Long Covid
Lord Borwick Excerpts(1 year ago)
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Lord Markham (Con)
I thank the noble Baroness. I think we all accept that this is a complex area where, naturally, we are being guided by the science. Our vaccination strategy has been focused on the highest-risk groups. On allowing other people to pay over and above, as with flu, I think it is best that I come back in correspondence.
Lord Borwick (Con)
My Lords, in the statistics for long Covid, are any particular professions overrepresented among sufferers?
Lord Markham (Con)
I thank my noble friend. We do not capture statistics in that way—I had a chance to ask the department quickly a few minutes ago—but I will inquire to see whether we can find out more on that. Obviously, some occupations, such as working in the health service, lend themselves more to it, because you are more likely to catch Covid, which is why how we look after our own staff is of paramount importance. On the wider point, I will come back to my noble friend.
Thyroid Patients: Liothyronine
Lord Borwick Excerpts(1 year, 10 months ago)
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Lord Kamall (Con)
NHS England is currently consulting on this revision, for much the same reasons that the noble Lord acknowledges. At the moment, liothyronine is a second-line treatment when the other one cannot be used or is not appropriate. At a local level, doctors should be advised that they are able to prescribe it. Clearly, that is not getting through. When we went to NHS England with this, it recognised this and said that there will be a consultation.
Lord Borwick (Con)
My Lords, I declare an interest as a thyroid patient and as patron of several thyroid charities. As my noble friend the Minister is aware, there are many patients suffering a misinterpretation of “routinely” in the advice that
“T3 should not be routinely prescribed”.
“Routinely” could mean either “regularly” or “without thought”. Can my noble friend make it clear that the meaning of “routinely” in this case is “without thought”, rather than “regularly”, as all thyroid medication must be prescribed regularly? If the Minister could make this clear from the Dispatch Box, I believe that the suffering of a lot of patients—notably, Christine Potts, who has written to me and to the Minister—could then be reduced.
Lord Kamall (Con)
I thank my noble friend for sending me the question in advance, since it was quite complicated—I sent it to the advisers, and when it came back, I had to ask for further explanation. So here is the advice that I have been given, and I hope that noble Lords will bear with me. The term “routinely” can be defined as “regularly”, as part of the usual way of doing things, rather than for any clinically accepted reason. It is actually regularly because patients should not be given liothyronine as the first-line treatment; the exception to that is when patients have tried the first-line treatment but still have symptoms. In that case, liothyronine is tried. I am assured that, although this may be confusing, the language is known to commissioners, whom the guidance is aimed at. However, they appreciate that others outside the commissioning process may not understand it as clearly.
Lung Health
Lord Borwick Excerpts(4 years, 10 months ago)
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Baroness Blackwood of North Oxford
The noble Earl is absolutely right. Prevention is a core part of the plan and as well as smoking, the clean air strategy and flu vaccinations, health visitors are a crucial part of it, and will be looked at as part of the forthcoming prevention Green Paper.
Lord Borwick (Con)
My Lords, I declare my interest as in the register. Does my noble friend agree that air quality is vital for lung health and will she comment on the distressing fact that lung diseases are strongly correlated with poverty, and that air quality is worst in poor areas?
Baroness Blackwood of North Oxford
My noble friend is right that poor air quality is one of the largest environmental risks to public health in the UK. That is exactly why we brought forward the air quality strategy, which has been identified by the WHO as an example for the rest of the world to follow. But he is right that it will not work if we do not also tackle variation across the country. That is exactly what we intend to do and why we will also look at air pollution as part of the Green Paper, which is due imminently.
Branded Health Service Medicines (Costs) Regulations 2018
Lord Borwick Excerpts(5 years, 10 months ago)
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Lord Borwick (Con)
My Lords, I declare an interest in this debate, as I am a patron of both the British Thyroid Foundation and the Thyroid Trust. I have heard it said that, somewhere in the Lords, there is always an expert on any subject raised; all I can claim is personal experience. I have suffered from Graves’ disease, which results in an overactive thyroid gland. Once it has had one episode, the thyroid can have an increased incidence of repeated episodes, and I had three in increasing frequency. The cure used often in the UK is to surgically remove the thyroid completely. Suddenly, the patient moves from too much hormone to none at all.
