Health and Care Bill

Debate between Lord Bethell and Lord Lansley

Lords Hansard - Part 2 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Lord Lansley (Con)]

My Lords, can I just take us back to Amendment 266, to which I have added my name, before we lose sight of it? It was helpfully introduced by the noble Baroness, Lady Wheeler, and its purposes were explained very well by the noble Baroness, Lady Brinton.

I just want to add a bit of context, which I hope will commend itself in particular to my noble friend Lord Howe on the Front Bench, in that he and I tackled together the PIP breast implant problems that emerged in December 2010 and which led directly, subsequently, to us asking the distinguished first medical director of NHS England, Bruce Keogh, to undertake an inquiry. Since the report of that inquiry, we have made considerable progress. Most recently, noble Lords will recall that the noble Baroness, Lady Wyld, took through the Private Member’s Bill from Laura Trott in the other place to assist in the regulation of Botox treatment for under-18s.

The point is that there is still unfinished business. Amendment 266 relates to giving the Secretary of State the power to set up a licensing process for non-surgical cosmetic procedures—not through the CQC in this case, because the CQC regulates healthcare professionals, but almost certainly through the mechanism of asking local authorities to undertake a licensing process. It gives the Secretary of State all the flexibility that we have grown accustomed to legislation having to give them, but it does so in a way that enables the regulation that would be brought in using this power to be proportionate, being very clear that it should apply only to those activities that present a significant risk. It makes sure that it takes advantage, for example, of the national standards that have been put in place by the Joint Council for Cosmetic Practitioners. It would be very helpful in trying to mitigate the risks associated with non-surgical cosmetic procedures.

Amendment 293 in my name is a follow-up to a Private Member’s Bill that made no progress. It again follows Bruce Keogh’s report and looks to give the General Medical Council the legislative opportunity and requirement to bring forward a scheme to put surgeons who have a specialty relating to cosmetic surgery on to its specialist registers. With Amendment 293, we have the benefit of being able to do this by virtue of the recommendations in recent years from the Cosmetic Surgery Interspecialty Committee of the Royal College of Surgeons. It gives us an opportunity to give those who wish to undertake surgical treatments for cosmetic purposes the opportunity to see who is on the specialist register. All this relates to the safety of those undertaking cosmetic treatments, which is a large number of people; there is a large amount of activity and a significant need for the consumers of these services to have a degree of protection. I think we can make progress on that.

In the rest of this group, we have another opportunity to take action. My noble friend was right when she spoke about a more general approach. She will recall that, in April 2014, the Law Commission produced its recommendations on the regulation of healthcare professionals, so there is an opportunity to do something here. If we do not do it in this Bill, it would not hurt for the Government to tell us more about how they might make progress on the broader regulation, in addition to what is being proposed here.

I want to mention two other things. First, we had an earlier debate about access to innovative medicines. This is another opportunity for my noble friend to tell the Committee that NHS England is proceeding with its consultation on the implementation of the innovative medicines fund. Secondly, we do not need to repeat the short debate we had in Grand Committee not so very long ago under the auspices of my noble and learned friend Lord Mackay of Clashfern, who enabled us to present a lot of arguments about the future of NHS Resolution and clinical negligence within the NHS. We do not need to repeat that, but Amendments 178 and 297E would of course help us in that direction, not least by repealing the redundant NHS Redress Act 2006, which has never been implemented. With that thought, I pass the ball to the noble Lord, Lord Storey.

[Lord Bethell (Con)]

My Lords, I support Amendment 266 in the name of the noble Baroness, Lady Merron, and Amendment 293 in the name of my noble friend Lord Lansley for all the reasons that my noble friend just articulated. I will not repeat them as he put them so very well. However, I would say to the Minister that, coming from the innovation space, I can see that the technologies for both cosmetic surgery and non-surgical cosmetic interventions are improving all the time. There is an incredibly rapid pace of change. They are set to continue to get better and better, so the marketplace is getting more sophisticated and their popularity is also exploding. We have been briefed on evidence about the role of social media in promoting non-surgical cosmetic interventions in particular. This is exciting, because it is great that people have access to these interesting products, but also extremely worrying, because not all the surgeries and non-surgical interventions are successful. It is the right time for the Government to intervene, so that we have a register of cosmetic surgical practitioners and a much clearer regulatory regime for non-surgical interventions.

I am pro cosmetic surgery. As a young boy, I had an inherited condition of having very big, sticking-out ears, which my father had and my cousins and aunts have, and it was miserable. I had them pinned back and I am very grateful that that happened. It meant that I could be a much more confident person as I grew up. I am pro cosmetic interventions; if people want to use the benefits of medicine to improve their confidence in the way they look, I applaud that. However, standing next to my noble friend Lady Cumberlege, I am also aware of Bruce Keogh’s extremely good report and the very large number of interventions that have not gone well. I know that the Minister’s instincts are not to intervene unless absolutely required and my suggestion to him is that we have hit that moment. The marketplace is exploding and now is the right time to intervene.

NHS Update

Debate between Lord Bethell and Lord Lansley

Thursday 22nd July 2021 Lords Chamber

[Lord Lansley (Con)]

My Lords, following our debates on the Medicines and Medical Devices Act earlier this year on an innovative medicines fund, the announcement in this Statement of a ring-fenced £340 million budget for innovative medicines is very welcome. When will those become available, so that clinicians and patients can access this funding? Given that it now takes us beyond cancer drugs and innovations, will there be a focus on those diseases for which there has been no effective treatment?

