Pharmaceutical Research and Development Spending

Baroness Walmsley Excerpts

Thursday 13th October 2022 Grand Committee

[Baroness Walmsley (LD)]

My Lords, I thank the noble Baroness, Lady Wheeler, for introducing this important debate so comprehensively. There is no doubt that the R&D and manufacture of new medicines already contribute in a major way to our economy, but it is also clear that there is considerable potential for improving that contribution in the interests of patients, the levelling-up agenda and the economy. However, as the noble Baroness said, over the past 25 years there has been a manufacturing capacity reduction of 25%, while other countries, such as Ireland, have seen an increase. We also saw how India produced a lot of our vaccines during the Covid pandemic.

Pharmaceutical companies can choose where they make their medicines, since they sell them all over the world, so what are the factors that they consider when deciding where to invest their capital and create well-paid jobs? Access to skills is important, as is the supply chain infrastructure, the regulatory environment, the attractiveness of the fiscal environment and upfront capital grants. Importantly, at this time of economic crisis, I should mention the importance of stability. In the past, companies have chosen the UK on that factor alone, even when other factors might have been better elsewhere.

There are many things we can do to make us more competitive. Ensuring that local communities have the right skills to attract these companies is vital and, at this time of pressure on public spending, the last thing we need to see is a cut in further and higher education opportunities, particularly in the poorer demographic areas.

As far as capital grants are concerned, the life sciences innovative manufacturing fund, £60 million over three years, is a small step in the right direction compared with our international competitors. This fund is vastly oversubscribed but could contribute to the Government’s growth ambitions. Are there any plans to increase it? The returns in increased profits, wages and taxes would surely pay for it in a few years. We must also encourage companies to increase their own capital investment in manufacturing capacity here. If capital expenditure were to be recognised within the R&D tax credit system, it would encourage them to invest more of their own money in the UK.

We need to get this right in the interests of patients, since UK manufacture of clinical trial medicines, for example, would get innovative medicines to patients quicker. It is really important that we do everything possible to speed up the time it takes to get new medicines to patients, because we are not doing very well at the moment. UK patients have lower access to innovative medicines than those in other countries, as my noble friend Lady Brinton said. For example, 43% of positive recommendations made by NICE between 2015 and 2019 were for a narrower population of patients than other regulators. Even when medicines are cleared by NICE, five years after they are approved for the NHS they are reaching only 64% of the patients reached by other nations. This could be because we spend less on medicines than other countries—9% of the healthcare budget, the lowest in the G7, compared with the average of 14% to 18%.

I now turn to clinical trials, which are so important to getting cutting-edge medicines to patients. In the last four years the UK has slipped down the international rankings for the number of clinical trials and the number of patients taking part, despite the Government’s declared ambition to make us a go-to country. The number of patients involved has almost halved during that period. This represents a cost to the NHS of around £447 million in the last financial year alone. Given that we heard from NHSE’s chief financial officer than the NHS is now short of £20 billion per year simply due to inflation in the cost of goods and services unless it can make serious cuts, surely the opportunity to save money by hosting more clinical trials is almost irresistible.

However, one of the problems is capacity. We have lost thousands of beds over recent years, as recognised by the Government recently in their announcement of 7,000 new ones. We have lost thousands of staff and are not training enough to take their place. Without adequate numbers of health professionals, we will not be able to host these beneficial clinical trials. That is why your Lordships focused so hard on the need for effective workforce planning during the passage of the Health and Care Act 2022.

The effect of this on patients is central to why we must improve their access to potentially life-saving treatments—but it is actually diminishing, partly because the setting-up time of trials is so slow. This also discourages companies, of course, despite the attractiveness of the NHS with its enormous cohort of patients. Relevant to the levelling-up agenda is the discrepancy between patients’ access to clinical trials in different parts of the UK. Cancer Research UK found that cancer patients in west London were 71% more likely to have opportunities to take part in research than patients in Cheshire and Merseyside.

I share the concern of the noble Lord, Lord Goodlad, about Alzheimer’s and dementia research. There is huge potential here for the UK to become a global leader—but again we are lagging behind. Over the past five years we have seen a decline in the number of dementia clinical trials taking place in the UK, and the number of participants. Since 2020, the number of phase 3 trials has increased in Germany, France and Italy but fallen here. So can I ask the Minister whether the Government are still committed to the £160 million of funding promised in their manifesto and recommitted to in August this year? Will the Government adhere to the recently announced national dementia mission? I ask because they have dropped so many other very important health-related measures which had been agreed by Parliament. I refer to the mental health Bill, the anti-smoking strategy following the Khan review, the health disparities White Paper and all the anti-obesity measures in the Health and Care Act—which we appear to have wasted our time on.

Looking forward, there are several other areas of research that show great promise and in which we have an opportunity to lead the world. My noble friend has talked about advanced gene and cell therapies. Those should be made and trialled here to make the most of the economic opportunities as well as the benefits for patients.

