Osimertinib Cancer Treatment

Baroness Thornton Excerpts

Tuesday 18th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, we estimate that there are currently just eight patients in Northern Ireland who would benefit from the expanded use of Tagrisso for early-stage disease. Perhaps I may reassure my noble friend that they will all have the same access as in the rest of the United Kingdom without any delay or restraint on that access.

[Baroness Thornton (Lab)]

My Lords, we should all wholeheartedly welcome the news of the agreement to enable early access to Osimertinib for early-stage lung cancer patients in England and I absolutely recognise that it is also available to patients in Northern Ireland. However, early diagnosis is as important as access to treatment. It is therefore deeply concerning that the number of people in England and, presumably, across the UK being seen by a specialist for suspected cancer, following urgent referral from their GP, has dropped dramatically. What steps are the Government taking to bring those waiting lists down? We certainly cannot wait for a reorganisation of the NHS, as proposed this year. Does the noble Lord acknowledge that reorganisations tend to have a chilling effect on the recovery of our NHS?

[Lord Bethell (Con)]

The noble Baroness is entirely right to be concerned about the backlog of oncological diagnostics. It is of grave concern to all of us. That is why the NHS has massively prioritised the tests she described. We are working extremely hard to get through the backlog. GPs are extremely focused on identifying those most at risk and those who are late for their tests are being followed up with great energy and endeavour. I pay tribute particularly to the role of NHS D, which is using the kind of data gains that we made during the pandemic to mobilise all the technology we can to get the right people into tests at the right time.

Eating Disorder Services: Referrals

Baroness Thornton Excerpts

Monday 17th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, undoubtedly, the increase in referrals is something of concern. It is something we are monitoring closely, with the round table and the ministerial group dedicated to looking at this. That shows the seriousness with which we regard it. The reduction in the impact of community services, which is the best way of addressing these kinds of issues, has undoubtedly had an effect on urgent needs. During this period, there has also been a large increase in the number of young people who have started treatment, which is encouraging. If the noble Baroness has evidence that measures such as nutrition information on packaging has an effect on anorexia, I would welcome correspondence from her.

[Baroness Thornton (Lab)]

My Lords, as the noble Baroness has said, we know that eating disorders among children and young people have increased during the pandemic. There is a very welcome increase in the grant of £11 million from the grant in 2018-19. Despite this, total spending by CCGs on children and young people’s community eating disorder services increased by just £1.1 million, from around £54 million in 2018-19 to £55 million in 2019-20. This increase is cancelled out if you adjust for inflation, and this means that total spend flatlined in real terms. What are the Government going to do to ensure that this money is spent on what is growing into an epidemic of eating disorders and the suffering they cause?

[Lord Bethell (Con)]

My Lords, the noble Baroness is entirely right that community eating disorder services are critical. They are the backbone of our measures to address these difficult cases. But money for the treatment of eating disorders comes from many different pots. During 2021, a total of 10,695 children and young people started treatment, which is up from 8,034 children in the year before. So, clearly, resources are getting through to cope with a large number of people, and that is an encouraging sign.

Health Protection (Coronavirus, Restrictions) (Steps and Local Authority Enforcement Powers) (England) (Amendment) Regulations 2021

Baroness Thornton Excerpts

Monday 17th May 2021 Grand Committee

[Baroness Thornton (Lab)]

It is regrettable, as my noble friend Lord Rooker said with a certain amount of robustness, that yet again the House is being asked to retrospectively approve significant legislation that impacts on individual liberty, well-being and livelihoods, five whole weeks after it came into effect and after it was further amended, on the day when a new lifting of restrictions is taking place—I suppose we will get to discuss that some time in the next month.

The regulations state that

“the Secretary of State is of the opinion that, by reason of urgency, it is necessary to make this instrument without a draft having been laid before, and approved by a resolution of, each House”.

