Medicinal Cannabis

Baroness Walmsley Excerpts

Monday 6th July 2020 Lords Chamber

[Lord Bethell]

My Lords, I cannot comment in detail on the specific situation the noble Lord refers to. I recognise the high costs of medicinal cannabis, and we have done an enormous amount to bring those costs down and to regularise the transport and regulation of those drugs, but this is the way our medical arrangements are made in this country. Private prescriptions are an option for those who can seek them, and we are working hard to get more of these medical cannabis treatments on the NICE schedule, but they require clinical trials.

[Baroness Walmsley (LD) [V]]

My Lords, will the Minister accept that the existing protocols and regulatory mechanisms suitable for most pharmaceutical medicines are not capable of handling medical cannabis, which has multiple active ingredients and is therefore not suitable for the usual randomised control trials? Does he therefore agree that a new regulatory system is required for medical cannabis, as there is in many other countries?

[Lord Bethell]

I do not think the noble Baroness is right. There are always groups advocating that their medicines are different from every other type of medicine, but the processes of clinical trials have served medical science extremely well. I share her frustration that the process of medical trials around cannabis has not moved quickly enough. That is why NIHR is looking again at the way these trials are funded; I have spoken to it about how this can be accelerated.

Ultra-processed Foods

Baroness Walmsley Excerpts

Thursday 2nd July 2020 Lords Chamber

[Lord Bethell [V]]

The noble Baroness is entirely right to say that Covid has focused our minds on obesity and the role of diet. However, voluntary approaches are necessary. We have to take people, industry and government with us. That is the core of our approach and it will remain our approach.

[Baroness Walmsley (LD) [V]]

My Lords, will the Prime Minister’s proposed obesity strategy include the full range of obesity services up to tier 4 in all areas, plus ensuring prevention measures such as calorie labelling, portion size, reformulation and the restriction of price promotions of HFSS foods? Will there be independent evaluation of the measures to be proposed?

[Lord Bethell [V]]

My Lords, it is not my role to pre-empt the Prime Minister’s strategy formulation, but the noble Baroness has articulated a very reasonable list of the potential measures. We are closely focused on this area. We are measuring ourselves keenly and our objectives are clearly laid out. The focus is on getting movement on this important area.

Covid-19: Track and Trace System

Baroness Walmsley Excerpts

Thursday 18th June 2020 Lords Chamber

[Lord Bethell [V]]

My Lords, we are in regular contact with many of the countries that are working with apps. Two things are crystal clear. The opportunity of using automated technologies to create extra tracing contacts is enormous, and we are working extremely hard to chase down that opportunity, but the technical challenges are also enormous. We are working very closely with our tech partners and with other countries to develop the best possible app, particularly for a moment when the prevalence in society might increase, for that is when the mass automation delivers its unique advantage.

[Baroness Walmsley (LD) [V]]

My Lords, can I press the Minister on his answer to the noble Baroness, Lady Young? In the first week of “test and trace”, over 8,000 cases were referred, but the ONS said that there were 33,000 cases. If only a quarter of cases are being referred, how does the Minister think that we will ever stamp out this virus? When will we get more widespread asymptomatic testing and tracing?

[Lord Bethell [V]]

My Lords, the epidemiological maths is as the noble Baroness describes, but our focus on symptomatic cases does not mean that the system does not work. Taking out more than a quarter of infected cases is a massively important and impactful event. Asymptomatic testing has started in healthcare and social care workers. It is making a big difference in both those forums, where prevalence is higher than the community prevalence, and we will be learning lessons from those schemes.

Covid-19

Baroness Walmsley Excerpts

Thursday 23rd April 2020 Lords Chamber

[Lord Bethell]

My noble friend Lord Lucas is quite right about IP, although I bear testimony to the private companies and major corporations which have reacted incredibly generously and enthusiastically by supporting the Government during this crisis. Our supply chains absolutely need to be reviewed. Resilience is clearly more important now than it has ever been. When we look at the way in which our medical, pharmaceutical and device supply chains are put together, they will look quite different in years to come.

[Baroness Walmsley (LD)]

My Lords, the Secretary of State said that he would mention treatments, but he focused only on vaccinations, which are of course important. However, I would like to ask about progress on developing antiviral drugs and the use of serum treatments, about which I have heard encouraging reports. Can the Minister say whether there are any plans to ask recovered Covid-19 patients to donate blood after a suitable recovery period so that the serum could be used to treat very sick patients and help them recover?

