Covid-19: Restrictions
Baroness Walmsley Excerpts(3 years, 3 months ago)
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Lord Bethell (Con)
My Lords, the noble Baroness analyses the situation extremely well and has laid out exactly the Government’s plan for rolling out the vaccine. She is entirely right that we are using lockdowns to bridge the gap until herd immunity is achieved through the vaccine. We have mobilised an enormous amount of the NHS, and are very grateful to the volunteers who have stepped up and are making an enormous difference. We are trying to get as much of the vaccine as possible out of the factories and warehouses, with batch control, and into the country’s surgeries and hospitals to vaccinate millions of people before the spring.
Baroness Walmsley (LD) [V]
My Lords, a weak link in the measures to suppress the virus has been the small percentage of people not self-isolating when they should. This is often because they cannot afford to do so. Dozens of times my Lib Dem colleagues and I have asked the Government to provide adequate financial support for self-isolators. So I ask the Minister again: in order to suppress the virus, will the Government pay the wages of poor people who need to self-isolate?
Lord Bethell (Con)
My Lords, I pay tribute to the advocacy of the noble Baroness and her colleagues on this important point. I acknowledge the financial pressures on those of limited means who are required to isolate. We have put in provisions for statutory sick pay and the £500 Covid bonus to help to support those people, and there are local authority funds and provisions to provide additional support. The point that she makes is made well and we completely acknowledge the challenge.
Obesity
Baroness Walmsley Excerpts(3 years, 3 months ago)
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Baroness Walmsley
To ask Her Majesty’s Government what assessment they made of the report by the All-Party Parliamentary Group on Obesity The Future of Obesity Services, published on 25 November 2020.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, we welcome the ongoing work and support of the All-Party Parliamentary Group on Obesity and its report The Future of Obesity Services, which continues to make a valuable contribution to the debate. We published Tackling Obesity: Empowering Adults and Children to Live Healthier Lives last July, which demonstrates an overarching campaign to reduce obesity, takes forward actions from previous chapters of the childhood obesity plan and sets out measures to get the nation fit and healthy.
Baroness Walmsley (LD) [V]
I thank the Minister for his reply, but he will know that we have had several obesity strategies before. What steps are the Government taking to ensure that this latest strategy is implemented in full without delay? Can he provide an update on the timelines for implementation? One of the main concerns of our witnesses was that the full range of services should be provided everywhere in the country, with easier access at any stage of the pathway. Will the Government take this on board?
Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 2) Regulations 2020
Baroness Walmsley Excerpts(3 years, 4 months ago)
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Baroness Walmsley (LD) [V]
My Lords, the last time that we discussed restrictions, I asked the Minister whether volunteers would be used for non-medical tasks to improve the speed of testing and tracing. The Minister dismissed the idea. Now they are asking for volunteers to marshal patients in vaccination centres. Will he now recognise the important role of these public- spirited people and tell us what resources will be given to St John Ambulance to organise them?
The Government spoiled Christmas for head teachers by insisting, on the last day of term, that schools should open on time next week and that all children and staff should be given the rapid test. Yet virtually no time, money or person power has been provided to enable them to do this. While I believe that keeping schools open safely should be a priority, what are the Government doing to support heads and teachers? Will there be enough testing kits provided for schools to use? Will staff be given priority for vaccination to give them the confidence to return to work? Will volunteers be recruited to help with the testing to allow teachers to teach?
Children’s education is vitally important, but many of them have lost weeks of classroom time intermittently, not because of lockdowns but because of serial Covid outbreaks in the school and the need to go home for two weeks—over and over again. If the imminent announcement by the Secretary of State for Health and Social Care does not introduce strict measures to stop the virus in its tracks and if the Government do not implement an efficient vaccination rollout, this stop-start education will continue. The effect on our children’s education is not just whether or not we open schools but whether or not we win the battle against the virus. Does he agree?
Coronavirus Vaccine
Baroness Walmsley Excerpts(3 years, 5 months ago)
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Lord Bethell (Con)
I am slightly surprised by the tone of the noble Lord’s question. If there were ever a moment when my right honourable friend the Secretary of State for Health deserved a bit of praise and a thank you, today would be that day. That ad hominem attack was beside the point. On his serious point about trust in the vaccine, it would not be helpful for politicians to lead the charge. Our approach is to put science and the NHS at the forefront of our communications. They are truly engaged with both the expertise and the communities that need to take the vaccine.
