Medicines and Medical Devices Bill

Debate between Lord Blunkett and Lord O'Shaughnessy

Committee stage & Committee: 6th sitting (Hansard) & Committee: 6th sitting (Hansard): House of Lords
Tuesday 17th November 2020 Grand Committee

[Lord O’Shaughnessy (Con)]

My Lords, it is a pleasure to follow my noble and learned friend Lord Mackay of Clashfern in talking to my noble friend Lady Cumberlege’s important amendment. It is impossible to match the passion and forensic skill with which she introduced her amendment—no one can make the case better and I will not try—but I offer her my deepest support for what she is trying to achieve through it.

The review that my noble friend carried out is quite simply one of the most remarkable of its kind, detailing as it does the extraordinary harm done to patients, mostly women, because of an inadequate safety regime that was too lax on products coming into the market, not capable of fully monitoring the adverse effects of products while they were used in the health system, and unwilling to heed the voices of those crying out in agony because of the harm being done to them and their families.

The First Do No Harm report is full of arresting facts: the 11-year delay between the first statistically significant evidence of the links between hormone pregnancy tests and malformations in babies; the lack of clinical evaluation of the use of mesh—a supposedly inert and harmless device—in the treatment of pelvic organ prolapse in tens of thousands of people; and the 20,000 people exposed in utero to sodium valproate in the UK, around half of whom have been affected physically or mentally, often very severely. But its true power comes from the testimony of those women whose lives were turned upside down by the adverse effects of these tests, pelvic mesh, sodium valproate and other medical scandals.

It was a privilege to hear this testimony at first hand when I was a Minister in the department, and I pay tribute to those brave women who led delegations to bring their message of pain and sorrow, and of being patronised by those who claimed to care for them, to us. Marie Lyon, Kath Sansom, Emma Murphy, Janet Williams—women like them are the reason why Ministers, and ultimately the then Prime Minister, asked my noble friend to carry out her review. It is to tens of thousands of women like them and their families that we owe a duty to implement the findings of that review.

There are many excellent proposals in the report, and it is my sincere wish that my noble friend Lord Bethell and his colleagues at the department will implement its recommendations as soon as possible. However, one recommendation stands out: the proposal for a patient safety commissioner, which is the subject of the amendment. Having served in government, I know that there is often internal resistance when a review proposes a new arm’s-length body or something of that kind, so I will explain why I believe that this one is so important and why there is a strong precedent for a Conservative Government introducing one.

As my right honourable friend Jeremy Hunt said when he first launched the medicine and medical device safety review in February 2018, it is the responsibility of the Government to listen, hear and act with compassion, speed and proportionality when things are going wrong. As the exhaustive findings of my noble friend’s review show, this did not happen, time and again, over many decades—and it must.

Whose responsibility, then, should it be? I, like other noble Lords, have great confidence in the NHS, the MHRA, the DHSC and other bodies, but we must be honest that none of them has consistently lived up to the maxim propounded by the former Secretary of State. More importantly, too many patients have had negative experiences interacting with these organisations when they were seeking help, so confidence in their ability to act in patients’ interests is not robust.

As the review continued, it became clear to me, as it did to my noble friend Lady Cumberlege, that there was a need for an entirely independent body that could act as the patient’s friend on safety in the system, a gateway and a support mechanism where those who were not being listened to could go—if you like, a conscience for the system. This would benefit the health system too, providing aggregated access to new information on safety issues and a potential to spot emerging concerns. Nothing that currently exists could perform both these essential functions in a way that carries the support of patients.

These are precisely the roles that the patient safety commissioner is proposed to play. There are different ways it could be implemented, of course, but it must be independent of the department and the NHS, as other noble Lords have said, and it must be patient-facing in all it does. We already have examples of how this could and should work. Many noble Lords have referred to the excellent work of the Children’s Commissioner. I also point to the Victims’ Commissioner, a role fulfilled until recently with great expertise by my noble friend Lady Newlove, and the new independent office of the Domestic Abuse Commissioner. It is absolutely right that these new positions have come into being, and I am proud that it was a Conservative Government who created them.

So once again I throw my weight behind the proposals of my noble friend Lady Cumberlege. I am sure that my noble friend the Minister is highly sympathetic to this cause. For the sake of all those women—and the men and children who have also been harmed—I hope that we can work together to make it happen.