Health and Social Care Update

Baroness Walmsley Excerpts

Monday 10th October 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness, Lady Finlay, for those excellent points. I have to declare a further interest: my wife is not only a dentist, she is a dentist originally from the Dominican Republic who practised in Spain for 20 years before coming here. So many of the excellent points the noble Baroness made are well recognised here. I am in the market for good ideas, so I will meet with the noble Baroness with pleasure to understand and discuss some of the ideas she spoke about.

[Baroness Walmsley (LD)]

My Lords, the health service is suffering from inflation in the same way as the rest of us. Julian Kelly, NHS England’s chief finance officer, told the board recently that it will have to find £20 billion in efficiency savings over the next three years because of the increased cost of goods and services that it buys. He said that

“clearly you have to completely revisit investment in cancer and mental health, primary care … diagnostic capacity and you would have to look at what it meant in total for what the NHS could deliver.”

With that situation, could the Minister say how on earth we are going to deliver the plan for patients?

[Lord Markham (Con)]

As I mentioned earlier, yes, there are inflationary pressures, but as a percentage of our national wealth—our GDP—we are investing more than ever before, at around 12%. That level is very high compared with most other OECD countries. So, the investment and the staffing are there. I think the correct challenge, which I have heard from a number of Members today, is whether we are getting the best performance out of that money and investment. Again, that is very much where I have been brought in—to make sure that we are taking those areas that are performing well and disseminating that good practice. That is where I would like to focus my attention, to make sure that we really are getting the maximum output possible from this record level of investment.

Cannabis: Medicinal Use

Baroness Walmsley Excerpts

Tuesday 12th July 2022 Lords Chamber

[Lord Kamall (Con)]

First, I thank the noble Baroness for meeting with my colleague, my noble friend Lady Penn, yesterday. When I became a Minister, the Permanent Sec recognised a potential conflict of interest, which I have been told means that I cannot meet with people about this particular issue, but I can answer this Question if I declare my interest. So I better quickly declare it: I used to work for a think tank that received some funding from the medicinal cannabis industry, and I shared a round table. That immediately ruled me out as having a conflict of interest. None the less, I am very happy to facilitate meetings with my ministerial colleagues. As the noble Baroness will be aware, there is a new ministerial colleague in place at the moment. The point remains that we have asked the industry, which makes lots of money in this area, to come forward and fund trials, but it has preferred not to do so.

[Baroness Walmsley (LD)]

My Lords, I understand that the MHRA is considering extending its compassionate access scheme, particularly regarding the import of Celixir20 from Israel. A number of children with rare forms of drug-resistant epilepsy rely on this medicine. Given the severity of the crisis of access to NHS prescriptions for medicinal cannabis, can the Minister ensure that there are no barriers to the MHRA acting now to extend this scheme?

[Lord Kamall (Con)]

The noble Baroness raises an important point about working with the importer of those medicines. The MHRA is exceptionally continuing to allow those medicines and is hoping to work with the importer and the Israeli company itself to see whether they will go through the MHRA approval process. In Israel, there are two ways of supplying the product: one is medicinal and the another is for non-medicinal cannabis uses. It has advised us that this is not a licensed medicine in Israel, and therefore we are asking the company to come forward. In the meantime, we are looking at an interim solution.

Health Improvement and Food Production

Baroness Walmsley Excerpts

Thursday 7th July 2022 Lords Chamber

Moved by

[Baroness Walmsley]

To move that this House takes note of the relationship between improving the overall health of the nation and food production.

[Baroness Walmsley (LD)]

My Lords, it is a pleasure to introduce this debate about three things very close to my heart: food, the health of our population and the planet. I do not need to explain the very strong link between these three.

We produce some excellent food in this country, but our farmers and fishermen have had a tough time over the last few years, especially if their markets are abroad and if they rely on foreign workers to harvest their crops. Therefore my first question to the Minister is: what are the Government planning to do about that?

Despite the quality of our food, our national food system is broken. We eat too much of the wrong things and it is making us ill, limiting our years of healthy life and costing the NHS millions. The Government are resisting some of the levers that could help put it right. As in other countries, the resilience of our food security is under pressure because of the illegal invasion of Ukraine, which is one of the world’s biggest wheat and vegetable oil producers; the cost of fertilisers for our domestic farmers is also badly affected. This is one of the factors causing the rise in the price of food. However, the recent national food plan published by Henry Dimbleby set out four objectives for improving our broken food system. They were:

“Make us well instead of sick … Be resilient enough to withstand global shocks … Help to restore nature and halt climate change … Meet the standards the public expect, on health, environment, and animal welfare”.


Those are four very good objectives.