Baroness Walmsley (LD) [V]
My Lords, the rollout will require many people, in addition to those giving the injection. Are there any plans to use the thousands of NHS volunteers who signed up during the first lockdown to act as marshals, drivers, identity checkers, or whatever else is required? In planning the appropriate use of the military, have the Government recognised the concerns of certain community leaders that their presence at testing sites would not reassure members of their communities who are hesitant about taking the vaccine because they do not trust authority?
Lord Bethell (Con)
The noble Baroness is right about the NHS volunteers. We would very much like to work with those who stepped forward. Their move was extremely welcome and kindly meant. However, the deployment of the vaccine is a precise affair. We are relying on people having to put in long hours—often not at their own discretion or convenience. Volunteers may well play a role, but the backbone and functional aspect of the deployment will rely on professional staff.
I appreciate her conundrum about the military. It is a delicate dilemma. I do not want to live in the kind of country where we turn our back on the military because some people might feel uncomfortable at the sight of uniforms on the streets. We need to build trust with communities. I want to use this moment of the vaccine to build a bridge of trust between those whom the noble Baroness reasonably described and the military. We must not make the mistake of disrespecting the military by turning them away from this important task.
Covid-19 Update
Baroness Walmsley Excerpts(3 years, 5 months ago)
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Lord Bethell (Con)
I share completely the noble Lord’s ambition for collaboration and a sense of national unity. I am grateful to the devolved Assemblies and the leaders of the nations for their collaborative approach, and to the leader of the Opposition for his support on a large number of matters. However, right now we need clear, simple, strong government, which is best supplied by the voted-in majority.
Baroness Walmsley (LD) [V]
My Lords, at the beginning of the first lockdown in Wales, we were forbidden from going out of our borough or travelling more than five miles for exercise. It worked. Now some Government Back-Benchers are demanding more granularity in the tier areas, with restrictions being eased in boroughs with lower case numbers. If this is to be done, it must be—as the Minister just mentioned—without risking the virus spreading from adjacent high-incidence areas, as it did before. If the Government are inclined to give in to this pressure, will they at least consider imposing travel restrictions in high-incidence areas?
Lord Bethell (Con)
The noble Baroness is entirely right. I share her sentiments. We are not inclined to give in to the pressure. There is a temptation for greater granularity, but we have learned the lesson on that one.
European Qualifications (Health and Social Care Professions) (EFTA States) (Amendment etc.) (EU Exit) Regulations 2020
Baroness Walmsley Excerpts(3 years, 5 months ago)
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Baroness Walmsley (LD) [V]
My Lords, my understanding is that these regulations are a tidying-up exercise to continue to recognise existing Swiss and other EFTA health professionals with qualifications after the end of transition this year. This does not address plans for future pathways of recognition. However, I would like to focus on professionals of whom we need more to clear the backlog of treatments—that is, dentists, who are a bit different from other health professionals. Can the Minister confirm that, irrespective of any new agreement made with the European Union, the General Dental Council will be able to continue to recognise the qualifications of all graduates of dental schools within the EEA, without the need for candidates to sit the overseas registration exam?
Can the Minister also tell me what steps have been taken by the General Dental Council to resume overseas registration examinations for non-EEA overseas dentists, which have been halted due to Covid, and ensure a continuing pathway for recruitment of EEA and non-EEA dentists? In light of the backlog of 15 million treatments, surely we need all the dentists we can get.
As the Minister will know, the NHS dental service does not have a registration system like the medical services do. Each course of treatment is a separate contract. Even with the same dentist, there is no obligation for either party to continue the relationship after a course of treatment ends, except to sort out any issues relating to a recent course of treatment. The patient is free to go to another dentist, and the dentist is free to decline further NHS courses of treatment.
The result of the lack of any registration system is that after a course of treatment ends, nobody has any obligation to find another NHS dentist for any patient. This gives NHS patients no security whatever about continuity of treatment, either preventive or responsive. Given that this situation has been made worse by Covid-19, and given the shortage of NHS dentistry in some areas, does the Minister’s department have any plans to ensure we have enough dentists going forward after the end of the transition phase of exit from the EU?
Medicines and Medical Devices Bill
Baroness Walmsley ExcerptsWednesday 11th November 2020
(3 years, 5 months ago)
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Baroness Walmsley (LD) [V]
My Lords, I add my voice to those of the noble Baroness, Lady Finlay, and the noble Lord, Lord Ribeiro, on their Amendments 86, 88 and 102, about having unique identifiers for medical devices. In these days of barcodes, this should not be too difficult nor add much, if any, cost for the manufacturers. Indeed, it has been proved to work with medical devices, as the noble Baroness explained.
