periods of protection than the current monthly jab—they give six months’ protection. They are open to a mass campaign, particularly for young children, who are the most at-risk group. That allows us to have a negotiation with both parties with some healthy competitive tension so that we can get the best price, because we know that either one will do the job quite well. Where we can reach a successfully negotiated outcome, we hope that will set us up either to do either a year-round programme, if it really is very cost effective, or, if it is still quite expensive, to focus on the winter months, because that is the time when young children are most at risk if they have just been born. Those negotiations are live, and I will be happy to update the House as we learn more.

Tobacco and Related Products (Amendment) (Northern Ireland) Regulations 2023

Baroness Ritchie of Downpatrick Excerpts

Monday 24th July 2023 Grand Committee

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

My Lords, the purpose of this instrument is to implement the EU Commission delegated directive (EU) 2022/2100 of 29 June 2022, which amends directive 2014/40/EU—the tobacco products directive—to withdraw certain exemptions in respect of heated tobacco products placed on the Northern Ireland market.

The instrument amends the Tobacco and Related Products Regulations 2016—the TRPR—in relation to Northern Ireland. The regulations will apply to producers, suppliers, retailers and wholesalers that produce or supply heated tobacco products for consumption in Northern Ireland. Subject to the regulations being approved by Parliament, they are due to come into force on 23 October 2023.

The regulations apply to Northern Ireland only and are made for the purposes of dealing with matters arising from the Windsor Framework. The SI implements a change so that, from 23 October 2023, heated tobacco products can no longer have a characterising flavour, such as menthol, vanilla and fruit flavours. This is not a ban on heated tobacco, but it will limit the flavours available. A characterising flavour ban is already in place for cigarettes and hand-rolling tobacco in the TRPR.

We do not need to make changes in light of the Commission delegated directive’s requirement for heated tobacco products to contain health warnings and information messages if they combust. If heated tobacco products that involve a combustion process were placed on the UK market, they would be regulated as tobacco products for smoking and subject to existing regulations in the TRPR that require these products to contain a combined health warning and information message. There are currently no heated tobacco products on the GB or Northern Ireland markets that involve a combustion process and, as such, they are subject to the labelling requirements applicable to smokeless tobacco products.

A full impact assessment has not been prepared for this instrument because the costs involved for business fall below the threshold for producing one.

Heated tobacco products on the UK market are produced and manufactured outside the UK by the tobacco industry. The characterising flavour ban will limit the products it can produce and supply to the Northern Ireland market and may impact on profits, in what is a relatively small market for the industry in Northern Ireland.

The DHSC has communicated with the tobacco industry, Northern Ireland retail representatives and enforcement agencies regarding the proposed changes. There is no significant impact on the public sector. Each district council in Northern Ireland will enforce the new requirements. They are not expected to be a significant burden on district councils, given the low use of heated tobacco products in Northern Ireland.

I am content to bring forward this legislation today. These regulations allow us to honour our current commitments under the Windsor Framework and will have limited impact on Northern Ireland business. I commend these regulations to the Committee.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, I thank the Minister for his presentation of the statutory instrument. I have to declare an interest: I am a member of the Secondary Legislation Scrutiny Committee, and we discussed this SI. There was no dissent from it and there was general support, but we drew it to the attention of your Lordships’ House.

I am a supporter of the Windsor Framework, and any shilly-shallying around it can lead to uncertainty in Northern Ireland. It is important that we and the people of Northern Ireland, particularly businesses, can avail themselves of the economic opportunities in relation to access to the UK internal market and the EU single market.

--- Later in debate ---

I am not aware of the Bath University study, but I will make sure that I find out about it. I hope that, in this conversation I have managed—

[Baroness Ritchie of Downpatrick (Lab)]

I thank the Minister for giving way. In relation to what he said about the transport of these substances, I indicated the issue of regulation, as did the noble Lord, Lord Allan. In the past, during our troubled history, cigarettes were used as a form of smuggling, and also used as contraband by paramilitary organisations. The Minister says there is only minor use of these cartridges, for want of a better description—but I have seen them sold along with cigarettes in locked-up containers in shops, and young people purchasing them, particularly the fruit-flavoured ones. If they do not have access to that, how will they be able to get them? What mitigation and control measures will be put in place to prevent them becoming like contraband and being abused by erstwhile paramilitary organisations?