The thyroid, which is a small butterfly-shaped gland in the front of the neck, produces two hormones—levothyroxine and liothyronine—known as T4 and T3. As the noble Lord says, it is much easier to use those words. As T4 is a base stage, T4 makes T3 and the vast majority of patients, perhaps 80% and including me, can convert T4, the inactive hormone, into T3, the active one. Some cannot do so or can only do so inefficiently. The level of research is so low that, alas, we do not know for sure why this is. It may well be a faulty gene.
The trouble with thyroid patients is that their experience of the disease is so varied and the effect on their bodies is sometimes so profound, that they can be “hard to treat”. This is a marvellous medical euphemism that carries a wide range of patients with it, from ones who feel well when they are actually quite close to death, like me, to those whose low thyroid level makes them apathetic, befuddled and exhausted. The latter are the most frequently occurring cases. The majority of them are female and they are often overweight, finding that diets tend not to work for them, however hard they try to lose weight. As the thyroid affects the speed of every single cell in the body, including the brain, a nasty aspect of the disease is known as “brain fog”. That is the inability to think anything through at all, let alone explain what is wrong with you. That aspect, coupled with hormone tests that can declare that everything is within normal limits when they are still wrong, makes some patients particularly “hard to treat”.
With a high level of thyroid activity, life may feel quite pleasant. Even Brexit seems to be simple. A high thyroid level has something in common with being mildly overserved, even tipsy, and yet I know someone who sadly died of this disease and, for a few, the symptoms can be dramatically unpleasant, even as severe as psychosis. With a low level of thyroid, everything can be too complex, too difficult, too depressing or gloriously clear but wrong. Endocrinologists are doctors with immense patience. Overall, any imbalance in thyroid hormones, which can occur rapidly or very slowly, from high to low or low to none, can trigger brain fog and a range of other debilitating and diverse symptoms.
This liothyronine problem affects a group of patients who may appear to have the right level of T4, but who cannot make sufficient quantities of T3 from it. T3 was made by a single supplier for a time, Concordia, a company that I have met and been impressed by. It deals with a wide variety of generic drugs to be supplied to the Department of Health. These drugs are subject to several layers of regulation, including on price and quality. Most important is consistency, as the thyroid patient is peculiarly sensitive to inconsistency. Consistency depends in part on modern methods of manufacture, and the problem that Concordia faced, it tells me, was a need to update the manufacturing equipment with a large capital investment for a small number of patients.
To put the problems into context, the Department of Health buys a vast number of generic drugs. Millions of different patients need thousands of different drugs, and it is amazing how few problems occur. This is because of the great work done by the unsung heroes of the department’s regulatory agencies. All this takes place without much political input, and probably is the better for that, but a price that goes up so much raises an eyebrow or two, particularly compared to a price that is so much lower abroad. Even if the price increases had been agreed with the department, as Concordia informs me they were, the solution is likely to involve negotiation between the manufacturer and the department. Competition is likely to play a part here, and I gather that there are now three manufacturers in the market to provide T3 for UK use and prices are falling.
The bottom line is that, where there is a portfolio of generic drugs, used by different patients for different syndromes, the marginal price of any one drug in any one quantity is somewhat arbitrary. Should it be a loss leader or priced as the star of the portfolio? It is clear to me that the pricing, like thyroid disease, only becomes noticeable when it varies quickly or goes out of control. What caused a problem was misinterpretation of health department advice into suddenly not prescribing T3 to patients who had been happily taking it for years. I am not sure that a referral to the Competition and Markets Authority did anything other than raise the stakes, when negotiation is surely the best way to deal with the problem.
While liothyronine is available at a lower cost from European suppliers, there have been calls for the NHS to source directly from overseas. This initially may seem appropriate, given that patients are currently being told to purchase directly from these overseas suppliers themselves, with a private prescription from their NHS GPs, who tell them that their practice or CCG will not pay.
The Thyroid Trust has given permission to me to share the alarming case of Maureen Elliott in South Thanet. Maureen was well for 10 years on liothyronine and agreed to stop taking it when her doctor flagged up the high cost to the NHS. Subsequently becoming very unwell without it, she was referred to an NHS endocrinologist, who confirmed that she should have it, yet the instruction she was given was to buy it herself from abroad. With prices from different suppliers varying wildly, from more than £600 to £50 a packet, and inconsistent quality, she has found the whole experience extremely stressful as well as expensive. Why should she and others have to do this as individuals, when the Department of Health could be doing it, presumably with the capacity to drive a better bargain?