[Lord Bethell (Con) [V]]

My Lords, I am grateful to my noble friend for highlighting this important development. The cancer drugs fund was a great success, and we are building on it with a substantial investment. The new fund will support patients with any conditions, including those with rare and genetic diseases. Dementia is one area where we are extremely interested in looking at investing further, and I hope that this would be captured, but we are waiting for recommendations from NICE and the data that it will provide before we set the right prioritisations. In terms of the date, I do not have that at my fingertips, but I would be glad to write to my noble friend with the details.

Covid-19 Update

Debate between Lord Bethell and Lord Lansley

Tuesday 6th July 2021 Lords Chamber

[Lord Lansley (Con)]

My Lords, I support the move from legislation to guidance in relation to the measures in the Statement. But does my noble friend agree that there is a case for continuing regulation of the circumstances where somebody is the contact of somebody who has tested positive? Can he update the House on what the Government are proposing regarding relaxing some of the restrictions for those who are contacts of positive tests?

[Lord Bethell (Con)]

My noble friend puts it very well. Clearly, with the infection rates rising but with a very large proportion of the country vaccinated, it is worth reviewing this. As the Secretary of State said in his Statement earlier this afternoon, from 16 August the Government intend to exempt people who have been fully vaccinated from the requirement to self-isolate if they are a contact of a positive case, with a similar exemption for under-18s. Anyone who tests positive will still need to self-isolate regardless of their vaccination status. Symptomatic testing will continue to be available. This is a proportionate direction, given the state that we are in.

Covid-19 Update

Debate between Lord Bethell and Lord Lansley

Tuesday 29th June 2021 Lords Chamber

[Lord Bethell (Con)]

The noble Lord is entirely right: those three things are linked. We cannot live in a world where there is a high infection rate in large parts of it, where new variants prosper and where we cannot travel. That would be inhuman and unpragmatic. I met with the CEOs of the major companies that manufacture the vaccines in Oxford during the G7, and we discussed this point in great detail. It is frustrating, but I also have optimism that the manufacturing capability in the hubs around the world—in the geographical places where populations live—are being built today and, by the middle of next year, there will be a huge amount of vaccine capacity in order to address this problem. It is frustrating that it cannot happen overnight, but vaccine manufacturing capability takes time to build up, as we know only too well. However, those investments are taking place, and I believe that, as a world, we can beat this pandemic together.

[Lord Lansley (Con)]

Notwithstanding the disclosures of the past few days, may I tell my noble friend that I, for one, very much appreciate what Matt Hancock did and the immensity of the effort he put in to combat Covid infection? Step 4 is not a return to normality, so, for example, self-isolation requirements will continue after contact tracing. The Government now have a lot of research to look at whether daily lateral flow tests can replace self-isolation both for schools and for businesses, which are must disrupted by self-isolation. Can my noble friend say when the Government may be able to proceed to allow some schools and businesses to shift to daily lateral flow tests?

[Lord Bethell (Con)]

My noble friend’s comments are very much appreciated and taken on board. On his question about daily lateral flow testing, he is very perceptive and correct. This is an area that we have been exploring for some months, and we are working extremely hard to bottom it out with rigorous clinical trials—clinical trials are difficult to nail down, by their nature, but we have invested substantially in them. He is right that, for schools, for international travel and for contacts—those three things—daily testing may well offer an alternative to 10-day isolation. That would be a huge relief to many in the country, and it is something that we are very focused on delivering.

Social Care Reform

Debate between Lord Bethell and Lord Lansley

Tuesday 29th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, new legislation will increase integration between health and social care by removing barriers to data-sharing, enabling joint decision-making and putting more power and autonomy into local systems. The noble Baroness is entirely right on that. The Bill has been published and the noble Baroness is very welcome to engage in some of the engagement sessions that I have had on it already. I should be glad to run more, if that would be helpful to her. A White Paper and a public consultation are not planned.

[Lord Lansley (Con)]

My Lords, press reports suggest that the Prime Minister is in favour of including in social care reform the Dilnot commission recommendations that are now a decade old. In doing so, he could bring into force Sections 15 and 16 of the Care Act 2014, which this Parliament passed seven years ago. Will the Government now consider doing exactly that to enable a cap on care costs to be implemented rapidly?

[Lord Bethell (Con)]

My Lords, we are extremely respectful of the Dilnot commission report and the recommendations in it, particularly those highlighted by my noble friend on Sections 15 and 16. It is one of many proposals that we will look at very carefully. We cannot make a commitment to anyone in particular at this stage but, as I said to the noble Baroness, we will put forward a full plan by the end of the year and will remain true to that commitment.

Osimertinib Cancer Treatment

Debate between Lord Bethell and Lord Lansley

Tuesday 18th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, we are watchful of the concerns to which the noble Lord refers but it is our hope and aspiration that there will not be the kind of delays or trouble that he explained. The Northern Ireland protocol means that Northern Ireland will stay aligned with EU rules, particularly for this kind of specific cancer medicine, but that does not mean that there need to be any delays. However, we are watching the situation carefully and the report that he described will give a full account of the problems, if there are any.