Nothing in the regulations or in what has been said by the Minister today justifies using the emergency procedure to introduce previously announced policy changes at the 11th hour. We are now well over a year into the pandemic and, while we encourage the Government to be proactive and driven by data, that does not prevent or exempt them from following parliamentary procedures. The Minister will be familiar with this repeated complaint.

The countrywide road map for lockdown lifting announced on 22 February advised that England would enter stage 2 on or after 12 April. This date was confirmed at a government press conference on 5 April, yet these regulations were not laid before Parliament until 9 April, coming into force three days later. While that is definitely an improvement on the three hours’ notice that we have had for some regulations in the past, there is simply no excuse for the Government’s continuing indifference to the importance of parliamentary scrutiny.

We have so many errors in the regulations given to us; that is another reason why they need to be subject to proper scrutiny before they become law. According to the Explanatory Memorandum, alongside the stage 2 easements the instrument also makes

“minor drafting changes to remove superfluous wording and to amend references”

in the original steps regulation. I am not sure that these are minor. The Minister will be aware that the JCSI report raised a number of serious concerns about these regulations: first, because of their unusual or unexpected use of enabling powers; secondly, because of defective drafting; thirdly, because they required elucidation; and, fourthly, because they failed to comply with proper legislative practice. Frankly, you would have thought that after a year the Government would have got used to all this, that they would be experts and certainly that they would not be making mistakes in the drafting of legislation.

That is quite a sad list of failures for one statutory instrument whose purpose is to see us safely opening society following lockdown. In one instance, the regulations are so unclear that the Joint Committee said that the law being laid down was unsatisfactory in terms of the rule of law. If a committee of legislative experts is unsure what is or is not meant by certain regulations and does not believe that they give sufficient certainty and clarity, how will the rest of us fare, and how can an average person expect to understand them? This is deeply unfair on those required to enforce the rules and on the businesses grappling to comply so that they can safely resume trading. I fully expect the Government’s use—or misuse—of the emergency procedure and the impact of defective drafting to be covered by the inquiry, but I sincerely hope that the Government will get a grip on this now, especially given the continued threat posed by new variants and the risk of a third wave, which many noble Lords mentioned.

Noble Lords will be well aware that the steps regulations have been further amended, with provisions to move England into stage 3 coming into force today. It is therefore important that the Minister addresses those changes, especially given the growing concern about the B16172 Indian variant in the UK and calls from leading experts to postpone the planned easements. I will not repeat the information given by other noble Lords, because that has been very well covered. However, can the Minister confirm how many people to date have been hospitalised with the Indian variant of concern and how many of those had been partially or fully vaccinated? Over the weekend, the Health Secretary suggested that many coronavirus in-patients in Bolton had not been vaccinated, despite being eligible. I would like the Minister to address how that is being tackled. He has already mentioned that, and I know that my honourable friend Yasmin Qureshi, the MP in Bolton, has been very active on this. Surge vaccinations have been introduced in many hot-spot areas, with some bringing forward second doses and others extending eligibility to younger age groups. Can the Minister confirm whether that is happening and what is the JCVI’s position on this?

It is clear that it was a mistake to delay adding India to the travel list and not to implement a comprehensive hotel quarantine policy. This morning, the Health Secretary, Mr Hancock, said that people should not travel to amber countries except for essential reasons and “certainly not” for a holiday, because of the risk of coronavirus. This is not what the regulations state. The Minister needs to confirm whether the regulations will be updated to reflect the Health Secretary’s comments or whether this is yet another case of the Government’s mixed messaging.

Office for Health Promotion

Baroness Thornton Excerpts

Thursday 29th April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, there is already considerable co-ordination between the department, DCMS and DfE on exactly that. I highlight the money that has gone from the tax on soft drinks to contribute to funding outdoor activity in schools, which has had an enormous impact. My noble friend is entirely right that physical activity is linked to better health outcomes; that is why it will form part of the agenda for the Office for Health Promotion.