It is important that products found to be faulty are speedily traced. If my digital radio can be recalled speedily because it might burst into flames, surely a medical device implanted in someone’s body must also be able to be recalled speedily. Recall could also be useful when something better comes along; it could be vital for the future treatment of the patient.
There are occasions when an individual product develops a fault, although the majority of products of that model are perfectly okay. If we are to learn lessons and improve products, as the noble Baroness, Lady Cumberlege, has just pointed out, it would be essential to know where they are and how the receiving patient has reacted to them. A unique identifier could facilitate that, and also provide some protection for the patient concerned, especially in the case of a recall.
I look forward to the Minister’s answers to the questions that the noble Baroness, Lady Cumberlege, asked about patient consent. It is vital that patients have confidence in the system. Confidence in their own privacy is part of that, and patients can have that confidence only if they know what is being shared, and by whom.
Baroness Redfern (Con) [V]
My Lords, I am pleased to speak to this group of amendments, and to thank the noble Baroness, Lady Cumberlege, who has been so diligent in her review in proposing such needed changes, and making good for the recipient and building user confidence in the devices offered. It is a pleasure to follow the noble Baronesses, Lady Finlay and Lady Walmsley, and the noble Lord, Lord Ribeiro—as well, of course, as the noble Baroness, Lady Cumberlege.
I spoke on Second Reading in support of an extensive programme for medical devices, to provide for high standards of safety and to share vital information, with data central to effectiveness. The noble Baroness, Lady Cumberlege, in her review, regarded being able to track which treatments and implants people have had as being of particular importance. A barcoded wristband, with equipment used in treatment, including implantable medical devices, being scanned and tracked to a patient’s record, would save much precious time for product recalls, and reduce drug errors.
This means knowing who has had a device used in their treatment, so that they can be swiftly notified if there is a problem. Having unique device identification is therefore very important. The noble Lord, Lord Ribeiro, said—and I agree—that we must consider tracking all medical devices used in the UK, rather than a select few.
Baroness Walmsley (LD) [V]
My Lords, I heartily support the noble Lord, Lord Field, and the noble Baroness, Lady Meacher. I thank the noble Lord for his important evidence, and congratulate the noble Baroness on her many years of energetic campaigning on this matter. Noble Lords may know that I too have campaigned long and hard for medicinal cannabis projects, that have been proved to be safe and effective, to be prescribed on the NHS for UK patients. When the Home Office changed the status of medicinal cannabis two years ago, many of us thought that, given the mass of evidence that there are many such safe and effective products in widespread use abroad, such medicines would become available free to UK patients. That has turned out not to be so. Although some expert clinicians are prescribing them for appropriate patients—including the noble Lord, Lord Field—in a private capacity at high cost, very few patients have received their medicine free on the NHS. Why is this? It seems that it is because NICE has not approved them because there have not been any random controlled double-blind trials. Therefore, several health trusts are forbidding consultants who want to prescribe these medicines to do so, on pain of losing their jobs.
There are children with intractable epilepsy in this country whose lives have been saved by the medicines, for which their parents have had to fundraise. The lives of some of those children have been put at risk because the coronavirus has prevented that fundraising, and they suffered serious preventable fits. Many of these children have been treated with approved pharmaceutical medicines that have never been approved for use with children and have serious side effects. That is why we need a proper regulatory framework based on the full cadre of available evidence, which this amendment proposes. It will not be difficult to establish the safety of these medicines, as required by subsection 3(a). If those making the regulations are allowed to take into account the health records of people who have already been taking these medicines, and also the vast amount of evidence from other developed countries which the noble Baroness, Lady Meacher, has listed, that will subsection 3(c). Subsection 3(b) requires that availability be considered when making the regulations. These medicines are readily available. Indeed, a lot of them are being made in this country and exported because they cannot be sold here. How mad is that? Nor are they expensive as medicines go, and the NHS can bulk buy at a discount anyway.