[Lord Lansley (Con)]

Can my noble friend, in this instance at least, explain the divergence between the MHRA and the European Medicines Agency? On 22 April, the EMA’s Committee for Medicinal Products for Human Use gave a positive opinion under an accelerated assessment, but the EMA has not yet given the new indication of marketing authorisation. What is the potential gap between MHRA authorisation and EMA authorisation?

[Lord Bethell (Con)]

My noble friend is, as ever, all over the detail. It is my understanding that the gap is a matter of weeks rather than there being any clinical divergence in assessment of the evidence. However, I am afraid to say that I would have to leave it to the EMA to think for itself on that.

Covid-19 Update

Debate between Lord Bethell and Lord Lansley

Thursday 4th March 2021 Lords Chamber

[Lord Lansley (Con)]

My Lords, the speed and scale of the vaccine rollout is indeed a remarkable achievement and reflects great credit to all involved. The House will have noted the publication this morning of the REACH study based on data from February. Among its findings was that there was some regional variation in prevalence, particularly in the later part of February. Will the Government on this basis consider regional variation in the pace at which restrictions are lifted, rather than necessarily assuming that it will be a uniform, national approach?

[Lord Bethell (Con)]

My noble friend is entirely right to raise the issue of regional variation. It had been our profound hope to be able to adjust and to focus lockdown arrangements on geographical locations so that national measures were not the only tool in our toolkit. The evidence from last year suggests that the amount of travel that individuals do makes regional and local lockdowns only partially effective. This has put a massive question mark over the way in which we can use regional and local lockdowns. There is more work to be done to understand exactly how that works but he is right to raise it as a considerable issue.

Covid-19 Vaccines Deployment

Debate between Lord Bethell and Lord Lansley

Thursday 11th February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I have heard the noble Lord’s concerns about this matter when he has brought them up previously, but I simply do not recognise the story he is telling. I would remind him that 95.6% of those aged 75 to 79 have had the vaccine. This is not the story of people who are concerned about going to mass vaccination centres. There are GP centres up and down the country that are closed because they do not have supplies, and it is supply that is undoubtedly the rate-limiting factor. That is because, as he knows, the supply comes in large boxes. If GPs do not have enough people to use up a large box, we have to prioritise those who have longer lists.

[Lord Lansley (Con) [V]]

My Lords, I want to ask my noble friend about the Moderna vaccine. I understand that we have 17 million doses on order, the first batches of which are likely to arrive in the spring—let us say, in May. Where will the vaccine be used? It seems that with a trial taking place in America of its use among 12 to 17 year-olds, there is an argument for it to be reserved for use in vulnerable younger people or, indeed, given its relative significant effectiveness, to be reserved for use later in the year as a booster vaccine for the most vulnerable groups. Can he tell us the Government’s thinking about the use of this vaccine?

[Lord Bethell (Con)]

As ever, my noble friend is extremely perceptive in his insight. The Moderna vaccine is indeed an interesting one that may well prove to be a useful complement to the Pfizer and AstraZeneca vaccines, which are the bulwarks of our vaccination deployment at the moment. As he probably knows, the MHRA has already sanctioned the use of existing vaccines in some children where there may be a strong clinical need, and under the advice of their clinicians. However, it is our aspiration to spread the vaccines as widely as possible. Unfortunately, children are a vector of infection and it may be that there are strong arguments for vaccinating not just vulnerable children, but perhaps a large number of children. We will look at various different vaccines for that, and Moderna may possibly be a candidate for the kind of A-B double-dose vaccine that I alluded to earlier.

Ockenden Review

Debate between Lord Bethell and Lord Lansley

Monday 14th December 2020 Lords Chamber

[Lord Bethell (Con) [V]]

My Lords, I respectfully disagree with the noble Baroness’s insight—the Ockenden review does not point the finger at staffing levels in relation to the problems; it points the finger at a number of items, particularly the cultural problems that emerge when differences of opinion between clinicians and midwives arise and where a culture of respect breaks down. Those cultural differences can be improved by what we would politely call education; it is essential that we invest in the right kind of education in order to bring midwives, obstetricians and gynaecologists closer together and to break down the hierarchical differences and the ideological differences about the best way to have a baby.

[Lord Lansley (Con)]

My Lords, as a Secretary of State responsible for the health service for some of this period—two years out of two decades—I share in the responsibility for what happened here and for the fact that it was not known about and that action was not taken sooner. I am sure that others who have been Ministers in the department over these two decades will feel likewise.

What is shocking is not only the individual trauma that parents have suffered but the scale of what the Ockenden review discloses—we are grateful to Donna Ockenden and her colleagues for persisting in trying to understand and disclose the scale of what has happened. I ask my noble friend about our responsibility, which was, of course, that there should be external oversight and action taken when these things go wrong. From my point of view, one of my objectives was that there should be more clinically led commissioning so that local clinicians would understand what was happening and have the power to step in.

The Ockenden report shows that, in May 2013, the clinical commissioning groups set up a review that, in October 2013, reported:

“The overall findings of the review demonstrate that this is a safe and a good quality service”.


I encourage Donna Ockenden and the department to look very carefully at how they could ensure that local clinicians responsible for commissioning take that responsibility seriously and act upon it.