However, if the quality control requirements of the UK’s Medicines and Healthcare products Regulatory Agency have triggered prices here to be higher than elsewhere, is the liothyronine from manufacturers that do not hold a UK marketing authorisation of questionable quality? Given the negative effect on patients such as Maureen, perhaps the Minister can help to stress to doctors that T3 has not been banned, that he agrees that some patients need it, that although it is expensive it is valuable to certain patients and that doctors should not restrict access for existing patients prior to clinical assessment by a specialist.
Lord Turnberg (Lab)
I want to restrict my observations to the case of the treatment of hypothyroidism, and elaborate just a little on the wise words of my noble friend Lord Hunt of Kings Heath.
We have here an unhappy coincidence of bureaucratic errors on the one hand and what can be described only as corporate greed on the other. The end result is that patients with hypothyroidism are suffering. I suppose that I should just say a little about this condition, in which these patients fail to produce enough of their own thyroid hormone, for one reason or another. Although I am no longer on the medical register, I do not feel too constrained: it causes a range of unpleasant symptoms and can be life threatening. It causes symptoms, some of which may sound familiar to your Lordships, including extreme tiredness and a general slowing down, which makes you gain weight, thickens your skin and makes you lose hair. It comes on insidiously, so that it can sometimes be difficult to diagnose. It is worth noting, as I think my noble friend said, that up to 5% of the population, or one in 20, are said to suffer from hypothyroidism—and, worst of all, it can cause heart attacks, if not treated.
Yet treatment is very easy indeed—just one tablet a day of the hormone thyroxine gets rid of all the symptoms and can make people normal again, which works for the vast majority. But here is the rub: a few patients do not feel better, and they need to take the more active metabolite of thyroxine, liothyronine, or T3, to make them well. There is some controversy over why some patients need that more expensive treatment. Do they have a problem with converting thyroxine to the active principle or not? That has not been resolved scientifically, but there is little doubt that, clinically, some patients get better only on the active metabolite, T3. That being so, clinicians should be able to prescribe it. Certainly, that is the case in many countries around the world.
Prescribing T3 here in the UK was never a problem until 2007, when the Canadian manufacturer, Concordia, got hold of it and was given the sole contract by the NHS to produce it. It was then that, as a monopoly supplier, it put the price up several-thousandfold, as we have heard, so that now the price has risen to over £900 for 100 tablets. Then, of course, NHS England found it increasingly unaffordable. So instead of trying to find cheaper suppliers, it put in draconian conditions on doctors under which it may be prescribed. On top of that, those conditions are so ambiguous that CCGs, GPs and consultants are fearful of prescribing it, so they have stopped. As we have heard, patients who have been on it for years now cannot get it and suffer the consequences. So what do the patients do? They go online and buy it privately in Europe for around €30, instead of £900 for 100 pills.
I have three questions for the Minister. Will the Government try to move the Competition and Markets Authority along after its preliminary hearing that the manufacturers should repay the several million pounds that they owe to the NHS? Will they consider purchasing the medicine from an alternative supplier, possibly elsewhere in Europe, for a fraction of the cost? Will he press NHS England to produce some straightforward, unambiguous guidance for patients and doctors about how it can and should be prescribed? I would be happy to help, if he would like that.
Smoking-Related Diseases
Lord Borwick Excerpts(7 years, 7 months ago)
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Lord Borwick (Con)
My Lords, I thank the noble Lord for raising this important Question for debate at the behest of my noble friend, and I declare my interests as a long-standing trustee of the British Lung Foundation. I know from its extensive work that the health of lungs is strongly correlated with wealth. Smoking prevalence is higher among those on lower incomes. That of course means that those people are more likely to get lung problems, and to be crippled by chronic obstructive pulmonary disease and lung cancer—on top of all the other pressures faced by those on the lowest incomes. There are social stigmas, too. Guilt associated with smoking-related diseases means that diagnoses are made much later, reducing the effectiveness of treatment. To top it all off, poorer people also tend to live nearer to roads and traffic, which further increases the likelihood of developing some kind of lung disease.