[Baroness Thornton (Lab)]

My Lords, the policy paper does not reference the measures proposed in the childhood obesity plan and the recent Tackling Obesity strategy released last July. I hope that omission is not significant. Can the Minister confirm—I was slightly concerned by his response to the noble Baroness, Lady Jenkin—that the ban on online adverts for foods high in fat, sugar and salt has been watered down? In awaiting the consultation from the advertising industry, is that a “whether” or a “how”?

[Lord Bethell (Con)]

My Lords, consultations are there to have an honest conversation. It would be wrong for me to try to pre-empt the outcome of that consultation from the Dispatch Box.

Northern Ireland: Flight Passengers and Covid-19

Baroness Thornton Excerpts

Wednesday 28th April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I recognise the challenge to which the noble Lord refers. It is, of course, a fact that coronavirus restrictions in Northern Ireland are determined by the Northern Ireland Executive as part of the devolution settlement, as I am sure he would recognise. The Secretary of State for Northern Ireland has raised the issue with the Irish Foreign Minister on a number of occasions to press for a resolution, and while the UK Government continue to work closely with the Executive to drive this virus down, we respect that healthcare is a devolved matter. This is a complex issue to resolve, but we are extremely grateful to all parties who are working hard to resolve it.

[Baroness Thornton (Lab)]

My Lords, the truth is that the Northern Ireland Health Minister, Robin Swann, found out that there were cases of the Indian variant of the virus in the Republic of Ireland only from media reports. This is deeply concerning, as was raised by the noble Lord, Lord Dodds. Northern Ireland is part of the UK, so we have the same responsibilities to our fellow citizens in Northern Ireland and therefore it is very concerning. Is the Minister confident that, going forward, mutually beneficial data-sharing processes are in place to ensure that new variants are controlled and do not become seeded and spread in any of our communities?

[Lord Bethell (Con)]

My Lords, I am enormously grateful to the Irish Government for the very large amount of informal clinical data-sharing that goes on. CMOs of both countries exchange data on such matters as VOCs the whole time, and that kind of day-to-day clinical exchange of on-the-ground information works extremely well. The specific question of travel information is a lacuna that needs to be closed, I recognise that it needs to be shut, a lot of work is going on to shut it and I am grateful to those involved.

National Health Service (Charges and Pharmaceutical and Local Pharmaceutical Services) (Coronavirus) (Amendment) Regulations 2021

Baroness Thornton Excerpts

Monday 26th April 2021 Lords Chamber

[Baroness Thornton (Lab)]

Like my noble friend Lord Hunt, I welcome the purpose of the 2021 regulations, as community pharmacies are contracted and commissioned in England under the national community pharmacy contractual framework, which sets out the services that need to be provided, how quality is assured and other expectations, such as safety.

As has been said, the CPCF is negotiated nationally between NHS England and NHS Improvement, the Department of Health and Social Care, and the Pharmaceutical Services Negotiating Committee. As has also been said, the latest CPCF runs from 2019-20 to 2023-24, but it has not been able to be reviewed, due to Covid. It makes it easier for pharmacies to dispense certain medicines under specific circumstances. If those medications to help treat coronavirus outside hospitals are found, the regulations aim to allow them to be dispensed in such a way as to maximise take-up—this must be the right thing to do.

Community pharmacies makes up one of the four pillars of our primary care system in England, along with general practice, optical services and dentistry. They must often feel that they are the poor relation—the wonky leg on this particular table, perhaps. I will not list all the contributions that they make to our primary healthcare system because that has been adequately covered by many speakers—in fact, all of them, in different ways—in this debate. They are an important feature and fixture on our high streets, in our rural communities and, often, in our supermarkets.

When Covid struck, community pharmacies did not close; they stayed open and served their communities. They continued to deliver medication to people who could not leave their homes. They have been a huge asset to our NHS throughout this whole period; they have been vital. We depend on them at a local level, in both rural and inner-city communities; as people have said, their expertise saves hundreds of thousands of GP and hospital visits. Indeed, the Government have encouraged people to go to their pharmacy before they do anything else—quite rightly.