[Lord Bethell (Con) [V]]

On behalf of the Chamber, I thank my noble friend for his touching testimony. He is entirely right; there are two CCGs in the local area: the Telford and Wrekin CCG and the Shropshire CCG. They did exactly what they should have done in 2013, launching an investigation into the levels of service at the Shrewsbury and Telford Hospital NHS Trust. It is not clear why the findings of that report turned out as they did; nor is it clear why other interventions, or potential interventions, by the CQC and other regulators did not get to the bottom of the problem. Those questions will be addressed in the second of Donna Ockenden’s reports, in 2021; there has not been time for them all to be addressed in the interim report, but there is much more to go into, and this is undoubtedly one of the important points she will need to address.

Covid-19 Update

Debate between Lord Bethell and Lord Lansley

Monday 30th November 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Baroness is entirely right. I share her sentiments. We are not inclined to give in to the pressure. There is a temptation for greater granularity, but we have learned the lesson on that one.

[Lord Lansley (Con)]

My Lords, the Faculty of Public Health and the directors of public health have expressed reservations about what they described as the distraction of the mass community testing programme in relation to the requirement to support the vaccination programme. Can my noble friend give them and me some reassurance that the vaccination programme will be an overarching priority for resources and that the testing of symptomatic cases and of essential workers, to which he referred, is a priority for the testing programme? Can he also say whether there is a realistic level of resources to support the community testing programme to which he has twice referred positively?

[Lord Bethell (Con)]

I welcome my noble friend’s challenge. I reassure him that the testing and vaccination programmes will absolutely run alongside each other and that this has already been happening. They are collaborating very closely. The resources being provided for both are generous enough to ensure full delivery of the vaccine. The rollout of the community testing programme is a sign of the success of test and trace, but it will in no way have a negative impact on the deployment of the vaccine programme, which remains a number one priority for the Government.

Medicines and Medical Devices Bill

Debate between Lord Bethell and Lord Lansley

Committee stage & Committee: 7th sitting (Hansard) & Committee: 7th sitting (Hansard): House of Lords
Thursday 19th November 2020 Grand Committee

[Lord Lansley (Con)]

I thank the Deputy Chairman. I sent the email only about 30 seconds ago so I suppose, strictly speaking, that apologies on his part are not required. I should have anticipated the need to ask a question, but I am afraid I was prompted by listening to the noble Lord, Lord Sharkey, and the Minister’s reply. I want to ask one question: how can what will become Section 1 be brought into force without Section 2? I do not understand. If a power is to be used under Section 1, it must surely make provision about some of the long list of relevant areas in what will be Section 2. In the absence of Section 2 being in force, I cannot see how Section 1 works.

[Lord Bethell (Con)]

My Lords, I will seek to provide an answer to my noble friend. Should it not be quite the right answer I will endeavour to write to him. It is my understanding that no substantive provision of an Act should be brought into operation earlier than two months after Royal Assent. However, some sections of the Act can be brought into force on Royal Assent, typically those setting out how the Act is to be cited and what the procedure is for making regulations or commencing them. It is under those arrangements that the sequencing which he describes can be undertaken.

Covid-19: Intensive Care Treatment

Debate between Lord Bethell and Lord Lansley

Thursday 29th October 2020 Lords Chamber

[Lord Bethell (Con)]

Our learning has come a long way. Practices within ICU units have changed as a result of what we have learned in relation to the way that oxygen is administered, the range of drugs available and the turning of patients. To date, triage has not been necessary because the NHS is so good at load management that patients can be dispersed and deployed through the system, which has not been placed under pressure. We expect to be in good shape for the second wave. The principle remains as the national medical director, Stephen Powis, stated in his letter of 7 April:

“The key principle is that each person is an individual whose needs and preferences must be taken account of individually.”


That remains our principle.

[Lord Lansley (Con) [V]]

My Lords, on precisely the point that my noble friend the Minister has just made, I know he will be aware of the revised version of ReSPECT—the Recommended Summary Plan for Emergency Care and Treatment—which was published in September by the Resuscitation Council UK. It is in wide, but rather variable, use. Will my noble friend encourage NHS England to make its use a best-practice requirement in relation to Covid-19 patients entering high-dependency or intensive care in the months ahead?

[Lord Bethell (Con)]

My Lords, we are extremely grateful to the Resuscitation Council for its work on this important tool. It gives an opportunity for patients to express their preference and for clinical judgment to be used at moments of acute intervention. It is being used in some places but, as the noble Lord rightly points out, its use is variable. I would be glad to take this back to the department to see what can be done to encourage its use more thoroughly.

Covid-19

Debate between Lord Bethell and Lord Lansley

Tuesday 20th October 2020 Lords Chamber

[Lord Lansley (Con)]

My Lords, the figures today for the number of cases and deaths are deeply worrying. It is a 20% increase in the week in the number of cases and, of course, the number of cases that we have seen in recent weeks is now tragically leading to a much-increased number of deaths, so there are no grounds for complacency. However, as I think we all understand, this is a marathon, not a sprint, and there is an inevitable tension in the question of how far businesses can be shut down on a permanent basis—and we want to avoid that.

I put it to the Minister that to support businesses that are Covid-secure and keeping open, we need compensating measures to try to limit the transmission in social circumstances. Would the Government consider extending the advice across England that, when indoors, people should mix only in their own household and social bubble, and that the rule of six, while continuing to apply, is not sufficient indoors? We need to limit the mixing of households indoors.