In order to satisfy those who do not trust evidence from other countries—although why is beyond me—we also need to collect data from UK patients who are managing to get cannabis medicines in order to provide the information required by NICE, but there is no system in place to do that. Will the Minister say why the NHS Commissioning through Evaluation system is not being used? It is a well-established and approved system that collects patient data and clinician observation on the use of novel medicines and treatments. It strikes me that, given that cannabis medicine’s illegal status made it impossible to collect much UK data before 2018, it would be an ideal candidate for this trusted method of evaluation. Finally, I would welcome the Minister’s response to this suggestion.
The Deputy Chairman of Committees (Baroness Watkins of Tavistock) (CB)
I call the noble Lord, Lord Norton of Louth. Lord Norton? We will move to call the noble Lord, Lord Patel, and come back to the noble Lord, Lord Norton if we have time. I call the noble Lord, Lord Patel.
Baroness Penn (Con)
I thank the noble Baroness for her comments about the importance of evidence. The Government and the MHRA recognise some of the difficulties around these trials. That is part of the reason that NIHR is supporting two trials and is asking people to come forward. The MHRA has also indicated that it is willing to work with those who have these products in order to support them in the process for licensing.
That has reminded me of one other point. The noble Baroness, Lady Walmsley, asked me about the NHS commissioning through evaluation programme. I undertake to write to her with a response, perhaps when I update the noble Baroness, Lady Thornton, on prescription numbers.
Baroness Walmsley (LD) [V]
My Lords, I thank the Minister for that. With regard to her earlier response, if it were as easy as that, there would have been tens of thousands of NHS prescriptions in the past two years, but clearly that has not been the case. The noble Baronesses, Lady Finlay and Lady Meacher, have both made it clear why it is very difficult to conduct randomised double-blind clinical trials for these products. That is why I have suggested that, while we wait for many more than two trials, the commissioning through evaluation system could be used. I am grateful to the Minister for promising to write to me about that.
Baroness Penn (Con)
I thank the noble Baroness for her comments. I emphasise that there has been a great deal of discussion in the debate about the use of evidence. That is what will guide the Government and the MHRA in this, and that is why we are supportive of these RCTs taking place.
Covid-19: Dental Services
Baroness Walmsley Excerpts(3 years, 5 months ago)
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Baroness Walmsley
To ask Her Majesty’s Government what measures they are taking to ensure the continued provision of dental services during the COVID-19 pandemic.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, the challenge presented to the dental profession by Covid is severe. We are grateful for the hard work of 10,000 NHS and private practices in introducing PPE and infection-control arrangements to keep patients and staff safe, and to the 600 urgent care centres that are providing services for the most severe cases. However, the impact on the nation’s health remains something that we are working hard to mitigate.
Baroness Walmsley (LD) [V]
My Lords, I thank the Minister for that reply, but 60% of dentists can now see only a quarter of their usual number of patients, particularly because of the measures needed for carrying out aerosol-generating procedures. There is a backlog of 15 million treatments, and many dentists are in danger of going out of business. They cannot afford ventilation equipment, which would enable them to see more patients in a day. Will the Government provide funding for this, so that the backlog of patients can be cleared?
Lord Bethell (Con)
My Lords, I completely acknowledge the challenge that the noble Baroness has described. Many dentists can see only 20% of their normal cases, and around half can see about 50%. The backlog is, as she describes it, severe, and the impact, particularly on private dentists, has been very hurtful for their businesses. I cannot make a commitment to fund ventilation arrangements, but we acknowledge the scale of this challenge and are looking at ways to mitigate it, including bringing in testing, which we hope would help provide a safe environment for both staff and patients.
Health Protection (Coronavirus) (Restrictions) (England) (No. 4) Regulations 2020
Baroness Walmsley Excerpts(3 years, 5 months ago)
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Baroness Walmsley (LD) [V]
My Lords, I support the need for the lockdown and will not be supporting any of the amendments to the Motion that express regret. However, I regret the fact that the Government did not accept the advice of their scientific advisers and take the decision to do this sooner; if they had, the NHS might not have needed to move to the highest level of risk in its emergency preparedness framework this morning.
I agree with my noble friend Lord Scriven that the Government must use the lockdown to get test, trace and isolate right. There is no point in boasting about the capacity of 500,000 tests per day; people do not trust that figure because we know that it does not mean 500,000 people tested, so it undermines trust and affects compliance. Although the processing time of the tests has improved, it is still not good enough. Tests have been returned several days late or are sent back to the wrong care home, so they are of no use.