[Lord Markham (Con)]

I thank the noble Baroness for that remark. I think that I probably need to give that a detailed response as well. The point I was trying to make was that these heated tobacco products are a very small part of the market to begin with and the flavoured versions are even smaller again. While the noble Baroness is correct that that potential is there, the amount is very small indeed, but I will give her a detailed response on that.

I have tried to answer the specific points raised; as I say, I will follow up in more detail in writing. We have to honour the regulations set out by our commitments under the Windsor Framework agreement. With that, I commend these regulations to the Committee.

MMR Vaccine

Baroness Ritchie of Downpatrick Excerpts

Thursday 20th July 2023 Lords Chamber

[Lord Markham (Con)]

The noble Baroness is correct. The unfortunate Wakefield effect had quite an impact on that cohort of people, so the campaigns have been targeted particularly at specific communities in particular areas. Outreach campaigns are being done as part of that, looking at every area where it can be done. Sometimes that involves looking at colleges and sometimes it involves going specifically to community centres themselves.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, the Minister referred to outreach campaigns in relation to the take-up of MMR. Will that extend to children who are disabled and who are forced to be off school for certain periods of time to ensure that they are able to access their MMR vaccines?

[Lord Markham (Con)]

Yes. This whole campaign is looking particularly at hard-to-reach communities. The concern is particularly in London. Whereas we have about 85% take-up across England as a whole, in London it is around 75%, so that is where the particular outreach is. That also involves looking at children who are not able to go to school or who are home-schooled.

Community Health Services: Waiting Lists

Baroness Ritchie of Downpatrick Excerpts

Wednesday 12th July 2023 Lords Chamber

[Lord Markham (Con)]

We all agree that unpaid carers are the backbone and hidden army behind a lot of what we see. We have made some good moves in that direction. We have the set-up for leave, so that they can have time away and a reduction in stress. We are setting up payment for them, albeit we all accept that there is such a hidden army we need to do more.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, recent research has found that almost three in five disabled children seeking physical and talking therapies are waiting more than 12 months for appointments, which is totally unacceptable? How do the Government plan to address such a large backlog and improve opportunities for disabled children? Perhaps the Minister can elucidate on that particular area.

[Lord Markham (Con)]

Unfortunately, as we know, we have a backlog in quite a few areas, often as a consequence of the pandemic and the period when we could not see as many people as we would have liked to. I wish I could say there was a quick solution; we all recognise the long-term solution is the long-term workforce plan, where we need to address the vacancies and have more staff to increase the output and supply. We are putting in a record investment of £2.4 billion behind this, but I freely admit it is not an overnight solution.

Respiratory Syncytial Virus

Baroness Ritchie of Downpatrick Excerpts

Thursday 19th January 2023 Lords Chamber

Asked by

[Baroness Ritchie of Downpatrick]

To ask His Majesty’s Government whether they have plans to introduce PCR testing and an annual vaccination programme for young infants, children and older adults in relation to seasonal Respiratory Syncytial Virus (RSV).

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

PCRs test are already in use to diagnose RSV and monitor its prevalence. Current RSV immunisation is targeted at infants at high risk of severe complications. New immunisation products, including vaccines, have been developed and are being reviewed by the Joint Committee on Vaccination and Immunisation, JCVI, which will potentially provide advice later this year. His Majesty’s Government will decide on future vaccination programmes once they have received that advice.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, as the Minister will know, RSV-related hospitalisations in the under-fives cost £48.2 million in the UK annually. At a time when the NHS is facing increasing pressures, both financially and through capacity, will the Minister clarify how the Government plan to reduce the infant burden associated with it to ensure that the NHS does not experience the same situation next season? If there are plans, will they publish them? If there are no plans, why not?