All that makes the objectives of public health initiatives laudable. Having seen the shocking human impact of smoking-related diseases, I think that it is good that people want to do something about it. Research published today in the BMJ found that e-cigarettes helped about 18,000 extra people in England give up smoking in 2015. Public Health England also found last year that e-cigarettes are 95% less harmful than regular cigarettes. Surely that is a welcome shift in the fight to reduce and prevent smoking-related diseases. After all, it is not nicotine that kills people or causes lung diseases—it is the tar and other chemicals found in cigarettes. While I would absolutely like more research to be done on the long-term impact and potential harms of e-cigarettes, it is important that they are not overregulated or treated in the same way as other tobacco products.
Evidence suggests that marijuana is more harmful than an ordinary cigarette. That may be because smokers inhale it more deeply and hold it in their lungs. It may be more to do with the illegality of marijuana than its inherent carcinogenic nature—although I have no doubt that that exists, too.
We also have a continuing problem with emissions from vehicles. PM 2.5s are particles that come from diesel engines that cause damage similar to that caused by cigarette smoke. Which is worse for our lungs? How do they interact and does one make the other worse? The truth is that we do not really know—but we should, and we would if we were able to spend larger sums on research.
We will need to ensure that the forthcoming tobacco control plan is robust and ambitious enough to lead to reductions in smoking-related illnesses. It should target those most in need of smoking cessation—those who already have a lung disease. This plan should be helped with a cross-departmental government strategy on improving air quality. Together, such actions will help better progress in ensuring that people breathe clean air, and in tackling smoking-related diseases.
Mental Health Services: Sign Language Users
Lord Borwick Excerpts(9 years, 3 months ago)
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Lord Borwick (Con)
My Lords, I declare an interest as a trustee of the Ewing Foundation for deaf children.
I am grateful to the noble Lord, Lord Ponsonby, for again raising for debate important issues on deafness, but I rather disagree with the noble Lord on the definition of deafness. It should not be defined as the characteristic of those who use sign language, because there are a host of elderly deaf people who do not use BSL and many children born with a profound hearing loss now have cochlear implants which, although leaving them still with a significant hearing impairment, enables them to communicate in spoken languages. Similarly, improvements in hearing aid technology have made it easier for other deaf children to communicate in a spoken language. The Oxford English Dictionary defines “deaf” as lacking the power of hearing or having impaired hearing. That is the definition we should use; a definition that depends on BSL implies that BSL is the only characteristic, and that is problematic.
Today’s debate is particularly important because there is a lot of evidence of depression and mental health issues among deaf people, including those who use sign language. All the evidence suggests that hearing loss can substantially increase the risk of mental health problems. Anxiety, paranoia and depression are particular risks. Those with hearing loss are overrepresented among samples of patients suffering from paranoid psychoses in later life. Older people with hearing loss are more than twice as likely to develop depression as their peers without hearing loss. It is therefore important that the appropriate mental health services are available for deaf people and that the right steps are taken to improve outcomes.
I know that some will argue that, because not everyone can use sign language, deaf people who use it may experience depression and mental health issues even more acutely. Deaf people using sign language to communicate may have fewer opportunities to access appropriate special services too, and there are still a few children who use BSL as their only language who would struggle to access mainstream mental health services because of language barriers. This no doubt accentuates the feelings of frustration. There is research showing that deaf children who live in families where BSL is the only language are less likely to experience mental health problems than deaf children in families who use English. If you cannot communicate with your family, it is little wonder that you feel isolated. However, that research is dated.
New technology, such as digital hearing aids and cochlear implants, is reducing the need for the BSL language, and early detection is further breaking down the reliance on BSL. We have to remember one crucial point in this debate: there is a whole range of deafness, and not all the people on the spectrum use BSL, but new technology and early detection mean that many more can take a full and active part in a hearing society while still being able to use sign language if they choose. Doors are opening and many deaf people or partially deaf people can enjoy the best of both worlds rather than becoming frustrated by the limitations of just one. Being able to access both deaf and hearing communities is going to be good for the mental health of those with hearing difficulties.
Much more care is being taken to focus on the mental and emotional health of deaf children. The National Sensory Impairment Partnership has worked with the National Deaf Children’s Society to produce documents for teachers of the deaf on emotional well-being. The website for the National Sensory Impairment Partnership has published guidance for teachers on how to deliver a course called Think Right Feel Good. This helps teachers to understand and develop emotional resilience in deaf children.