The first questions are: what is a healthy diet and is it available to everyone? Experts agree that it must contain a balance of all the major nutrients, vitamins and minerals in adequate quantities for our age and other physical factors. However, the evidence of obesity in our country and the rise of diseases connected to it, such as diabetes, heart disease, cancer, musculoskeletal problems and stroke, shows that a healthy diet is not acceptable to many, particularly in the poorest demographic groups. Two out of five children are above a healthy weight by the time they leave primary school and a quarter are obese. Children in deprived areas are twice as likely to be overweight. Some 28% of adults are overweight and 36% obese; again, the risk is higher in the lower demographic groups and certain ethnic communities. This is not because these people are greedy, but mainly because they are poor and are eating the cheapest food they can get hold of. Many in fact do not have enough food and are forced to use food banks to feed the family. It is a disgrace that, in a rich country such as ours, some children would go hungry but for charities such as the Trussell Trust.

Sadly, the cheapest calories are often high in sugar, salt and fat and are the ones that contribute most to being overweight. Fruit and vegetables, and good-quality meat and fish cost more than fast food but highly processed food, manufactured in massive amounts, is sold cheaply on every high street. Henry Dimbleby explained it this way:

“Because there is a bigger market for unhealthy food, companies invest more into developing and marketing it. This in turn expands the market further still. The bigger the market, the greater the economies of scale. Highly processed foods—high in salt, refined carbohydrates, sugar and fats, and low in fibre—are on average three times cheaper per calorie than healthier foods.”


So, what can we do? Dimbleby suggested that we must escape this junk food cycle to protect the NHS and reduce diet-related inequality by reducing the consumption of HFSS foods by 25% and increasing fibre by 50% and fruit and veg by 30% to reach healthy levels. To reach the carbon budget, we need to reduce our meat consumption by 30%, because 85% of our farmland is used to grow feed or grass for farm animals. If we could make these changes, we could promote a healthy gut—one of the most important organs in the body—save the NHS millions and put some less productive farmland to other, desirable uses. There are various ways in which the Government could contribute.

I agree with Dimbleby’s conclusion that we must get healthy food directly to our children and at the same time save their parents money by expanding eligibility for healthy free school meals. This has now twice been recommended by Dimbleby but twice refused by the Government—can the Minister say why? The Government set up the Healthy Start scheme and the holiday food scheme, on which they should be congratulated, but have not accepted Dimbleby’s latest proposition to expand those schemes, despite their success. The Lords Committee report in 2020, Hungry for Change, also recommended this. Can the Minister explain why it is not being done?

I turn to food production. We are not self-sufficient and probably never will be, but 54% to 60% of our food is grown by our own domestic farmers. We must protect them, but that is not to say that they might not need to change what they do. Only last week the Climate Change Committee issued serious warnings about agricultural policy, but farmers are currently under pressure from many quarters. We ask them to grow more food and, at the same time, to reduce greenhouse gas emissions, use less fertiliser, stop polluting watercourses, increase biodiversity, plant more trees, improve their soil, protect carbon sinks such as peatlands, grow biofuels, site wind and solar farms, provide leisure opportunities—and on it goes. The pressure on land use is enormous, and they are not making it any more. I welcome the Government’s recent announcement that they will produce a land use strategy next year. Can the Minister give us any insights into how health and food production will be balanced with all the other pressures on land in the forthcoming strategy, and what levers the Government are considering using to achieve it?

Farmers have to plan now, and they need help with the environmental land management scheme payments, which are to replace the former support system. It certainly makes sense that farmers should not be paid for how much land they have but for the public goods they provide. However, every farm, and every soil, is different, and there are many schemes to which farmers can apply for support. The large landscape section of ELMS has had 51 applicants for 15 initial schemes—some from large estates, but some from groups of farmers who want to work together to improve the landscape. That is encouraging, so I hope the Minister can assure me that some of the successful schemes will include small farms working together. I know he has received a note about this from Defra, because I asked the department to send it to him, so I hope it is not unfair to ask him these questions.

The local nature recovery scheme criteria will be available at the end of the year. This strikes me as rather slow, because farmers have to plan now how to respond to all these pressures. Can the Minister say how soon the funds for that part of the scheme will become available? The sustainable farming initiative applications opened last week. Farmers can apply online, and new software can help them identify what might be appropriate for them. However, we still have the overlapping countryside stewardship scheme, environmental stewardship scheme and others. I hope your Lordships see where I am coming from: we currently have maximum complexity of schemes—some beginning, some ending—and an alphabet soup of acronyms.

In its recent report on nature-based solutions to achieving net zero, the Science and Technology Select Committee recommended that an independent advisory service—human beings rather than software—should be provided to help farmers increase food production sustainably while also making a living. Can the Minister say what progress has been made in this respect? Many farmers will have to change their business model. That is risky, so they need good advice.