[Lord Bethell]

The noble Baroness is entirely right. Serum offers an encouraging opportunity, not least because it is a proven technology. The national blood transfusion service has been asked to start investigating how to collect serum, and a grant for the purchase of new machines to help that has already been made.

Major Trauma Centre: Westminster

Baroness Walmsley Excerpts

Thursday 30th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

The NHS develops its plans in each hospital according to the Government’s national risk register and its planning assumptions underpin this. The security services then evaluate and publish the current threat level to the UK from terrorism and the NHS is made aware of any change to this, so that it can react accordingly. In addition, we provide training for paramedics for terrorist attacks, as I have mentioned. We have the hazardous area response team, comprising specially trained personnel to provide ambulance response to particularly hazardous or challenging environments, including following a terrorist attack. London also has the tactical response unit, which is designed to work as part of a multiagency team with police and fire services to respond to firearms incidents. In the most recent attacks, the response time for paramedics was within seven minutes. We have recently agreed to increase the number of marauding terrorist attack and chemical, biological, radiological and nuclear trainee paramedic responders, and we will have a minimum of 240 responders in each ambulance trust.

[Baroness Walmsley (LD)]

My Lords, I welcome the Minister’s reassurances. Is she aware that in London last year 265 fewer members of the public attempted CPR on people nearby whose hearts had stopped? Does that not suggest that it would be more help to the people who work in and visit this building if we invited St John Ambulance to come to us again to deliver training on CPR and wider first aid interventions?

[Baroness Blackwood of North Oxford]

As ever, the noble Baroness makes a very sensible suggestion about wider CPR training. I will take up that point.

Health: Sepsis

Baroness Walmsley Excerpts

Wednesday 22nd January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

I am not quite sure which data the noble Baroness was referring to. The study stated that the number of UK deaths was at 48,000. This was a modelled estimate; it was inaccurate. Our data, published by the Office for National Statistics, states that the figure is 22,341 and puts the UK’s performance at a better rate. We are not complacent in any way. This is why there has been concerted action through a number of routes not only to improve the performance in sepsis diagnosis and screening but to make sure that we raise public awareness and provide training for NHS staff. The early warning system has been introduced as the revised national early warning score. As the noble Baroness said, it is intended to improve and standardise the process of recording, identifying and responding to patients at risk. It was introduced as a CQUIN incentive and included in the 2020-21 scheme which was published yesterday. This means that it will be in every hospital across the country.

[Baroness Walmsley (LD)]

My Lords, it can be difficult to diagnose sepsis in people with learning disabilities and difficult for them to realise that they may have it. The NHS has a very good little video prepared by and for people with learning disabilities and their carers. Is there anything the Minister can do to make sure that that helpful video is disseminated more widely?

[Baroness Blackwood of North Oxford]

That is an extremely helpful and constructive proposal. If the noble Baroness would like to raise it with me outside the Chamber, I will take it up as a matter of priority.

NHS and Social Care: Staffing

Baroness Walmsley Excerpts

Wednesday 15th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her question and pay credit to the work she has done in this area. She is absolutely right that we have to make urgent progress in delivering a sustainable social care solution. In the first instance, we have given councils up to £3.9 billion of additional funding in 2019-20, and the Prime Minister has been clear that he wants to see cross-party consensus on a sustainable way forward this year. I look forward to seeing progress made as swiftly as possible and hope that we will see work across this House on it, as I know this place takes the issue very seriously. In addition, we have run a national adult social care recruitment campaign to raise the profile of adult social care and encourage applicants. This has been successful; we have seen a 23% increase in the number of vacancies advertised on the DWP’s “Findajob” platform, which is improving the situation in the short term.

[Baroness Walmsley (LD)]

My Lords, there are particular shortages of nurses in certain specialties such as children’s palliative care, children’s mental health and learning difficulties. What will the Government do to improve the situation in those very important and sensitive areas?

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right that we want to target recruitment towards the areas with the greatest shortages. That is one of the reasons why, when we announced the new non-repayable funding, we also announced a top-up for targeted specialties struggling to recruit. It is also why we have announced the availability of placements which can enable nurses to develop experience in specific specialties, which make it easier to recruit and retain those nurses in very rewarding and sometimes hard to recruit specialties.

Queen’s Speech

Baroness Walmsley Excerpts

Thursday 9th January 2020 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I thank the Minister and the other winders for graciously giving me permission to speak, even though I may have to leave before the end of the debate because of a health issue concerning my husband. I wish to speak on health.

