Covid-19 Vaccinations
Baroness Walmsley Excerpts(3 years, 3 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Walmsley (LD)
My Lords, is the Minister aware of an article in the Health Service Journal today in which a highly respected chief executive of a highly rated acute trust said that his hospital was struggling on every front and that it was far worse than in January? He said that the emergency department was at record levels and elective referrals were increasing as exhausted staff turned down extra shifts needed to reduce the growing backlog. One in five of his beds is filled with medically fit people who cannot be discharged because they cannot find a care package. There have been more than 65,000 Covid admissions to English hospitals in the last three months; that is double the same period last year when, of course, there were no vaccines. Does the Minister agree with this chief executive when he said, “This time the vaccine hasn’t saved us”?
Lord Kamall (Con)
The most important thing is getting the third vaccine. The Government are monitoring and considering a wide range of factors, including cases and immunity, but also advice from the NHS as to whether it is feeling overwhelmed. That is the situation at the moment. We continue to monitor it; it is not a static situation. We are trying to get the booster out as much as possible and are really driving home the message that the booster is the most effective way to fight against Covid. We are making sure that we get as many people as possible vaccinated and taking up the opportunity of a booster.
NHS: Fracture Liaison Services
Baroness Walmsley Excerpts(3 years, 3 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Kamall (Con)
The department and the NHS continue to work with interested groups to expand the understanding of the wide-ranging needs of people across the country. One example is NHS England’s Covid-19 MSK—musculoskeletal—stakeholder group, which is advising on the impact that lockdowns have had on the physical and mental health of those with MSK conditions. Collaborating with NHS England were the British Orthopaedic Association, the British Society for Rheumatology, the Chartered Society of Physiotherapy, the Arthritis and Musculoskeletal Alliance, and Versus Arthritis. Self-managed resources for patients are being developed. I will write on the specific question that the noble Baroness asked.
Baroness Walmsley (LD)
My Lords, could the Minister say what research is being carried out to establish the extent to which universal provision of fracture liaison services could relieve the pressure on hard-pressed GPs, ambulance services and A&E departments?
Lord Kamall (Con)
NHS England and others are well aware of the need to reduce the pressure on GPs and other services that the noble Baroness mentioned. That is why they very much welcome the investment in 100 community diagnostic centres, not only on NHS premises but in places such as football stadiums, shopping centres, and so on, making sure that there is more access to these services and that patients can be seen quicker and more speedily.
Smoking Cessation: Prescription of E-cigarettes
Baroness Walmsley Excerpts(3 years, 3 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
I thank the noble Baroness for her questions. It is really important that we look at how we can reduce smoking in this country. The point about the e-cigarettes and the MHRA’s wish to licence products is that it wants to move smokers on to a pathway away from smoking cigarettes and on to e-cigarettes since they are seen as a safer option. It does not want to encourage people to smoke e-cigarettes, but to move them off cigarettes and on to e-cigarettes. At the moment, the MHRA does not feel comfortable licencing any of the existing products, and therefore wants to have conversations with manufacturers and others to see if there can be a product produced that it feels comfortable licencing so that it can be available for prescription. Moreover, by having that MHRA stamp of approval, it may well encourage others to buy it over the counter.
Baroness Walmsley (LD)
My Lords, it is three years since the change of rules that allowed medicinal cannabis to be available on NHS prescription, but there have been only three NHS prescriptions in that time. How confident is the Minister that smokers will be able to benefit from regulatory change when children with intractable epilepsy cannot? Do not both of these situations require further training for doctors to ensure their confidence to prescribe?
Lord Kamall (Con)
The hope is that we will be able to move current cigarette smokers to e-cigarettes, but I am afraid that I will have to write to the noble Baroness on her specific question.
Covid-19: Vaccinations Administered Abroad
Baroness Walmsley Excerpts(3 years, 3 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Lord Speaker (Lord McFall of Alcluith)
The noble Lord, Lord Flight, is not present, so I call the noble Baroness, Lady Walmsley.
Baroness Walmsley (LD)
My Lords, another group of people who are not having their jabs recognised are the public-spirited people who took part in the Novavax clinical trial. Novavax has said that it cannot guarantee that having a Pfizer booster is safe for those in their trial, because it has not trialled it. Yet, the Government are now saying that they can have the booster—or they can start all over again and have one of the other jabs. Why?