One of the problems we face is the large number of tenant farmers in the UK. Tenants might be reluctant to make improvements to the land if it is their landlord who will benefit in the long term. Soil improvement does not happen overnight—I know that from my own garden—so a farmer with a short tenancy might be reluctant to do it. I know that the noble Baroness, Lady Rock, is looking into this for the Government. I hope the Minister might be able to give us an insight into her interim recommendations; otherwise, I will have to ask her.

Our farmers have very high standards, so the last thing we must do is offshore our food production to countries that might produce higher emissions. We cannot police their standards of animal welfare or pesticide use. Then, of course, there are food miles. Since Brexit, there has been a reduced ability to check the quality of food coming in, according to a recent report by the Food Standards Agency. In addition, countries such as Australia and New Zealand have economies of scale in meat production with their enormous farms, which could put our livestock farmers at a great disadvantage. Can the Minister say how the Government will avoid putting farmers out of business or offshoring food production when negotiating trade deals? Will the Government set up a trade and agriculture commission, as proposed by Dimbleby?

The Government have indicated that they will provide more support for horticulture. This is good news, as we produce only 35% of our current supply of fruit and veg, but this will need to increase by nearly 90% if we are to increase our consumption, as advised by Dimbleby. Will the Minister say whether projects that make use of rainwater and renewable energy capture, technology and innovation will attract government support?

In north Wales a couple of years ago, a proposal to use the heat from a sewage works through heat exchangers to heat glasshouses to produce half the tomatoes and cucumbers needed by Wales was turned down by the local planning authority—all that locally produced food, all those jobs, all that energy and water saving lost because of a lack of vision. I hope the Minister can tell me that the Government have more vision than my local authority.

I turn to highly processed food. Not all our food comes straight out of the ground or the water; a great deal of it comes out of a factory. As we have heard, it is cheap and often contains too much salt, sugar and fat. There have been voluntary reductions, but they do not go far enough. Yet the Government resist mandatory measures, such as an extended sugar and salt tax. Can the Minister justify the claim that a small tax on sugar and salt in HFSS foods for manufacture and catering will increase the cost of food for poor people?

The advertising restrictions on HFSS foods before the watershed and online have been postponed. Can the Minister confirm that there will be no further postponement, despite today’s events?

Labelling can help people choose healthier food, but it can be difficult to identify what is really a healthy food. It is not hard for a piece of broccoli, an apple or a piece of fish, but it is a different matter for products with multiple ingredients. The Minister might remember our discussions, led by the noble Lord, Lord Moylan, during the passage of the Health and Care Bill about high-protein bars. The noble Lord, Lord Krebs, helpfully pointed out that the bar in question was high in salt and sugar and low in fibre, so not very healthy at all.

Since then, the noble Lord, Lord Krebs, and I have received material from a group of young people called Bite Back. Its report, Don’t Hide What’s Inside, explored the eating habits of 1,000 13 to 18 year-olds and examined the impact that packaging claims have on their perceptions of health. It found that three-quarters of young people think that their diet is healthy, despite the fact that their intake of sugar, fruit and veg, and fibre is nowhere near the Government’s daily recommendations. Almost nine in 10 think that smoothies are healthy, but 76% of juices and smoothies would get a red traffic light label for sugar. Eight in 10 believe that cereal bars are healthy, but 81% of those would get a red traffic light label for sugar. The report gives other examples.

Half of those surveyed agreed that health and nutrition messaging makes them more likely to buy a product. This makes the rules about labelling important but it is too often misleading. To demonstrate this, a fake snack bar was invented. It was made entirely from mud but branded as 100% natural, high in fibre, a great source of minerals and low in fat, which was true but also completely outrageous, since there was nothing in it but mud. It was done to call out big food brands on their manipulative marketing tactics and to make them step up with clear and honest packaging. The Government are being asked to introduce a clear, mandatory labelling policy, including declarations of free sugars, traffic-light labels, a review of where the thresholds should be lowered, regulation to end the use of health and nutrition claims on an unhealthy product and consistent portion sizes across categories. Will the Minister consider the young people’s proposals? If not, I suspect they might send him a mud bar.

--- Later in debate ---

[Baroness Walmsley (LD)]

My Lords, I thank the Minister and everybody who has taken part in this small but perfectly formed debate. It has been cross-departmental, which is why I asked Defra to send the Minister some notes. If the Defra Minister had been responding, I think the noble Lord would have had to send him some notes, and vice versa. It was quite a difficult challenge for the Minister to have such a cross-departmental topic.

I am very grateful to noble Lords who elaborated things that I had time to mention only briefly in my initial remarks. In fact, some mentioned things that I did not have time to mention at all. I am grateful that the Minister mentioned the link between mental health and being overweight, and the noble Baroness, Lady Merron, mentioned the difficulties of the Procurement Bill and the possible contradiction between that Bill and the Health and Care Act. None of us had the chance to talk about the importance of teaching children to cook, for example, but I am so grateful that everybody mentioned food and health inequality, because it is a very big issue. Although the Government are doing some things to help address that, I think most contributors to today’s debate have suggested more things that we would like to have seen them do.