There are a host of foreign languages in the UK. All speakers of unusual languages have the same problem: the inability to communicate except in their own community. The number of deaf young people who are reliant on BSL to communicate and access teaching and learning has declined significantly, and this will be reflected over the next few years in the adult population. I am full of admiration for the wonderful children who use BSL while learning to read and write English at the same time, but technology is changing that and we have to embrace it. It is so exciting that we can bring deaf people into the speaking world. Look at the new apps available on smartphones nowadays. Google Translate and Skype Translator both instantly translate foreign languages. Siri is starting to do so on Apple products. The app Mimix says that it will simultaneously translate from English into American Sign Language. MotionSavvy will translate the other way. I am sure it is not yet perfect, but a great start would be for BSL users to carry this sort of technology when having a vital conversation with a doctor. This is a story of success—not perfect by any means but apparently getting better.
It is, of course, very sad that the situation was so bad in the past, but the important thing is that things get better, and it will be ameliorated by technology, not by government expenditure. The overall priority should be to integrate deaf children into society, and as a fully integrated group they will no doubt have a similar incidence of mental illness, tooth decay and cancer as the rest of society. Any incidence of mental illness is appalling, but I am not sure that it is sadder because the victim is deaf than because the victim speaks Pashto or Welsh.
I ask my noble friend the Minister if he is able to publish data on the characteristics of children referred to specialist deaf mental health services. What percentage of the children are lip-readers, use BSL or have cochlear implants? I believe that more information will only help us to learn and improve. It would be very helpful to see the data on the characteristics of children referred to specialist deaf child and adolescent mental health services to see what we can learn. If we were aware of the most common profiles of children referred to the specialist services, perhaps this would inform preventive work and where it should be targeted.
Mesothelioma: Research Funding
Lord Borwick Excerpts(10 years, 3 months ago)
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Lord Borwick (Con)
My Lords, I declare my interest as a trustee of the British Lung Foundation. Lung diseases are predominantly diseases of the poor because they are often associated with tobacco. Because of this association, there is a strange guilt attached to lung disease, and so the level of research generally into lung diseases is very low.
Asbestos exposure is a subject that is correlated with workmen who dealt with asbestos in the construction or shipbuilding industry at a time when it was regarded as a safe, reliable fire protection. We now know that it is a killer. Like Jimmy Savile, that which was presented by the BBC as safe and cuddly turns out in reality to be a monster. It is very difficult to raise money for lung research because of this guilt complex and, as a result, the BLF has a turnover of about £6 million per annum, which is tiny in comparison with that of the British Heart Foundation. I am afraid that the British Government seem to have been affected by this as much as others. It is only recently that the Government have been working hard to help with fundraising for research into this, and of course they have been doing so against a background of a dreadful recession. It is hard to raise funding at this time.
If we look at breast cancer, a disease that 40 years ago was seen as being just as fatal as mesothelioma is now, the prospects have been transformed by good research and by attracting the best researchers into working on that subject, and the same could be done for lung disease. Normally I believe that the private sector will always be better than the Government at achieving almost anything, and I should pay tribute to the four insurance companies which funded the first three years of the research push. They are Axa, Aviva, Royal Sun Alliance and Zurich—heroes all. However, the insurance industry is beset by the problem of free riders—those who gain the benefit without picking up any of the cost. Notably this has happened in the car insurance industry, and even with modern number plate recognition the cost of uninsured drivers in accidents is an enormous burden on the price of motor insurance. Is that not structurally similar to the cost of insurance companies not contributing to the research fund for mesothelioma?
A general problem for lung disease is the guilt implied by the reaction of so many people. Even if people choose to smoke or do not have the ability to give up an addiction, no such criticism should possibly be made of mesothelioma patients. The sad thing is that Governments in the past have generally not treated the subject of lung disease with the importance or priority that other diseases have achieved. I do not want to criticise past Governments, but I will say that the general level of research into lung disease is much less than into other diseases. Of course, I applaud the work that the Minister has been doing in trying to negotiate more funds. The Government certainly believe that they are enlightened—even the whole source of enlightenment—so can I suggest that lung disease is a cracking good place to prove it?
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, I thank the noble Lord, Lord Alton, for having tabled this debate. Mesothelioma is, as we have heard, a terrible and devastating condition. There is no cure and uncertainties remain about the best available approaches to diagnosis, treatment and care. It is therefore completely right and appropriate that mesothelioma research has been discussed a number of times, both here in your Lordships’ House and in the House of Commons.