Our NHS is a precious national asset, which comes right at the top of most people’s priorities, and rightly so. In the gracious Speech, the Government promised a number of measures on health. I welcome the commitment to look at legislation proposed by NHS England to facilitate delivery of the long-term plan, and I look forward to working with the Government to implement it. However, I do not believe that the Government were addressing the right priorities when they promised to build 40 new hospitals over 10 years. The fact is that our hospitals are full, and one might think that a solution to that problem might be to build some more. But would it not be better to look at why the hospitals are so full and do something about it? The main problem lies at both ends of the throughput. Many people remaining in hospital beds would be better off in social care. This results in dangerously high levels of bed occupancy, with vulnerable patients having to wait for 24 hours in A&E for a bed on a ward. Yet we have been waiting years for the Green Paper on social care, and now all the Government can propose is cross-party talks. Fine—but when will we get a remit, a format and a timetable, and why not start with Dilnot and the report of the committee of the noble Lord, Lord Forsyth? We urgently need a courageous solution which is fair to all patients and all generations. It must address the predicament of those suffering from that distressing condition Alzheimer’s disease, who face on average 15% higher care costs than other patients. A way must be found to spread the costs across the whole of society.

At the other end of the throughput is primary care. We are promised 6,000 more GPs but the last Conservative Administration did not hit the previous target. At the same time we disadvantage ourselves when recruiting doctors and nurses from other EU countries by leaving the EU. Speeding up visa applications and reducing fees will not help when people still have to pay thousands of pounds to bring their families and to use the very NHS for which they are being recruited. Primary care is under great pressure and nowhere near enough capital is being allocated to the facilities needed to attract GPs. Perhaps new local health centres do not make such good headlines as 40 new hospitals. What are the Government’s plans to invest in modern primary care facilities?

In December, A&E hit its worst-ever waiting times because people cannot get to see a GP. Patients who really need hospital treatment wait in ambulances outside, like the lady in my village who died of sepsis having waited for hours outside the hospital.

That brings me to staffing levels. The Government are relying on retaining 19,000 nurses who might otherwise have left to deliver their promise of 50,000 more, but they need to make staying on much more attractive. That means much better working conditions and less need for, for example, staying on for an extra two hours at the end of a 12-hour shift because no one is there to take over.

Finally, I turn to gambling addiction, a preventable mental health issue that is growing. More than 400,000 people in England are addicted to gambling, and hospital admissions have more than doubled in the past 12 months, while the age of sufferers is getting younger. I am pleased that 14 new treatment clinics are planned by 2024 but we need to do more now to prevent the problem while we treat those affected. Will the review of the Gambling Act seek to tighten the regulation of companies that promote gambling, which take more than £14 billion a year from the punters, and to restrict the way that they market their services, especially to young people?

We allow far too much gambling advertising. Companies would not spend £1.5 billion a year on this if it did not result in more gambling. We realised long ago that advertising smoking encouraged people to do something that damaged their health and that of others, so we banned it. We should do the same for adverts that endanger the mental health of susceptible people and bring misery to their families. Will the review of the Gambling Act seek to reverse the normalisation of gambling?

Health Service Safety Investigations Bill [HL]

Baroness Walmsley Excerpts

2nd reading (Hansard): House of Lords
Tuesday 29th October 2019 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I too thank the Minister for introducing this Bill.

I have always believed that, if you want to know what is wrong in an organisation, the best thing you can do is ask the people who work there. They will also very often know what to do about it. If you want to manage change effectively, your first principle has to be to involve in its design those who are going to implement it. I am also, as a keen gardener, a fan of the old saying that the best fertiliser is the farmer’s boot. In other words, there is no substitute for getting round the farm to see what is growing well and what is being eaten by caterpillars. The same goes for organisations. If managers do not get out of their offices to see how things are working on the ground, they will miss what is going wrong and lose out on valuable opportunities to hear from staff informally. Nowhere is that more important than in an organisation where people’s lives depend on getting things right the first time.

We therefore welcome the Government’s objective of moving towards a learning culture, but in many good NHS organisations this is nothing new. There have been many successes when the principles I have just outlined have been put into operation and staff have embraced change, especially when it was their idea in the first place—or at least they believed it was. Sometimes small management and systems changes can make a big difference to patient safety: for example, the introduction of checklists in surgery has reduced mistakes considerably. These things are not the responsibility of any one member of staff but involve people working together. The Bill deals with thematic or systemic issues rather than individual cases so it has a rather different role from the existing systems for improvement and safety management, but I would like to know how its operation will link with and impact on those existing systems.