I want to take the Minister up on one point: he said that there appears to have been some sort of opposition to importing food. In fact, I think both the noble Baroness, Lady Merron, and I acknowledged the fact that we are not self-sufficient in food and are not going to be. What is important is that, first, we make sure that the standard of food that comes in is what the public expect and, secondly, as even the Government are now saying, in order for our food system to be resilient we need to produce as much as possible in this country in a sustainable way, while acknowledging all the other things that farmers have to do.

The noble Lord, Lord Kirkham, talked about happiness, and I could not agree with him more. My noble friend Lady Brinton talked about the socialisation of food, and somebody mentioned that the slower you eat, the less you probably eat, and that you relax while you do it and it does you good. I certainly agree on that point, but I do not agree with the noble Lord, Lord Kirkham, that anybody is trying to lecture people. What people are trying to do is to help and encourage others, to make recommendations and to make good food accessible to everybody in the country. Of course, that is what the Government are trying to do, but we would like to see more. Henry Dimbleby was certainly not lecturing anybody; he based his recommendations on the science and good advice from experts. We should all listen to what he had to say.

I was a bit concerned about what my noble friend Lady Brinton said about the danger of reducing the quality of school meals, and I hope the Minister will keep an eye on that as the price of food increases. We do not want to see that, because I know that the Government are trying to get good food directly to children.

With those few words, I thank everybody who has taken part. I know more people would have liked to speak, but the time of day and day of the week meant that some of the great experts on this topic in the House were not able to join us—and we miss them, of course.

Motion agreed.

Personal Protective Equipment: Waste

Baroness Walmsley Excerpts

Tuesday 14th June 2022 Lords Chamber

[Lord Kamall (Con)]

I think we should look at the context of this £9 billion or £12 billion figure. We must remember that, at the time, market prices were inflated. We could not have bought the equipment at the prices you can pay for it today. The Government at the time had to make an estimate. If they had bought too little equipment, they would rightly have been criticised. Given that you can never make absolutely accurate predictions, on balance it is better to procure more than less. I was speaking to a Democrat politician from United States the other day. He said, “I just made the decision to procure as much as possible, but I knew I would get the flak afterwards. Lives were more important.”

[Baroness Walmsley (LD)]

My Lords, at the beginning of the pandemic a great deal of PPE which was in store was already out of date and could not be used. Any homemaker knows that you look at the use-by date of the stuff in your fridge and try to use it before it goes out of date. Can the Minister say whether there is now a proper record-keeping system for the use-by dates of any PPE that is in store in anticipation of any future emergency need?

[Lord Kamall (Con)]

I think that the noble Baroness will recognise from when I was asked a previous Oral Question on this issue that where there was an official sell-by date, we had asked a couple of companies from which we had procured the equipment to look at whether that life could be extended. I am not sure of the details, so I commit to write to the noble Baroness.

Sugar Reduction Programme: Bread

Baroness Walmsley Excerpts

Wednesday 25th May 2022 Lords Chamber

[Lord Kamall (Con)]

I pay tribute to the noble Lord. Since my first day at the Dispatch Box, he has challenged me on both sugar reduction and alcohol abuse. There comes a stage where it is diminishing returns. I know that the noble Lord and I are very keen on puns and dad jokes. When bread is being made, sugar is needed—kneaded; excuse the pun—because it extends shelf life by reducing the oxidation which causes food to deteriorate, it reduces the rate at which bread becomes stale, it activates yeast for fermentation, it adds the colour during the baking process, and it adds to the texture. The sugar contributes only about 2% of free sugars intakes in children. Therefore, it is much more worth while and targeted to focus on products that are higher in sugar.

[Baroness Walmsley (LD)]

My Lords, will the Minister join me in congratulating Tesco and Sainsbury’s? They have announced that, even though the Government are backtracking on the proposed ban on volume promotion offers of foods high in sugar, salt and fat, they will do it voluntarily anyway, and on time, to support the anti-obesity campaign. Will he encourage other retailers to join them and to work with their suppliers to reformulate and reduce sugar?

[Lord Kamall (Con)]

We should welcome moves by those in the industry, including retailers; if they can meet deadlines earlier, that is all to be welcomed. Perhaps I might correct the noble Baroness on one inaccuracy. The Government have not backtracked; we have delayed location measures until October 2022.

Pharmacy (Preparation and Dispensing Errors—Hospital and Other Pharmacy Services) Order 2022

Baroness Walmsley Excerpts

Monday 23rd May 2022 Grand Committee

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

My Lords, the Pharmacy (Preparation and Dispensing Errors—Hospitals and Other Pharmacy Services) Order 2022 was laid before Parliament on 28 April. This draft order extends to the United Kingdom. I note that the noble Lord, Lord Hunt, has submitted a Motion to Regret in relation to the draft Pharmacy (Responsible Pharmacists, Superintendent Pharmacists etc.) Order 2022. This will now be subject to a separate debate.