[Lord Blunkett (Lab)]

First, I declare a tangential interest in the sense that I am patron of the Society of Occupational Medicine and, together with the faculty, it obviously has a real interest in this area, as well as its broader remit. I apologise to the noble Baroness, Lady Cumberlege, and the Committee for not being in my place at the beginning of her incredibly powerful speech, and I endorse what people have said already about not only the speech but the incredible work and reflections in the report.

The history that the noble Lord, Lord Patel, gave us, indicates very clearly the challenges that have been faced in this area. I am the first Member to speak who, as a former Member of Parliament, had people at my surgery bewildered, frustrated and not in a position, as they were in America, to go down the litigious route to get any satisfaction. But, of course, down the road and down the line is, as the report of the noble Baroness, Lady Cumberlege, indicates, is too late. Having someone who can intervene to prevent misery, hurt and, for many, terrible trauma for life is really important.

When you have the noble and learned Lord, Lord Mackay, and a former Health Minister, the noble Lord, Lord O’Shaughnessy, on your side, you are on a winner, and I hope that the noble Lord, Lord Bethell, will be able to indicate that he is prepared to go back to what we used to call the Legislative Committee—difficult as that is, because there is enormous resistance in government, as the noble Lord, Lord O’Shaughnessy, will remember and my noble friend Lord Hunt will be painfully aware, to having substantial amendments to Bills and to conceding that measures were not thought of first within the department. But I hope that on this occasion it will be possible to do so.

Reference has been made to other commissioners, and I endorse what the noble Lord, Lord O’Shaughnessy, said about the noble Baroness, Lady Newlove, and the powerful work that she did. I respect her greatly, as I do Anne Longfield, the Children’s Commissioner. I say to my good friend and noble friend Lord Hunt that I like to think that some of us in the political arena played a bit of a part in getting the schools reopened as well as the commissioner, but she did a phenomenal independent job in that area. I hope that the commissioner recommended by the noble Baroness, Lady Cumberlege, would be able to do the same in this sometimes forgotten area.

I am not sure that she will thank me for this, but perhaps the noble Baroness will accept that there may be a connection with the Health and Safety Executive, because the research and testing facilities it has may have a relevance here, and some connection with the commissioner that she has recommended may be sensible. My noble friend Lord Hunt and I shared an interest in this when we were both at the Department for Work and Pensions and the HSE reported to us. We had a number of ideas which, because we had both moved on, did not come to fruition—but here we are, all those years later, with an opportunity to do something that would be of great benefit to many people—mainly, as the noble Lord, Lord O’Shaughnessy, said, women—who have suffered so grievously and did not need to.

Coronavirus Bill

Debate between Lord Blunkett and Lord O'Shaughnessy

Committee stage & Committee: 1st sitting (Hansard) & Committee: 1st sitting (Hansard): House of Lords
Wednesday 25th March 2020 Lords Chamber

[Lord O’Shaughnessy (Con)]

My Lords, the noble Lord, Lord Adonis, asked for a cross-party view so I will make a brief intervention. The economic and moral case for doing something for this group of people is unarguable. No one in this House or in the other place disagrees with that. Their needs are just as great as of those who have the good fortune to have employed jobs, and it is on all of us to make sure that we have a solution.

If it was possible to do what is in the amendment, it could have been done already. There are technical and potentially moral hazard issues why this specific amendment might not be right. I do not stand in judgment; I just know that there are technical issues, and I know that there is a great deal of sympathy for this kind of solution. However, I know that the Treasury has been looking at this and other solutions and that it has its concerns. However, the most important thing is not to agree today on the specific line-by-line items of a package. Exactly as noble Lords have said, this is about getting a sense from my noble friend about when this package of equal weight and power will happen.

There are economic and moral reasons for doing this but health reasons too. If you are young, financially insecure or both of those things, you are highly likely to be at the very wrong end of the economic consequences, but you are also likely to look at it and think, “I might not get this disease and I’m almost certainly not going to die of it, so I’ll take my chances. I need to pay the rent”—or whatever it is. We simply cannot all be in this together if we have created a system which creates perverse incentives for certain groups. My noble friend knows that I am saying this with support for him and for the Government, but it is incumbent on us all to solve this so that we can act in unison to make sure that we deal with this health crisis together.