Invasive Group A Streptococcus and Scarlet Fever

Baroness Ritchie of Downpatrick Excerpts

Monday 5th December 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness for bringing this important issue before us today. To give context and answer the point, there were about 850 cases in the latest week, compared with about 186 in previous years. Generally, in peak years such as 2018, we had as many as 2,000 cases per week. We are not at those levels at the moment, but we seem to be seeing an earlier season: we normally expect levels to be higher in spring. At the same time, it is essential that we are alert. We have given instructions to doctors that they should proactively prescribe penicillin where necessary, as it is the best line of defence, and that they should be working with local health protection teams to look at whether to sometimes use antibiotics on a prophylactic basis where there is a spread in primary schools, which we know are the primary vector.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, the UK Health Security Agency is to work in collaboration with the public health agencies in Scotland, Wales and Northern Ireland. What level of collaboration has taken place on issues around strep A and scarlet fever, and what have been the results and outcomes? I am aware that there have been some cases in Northern Ireland.

[Lord Markham (Con)]

I know that the health agencies in each country work very closely together. I do not yet have the specific details, so I will happily follow up on this. I know that they are working very closely because it is clearly an area of concern. Right now, we have not seen any evidence of a new strain, so we think that we are looking at existing strains. We are seeing this number of cases because of a general situation where there is less immunity in the population because of the isolation related to Covid.

Coronavirus: New Cases

Baroness Ritchie of Downpatrick Excerpts

Monday 11th July 2022 Lords Chamber

[Lord Kamall (Con)]

Undoubtedly there will be an inquiry; in fact, the Government announced that there would be one. There will also be lots of independent inquiries and academics writing about what different countries got right and got wrong. When speaking to my friends who are Health Ministers in other countries, we all say that, looking back, there are things that we could have done differently, in various ways, if we had had that knowledge. But we also have to be very careful about the fallacy of hindsight, and of saying that we would have acted differently had we been in that situation. We can learn from hindsight, and we need to make sure that we do so for future pandemics.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, will the Minister take up the offer made by the noble Lord, Lord Foulkes, of a meeting of the four chief medical officers of the regions and nations of the UK to explore further possibilities and solutions in relation to Covid? Only last week in Northern Ireland I heard two separate virologists indicating that to reduce the advisory limit for self-isolation to five days was a dangerous precedent because many people in that group would remain positive, thereby spreading Covid in their local area. In view of that and the rising levels of Covid and other respiratory viruses, will the Minister immediately talk to his ministerial colleagues and set up such a meeting?

[Lord Kamall (Con)]

One of the things we do in the Department of Health and Social Care is to have regular meetings with our counterparts in the devolved Administrations—all the Ministers do. The noble Lord, Lord Foulkes, shakes his head, but I can tell him that we regularly have meetings with the devolved Administrations. I commit to go back to the department and see who is next due to have a meeting with their devolved counterparts, and ask whether we can put Covid on the agenda.

NHS: Respiratory Syncytial Virus Infections

Baroness Ritchie of Downpatrick Excerpts

Thursday 9th June 2022 Grand Committee

Asked by

[Baroness Ritchie of Downpatrick]

To ask Her Majesty’s Government what assessment they have made of the cost to the NHS associated with managing Respiratory Syncytial Virus infections.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, I thank the Minister and the Front-Bench speakers in this important debate, particularly as we emerge from Covid-19 and given the other respiratory viruses that are live in the community. I declare a personal interest: as an infant, I had pneumonia, which was one of these deep-seated respiratory viruses. I am talking about 64 years ago, but the viruses were all put in the family of pneumonia. Out of that emerged bronchiolitis.