Getting to the bottom of problems in the past has often been hindered by staff hesitating to report concerns because of worry about being victimised as a whistleblower —there have been some very bad cases of that—but also because of a lack of confidence that anything will be done. The safe space idea should help with this. However, I agree with the noble Lord, Lord Hunt of Kings Heath, that it has to be seen that the recommendations are put into place for that confidence to arrive.

Currently, the duty of candour means that staff must express concerns when they believe there is an unsafe situation. However, the RCN tells us that half of those who do so are not convinced that any action has been taken. As the noble Lord, Lord Hunt, said, it will be a challenge to the new body to ensure that those who give evidence in the new safe space see that effective safety improvements are put in place as a result of their co-operation. It is also important that those who give evidence are not inadvertently put at risk by doing so. That means that the exemptions to disclosing information to other bodies must be narrow, clearly defined and well understood. I think my noble friend Lady Parminter will say something about the Parliamentary and Health Service Ombudsman, which feels that it should be treated the same as coroners. There must also be clearly understood definitions of what serious professional misconduct means.

Therefore, to fulfil the ambitions for the HSSIB, investigations must look at the whole picture, not just at the individuals involved in any incident. They must consider whether the shift at the time of the incident contained an appropriate number of staff for safe working, with the correct skill mix, training and experience for the situation they find themselves in. For example, we know that there are currently 40,000 nursing vacancies, and half of nurses in a recent RCN poll reported that their last shift was understaffed. Brexit has and will make things worse.

The investigations should also consider local and national policy and report on how they impacted the incident, and should be able to make recommendations to the Secretary of State about the need for structural changes indicated by the investigation. That is why it is so important that the organisation is independent. How do the Government plan to ensure that the recruitment of the board is really independent of government and includes lay members as well as medical professionals? Again, I agree with the noble Lord, Lord Hunt of Kings Heath, about the appointment of the chief investigator and the involvement of the Secretary of State.

It is arguable that all patients, however funded, should be able to benefit from the work of the HSSIB. Are there plans to extend its remit, after a period, to all health services, including those provided by independent providers? Indeed, the BMA has already suggested that its remit should be extended to incidents that affect the safety of healthcare workers as well as patients. In Committee there will be discussions about the potential expansion of the remit. Can the Minister clarify the relationship with other bodies with responsibility for quality and safety in health and care such as the CQC and the various regulators? Also, there are already various pathways that staff can take to express concerns, so there needs to be clear guidance as to which path to take in each situation.

Resources for up to 30 investigations per year are being provided. How has this number been arrived at? What if a serious qualifying incident happens just after the annual budget has run out? Will the HSSIB have to publish the number of incidents referred to it alongside the number conducted, to determine whether further resources are needed in the future?

How will decisions on the criteria for investigations be made? The groups consulted should be as wide as possible, including patient groups as well as healthcare professionals and managers. The Secretary of State seems to have a slightly suspiciously large role in an organisation that is supposed to be independent.

As I said, I welcome the safe space approach, but it is important that staff feel supported when they disclose what happened, especially if their view with hindsight is slightly different from what they might have said at the time. The primary objective of learning from mistakes will be achieved only through full disclosure to the investigators, and that will come only from confidence in the system.

We welcome the plan to put the new medical examiners on a statutory footing. It is important that bereaved families are helped to understand what happened and, if there is any doubt about the cause of death, that further investigations are put in place. Of course, we need the right sort of people for this with the right sort of training. It is essential that the service is properly resourced, particularly if it requires input from staff who are already stretched in their ability to provide good-quality and timely care to patients. Will the Minister say something about the staffing model for medical examiners? If they are to examine all deaths apart from those that go to coroners, there will be times of the year when they are very busy indeed, such as the winter months or in a heatwave. This is the same time when all clinicians are very busy, so if the MEs are clinicians employed elsewhere, doing shifts as medical examiners as well as their other job, they may need to be in two places at once at some times of year. How will the staffing model be designed to be resilient in that situation?

In summary, one could hardly be against a plan to develop more of a learning culture in the NHS and enhance patient safety, but there are questions to be answered and reassurances to be given, and I hope that the Minister will be able to do that.