[Lord Bethell (Con)]

My Lords, my noble friend’s observation is entirely right. In Manchester alone there have been more coronavirus infections already in October than in July, August and September combined. The average daily hospital admissions in Greater Manchester are now higher than they were on 26 March, and there are now more Covid-19 patients in Greater Manchester hospitals than in the whole of the south-west and the south-east combined. These are illustrative of one region but it is a story that has already played out in others, and we naturally fear that it will play out in others in the future.

My noble friend’s advice on the mixing of households is very perceptive. One thing with that we cannot do anything about is the kind of infection that the noble Baroness, Lady Thornton, described among her friends, where it spreads within a household. That is something that no household can reasonably fight against. However, stopping the spread of disease between different households is something that we can lean into. It requires an enormous amount of social distancing and a return to the kind of lockdown measures that we had at the beginning of this year. That is something that we are extremely anxious to avoid because it has enormous social impact, it is disruptive to our way of life, and it has an economic impact because it has implications on social distancing and on some businesses. Still, my noble friend is entirely right that that is exactly the kind of area that we will need to look at if we are to contain the spread of the virus.

Medicines and Medical Devices Bill

Debate between Lord Bethell and Lord Lansley

Committee stage & Committee: 1st sitting (Hansard) & Committee: 1st sitting (Hansard): House of Lords
Monday 19th October 2020 Grand Committee

[Lord Bethell (Con)]

My Lords, Amendments 2, 7, 51, 54, 56, 68 and 72 are a package intended to respond to the comments made at Second Reading and the consideration of the Bill by your Lordships’ Delegated Powers and Regulatory Reform Committee and the Constitution Committee.

I have said at both the Dispatch Box on Second Reading and in meetings with a number of noble Lords that I am listening and ready to make improvements to the Bill where they are necessary. I am ready to provide reassurance about how the powers are intended to be exercised. Amendments 2 and 68 would require that regulations may be made only if the appropriate authority is satisfied that the regulations promote the health and safety of the public. A number of noble Lords spoke in favour of clarity regarding how the considerations applied in making regulations and whether the first consideration—that of safety—had primacy. This was a point made by the noble Baronesses, Lady Barker, Lady Andrews and Lady Walmsley, and by the noble and learned Lord, Lord Woolf. Their remarks on how the Government could improve the nature of the framework Bill were ones that I paid particularly close attention to. In making legislation, there is a delicate balance between making it absolutely clear that regulatory change will not be made that is contrary to promoting the health of the public and not binding the Government so completely that necessary regulatory change that is not explicitly for the purpose of promoting the health of the public is not possible. This amendment seeks to provide that comfort: that the Government’s making of regulations must satisfy that obligation.

Amendment 51, on veterinary medicines, is drafted differently to reflect the specific circumstances of how veterinary medicines are made. For example, a medicine that might be suited to the health of an animal might unhelpfully contribute to antimicrobial resistance in humans. An overarching requirement to be satisfied that regulatory change promotes the safety of animals, without reflecting that we must also consider the safety of animals as food products in the food chain, would have inadvertent consequences. Amendments 7, 54, 56 and 72 are consequential to these.

I have considered carefully the alternative constructions tabled by your Lordships. I wanted to demonstrate our absolute commitment to patients’ health and safety that is at the heart of this Bill. My noble friend Lady Cumberlege’s report has highlighted the importance of this.

My amendments do not fetter our ability to make good regulations that will enable the development of new medicines and devices in the UK and ensure the availability of those medicines. But, in doing so, the requirement to be satisfied will protect against the inadvertent impact on the health of the public. This will answer the requirement to make it clear how the Bill is a framework Bill, as opposed to a skeleton Bill, providing that test against which regulations can be measured.

I hope that these amendments provide assurance not only to those in this House who sit on the Delegated Powers and Regulatory Reform Committee and the Constitution Committee but to others who are keen to see the Government reflect my noble friend’s recommendation that patient safety be put first. I beg to move.

[Lord Lansley (Con)]

My Lords, I am glad to have this opportunity to speak to my Amendment 5 and to Amendments 70 and 76 in this group. I am particularly grateful to the noble and learned Lord, Lord Woolf, and the noble Baroness, Lady Jolly, for putting their names to Amendment 5. As the Minister rightly said, he set out to respond in government Amendment 2 to the remarks of the Delegated Powers and Regulatory Reform Committee and the Constitution Committee. We discussed this a lot at Second Reading. The essence of the argument that I among other noble Lords made was that the Bill was a skeleton, the skeleton approach was criticised by the Delegated Powers Committee and we needed to move it from a skeleton to a framework by making it clear that the power to make regulations is for a purpose. The noble and learned Lord, Lord Woolf, and I set out to do that in our amendment: to express a purpose rather than have a power that essentially had no test other than whether the Secretary of State had had regard to certain factors—there was no objective test that could be examined, because it is very easy for Ministers to say that they have had regard to something.

Why did we have the objective of safeguarding public health? The relevant EU regulation, which is the EU human medicines directive 2001/83/EC, as amended, says at what is essentially its first article:

“The essential aim of any rules governing the production, distribution and use of medicinal products must be to safeguard public health.”