Lord Kamall (Con)
One of the difficult issues we face is pushing international partners to agree that the participants of well-regulated vaccine clinical trials should be treated as fully vaccinated. Only a couple of weeks ago I was on a call with G7 health and transport Ministers, trying to push them to ensure that they recognise those very brave people who came forward for vaccine trials. So far, sadly, we have not had much success. We continue to push them, but, in the meantime, we have found the solution of giving people another vaccine in order for them to be recognised. However, we would prefer international recognition.
Ageing: Science, Technology and Healthy Living (Science and Technology Committee Report)
Baroness Walmsley Excerpts(3 years, 3 months ago)
Grand CommitteeRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Walmsley (LD)
My Lords, it is a pleasure to begin the winding speeches on behalf of the Liberal Democrat Benches, not least because we have just had 19 excellent speeches. Indeed, the level of agreement about the relevant issues indicates to me that the Science and Technology Committee had a lot of the right answers, and I make no apology for repeating some of them in a few minutes.
First, I thank the noble Lord, Lord Patel, the committee staff, our witnesses and, in particular, the medical experts on our committee who helped me to understand some of the more scientific elements of what we were hearing. As a member of the committee, I enjoyed it very much. I found it interesting but also important because in the introduction to the report on ageing we pointed out that by 2035 there will be some 5 million people over 80 and I will be one of them—in fact, I will be over 90 if I live that long, so I have a vested interest in the Government’s response to this report. In welcoming the noble Lord, Lord Kamall, to his new Front Bench role, I hope he is going to give me some comfort at the end of this debate.
As the noble Viscount, Lord Ridley, emphasised, we can thank medical science for the fact that we are living longer. The doctors and scientists are keeping us alive, but we have to ask ourselves: for what quality of life? That is why the Government issued their grand challenge of five more years of healthy life by 2035, while narrowing the gap between rich and poor. I welcome that, but is it achievable? That is what the committee set out to discover.
We heard that although average life expectancy in the UK has continued to increase year on year, although recently at a slower rate, healthy life expectancy has not kept pace. Indeed, there is a widening gap between the two, and between rich and poor. People are living longer—although women in the lowest 10% demographic group are not—but many of those extra years are spent in poor health, with multiple diseases that can mean a person spending half the week visiting several different departments in their local hospital.
The health and care system is not designed for people with multimorbidities, as the noble Baroness, Lady Manningham-Buller, just said, nor for early diagnosis in many cases, as mentioned by the noble Viscount, Lord Ridley. We therefore recommended that older people should have a designated medical professional to integrate their care and smooth out the bumps in the availability of treatment; the noble Lords, Lord Crisp and Lord Kakkar, recommended this too. The Government say that it is already happening, but not according to the evidence we heard. We think it could save money in the end, as well as providing a better service for older people.
However, there is something to be thankful for, although the noble Lord, Lord Kakkar, pointed out the problems with the clinical trials regulation. Our report outlines considerable progress in researchers’ understanding of the biology of ageing, and we reported on the work on new therapies and repurposed drugs to tackle age-related diseases. We urge the Government to continue to support this work, but believe that the “R” of R&D is often better supported than the “D”. More effort thus needs to go into developing the discoveries of our scientists here in the UK, to avoid the benefit going to companies and patients abroad.
Age-related diseases do not just happen as soon as you turn 60. We heard evidence of the lifelong lifestyle and environmental factors that correlate with health in old age. This is particularly relevant to the second part of the grand challenge mission: to narrow the gap between rich and poor, as many noble Lords have mentioned. We concluded that this knowledge should be used by public health authorities and national regulators to help individuals to understand and make use of it but, critically, to enable them to do so.
However, no matter how healthily a person lives through life, inevitably they will become frail in old age, even if relatively fit, because of the cellular and molecular changes referred to by the noble Lord, Lord Patel. Most people would rather live safely—significantly, he also used the word “independently”—in their own home when they get old. They would of course be happier in their own community and, as the noble Lord, Lord Crisp, said, in control. This would also be cheaper for the health and care services and it is where home care comes in. Sadly, we know about the pressures on that, as well as on residential care, but the recent government announcement of an increase in national insurance contributions will do little for social care. Staff shortages and poor pay and working conditions mean that many old people, who would be better off at home, are kept too long in a hospital bed which could better be used to clear the backlog of procedures resulting from the pandemic. This illustrates the spider’s web of linked policy areas.