The draft order before your Lordships has been in development for a long time under the auspices of the Rebalancing Medicines Legislation and Pharmacy Regulation Programme Board, whose members include representatives from across the pharmacy sector and professional and regulatory bodies. The draft order is welcomed by pharmacy professionals working in hospitals and relevant pharmacy services, and has the support of the four Chief Pharmaceutical Officers of the UK.

I apologise for the parliamentary time taken to progress this order. The Government had to make some difficult decisions to deprioritise non-urgent legislation following the general election in 2019, EU exit and the Covid-19 pandemic. We are now returning to more business-as-usual matters.

The purpose of the order is to extend the defences already available to pharmacy workers in community pharmacy premises made under the Pharmacy (Preparation and Dispensing Errors—Registered Pharmacies) Order 2018 to ensure that registered pharmacy professionals working in hospitals and other settings, such as prisons and care homes, have access to the same defences. This would provide them with access to the defences to the criminal offences set out in Sections 63 and 64 of the Medicines Act 1968, which concern the adulteration of medicinal products in Section 63 and the sale of any medicinal product which is not of the nature or quality demanded by the purchaser in Section 64. The order makes these defences available in defined circumstances and, importantly, incentivises the reporting of errors where pharmacy professionals make genuine dispensing errors, improving learning to prevent such errors occurring.

In summary, the order will support improved patient safety by encouraging a culture of candid and fulsome contributions from those involved when things go wrong. This is a culture we want to see right across the NHS. Within this culture, pharmacy professionals can increase their learning from dispensing errors and identify mitigating action to make recurrence less likely in the future. I therefore commend the draft order to the Committee.

[Baroness Walmsley (LD)]

My Lords, I have always thought that the purpose of highlighting errors in the health service should be to learn and to avoid repeats, rather than to lay blame. That is why I supported the HSSIB, which was made mandatory in the recent Health and Care Act 2022. For that reason, I also support this order, which can contribute to patient safety by extending the removal of the threat of criminal sanctions for inadvertent dispensing errors beyond current community pharmacies and into other places where medicines are legitimately dispensed. These will include hospitals, care homes, prisons and detention centres. Anything which deters people shining a light on errors is a bad thing and should be addressed; anything which enables learning from them is welcome. However, although the order is welcome, I ask the Minister whether there has been evidence that staff have been deterred from exposing or informing patients about a mistake that has been made.

It is vital that the duty of candour that applies to all health professionals is upheld. I welcome the news from the General Pharmaceutical Council that it plans to develop new learning resources to help pharmacists understand how to fulfil this duty and, crucially, why they should do so. Of course, the duty already appears in the Standards for Pharmacy Professionals. This is where actual offences come into the picture. It is right that pharmacists could still be prosecuted if they can be shown to have had deliberate disregard for patient safety, as such a person would not be acting in the course of his profession, so patient protection still applies.

Identifying such a situation would probably rely on whistleblowers, who need protection and confidence that they would not be penalised for revealing information. Will the Minister say who would be responsible for making this judgment? Would it be the General Pharmaceutical Council or a magistrate with professional advice?

National Institute for Health and Care Excellence

Baroness Walmsley Excerpts

Monday 23rd May 2022 Lords Chamber

[Lord Kamall (Con)]

I am sure that the noble Baroness appreciates that this was a new process, because of the Orbis trial. In some ways, NICE was not exactly prepared for that. NICE has learned from that lesson and 100% of its guidelines are issued within 90 days of licensing. It has learned the lesson but, sadly, there was a confluence of factors: one was Orbis and the other was that the committee meeting regarding recommendations ran over because there were a number of other cancer drugs that it was trying to look at. It has put this on the agenda for the next meeting.

[Baroness Walmsley (LD)]

One of the ambitions in the life sciences vision is to enable early diagnosis and treatment, including immunotherapies such as cancer vaccines. However, last year, 20 treatment evaluations were paused because of lack of capacity at NICE. If successful R&D cannot be translated into treatments because of lack of NICE evaluations, how will that impact on commercial incentives and the ambitions set out in the life sciences vision?

[Lord Kamall (Con)]

The noble Baroness makes an important point about how this fits into the life sciences vision, and NICE is very aware of it. In fact, only last week, I saw a draft business case for NICE for future years, and it takes on board the very point the noble Baroness refers to. NICE is looking at making sure that is has more timely advice and that it can respond quickly; it has also increased capacity, not only for conditions like this but for more digital devices.