I support the housekeeping point made by the noble Baroness, Lady Brinton, about the instrument breaching the 21-day rule, with its provisions coming into place before that. The noble Lord knows that a bit of forward planning would be appreciated, but I do not deny it is clear that, because of the rollout of the vaccine, it was necessary to ensure that no one paid for their vaccine, or any treatment in another pandemic situation, to support the maximum take-up of treatment.

However, why would the Government underfund and behave in such a fashion as to undermine and put at risk these businesses? That is the basis for my noble friend’s regret Motion. I have a further question about the uncertainty over the hub and spoke proposals that were in the recent MMD Act: does the Minister have an update on how implementation work is progressing and when we can expect the consultation process to commence?

I finish by asking three questions. Can the Minister advise the House when community pharmacies can expect a final decision on the reimbursement of their extra Covid costs? Like the noble Baroness, Lady Wheatcroft, I agree that the likes of Greensill are not an answer to this. Can the Minister explain why the NHS is refusing to increase investment in community pharmacies to support the NHS? Given the vital role they play, as everybody has acknowledged in this debate, they need certainty about their ability to play their full part in tackling the Covid healthcare backlog, for example. Finally, would the Minister willing to meet me, my noble friend Lord Hunt, other noble Lords, and representatives of pharmacy associations, for instance the Company Chemists’ Association, to discuss long-term funding for this sector?

Folic Acid

Baroness Thornton Excerpts

Monday 26th April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I would be glad to take the noble Lord’s recommendation back to the department; he puts it extremely persuasively. As I said, we have looked at the substantial point closely and it is extremely persuasive, as the noble Lord rightly put it. We hope to come forward with recommendations as soon as the elections are over.

[Baroness Thornton (Lab)]

I reinforce what my noble friend Lord Rooker said. I may be addressing this with my third or fourth Minister. I am not certain whether the noble Earl, Lord Howe, dealt with it when I was opposite, but he may have done, which would make the noble Lord my fourth Minister on this issue. It is even more irritating that it was research in the UK that led the United States and other parts of the world to adopt this policy. I think The Minister has run out of road on this one, and I would like to hear what the timetable to implement this policy is.

[Lord Bethell (Con)]

I completely endorse the tribute of the noble Baroness to those who have worked on this policy. She is right: the science that has gone into this has been persuasive around the world. I thank those in industry who worked with us on our pilot, which proved extremely successful. We are in good shape when it comes to thinking through the implementation of such a policy. My hands are tied at the moment, because of purdah, but I hope to return and fulfil the noble Baroness’s wishes.

Body Mass Index

Baroness Thornton Excerpts

Thursday 22nd April 2021 Grand Committee

[Baroness Thornton (Lab)]

My Lords, I congratulate the noble Lord, Lord Addington, on this debate, which has already raised many interesting issues. Indeed, the report of the Women and Equalities Committee into body image is not new. Over 40 years ago, Susie Orbach wrote Fat is a Feminist Issue; she challenged body mass index as a measure of—as she said—“nothing useful” and pointed out how it affected women’s self-image. On the 40th anniversary of FIFI, as many of us know it, she said:

“When you grow up absorbing the idea that food is quasi-dangerous, it is hard to know how to handle it. There are no end of experts selling their wares whose books and products end up generating enormous profits … So, too, with other food and diet fads. The desperation that exists to be at peace and dwell in our bodies clashes with the knowledge that such schemas promote or reinforce confusion about appetite and desire.”


The fact is that, 40 years on, it is still pretty grim:

“It’s a story of … destabilising the eating of many western women and exporting body hatred all over the world as a sign of modernity”,


as a way of medicalising and pathologising

“people’s relationship to food and bodies so successfully that vast industries would grow up to treat problems that these industries had themselves instigated.”