We heard encouraging accounts of where technology can help older people look after themselves, to ensure that they are safe and well, but many older people do not have the digital skills needed to operate these aids. They also cost money, which again is a challenge to achieving the second part of the mission: narrowing the gap between rich and poor. The availability of technological solutions should not further add to health inequality by being available only to the better off and digitally savvy. Do the Government have a plan to avoid that happening?
As the noble Baroness, Lady Watkins, said, loneliness can be a negative factor in well-being, as we have seen during the pandemic, when many people living alone have suffered mental health challenges. The internet can provide some communication but only if you have a connection, so this depends on the availability of decent broadband and a costly device, as well as the skill to use it. I join the noble Lord, Lord Mair, in asking: what are the Government doing to make sure older people are not left out of the digital age?
We heard from civil servants and Ministers that there is enthusiasm for achieving the grand challenge, but we came to the conclusion that this is unlikely. Why? It is partly because the progress towards achieving the challenge is not being monitored, while there is no road map to ensure the actions needed happen in a timely way. Achieving such a goal would have required a two-pronged approach: action to pick the low-hanging fruit—better support and joined-up health services for older people—alongside a prompt start on the long-term actions which can prevent many age-related diseases through lifelong strategies.
I repeat my noble friend Lady Sheehan’s question: has the grand challenge mission been ditched, diluted or incorporated into something else? Prevention of age-related illness is not just a matter of information and education about how to live a healthy life. Many people know exactly what they should be doing yet lack the resources to do it, such as enough income to buy healthy food and keep their home warm. But it also requires government to look at the lived environment and pressures under which people live. Examples of these are tackling our polluted air, which causes 40,000 extra deaths every year, enough income to keep the home warm and dry and the availability of nutritious food near to where people live, rather than high streets full of cheap fast-food takeaways.
The Institute of Health Equity recently reviewed the Marmot report 10 years on, and it emphasises that health and life expectancy follow the social gradient. It is abundantly clear that the challenges are worst in certain groups, so interventions to prevent the diseases of old age should be prioritised in the poorest groups if levelling up is to mean anything at all across all constituencies, not just the former red wall.
When all is said and done, what became obvious to me was that we should not start action on healthy old age when we are old; we should start when we are children. That would help us all and protect the NHS. The noble Baroness, Lady Young of Old Scone, commented on that, and I very much agree. The widening gap between rich and poor among older people living with multimorbidities says it all. Clearly, although we can mitigate the ill effects of an unhealthy old age with all the technical solutions we have recommended, such as research into the diseases of old age, repurposed drugs, technological aids, co-ordinated medical treatment and oversight—I recommend the sort of electric hob that turns itself off when you remove the pan, which is much safer for old people—in the end and over the longer timescale, it is the socio-economic factors that will have the greatest effect in giving us all more years of health at the end of life. I look forward to the Minister’s reply.
Drugs: Black Review
Baroness Walmsley Excerpts(3 years, 3 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Kamall (Con)
The Government have committed to answering in full the recommendations of Dame Carol Black’s review. In terms of joined-up thinking across government, the Government established the new Joint Combating Drugs Unit—the JCDU—in July 2021 to co-ordinate, and drive a genuinely cross-government approach to, drugs policy. The JCDU brings together different government departments, including those that the noble Baroness mentioned—the Department for Health and Social Care, the Home Office, the Department for Levelling Up, Housing and Communities, the Department for Work and Pensions, the Department for Education and the Ministry of Justice—to help tackle drugs misuse across society by adopting a cross-government approach.
Baroness Walmsley (LD)
My Lords, the drug treatment and recovery workforce has deteriorated in quantity, quality and morale in recent years, with excessive case loads, decreased training and lack of clinical supervision. How do the Government plan to increase the number of professionally qualified drug treatment staff and improve occupational standards and training requirements?
Lord Kamall (Con)
The Government will answer all the recommendations in Dame Carol Black’s review by the end of the year. In response to the noble Baroness’s specific question, I shall write to her.