Therefore, rather than invent our own purpose, we thought that the starting point for the legislation should be to reflect the same objective as incorporated into the regulation-making power up to now. The Minister may well say, “But the EU regulation is not only based on the public health treaty objective but on the internal market objective”. However, Article 3 of the EU regulation, which follows that, is quite clear:

“However, this objective must be attained by means which will not hinder the development of the pharmaceutical industry or trade in medicinal products within the Community.”


Therefore, the other legal bases, if anything, tend to act alongside and be balanced with the original treaty objective, which is to safeguard public health. It seems that there is therefore nothing inherently wrong in our own power to set out the objective, which is to safeguard public health, and then to set alongside it in the subsequent subsection the other considerations to which the Secretary of State must have regard. We will go on to discuss those, but they include the safety of human medicines, the attractiveness of the UK as a place to conduct clinical trials, and so on.

This is the test: why are we moving from the current legislative basis to a new one? What is inherently better in saying that Ministers must be satisfied that they will promote the health and safety of the people and in what sense is that different from safeguarding public health? Noble Lords might well say, “You have won—you put your amendment down and the Minister has put government Amendment 2 down, and they say more or less the same thing”. We submit that they do not quite say the same thing, since the government amendment’s construction is that the Secretary of State “must be satisfied that”. Our construction is that it

“must have the objective of”.

I am not qualified to say any more about this matter; I will leave that to my noble friend in this regard, the noble and learned Lord, Lord Woolf. An objective test should be expressed in the legislation in objective terms, not in subjective terms of whether the Secretary of State is satisfied.

Amendment 70 does a similar thing in relation to medical devices. Amendment 76 begs the question: is the safety of a medical device to be assessed in the absence of knowing its therapeutic use? It may well be that the answer is that assessing the safety of a medical device must necessarily consist not only of the approval process but of understanding its use in therapeutic settings. If the answer is that that will necessarily be the case and if Clause 12 of the Bill means that anyway, I am perfectly happy to accept that. However, I am looking for an assurance from the Minister that that is what Clause 7 means: safety of a medical device is not simply through its approval processes but through understanding in the approval process how it will be used in therapeutic practice.

In conclusion, from what I have said we do not think that government Amendment 2 is better than our Amendment 5. However, government Amendment 2 is clearly better than what is in the Bill at the moment, because it gives us a purpose for which the regulation-making power is to be used. I make a plea to noble Lords. At this stage, in Committee, I would far rather change the Bill by accepting the government amendment and its sequelae, as we would say, and therefore send the Bill to Report in at least a form that one Front Bench agrees with than not change the Bill and have to have this same debate all over again on Report. We might have the same debate, but it would clarify for the benefit of noble Lords on Report if at least the Bill has moved from where it has been to show how the Government are seeking to meet the objectives set out at Second Reading and by the Delegated Powers Committee so that we can look at it again properly on Report. I of course reserve my position and that of my noble friends whose names are attached to this amendment, as we might well want to come back to the issue on Report and say that our formulation with an objective test is better than the subjective test that government Amendment 2 implies.

Coronavirus

Debate between Lord Bethell and Lord Lansley

Wednesday 16th September 2020 Lords Chamber

[Lord Bethell (Con)]

That list is already published. I would be glad to send the noble Lord a link.

[Lord Lansley (Con) [V]]

My Lords, one of the big risks this autumn is from students going to university and, perhaps more particularly, returning from university in the run-up to Christmas. How has the guidance been prepared with universities to try to mitigate that risk? I know that Cambridge University is looking even at the possibility of testing all its students on a weekly basis.

[Lord Bethell (Con)]

My Lords, I thank colleagues at the DfE for their hard work in providing guidelines to universities and to vice-chancellors for implementing thoughtful arrangements for the return of students. It is very much the ambition of this Government that universities are brought back to life and that education and the impact of their work continues. None the less, it is not just the campus environment that concerns us—it is also the off-campus activities of students. For that, we look to universities to provide pastoral guidance to students to ensure that they are socially distanced and behave responsibly. We are keeping an eye on those behaviours and, should outbreaks or prevalence rise among students, we will have to review those guidelines.

Covid-19 Update

Debate between Lord Bethell and Lord Lansley

Thursday 10th September 2020 Lords Chamber

[Lord Lansley (Con) [V]]

My Lords, the consistency of messaging over time is immensely important to secure public support and adherence. Over the last six months, we have consistently explained that indoor and outdoor gatherings are significantly different, and that the scientific evidence has clearly shown much greater risk for indoor gatherings. Can my noble friend the Minister explain to the House why the Government appear to have abandoned this important distinction in their current guidance?

[Lord Bethell (Con)]

My noble friend is right to point out this important change. The truth is this: from the feedback we had from the public, and from our own analysis of the facts, we see that our guidance was growing increasingly complicated and was confusing the public. While the science may suggest all sorts of clever differences between one situation and another, and between inside and outside, the guidance is effective only if it is clear, understood and obeyed. At the end of the day, what we have done is to clarify some of the more complex areas of our guidance to make it more effective.

Covid-19: Response

Debate between Lord Bethell and Lord Lansley

Monday 27th July 2020 Lords Chamber

[Lord Bethell [V]]

My Lords, I pay tribute to my colleague Helen Whately, the Minister for Social Care. She has worked incredibly hard and tirelessly on this area, which is her ultimate responsibility. There is a social care team which handles those negotiations, and I thank all those in the social care industry who are engaged. The social care industry is highly fragmented so engaging with the entire industry is a massive challenge. That is why we have put in place new structures, new dialogues, new guidelines and new ways of working to ensure that we are match-fit for the winter.