Queen’s Speech

Baroness Walmsley Excerpts

Tuesday 22nd October 2019 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I have recently had cause to be very grateful to the NHS and its dedicated staff. However, a service that leaves a vulnerable elderly patient in A&E waiting seven hours to see a doctor and, on two other occasions, waiting in A&E for a bed in a ward for 12 hours and overnight is a service that is either inadequately resourced or inadequately staffed, and probably both. Patients are well named in the health service of today.

The health service relies on a thriving economy to provide its funding. This Government have played fast and loose with the prospects for our health service by their relentless pursuit of the hardest of hard exits from the European Union, within which our economy has thrived for more than 40 years. Brexit has already cost our economy £70 billion. It has also hit NHS staffing hard, with many well-trained and well-motivated staff either going home or not coming here at all.

Why are so many A&E departments not reaching the target of seeing 95% of patients within four hours? It is not because the staff are not working hard. Clearly the reasons are complex, and demographics play a part. There are people who go to A&E who could have used other services. Here, I stress that all three visits I mentioned earlier were made after all other sources of help had been tried.

However, two elements of the problem are outside A&E. One is delayed transfers of care, meaning that beds are occupied by patients who would be much better off at home with support or in social care. The second lies in primary care. Therefore, when I heard the Prime Minister’s headline-grabbing claim that his Government will build 40 new hospitals, I looked at it very closely and found that it is really only six new hospitals and a bit of seed corn money for the rest. More importantly, I realise that this unelected Prime Minister has no idea what the problem really is if he thinks that the solution is six new hospitals.

Patients who cannot get to see their GP will go where the lights are on, and that is A&E. It is very common for patients to have to wait three weeks to see their GP, and that is unacceptable. In many parts of the country, there are not enough GPs. In some places, this problem has been tackled by GP practices taking on other professionals to lighten the load on the doctor. This is an enlightened approach but it requires forward planning, funding and suitable premises. In the case of my local primary care services, that is not happening. There are no suitable premises for a modern all-service primary care facility, and that can make it hard to attract GPs. Therefore, to move to an efficient primary care service and reduce the pressure on A&E, we need funding and planning, but we are unlikely to get that from a Government intent on damaging our economy and promising not to increase taxes. Of course, the best course is to avoid damaging our economy and our health service by remaining in the EU.

The other way to reduce pressure on our health services is to prevent ill health, and I absolutely agree with the gist of the speech of the noble Lord, Lord Young of Cookham. I welcome the focus on prevention in the NHS Five Year Forward View. However, I would like to mention a preventable cause of illness which the noble Lord, Lord Young, did not mention and which is linked to another of the Government’s stated objectives—that is, action on climate change.

Outside this building for the past two weeks, thousands of citizens have demanded urgent action on the climate change crisis. They did so while breathing air that has 50% more of the most dangerous small particulates than the WHO recommended maximum. In London, the average level of PM2.5 is 15 micrograms per cubic metre, while the WHO recommended limit is 10. Polluted air kills about 40,000 people a year. It causes respiratory and cardiovascular illness and affects the brain development of babies and young children. There is evidence that older people who breathe polluted air have a steeper reduction in cognition with advancing age compared with clean air breathers. Research from the University of Warwick shows a significant reduction in memory, equivalent to ageing 10 years, in those who breathe polluted air. Polluted air therefore attacks our thinking power as well as our health.

Tackling climate change from the health perspective is also the right thing to do for the planet. It is bad for your health and tackling it is the healthy option, but the forthcoming Environment Bill needs to go further. It promises legally binding limits on air pollution but we have not been told what those will be. Actually, we already have them within the EU but have continually failed to reach them. What is required, as called for by the All-Party Parliamentary Group on Air Pollution, is much more than painting the number plates of electric cars green; it is a phased reduction in the legal limit for PM2.5 to 15 by 2020, 12 by 2025 and 10 by 2030. This would provide the incentive to government and local councils to reduce car use and speed up the introduction of non-polluting electric and hydrogen-powered vehicles, while bringing forward the phasing out of those powered by fossil fuels to 2030. We need radical action on charging and refill infrastructure. This would help the UK meet its climate change commitments, which it is otherwise unlikely to do.

The proposed office of environmental protection also falls short. We need an independent body capable of rigorous scrutiny, with powers to investigate and gain access to data and the ability to monitor and force compliance and take Ministers to court if they fail to address these issues. We need these things for our health’s sake and our planet’s sake. So will the Government support the Private Members’ Bills introduced today by my noble friend Lord Tope and the noble Baroness, Lady Jones of Moulsecoomb? That would be a step in the right direction.