Funding is, of course, needed for further research to be carried out. The four largest insurance companies have previously made a donation of £3 million between them, and this is supporting valuable research into the disease. A higher level of funding has come from government—through the Medical Research Council and the National Institute for Health Research. Together, these funders spent more than £2.2 million in 2012-13.
The MRC is supporting ongoing research relating to mesothelioma at the MRC Toxicology Unit and is also funding two current fellowships. The NIHR is funding two projects in mesothelioma through its Research for Patient Benefit programme, and its clinical research network is recruiting patients to a total of eight studies, including industry trials. The NIHR funds 14 experimental cancer medicine centres across England with joint funding from Cancer Research UK, and these centres have four studies focused on mesothelioma.
However, as I have said previously, the issue holding back progress into research into mesothelioma is not—as a number of noble Lords have intimated—a lack of funding but the lack of sufficient research applications. I want to clarify and stress that the work currently being funded is of high quality, and that is consequent upon high-quality applications.
Money is available to fund more research, but measures are needed to stimulate an increase in the level of research activity. That is why the Government have committed to doing four things and I am delighted to have this opportunity to report on progress to the noble Lord, Lord Kakkar, in particular, and other noble Lords who have spoken with considerable insight in today’s debate.
First, we promised to set up a partnership to bring together patients, carers and clinicians to identify what the research priorities are. This is now well under way and a formal launch event took place successfully last month. It is supported and guided by the James Lind Alliance, which is a non-profit initiative overseen by the NIHR Evaluation, Trials and Studies Coordinating Centre. The partnership has a steering group of 16 people, comprising six patient/carer representatives and 10 clinical representatives.
The next stage is a survey asking patients, families and healthcare professionals for their unanswered questions about mesothelioma treatment. The partnership will then prioritise the questions that these groups agree are the most important and the end result will be a top-10 list of mesothelioma questions for researchers to answer. The partnership plans to have the list ready by the end of this year, when it will be disseminated, and work will begin with the NIHR to turn the priorities into fundable research questions.
Secondly, the NIHR will highlight to the research community that it wants to encourage research applications in mesothelioma. The launch of this highlight notice will take place in advance of the identification of research questions by the priority-setting partnership to prepare researchers.
Thirdly, the NIHR Research Design Service will be able to help prospective applicants develop competitive research proposals. This service is well established and has 10 regional bases across England. It supports researchers to develop and design high-quality proposals for submission to the NIHR itself and to other national, peer-reviewed funding competitions for applied health or social care research. The service provides expert advice to researchers on all aspects of preparing grant applications in these fields, including advice on research methodology, clinical trials, patient involvement, and ethics and governance.
Finally, we have made a commitment to convene a meeting of leading researchers to discuss and develop new proposals for studies. Initiatives like this are one reason why it is so valuable to have the National Cancer Research Institute, the NCRI, which enables the major funders of cancer research to work in strategic partnership. I can report that NCRI officials held a meeting with clinical research leads yesterday, 15 January, to develop plans for bringing researchers together, and a representative from the British Lung Foundation also participated. The outcome was encouraging: the NCRI will be organising a mesothelioma workshop in the early summer with the aim of encouraging competitive grant applications in the field of mesothelioma. This will cover the full spectrum of basic, translational and clinical research.
Several noble Lords have—not unnaturally—spoken of a need for an ongoing role for the insurance industry in funding mesothelioma research. While the Government have money available to fund high-quality mesothelioma research proposals, we are also encouraging insurers to provide further funding. My honourable friend the Minister for Disabled People, Mike Penning, has met the Association of British Insurers, and following that meeting I have written to the association’s director general, Otto Thoresen. I am pleased to say that he has confirmed in a reply today that a further £250,000 will be paid directly to the British Lung Foundation. He has also confirmed the industry’s commitment to explore with the Government the range of future funding options. We would welcome another opportunity to meet insurers to discuss this.
Lord Borwick
I thank the Minister for that news. I also have a copy of the letter. The £250,000 is very useful, but it is less than one single claim from a sufferer of this disease. This has to be a short-term solution. If the voluntary agreement mentioned by the noble Earl does not happen for some reason, will the noble Earl push for legislation to make it happen compulsorily?