[Lord Lansley (Con) [V]]

My Lords, a number of countries, including Hong Kong and Austria, undertake testing at ports of entry. Under certain circumstances, that can limit the time that people have to spend in quarantine. Will the Government offer such testing at UK ports and airports?

[Lord Bethell [V]]

My Lords, that is not in the current guidelines. The noble Lord is entirely right that it is incredibly time-consuming and not currently practicable. For the reasons I outlined in answer to an earlier question, a test today does not guarantee that someone will not be infectious either tomorrow or the next day. That is why we have not focused on testing at ports, but we remain open to suggestions. We assess a large number of options and, as evidence and trials emerge that may demonstrate the efficacy of different policies, we will of course consider them and remain open-minded.

Independent Medicines and Medical Devices Safety Review

Debate between Lord Bethell and Lord Lansley

Wednesday 15th July 2020 Lords Chamber

[Lord Bethell]

The noble Baroness is right that regulation is important, but so is culture. I emphasise the importance placed by the Cumberlege report on a change in attitude in the healthcare service as much as on a change in regulation. I cannot guarantee that the EMA and the MHRA will be aligned on regulation in all matters, but I can guarantee that the MHRA will be given the resources it needs to do the job properly.

[Lord Lansley (Con) [V]]

My Lords, as a former Secretary of State for Health, perhaps I may say that I and all my colleagues who have taken responsibility for the NHS over decades should join in expressing our deep regret at the systemic failures laid bare in the report of the noble Baroness, Lady Cumberlege. Will my noble friend reiterate the point about cultural change? It is not just about implementing the recommendations, important as that is, but about achieving cultural change. I direct that point in particular to patient involvement. By that I mean not just consultation, not just a patient voice, not just decision aids but patient-reported outcomes being a central part of the measurement of the performance of our health service and its accountability.

[Lord Bethell]

I completely endorse the comments of my noble friend. To embellish his point, it has been very interesting to see through Covid how patients have had to track their own symptoms, take advice on 111 for themselves and, in millions of cases, look after themselves at home, possibly with telemedicine to support them. This may an inflection point in the attitude of many people to their health. I certainly welcome a revolution of patient power and putting patients first in our healthcare system.

Covid-19 Update

Debate between Lord Bethell and Lord Lansley

Wednesday 1st July 2020 Lords Chamber

[Lord Bethell]

The noble Lord is entirely right. I have four children, all of whom have returned to school this week, and they are all attending smaller classes for smaller amounts of time on different days of the week. As a parenting challenge this is considerable, but it has meant that they have returned to both the social and disciplinary aspects of school. I embrace this development and entirely agree with the noble Lord’s prioritising of this important subject.

[Lord Lansley (Con) [V]]

My Lords, will my noble friend the Minister commit the Government to maintaining their financial support for the Covid-19 volunteer testing network? He will know the important work that it is doing.

[Lord Bethell]

My noble friend is right to raise this important subject. I know the volunteer testing network; I value it enormously and am extremely grateful for its support. I am currently looking into its funding, and I would be glad to write to my noble friend to provide a clearer answer on that.

Covid-19: Deep Cleaning

Debate between Lord Bethell and Lord Lansley

Wednesday 11th March 2020 Lords Chamber

[Lord Bethell]

The noble Baroness is entirely right to emphasise the importance of personal hygiene. The Government are working hard to drive these messages home. Ultimately, it is up to the public to embrace the messages. A substantial public awareness campaign was launched 10 days ago. From the polling that we have done so far, it appears to have been extremely effective. Based on that polling, we will be launching a further campaign to ensure that everyone is aware of the hygiene protocols the noble Baroness describes.

[Lord Lansley (Con)]

My Lords, the Minister made a good point about timing. Sometimes certain measures require preparation by public authorities and the public before they can be initiated. Does he agree that we may be not too far off a point when we ask those who are elderly and have underlying health conditions not to leave home, and that many public authorities—parish councils, town councils, local government, the NHS and Age UK—might soon want to undertake preparations?

[Lord Bethell]

My noble friend is quite right that measures require preparation. This Government are determined not to be caught on the hoof. In his public statements on Monday the CMO was clear that there are three areas where the modelling suggests there might be a major difference to the delay processes that the House has heard about and understands. My noble friend is also right that the safeguarding of older and vulnerable people would be a likely candidate for that. A substantial amount of time is required though, maybe 10 to 12 weeks or more. It is important that social acceptance of that kind of measure is in place before it is initiated. We are also looking at modelling the kinds of changes which would mean that those who display any symptoms might seek to socially distance themselves or that those who have been tested think about ways of putting space between themselves and their families. These are the kinds of illustrative examples that the CMO has already discussed publicly, and the Government are preparing for those kinds of scenarios at the moment.

NHS: Doctor Retention

Debate between Lord Bethell and Lord Lansley

Wednesday 4th March 2020 Lords Chamber

[Lord Bethell]

The noble Baroness’s figures are not exactly the same as the ones I have. Last year, 3,250 students were studying to be doctors; this year there are 3,500, and next year there should be 4,000. Those are the numbers provided to me. If there is any difference between the two, I would be glad to discuss them with her elsewhere.