Health and Care Bill

Baroness Walmsley Excerpts

Consideration of Commons amendments
Tuesday 26th April 2022 Lords Chamber

He says that, eight months after asking Hikvision to address shocking allegations, it has failed to answer his questions. There are more Bills coming: there will be a new modern slavery Bill and a procurement Bill. As my noble friend said, there will also be an opportunity for more amendments. However, it would be helpful to know this evening whether this excellent amendment will be used as a yardstick when it comes to framing other putative legislation.

[Baroness Walmsley (LD)]

My Lords, I begin by welcoming Motion B, which puts in place government Amendments 30C to 30K, laid in another place. They relate to the Secretary of State’s role in major NHS reconfigurations and are a credit to the Minister, his ministerial team and the Bill team. They have listened to the strong arguments from across this House, led so ably by the noble Lord, Lord Stevens of Birmingham, who is unable to be with us tonight. I thank the Minister for agreeing—eventually—that the powers originally proposed in the Bill were excessive, disruptive and unnecessary.

Unfortunately, we have not had such a fruitful consensus on the matter of workforce planning. We do not agree with the Commons that our workforce amendment, Amendment 29B, was unnecessary because appropriate measures already appear in the Bill. If that were so, and if the sector had had confidence in the Government’s track record in planning for adequate and safe staffing levels in health and care services, we would not have had more than 100 organisations backing our earlier attempts, led so well by the noble Baroness, Lady Cumberlege, to put in place a mandatory system for reviewing the available workforce and predicting what will be needed in future. However, here we are, with the Government having set their face firmly against any compromise on or serious discussion about the matter. One has to ask what the Government are afraid of.

Any effective workforce strategy must be based on reliable information, be regularly refreshed and have numbers in it. This House and the whole sector have no confidence that what the Government are proposing will do that. I understand that the Treasury has had a hand in the Secretary of State’s determination to just say no. Perhaps the Treasury is unwilling to foot the Bill, which will prove to be essential when all is revealed.

I put it to the Minister one last time that our proposal would be cost-effective. Staff shortages are a false economy. Missing staff are often replaced by very expensive locums and agency staff, and the stress of unsafe staffing levels causes valued staff to leave the service. Training and recruiting staff to replace them also costs money. High staff turnover is not an effective strategy for any business or service, and poor treatment for patients often has to be done again or leads to greater and more expensive needs further down the track. No efficient shopkeeper would fail to do a proper stocktake or take account of what people are buying and therefore what he needs to order to replenish his stock—but that is what the Government are doing if they fail to plan effectively for safe staffing. It is much more serious than empty shelves, because it is playing with people’s lives, as was recently demonstrated so clearly by the Ockenden report.

If the Government are determined not to carry out the reviews and consultations in Amendment 29D, I would like to ask the Minister whether they would be happy for some other organisation, such as NHS England, to do so and whether they will take note of the results of that investigation. Amendment 29D from the noble Baroness, Lady Merron, in Motion A1, is not a silver bullet; it will not solve the current staffing crisis in the NHS and care services. But it would provide a strong foundation for future safe and cost-effective staffing, which would be to the benefit of the whole population. It is our duty to ask the Government to think again—again.

[Baroness Wheeler (Lab)]

My Lords, in closing the debate before we hear from the Minister, I make no apology for concentrating on social care, on how the care cap is to be implemented, and on my Motion D1, which implores the Commons to think again on this vital issue. I thank noble Lords who have given their strong support to Motions A1 and D1.

I wish to reinforce the key point that, from the outset, social care and Parliament have been treated pretty shabbily as part of this Bill. It is essentially an NHS Bill. As we know, the social care cap and charging arrangements were added to the Bill in the Commons, with no notice and after the Bill had finalised its Committee stages, and were then pushed through, without any opportunity for full explanation, scrutiny or time to consider the impact on the hundreds of thousands of people who are desperately in need of social care and support and will not receive it under these proposals. We later also had the money-saving bombshell announcement of local authority contributions not being allowed to accrue against the care cap, which was designed to achieve savings on the Government’s original package—even before any form of scrutiny of the Bill had commenced—that will be at the expense of some of the country’s poorest and most vulnerable people.

As noble Lords have pointed out, in reality, we in the Lords Chamber have had little actual time to consider and debate these vital social care provisions, despite many hours and days being spent overall on a long and complex Bill. Worst of all, we had the blank refusal by the Government to discuss or address any of the concerns and issues expressed or put forward by noble Lords from all sides of the House, with their deep expertise and knowledge across social care, or the detailed and painstaking evidence and modelling work undertaken by key stakeholders, such as Age UK, Mencap, the Alzheimer’s Society, and the King’s Fund, Nuffield Trust and Health Foundation expert think tanks. We have instead been told that Ministers have done their best to explain their proposals, but they have absolute red lines against making any changes whatever. Is this what must now pass for parliamentary dialogue, scrutiny and debate?