[Lord Blunkett]

I add my support by saying that those words from the noble Lord, Lord O’Shaughnessy, were very wise. On the people that we have addressed so far and who have been talked about publicly, I reinforce that it is quite right that we should seek, in whatever way we can, to provide the support that has just been described. However, there is a group that falls between those who have already been assisted in support to companies and the purely self-employed: the worker working for themselves in our economy.

There is a group of entrepreneurs, many of them with start-ups and some with continuing businesses, who cannot access what is on offer to those in slightly different circumstances because of this. If they are using serviced premises—I will give an example in this House in a second—and therefore do not pay business rates, they are not entitled to the help that is already been granted on business rates or the grants that have been put in place, all of which are extremely welcome. In addition to what we describe as the self-employed there is therefore a group of people with very small microbusinesses.

The hairdresser’s in the Palace of Westminster—I make no declaration other than that I use it—is not unique but is a good example of someone running a small business which employs people but which cannot draw down on the help currently available for the reasons I have just described. It does not pay business rates in this building, and those with serviced premises that they rent do not pay them either. I hope that the noble Earl will be able to take back to his colleagues that there is this little additional gap that we should not have to come back to and say, “We forgot about those.” I am sure that is not the case but I just want to reinforce it.

Cannabis-based Medicines

Debate between Lord Blunkett and Lord O'Shaughnessy

Thursday 21st June 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Baroness makes excellent points. I know she has been deeply involved in the Alfie Dingley case and I thank her for her work on that. What we are discovering is that it is not the case that just one drug is going to fix this for the 200,000 people who are suffering. There is a need for variety. So it cannot be the case that just because one thing is licensed it is used for everyone; it needs to be specific to the needs of the patient, which is the noble Baroness’s main point. The interim panel is there precisely to make decisions on an individual basis. It is a patch to the system, if you like, not a long-term change, which is why the review is in place so that we can ensure that many other products derived from cannabis, if they are proven to have therapeutic benefits, can be developed into drugs for the range of needs that are out there.

[Lord Blunkett (Lab)]

My Lords, 15 years ago trials were undertaken, one of which led to a separate authorisation of a derivative from cannabis for MS sufferers. I have not been clear on this from any of the reporting, so will the Minister say what trials are currently taking place in this country that could be brought to fruition? What evidence can we very quickly obtain from trials and evidence of legitimate use for medicinal purposes from the rest of the democratic world? How can it possibly be justifiable for us to provide 45% of usage for derivatives from cannabis grown in this country but not to be able to use it ourselves?

[Lord O’Shaughnessy]

The noble Lord speaks with great wisdom on this topic. The problem, as he knows, is that these drugs have been in Schedule 1 and, although in theory that allows for research, in reality it creates a very cautious environment that makes research difficult. That means that apart from Sativex, which has been licensed, and Epidiolex, which is in the process of being licensed, there are very few, if any, other drugs actually going through the clinical trials process in this country because of the very tight rules that have governed usage. Other countries have of course relaxed their rules and developed that evidence, and it is precisely that kind of evidence base that will be considered by Professor Davies in her review.

Chronic Lymphocytic Leukaemia: Ibrutinib

Debate between Lord Blunkett and Lord O'Shaughnessy

Thursday 7th June 2018 Lords Chamber

[Lord O'Shaughnessy]

I thank the right reverend Prelate for that question. As he will know, NICE consults widely with patient groups and others in making its decisions. I am not clear at this stage whether NHS England met patient groups and others in designing its clinical commissioning guidelines, which is of course what I shall investigate next week.

[Lord Blunkett (Lab)]

First, I commend the Minister for being prepared to come to the noble Baroness Jowell’s funeral last week, which was greatly appreciated. Secondly, I commend him for his obvious commitment and detailed understanding on this particular issue that has been raised this morning. Is it not exactly the same issue as Baroness Jowell was raising, although on a very different treatment and challenge, which is that the best and most appropriate treatment should be available as quickly and easily as possible everywhere and to everyone, wherever they live?