Several questions are raised about this issue. The first is: what is respiratory syncytial virus infection? It is a leading cause of severe lower respiratory tract infections among young children and infants. An RSV infection usually causes mild and self-limiting symptoms in children and adults, which resolve within a couple of weeks. Symptoms can include a runny nose, fever and persistent cough—something that most of us can identify with. However, modelling suggests that the virus is responsible for 50% to 90% of hospitalisations among young children due to bronchiolitis, which is a common lower respiratory tract infection predominantly affecting babies and children under two years old. Up to 40% of hospitalisations are due to pneumonia.

So why the concern about RSV now? In late 2021 and early 2022, modelling predicted that RSV levels may double compared to a normal year, with a 100% increase in cases in young infants and a 40% increase in overall infections expected. As a result of the Covid-19 pandemic, the 2021-22 RSV season may be longer, with spikes in infection expected sooner than usual. There was a significant reduction in respiratory viruses during Covid-19 lockdowns, which limited infant exposure to RSV and thus impacted overall immunity. As the restrictions eased, it became apparent that there had been a significant rise in RSV cases and admissions.

Most hospital admissions for RSV in the UK occur in babies who are otherwise healthy. Despite the risk to all infants, studies suggest that 88% of pregnant women and 66% of midwives have no or little awareness of RSV. There are now widespread concerns in the medical community around the impact of RSV on an already stretched health service in the coming months and the cost to the health service of managing RSV infections—hence the subject of this debate.

In an average season in the UK, RSV is estimated to be responsible for more than 450,000 GP visits in children and adolescents, 125,000 cases of ear infection and 416,000 prescriptions of antibiotics. On secondary care, the Academy of Medical Sciences said:

“A lethal triple mix of COVID-19, influenza, and the respiratory virus Respiratory Syncytial Virus (RSV), could push an already depleted NHS to breaking point this winter unless we act now”.


With RSV, there is a cost to the health system, including £48.2 million for secondary care and hospitalisations. There is a direct cost of £65 million, with £15.7 million being spent in primary care on GP consultations. There is also a socioeconomic cost from the direct financial losses of the family and carers of children diagnosed with RSV. These estimated costs are just over £14 million in productivity losses every year. In addition, RSV in children under the age of five is estimated to cost an accumulated total of almost £1.5 million from the out-of-pocket costs incurred to families.

We have to ask what should be done to alleviate the burden on the NHS and to provide relief to infants and young families. In the wake of the Covid-19 pandemic and the nature of RSV infections, what consideration have the Minister and the Department of Health given to this matter? What assessment have the Minister and the department, working with the NHS, undertaken on those costs, bed blocking and the impacts on primary and secondary care? What is the impact on hospital and workforce capacity and waiting lists? What consideration have the Minister and the department given to ensuring that RSV infections could be treated in the community and in homes?

There are other questions to which I would like answers. What steps is the Department of Health and Social Care taking or planning to take to reduce the costs of managing RSV for the NHS, families and the economy, particularly with the overprescription of antibiotics leading to problems with resistance? What is the proper treatment? What discussions have taken place with medical professionals and clinicians to ensure that infants and young children receive the best treatment for full recovery? What learnings from the Covid-19 pandemic is the Department of Health and Social Care considering implementing for other respiratory viruses, such as RSV?

In conclusion, the bottom line is to ask what plans are being made and what funding has been set aside to ensure that protection against respiratory viruses remains a health priority for the upcoming season this autumn and into the winter and that there is better management to deal with them. What new policies are being forged to address RSV infections and to cope with the demands on the NHS? We must not forget that not only the infected child feels the burden of RSV; their families, carers and the health service are also impacted. The seasonal and contagious nature of this infectious disease has raised wider concerns over the possible impact on healthcare capacity, which has been re-emphasised during the Covid-19 pandemic, particularly when the NHS has been overburdened and overstretched.

I look forward to the developing debate and the answers that the Minister can provide. I like to think that this will be the first stage of an opportunity to give this subject a greater level of debate in your Lordships’ House, as it will become much more acute and apparent as we emerge from the Covid-19 pandemic and approach this autumn’s influenza and RSV season.