For the record, I will underline some of the key reasons why opposition to the Government’s proposal for the cap implementation is so clear and strong. The cap level and implementation strongly favour the better off and would bring almost nothing to the worst off. This is unfair and the opposite of levelling up. Older people and those with modest means all fare badly under the Government’s charging proposals.

Even the Government’s own impact assessment admits that only 10% of working-age disabled adult care users will benefit, that one in five older people will not see the benefits of the cap and that poorer care users are much more likely to die before they reach the cap than others with the same care needs. Among older people, those in the north-east, Yorkshire, Humber and the Midlands will be worse off. For dementia sufferers regionally, just 16% of people in the north-east and 19% in the east Midlands would hit the cap, compared with 29% in the south-east. The overall figure, as a result of disallowing local authority contributions towards the cap, is that only 21% of people living with dementia would reach it.

The mountain of evidence produced by stakeholders and think tanks shows that social care is not being fixed, as the Government continue to try to have us believe. The “nobody will have to sell their home” promise is firmly debunked, too, despite the Government desperately clinging on to it; it is a hollow and false claim. Somebody with assets of £100,000 will lose almost everything, while someone with assets of over £1 million will keep almost everything. How can this be the fair plan that the Minister insists it is?

The reality is that, as the Government holds to their solid red line, their arguments just do not stand up but get weaker by the minute. The Minister argues that his is the only affordable plan, but, if that is the case, why do the £90 million of savings have to be paid for by those who can least afford it, and why are there not better plans to protect those with fewest assets?

Local authority care contributions counting towards the cost are presented by the Government as unfair. Instead, they insist that setting the cap at the same level for everybody,

“no matter their age, where they live in the country or the nature of the care and support they need to draw on”,—[Official Report, 5/4/22; col. 1986.]

is the fairest system. Is that not also the opposite of how levelling up should work?

The argument that no one will be worse off than under the current system is just not borne out by the overwhelming evidence from the stakeholders and think tanks. The contention that the Government are reforming and changing the system where previous attempts have failed just is not true. There was cross-party agreement on the implementation of the Care Act after detailed scrutiny of the Dilnot proposals, and it was this Government who failed to implement it. I remind the House, as someone who was heavily involved in the scrutiny of that Bill, that there was no mention of the Care Act provisions being unaffordable when the Act and its implementation proposals were agreed in 2014.

On working-age adults, as the noble Baroness, Lady Campbell, has again forcefully underlined, the Government’s proposals will mean that they remain trapped in poverty. The Minister’s previous reference to the uprated social security benefits that they will receive instead under the minimum income guarantee completely missed the point of how social care needs have to be supported.

Ministers have doggedly stuck to their responses, without either acknowledging or addressing these clear counterarguments and evidence. My Motion again reinforces the key issues that we have tried all along to get the Government to respond to: the importance of implementing the care cap under the consensus provisions of the Care Act, and ensuring that local authority care costs are allowed to accrue towards the cap to avoid the huge unfairness that not doing so will cause to key groups in need of social care.

Finally, we want to make sure that the Government’s much-vaunted but little-explained trailblazer pilots are completed before regulations on the cap are agreed, as well as including the analysis of the impact on regional eligibility and the effect of the cap on working-age disabled adults under 40 with eligible care needs. Is this not both sensible and fairer to the key groups who stand to lose so much under the Government’s proposals? Why is this so difficult for the Government to agree to? I referred to “little-explained pilots”, but I did receive a letter three hours ago from the Minister, for which I thank him, setting out information about the pilots that in fact adds very little more than the DHSC press release in March and also shows that they will not be evaluating the key areas of impact that my Motion calls for.

I will also add that I have seen recent government claims in the media that deleting the social care cap arrangements in the Bill would jeopardise the whole Bill. I emphasise that that is not so. In their place we would instead have the rest of the Bill and the Care Act 2014 provisions, which would form the basis for moving forward quickly and implementing the cap in a much fairer and more inclusive way that would benefit many more people in desperate need of social care support.

I hope that even at this late stage the Government will listen, address the overwhelming concerns and evidence from all the stakeholders and experts on social care services and delivery and accept my Motion as the best way forward.

Folic Acid Fortification

Baroness Walmsley Excerpts

Wednesday 6th April 2022 Lords Chamber

[Lord Kamall (Con)]

This will all be part of the consultation, but once the policy has been decided on and fortification starts, clearly, we will be communicating to parents, families and others. If there is a risk—which noble Lords in their expertise seem to disagree with—we will have to identify that. The history of good intentions is littered with unintended consequences. We must be aware of those in our pursuit of increased folic acid in flour.

[Baroness Walmsley (LD)]

My Lords, over the past two years, the Government have made urgent decisions about Covid-19 to save lives and save sickness. Why can they not, in light of the strength of the evidence we already have, make a similarly urgent decision on this issue to save harm to 400 babies a year?