Earl Howe
My Lords, I note my noble friend’s question. My best answer to him at this stage is “one step at a time”. However, I can assure him that we will use our best endeavours to see a successful outcome from our discussions with the insurance industry. It is perhaps premature for me to go further at this stage.
Smoking: E-cigarettes
Lord Borwick Excerpts(10 years, 4 months ago)
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Lord Borwick (Con)
My Lords, first, I declare an interest as a trustee of the British Lung Foundation. Lung disease can affect everyone but it seems to be particularly prevalent in the poorest parts of the country. Of course, heavy smoking is strongly correlated with poverty.
Tobacco is by far the largest cause of lung disease, and a very large number of people suffer debilitation and a painful death because of it. I have many friends who have spent their lives trying in vain to help people addicted to cigarettes, and it is understandable that they passionately hate anything to do with smoking, including e-cigarettes.
When I visited the Consumer Electronics Show in Las Vegas, which I think is the largest trade exhibition in the world, in January this year, I saw about 200 Chinese manufacturers of e-cigarettes open for business. There is a tide of these things coming. They were the most common new product at the show after iPhone cases. One could wish that they would just go away, but of course they will not. So I congratulate my noble friend Lord Astor on opening this debate. Many people have been wishing e-cigarettes away; this is a useful chance to debate them.
People are addicted to nicotine but it is the tar that kills them. This seems well established. However, part of the addiction to cigarettes is not just the chemical nicotine but the handling of a cigarette, the sociability and the feel of it. Certainly, e-cigarettes provide a substitute for some of these sensations. They seem a reasonable and less dangerous product than conventional cigarettes.
The trouble is that we are fighting the battle against the killer tobacco on three fronts: on cost, by increasing consumption taxes; with education at earlier stages to ensure those likely to start smoking, namely teenagers, are aware of the risks involved; and by making cigarettes abnormal, by keeping them locked behind shutters at the supermarket and with other proposals such as plain packaging. It seems that the third front, denormalisation, is at least as powerful as the other two. The concern is that e-cigarettes can undo a lot of the good work that has been done to make smoking an unusual habit and smokers akin to pariahs. If it is okay to smoke e-cigarettes, will it become okay to smoke normal ones again? Will users ever kick the habit of enjoying nicotine and holding a cigarette?
Another important question must be addressed: what are e-cigarettes? Do they contain just nicotine and vapour, or anything else at all? This seems to call for regulation as a simple product, to ensure quality. Will my noble friend the Minister encourage his department to sponsor some research into the effects of nicotine alone? It is said to be dangerous to those with a heart problem or to pregnant women, but the truth is that there has not been enough research on the subject to be sure.
It is important to understand how e-cigarettes are changing the behaviour of smokers of conventional cigarettes. ASH has reported that as many as 1.3 million people occasionally use e-cigarettes and that 400,000 people are using e-cigarettes in total or partial replacement of normal cigarettes. That is great news.
The danger people spot is that children might become more likely to take up normal cigarettes after trying e-cigarettes. We cannot tell if that is so, because there has been not been any research on it, but logic suggests otherwise. Teenagers smoke cigarettes to look cool, and e-cigarettes are not cool—they are about giving up an addiction. No teenager wants to look as though they are giving up something: they want to look as though they have no problems.
According to research from the Institute of Economic Affairs from July 2013:
“Far from acting as a gateway to smoking, all the evidence indicates that e-cigarettes are a gateway from smoking”.
Evidence from ASH supports that statement. Indeed, the fact that 400,000 people have given up cigarettes is great news, and if we concentrate on that, we should say that there should be no real restriction on the sale or advertising of e-cigarettes. If they are mainly used by existing smokers as a way of quitting, we could even do good by giving them away to smokers.
If we are to have any regulation, it should be of the quality of the contents alone: restricting the ingredients to nicotine; ensuring damaging toxins are kept out of them; and not allowing flavoured e-cigarettes specifically designed to attract children, such as bubblegum e-cigarettes or such like.
In choosing today for this short debate, my noble friend Lord Astor has shown a downright astonishing ability to predict the future, because a provisional deal was reached last night in Brussels between MEPs and national Governments on a new tobacco products directive. Martin Callanan MEP has said that this directive will take the majority of e-cigarettes off the market. It would restrict all but the weaker e-cigarettes, even though smokers who are considering using e-cigarettes to break their addiction tend to begin on stronger e-cigarettes and gradually reduce their usage. Making stronger e-cigarettes harder to come by will encourage smokers to stay on tobacco. Among the points made in the draft directive, paragraph 3.7 states that its purpose is to stop the situation whereby,
“more people—unaware of the content and effects of these products—inadvertently develop a nicotine addiction”.