Isolating rates may be as low as 10% and the ability of police and local officials to enforce quarantine is low. We need to use the carrot rather than the stick and make more support available for those isolating. I heard an MP the other day say, “Just pay their wages”. After all, it is for only two weeks, but it would have a massive effect on people’s willingness to isolate, and that matters for getting the R rate right down. If we do not reduce the R rate well below one, it will cost the economy a lot more because the lockdown will have to be extended. Will the Government consider this?
The Government are now trialling the new mass testing system in Liverpool, and I wish it well. However, from residents’ comments I have heard, they do not seem to have the messaging right. People are questioning why they need to take a test if they feel well. That, of course, is the point—testing potentially asymptomatic people—but, clearly, the message has not got through. What does the Minister propose is done about that?
Now that the rapid test is available, could it please be given to relatives of care home residents so they can safely visit their loved ones whom they have not seen for many months? Finally, there are children with very rare diseases who need special treatments which schools cannot cope with and who therefore cannot go to school, and their parents are getting to the end of their tether. The prospect of another four weeks of lockdown fills them with dread. They also need more clarity about who should shield. Will the Minister look into this because these families have been left behind?
Blood Safety and Quality (Amendment) (EU Exit) Regulations 2020
Baroness Walmsley Excerpts(3 years, 6 months ago)
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Baroness Walmsley (LD) [V]
My Lords, I intend to focus my remarks on the human tissue and organ transplant regulations and, in particular, on the issues of timeliness and trust.
I have a particular interest in both of these issues. Back in 1995, I gave my consent in Brussels for organs from my deceased husband to be removed for transplantation. I was happy to do so and received considerable comfort from the fact that, even after his death, he could do some good for other human beings somewhere in Europe. I mention this because, at the time, we and Belgium were both members of the European Union, and the administration and procedure were expedited smoothly and professionally. Since the 2016 referendum, I have been anxious that no barriers should be put in the way of the continued smooth running of this process.
As we have heard, in 2019 a set of regulations was approved to ensure that EU standards would continue during the implementation period, and today we have regulations that take account of the unusual position of Northern Ireland following our exit from the EU. The regulations ensure that, as long as Northern Ireland takes certain steps which have little or no cost, the same standards will apply and no barriers will be put in the way. I am reassured about that—in theory.
However, there are many practical considerations when you are dealing with human tissues that must be delivered in a timely way. The numbers we are dealing with are significant. Between April 2019 and March 2020, 32 organs from deceased donors moved from GB to Northern Ireland, and 126 organs moved in the other direction. As the Minister said, there are two tissue establishments in Northern Ireland, and they will continue to be able to receive tissues and cells from GB, but they will treat GB as a non-EU member state for this purpose.
I understand that Northern Ireland must continue to meet the requirements of EU directives for as long as the protocol is in force. But, as other noble Lords have said, changes to these instruments may be needed if there are changes to the directives. Can the Minister confirm that the Northern Ireland Administration intend to make these changes if they happen, and, if that is the case, what is the British Government’s intention?
My interest in the human tissue regulation is both personal and general. I have a family member who is currently awaiting a bone marrow transplant and, fortunately, matches have been found in other countries, possibly Northern Ireland. Time is of the essence, so my concern is whether organs and tissues from abroad will reach UK patients in a timely way after the end of the transition phase. If the ports are blocked, the Government have suggested that tissue and medicines—and indeed pharmaceuticals—will be flown in. But look what has happened to the aerospace industry during the pandemic. Will there be enough resource? Will the military be used if there are blockages?
I am also concerned about UK bioscience research. There are about 5,000 imports of tissues and cells from the EU alone in a typical year, so it is essential for UK life sciences that there are no barriers to this work. Can the Minister reassure me?
These SIs are to bring EU regulation into UK law, whether or not we get a deal. It is looking as if we will not. When the 2019 SIs were debated in Grand Committee on 9 January 2019, in Hansard col. 201 the Minister said that such materials would be “prioritised”. However, the problem is that everything will need to be prioritised.
In that debate my noble friend Lady Barker raised the issue of inspection of premises, pointing out that the UK and the EU will each inspect their own premises. But what happens if there is a serious incident on one side or the other? Will this not destroy the trust that is needed for this system to work? It is also essential that the public trust the regulations since, in many cases, such as transplantation, their permission is needed. How will the Minister reassure any member of the public listening to this debate that they can have the confidence to give that consent once we are independently responsible for our own standards? As the noble Lord, Lord Alton, said, confusion and inconsistency can destroy trust.