Calorie Labelling (Out of Home Sector) (England) Regulations 2021
Baroness Walmsley Excerpts(3 years, 6 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Walmsley (LD) [V]
My Lords, we are living in an unhealthy food environment in which an obesity epidemic sits alongside eating disorders, hunger and malnutrition, and consumption of damaging amounts of ultra-processed foods. We need an integrated public health approach to food. My attitude to these regulations is cautious but optimistic that they might do some good if implemented as part of a wider strategy, and with compassion for those who are concerned about their effects. I share the Minister’s hope that they may result in reformulation by restaurants and takeaways, as the sugar tax has done already. We all know why action is needed.
We heard the figures on childhood obesity from the noble Lord, Lord Bethell. UK childhood obesity is almost the worst in Europe. He also reminded us that two-thirds of adults are overweight and 28% are obese. That matters because obesity ruins and shortens lives. It leads to type-2 diabetes, heart disease, high blood pressure, cancer, liver disease and skeletal problems. We have also seen to our horror how obesity affects a person’s probability of dying from Covid-19. The issue is complex, the numbers are enormous and the cost is eye-watering.
On the other hand, we hear that 1.25 million people suffer from eating disorders. Those are acknowledged to be mental health issues requiring expert therapies that are not sufficiently widely available. I hope that all noble Lords will acknowledge that mental health is also an issue for people living with obesity. It can be either a cause or an effect, and similarly require emotional support. It is no use just giving an obese person a diet sheet and telling them to get on with it.
Therefore, both problems endanger life and we must find a balance. In what way could these regulations help or hinder? I should emphasise that they must be only a tiny piece of the jigsaw. Let us look at the facts. We know that 96% of people eat out regularly, many of them families, and that number is rising. We know that the calorie content of restaurant and takeaway meals can be twice that of the same meal bought from a shop or home-cooked. How could knowing the number of calories help an obese person? It fills a gap in their knowledge. Most overweight people have no idea how many calories are in meals from a takeaway or restaurant. Knowing can help them to choose something lighter if they are trying to reduce their weight. Information is power.
On the other hand, people with eating disorders usually already know exactly how many calories are in every food because they have been limiting them for years. Therefore, putting figures on a menu tells those people nothing that they do not already know. But it is a difficult situation for them. I understand the concern that just seeing the amount of those calories might trigger a relapse for those who are valiantly fighting an eating disorder. I therefore hope that all restaurants will make a non-calorie-labelled menu available. However, the primary need for such people is expert support in order for them to make those difficult food choices. That is the crux of the matter—the need for expert therapies for eating disorders, and information and support for obesity.
I realise that, unfortunately, it is impossible to have a pilot for this measure. However, the three years quoted in the regulations is too long before reviewing them to see whether they meet their objectives or, conversely, do harm. I therefore share the concern of the noble Baroness, Lady Bull. The regulations must be reviewed after a year and the concerns of those with eating disorders taken seriously. I also share the concern of the noble Lord, Lord Brooke, and sincerely hope that the Government will add alcohol calorie labelling when carrying out an early review of this measure.
Women’s Health Outcomes
Baroness Walmsley Excerpts(3 years, 7 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Walmsley (LD) [V]
My Lords, I am delighted to take part in this debate on women’s health issues, so ably introduced by the noble Baroness, Lady Jenkin.
A common issue coming out of all the briefings, and particularly from the report by the noble Baroness, Lady Cumberlege, First Do No Harm, published last year, is the need to listen to women when they talk about their health. We all heard the noble Baroness talking movingly in this House, when we first debated her report, about how upsetting it was when she really listened to the women who had been damaged, or whose babies had been damaged, by valproate, Primodos or vaginal mesh and how relieved the women were to be listened to at last. Can the Minister say when the Government will implement all her recommendations?
Information is vital because, without it, women cannot exercise proper choice. In the case of the anti-epilepsy drug valproate, we heard from women with epilepsy when we debated the report last year that women were still not being fully informed of the risks in case they become pregnant. Let us remember: about half the pregnancies occurring in the UK are unplanned.