The idea that somebody will inadvertently become addicted without the help of the EU seems rather unlikely.
Finally, I pose a conundrum for the Minister. If we go ahead with plain packaging for cigarettes—which are actually illustrated with lurid photographs of health problems—do we allow e-cigarettes to be sold in similar packages if the manufacturer wants to? That is something that the great Sherlock Holmes might perhaps describe as a “three pipe problem”.
Ageing: Public Services and Demographic Change Committee Report
Lord Borwick Excerpts(10 years, 6 months ago)
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Lord Borwick (Con)
My Lords,
“Old age ain’t no place for sissies”,
as the late, great Bette Davis once said. This excellent report underscores the importance of that statement, and in markedly better English too. I am grateful for the opportunity to deliver my maiden speech on a subject so vitally important.
I took my oath on 29 July, after the whole House so generously elected me as a hereditary Peer to the Conservative Benches. I noticed that your Lordships considered my arrival and immediately went on Recess. This allowed me, though, to wander the temporarily lonely corridors of this fine building and to consume the time so unselfishly given by so many of the senior staff to bemused new Members such as me—and what an extraordinarily talented group of directors and senior staff I have met. My thanks are due to all of them, and particularly to my whip and mentor, my noble friend Lady Perry of Southwark.
My previous career has been in the automotive, housing and finance industries, but with a constant thread of disability. The reason may be that our two eldest sons had very bad heart defects when they were born. Our eldest son had to spend his entire first year of life in the intensive care ward at the great Royal Brompton Hospital, leaving him with some permanent disabilities. However, my wife Victoria and I are great believers in the American maxim, “When life gives you lemons, make lemonade”. Perhaps this is why I worked to make the London taxi wheelchair accessible. The secret was to make the accessibility ordinary rather than extraordinary; to make it normal and not mark it with wheelchair signs.
Disability will be ordinary in the future of our ageing society, as ordinary as hearing aids and glasses are today. The truth is that every one of us spends time in a wheelchair. That wheelchair is called a pram, or maybe I should say a baby buggy now, and we are very lucky if it is only at the beginning of our lives that we need such a wheelchair. If our physical environment must change to become even more accessible, our younger citizens had better start demanding it now so that it is ready when they need it for themselves. And yet our young people ignore their longevity—a point made in this remarkable report.
As the report says, arbitrary age triggers are out of date now, such as getting a free BBC TV licence at the age of 75 or being compelled to retire at any particular age whatever. Age-based benefits become increasingly absurd as the population grows older. Nobody knows better than the individual how well he or she is ageing. Many people will be able to start whole new careers when they are retired. In America, the Prudential advertises pension savings plans with the strap-line, “If you could pay yourself to do what you love in retirement, what would you do? Would you be a teacher? Would you be a musician or a painter?”. That is the optimist’s point of view. For many people who have saved wisely, the freedom to take risks and learn new skills will be very attractive. Many of us here in the House certainly are lucky to have started whole new careers as parliamentarians. The point is that arbitrary regulation by age is flawed.
Two differences stand out about the current cohort of young people who will eventually become Britain’s ageing population. The first is that they are definitely more computer literate than today’s average pensioner. They will expect information to arrive via the internet, not through newspapers or TV. Monitoring their health, happiness and well-being will be so much easier and cheaper in the future. We also need new ways to reduce their loneliness.
The second difference is that the level of debt they will bear will become heavier than anyone imagines, both as their share of our national debt but also through their own personal debts. I do not know what brouhaha will erupt when it finally dawns on people how much their predecessors have spent, leaving the bills to be financed later. The cost of servicing debt will inevitably claw into the cash available to look after our older citizens.
Next month Britons will remember fondly the veterans who gave their lives to protect our nation from destruction in two world wars. I hope that in decades to come Britons as yet unborn will look back in gratitude at what today’s leaders did to bequeath them a financially sound economy with debts at lower and more manageable levels.
There is nobody more aware of the value of experience than a brand new Member of your Lordships’ House, surrounded by the experienced people who constitute his new colleagues. I look forward to learning from all of you.