[Lord Lansley (Con)]

My Lords, does my noble friend agree that the well-being of doctors is a critical factor in this? He will recall that Professor Michael West and Dame Denise Coia produced a report commissioned by the General Medical Council at the end of last year. Will the Government and the NHS work together with the GMC to try to implement their recommendations?

[Lord Bethell]

The culture of the NHS and the well-being of those who work in it are of paramount importance. Getting that right is the focus of the NHS people plan. Working with the GMC on all these arrangements is a priority for the Government and I would be glad to follow up my noble friend’s suggestion.

Brexit: Medicines and Medical Devices

Debate between Lord Bethell and Lord Lansley

Wednesday 2nd October 2019 Lords Chamber

[Lord Bethell]

The noble Baroness makes a very fair point that touches on the challenge of medical supplies that we live with whatever the circumstances, whether Brexit exists or not. Medical shortages happen and are part of the life of the NHS. If anything, this preparation for a no-deal Brexit has shone a light on our arrangements for medical supplies, and they have never been in better shape. One of the advantages of the process that we have gone through is to improve the circumstances. However, as the noble Baroness pointed out, shortages do happen in every country in Europe, including Britain. But I predict that these will happen less and less because of the investment of time and resources into understanding our medical supplies.

[Lord Lansley (Con)]

My Lords, on precisely that point, my noble friend will be aware that, as he said, shortages of medicines are occurring across Europe. That was highlighted in the latter part of last year when a survey of 1,600 hospital pharmacists across Europe found that 92% were experiencing shortages, particularly of antibiotics, vaccines and cancer drugs. So this is an opportunity to secure greater long-term resilience in medicine supply in this country if we work with other Governments across Europe. Will the Government commit to doing that?

[Lord Bethell]

The Government are working very closely with European partners on the supply of medicines. As my noble friend will be aware, a large proportion of the medical supplies in this country originate from our European partners, and therefore that collaboration is absolutely essential.

Health Infrastructure Plan

Debate between Lord Bethell and Lord Lansley

Monday 30th September 2019 Lords Chamber

[Lord Bethell]

My Lords, the noble Lord raises an important question about how infrastructure spending is approved and green lit. He is quite right that today’s announcement sees the final green light given to six hospitals and a further 21 projects—some of which are multisite projects—are on the runway but are not 100% green lit. That is because their plans are not yet ready, but there is a full intent by the Government to work with the trusts involved to develop those plans to final proposals and to have the money available to finance those plans in their current form. It has been publicly put out by NHS England that the rough current estimated cost of those projects is around £10 billion and that that money is put aside and allocated for those projects, as long as they meet the requirements of infrastructure scrutiny.

[Lord Lansley (Con)]

My Lords, I welcome what my noble friend said from the Dispatch Box in repeating the Statement. I say that as one who became Secretary of State in 2010. Although the noble Baroness, Lady Thornton, seemed to think that I had a large capital budget, it did not seem like it at the time. It was consistently underspent, because the spending of many of the trusts was determined by their resource. Capital and resource have to travel hand in hand. What is really important, as I hope my noble friend will confirm, is the commitment to future increases in resources for the NHS. The revenue alongside the capital is really important. It got to the point where, as we know, capital was raided to support revenue. Now we have a capital budget that will be supported by increases in the revenue budget.

If the noble Baroness, Lady Pinnock, had spent 10 years visiting hospitals as I did as shadow Secretary of State and then as Secretary of State, she would not ask, “How do you know which hospitals need rebuilding?” I stood in many of these hospitals, such as Epsom and St Helier, and looked at them. Why not Huddersfield Royal Infirmary? I went to Huddersfield and the truth is that it has never agreed what it wants to build, whether at Huddersfield or elsewhere. Some decisions have to be made before putting forward a capital project.

May I ask my noble friend a key question? We are abandoning PFI. The largest capital building programme that Labour talked about is a bit of an own goal, because it was all PFI and that is no good, but we must not throw the baby out with the bathwater. What was proven before the PFI project was extended and went wrong was that fixed-priced contracts deliver greater efficiency and that the NHS is not necessarily very good at building new hospitals. Can we make sure that we get some really good fixed-price contracts for these projects? They are funded through PDC and land sales, which is great, but can we make sure the NHS brings in additional expertise to make sure we have good designs and cost-effective delivery? In my experience, that was not available within the NHS. We do want not to go back to the days when every hospital invents for itself how to build a hospital. We want to go beyond that.

[Lord Bethell]

My noble friend makes powerful points. His point on income over capital is extremely well met. If it were the case that the income of the NHS had been driven down last year and we plonked a large amount of capital on top there would be a really big problem, but this capital announcement is on top of a record cash increase up to £33.9 billion a year by 2023-24 to the NHS budget. It feels, to the Government at least, that this is the right balance between income and capital.

However, the implementation of this infrastructure plan is definitely challenging and it is worth stepping back and thinking about how we will implement a massive step change in the capital infrastructure of our hospitals. The Government are aware of two areas where there is a need to focus resources. The first, as I referred to earlier, is on the actual design and planning of hospitals to ensure that they are to the highest standards and take into account the long-term needs of the community. Secondly, as my noble friend mentioned, NHS trusts will need greater capability in the management of contracts and the building of the hospitals. We will put aside money and expertise to ensure that those resources are in place.