So information is key, but so is listening. I am horrified when I hear that women who eventually get a diagnosis of endometriosis have usually been to their GP 10 times before they finally get a proper investigation, diagnosis and treatment—just one example of where women’s pain is not taken seriously. I recognise that the non-specific symptoms are of course difficult to diagnose, but I would like to know what training trainee doctors get in actively listening to women.
As we just heard, women are also underrepresented in clinical trials, even for drugs specifically aimed at women. This is completely unscientific when you understand the differences between women’s and men’s biology. Can the Minister say why the regulator allows this?
I am, like the noble Baroness, Lady Massey, very concerned about women’s mental health services, particularly since the pandemic has isolated so many women in their homes with sole responsibility for caring for their children and sometimes elderly relatives. A listening ear has been more important than ever during the pandemic and many kind members of the community have stepped up, but they are no substitute for clinical services. Asking questions and listening to the answers is particularly important in antenatal clinics, where mental health issues and domestic violence can often be detected early. I ask the Minister: will women’s mental health be specifically included in the new Secretary of State’s plan for mental health?
Another factor of women’s health which has worsened over the past year is nutrition and obesity. We have seen an increase in poverty, which is linked to obesity, and an increase in eating disorders. When will we get Henry Dimbleby’s long-awaited national food strategy? This is really important for women themselves and for those they feed and care for.
Covid-19: Wuhan Institute of Virology
Baroness Walmsley Excerpts(3 years, 7 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Bethell (Con)
My Lords, I have written to the commissioner for standards in response to that precise question and I should be glad to share that correspondence with the noble Lord.
Baroness Walmsley (LD) [V]
It is believed that given the slow rate of mutation of Covid viruses, Covid-19 would have taken around 35 years to evolve from its nearest known relative. What has been done to identify any intermediaries in which it may have lived during that period and any knowledge useful for preventing future pandemics that may arise from that knowledge?
Lord Bethell (Con)
I entirely agree with the noble Baroness. It is extremely frustrating that we do not know the steps of evolution that this virus went through. It has come to us completely out of the blue. That leaves us in a vulnerable state when we are preparing for the next pandemic. It is absolutely essential, as any epidemiologist will say, that one knows and understands where the virus came from—whether that is the water pump handle for an outbreak of cholera or a virus from China.
Social Care and the Role of Carers
Baroness Walmsley Excerpts(3 years, 7 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Walmsley (LD) [V]
My Lords, it is a pleasure to support my noble friend, Lady Jolly, who laid out so well the importance of social care to all of us. It is clear that the crisis in social care must be addressed urgently and a cross-party consensus reached on a fair system of funding. That will happen only if the Government liaise with other parties, not just the Chancellor. The pandemic has highlighted the interdependence of social care and the NHS, but there has been a damaging shortfall in social care funding over the past few years—currently at £6.1 billion—and local authorities have struggled to subsidise social care from other funds.
The social care workforce is dedicated, but its pay is on average 25% less than that in the NHS. No wonder some are moving into retail and agriculture: the Brexit shortages in those workforces has meant that they can earn a lot more if they work in those sectors. There were 112,000 vacancies before the pandemic, and a shortfall of half a million care workers is predicted by 2035 unless something is done. The public support parity of esteem with NHS staff. I agree with the noble Baroness, Lady Hollins, that we need a social care people plan similar to that for the NHS. What is the Government’s plan for this?
Domiciliary care workers are particularly hard hit as they are not paid for travel between clients and have too short a time to carry out their duties. They are in some respects even more important than those working in residential care because they contribute to keeping clients out of hospital and preventing their move to more expensive residential care. Related to this but slightly beyond the scope of the Minister’s department—but just as crucial to the objective of keeping elderly people safely at home—is housing design and adaptations. Can the Minister tell the House who in government takes responsibility for this?
The shortfall in funding means that the burden of care has fallen on the shoulders of 11.5 million unpaid carers, family and friends. Their care allowance is a pittance and must be increased. Although their rights to support were laid down in the Care Act 2014, they have not been met because of the requirement that local authorities remain within their budget. Can the Minister say when those rights will be fulfilled?
Many people are unaware that half the cost of social care is for working-age adults with physical and mental disabilities. During the pandemic there has been even more pressure on services for them. Is the Minister aware that, although the emergency powers to modify entitlement to services have not been overtly used, organisations that speak for these groups report that their services have indeed been curtailed? Will he look into that?