What is clear from this short debate is that it should come as no surprise that BMI as a single measure would not be expected to identify cardiovascular health or illness; the same is true for cholesterol, blood sugar and blood pressure. As a single measure, BMI is clearly not a perfect measure of health, but it is probably a useful starting point for important conditions when a person is overweight or obese.

The Select Committee said that it was

“not satisfied with the use of BMI as a measurement to evaluate individual health.”

On the other hand, as other noble Lords have said, Diabetes UK says that it provides

“valuable information for care focused on individuals that doesn’t discriminate against anyone.”

I dispute that, but it also goes on to say that it has been an important tool for monitoring the population’s health and informing policy decisions and has been fundamental in the rollout of the Covid population risk assessment, which identified 1.7 million people at increased risk of hospitalisation and death from coronavirus. Without that use of BMI, a population-based intervention would not have been possible.

The challenge for the Minister is how to reconcile these issues. I look forward to hearing his answer.

Alcohol Harm Commission: Report 2020

Baroness Thornton Excerpts

Thursday 22nd April 2021 Grand Committee

[Baroness Thornton (Lab)]

My Lords, I thought I would read out all the recommendations very quickly. They are:

“1. A new comprehensive strategy… 2. Alcohol harm should be a specific part of the remit of the new Domestic Abuse Commissioner … 3. All professionals who have regular contact with children and families must have a core competency to intervene and provide support in cases where alcohol harm is evident … 4. Action to prevent, identify and support Foetal Alcohol Spectrum Disorder … 5. Reduced price promotion of cheap alcohol through increased alcohol duty and minimum prices with regular reviews of prices in relation to inflation and income … 6. Restrictions on availability of retail alcohol through reduced hours of sale and reduced density of retail outlets … 7. Comprehensive restrictions on alcohol advertising across multiple media, including restrictions on sponsorships and activities targeting young people … 8. Alcohol labelling to provide consumers with information about alcohol harm … 9. Treatment and care for alcohol use disorders and co-occurring conditions … 10. Brief psychosocial interventions for people with hazardous and harmful alcohol use, with appropriate training for providers at all levels of healthcare … 11. Action to reduce drink driving”.


Almost every one of those has been mentioned in some way or other during this brief debate, so I hand them all over to the Minister, asking whether the Government agree with them. Will they enact them, and in what timeframe?

Covid-19: Obesity

Baroness Thornton Excerpts

Wednesday 21st April 2021 Lords Chamber

[Lord Bethell (Con)]

As the noble Lord rightly points out, the cost is enormous: £27 billion is the estimated cost to society, and 64% of people are classified as overweight. The challenge is enormous. We have to strike the right balance between government action and personal agency. The noble Lord is right that the return on investment is huge, but the Government cannot lose weight for people on their behalf. No amount of government initiative will shed the pounds. We have to get people to change their behaviours. We are trying to understand what the right measures are to give people the inspiration and information they need to take the right steps.

[Baroness Thornton (Lab)]

My Lords, this Government’s proposal is the 14th government obesity strategy since 1992. Despite 689 policies having been introduced in the past 29 years, obesity rates have increased. Another major indicator is deprivation. Children from deprived areas are twice as likely to be obese as children from the richest areas, as acknowledged by the Government’s strategy. However, the strategy was criticised for not going far enough on poverty. Healthy foods are three times more expensive per calorie than less healthy foods. Can the Minister address this grave and vital matter of people from lower socioeconomic backgrounds not having access to, and being unable to afford, healthy and nutritious food?

[Lord Bethell (Con)]

My Lords, I agree with the correlation pointed out by the noble Baroness. We must acknowledge and address the fact that areas of deprivation undoubtedly have higher levels of obesity. However, we have to be careful about taking away people’s sense of agency. It is possible to buy affordable healthy foods at any price point. Food has never been cheaper than it is today. We must put into people’s hands the knowledge and inspiration to take the steps necessary to shed the pounds that need to be shed.