[Lord O'Shaughnessy]

I am grateful to the noble Lord for that. I was privileged to be invited to the funeral, which was a very moving occasion for a very special lady. On his overall point, NICE approves 71% of cancer drugs that are applied for, so there is an absolute focus on making sure that the most effective cancer drugs can be brought to patients in England as soon as possible. Under the reformed cancer drugs fund, that can now happen from the point at which there is a draft guideline, which is often many months before it would otherwise be the case. That means that tens of thousands of people have been able to access cancer drugs earlier than they would ever have done before and, as a consequence, many lives have been saved.

Children: Obesity

Debate between Lord Blunkett and Lord O'Shaughnessy

Thursday 10th May 2018 Lords Chamber

[Lord O'Shaughnessy]

It goes to show that public health campaigns can be effective. I remember the “Go to work on an egg” campaign—although I had a banana myself. The serious point is that too many children do not go to school after a proper breakfast, and one of the great advances with the sugar levy has been a commitment of around £26 million to support breakfast clubs in about 1,500 schools in areas that unfortunately have the worst outcomes for healthy children and obesity. That support will help those children go to school on a good breakfast and function properly.

[Lord Blunkett (Lab)]

Does the Minister agree that one of the tragedies of the demise of so many Sure Start programmes was that parents were engaged in not just nurturing but understanding what happened to their children, particularly in poor areas where junk food was bought as opposed to learning to cook? Will he put some emphasis on parents being taught how to cook nutritious food, and not just children?

[Lord O'Shaughnessy]

I could not agree with the noble Lord more about the importance of good parenting and parents setting an example in this area. I would focus on a major Public Health England initiative, Change4Life, which is about equipping parents with the knowledge and understanding of how to prepare good-quality, healthy meals that are affordable.

Children: Obesity

Debate between Lord Blunkett and Lord O'Shaughnessy

Thursday 19th April 2018 Lords Chamber

[Lord O’Shaughnessy]

Following the debate that we had the other day, I looked up the Daily Mile online. It is now in 2,000 schools across the UK. My right honourable friend the Secretary of State has described it as an excellent initiative, which indeed it looks like. It certainly seems to develop good habits of physical and mental health. Writing to schools is of course a matter for the Department for Education, but I will certainly speak to my colleagues in that department to encourage schools to take this up. In the spirit of the debate of the noble Baroness, Lady Walmsley, I think it would be better to end with a quote from William at Woodfield Primary School in Wigan, who said that the Daily Mile,

“helps you with your maths, English, and you get faster each time, which makes you healthier”.

What more could you want?

[Lord Blunkett (Lab)]

My Lords, I cannot match the alliteration of the Minister but I ask him if he and his colleagues in other departments would consider an addition to the sport, to the dietary and to the drive against sugar, given the evidence of the recent review that the Government undertook into full-time social youth action in which organisations such as Volunteering Matters and City Year UK demonstrate that work by young people for young people against bullying, emotional trauma and mental health problems can have a real effect.

[Lord O'Shaughnessy]

I completely agree with the noble Lord. I believe that he chairs the National Citizen Service, which has been a massive initiative to encourage such habits in teenagers. I completely concur with him: the Government take a number of approaches to encourage youth social action, and that is something that we will continue to support.

NHS: Sustainability and Transformation Plans

Debate between Lord Blunkett and Lord O'Shaughnessy

Monday 20th March 2017 Lords Chamber

[Lord O’Shaughnessy]

I am sorry to hear the noble Baroness say that about the STPs, which have received support from the King’s Fund and NHS clinical commissioners. I hope that she is also aware that in the Budget the Chancellor announced £325 million of capital spending to support the strongest STPs, those which are capable of providing the kind of integration she has talked about and are delivering the highest levels of performance.

[Lord Blunkett (Lab)]

My Lords, will the Minister share with us whether the department has provided advice or best practice in the localities on the first test of the service reconfiguration? A great deal of disquiet has emerged about a lack of engagement of key partners, never mind mobilising the support of the wider community.

[Lord O’Shaughnessy]

The noble Lord is quite right to bring up the issue of engagement. Those STPs which have been completed and published in draft form are now going through the engagement process. They are also being stress tested by NHS England and NHS Improvement to provide exactly the kind of scrutiny that he has talked about. Finally, in addition to the tests I have mentioned, there can be no significant service reconfigurations or bed closures without passing those tests and without public consultation to provide precisely the reassurance that these changes are about delivering national standards—they are not about trying to find a way around them.