Ageing: Science, Technology and Healthy Living (Science and Technology Committee Report)

Lord Crisp Excerpts

Wednesday 20th October 2021 Grand Committee

[Lord Crisp (CB)]

My Lords, I am not a member of the committee so it gives me great pleasure to say that I thought this was a really excellent report. The science was fascinating and it was very readable as well. I almost thought I understood most of it, which was gratifying. It deserves a wider audience for bringing it all together in the way that it does. It is also a privilege to follow on behind a distinguished doctor and to be followed by a distinguished nurse; I suppose that is the right place for somebody whose background is in health management.

I want to pick up three points. Two of them are about the Government’s response and the other is about something specific within the committee’s report. As a health manager, perhaps the right place for me to start off is with that nexus of issues that noble Lords have talked so much about: the multimorbidity, the unplanned cocktail of drugs that people are taking and the lack of co-ordination. Very interestingly, there was also the point that the noble Lord, Lord Kakkar, picked up about older people not being included in drug trials. Indeed, as the report said, there was no real research being done on ageing in general, as opposed to the more specific points as a whole.

This area of co-ordination and oversight of what is happening with old people’s medication and their health is vital. I am not sure the committee’s recommendations were strong enough—other things could be there—but, frankly, the Government’s response was bland, as if to say: “Yes, you have already got a designated clinician.” I do not know if many older people know that, and I speak as somebody with a 97 year-old father-in-law. The truth is that it is left to the family. It is left to the individual, the family, the carers, the friends, and so on. That is another manifestation of inequality, because of access to having people who can help you.

I liked the point made by the noble Lord, Lord Kakkar, that maybe this can be picked up in the forthcoming Bill or the debate in the House about it. But I would like to ask the Minister if he recognises that there is inadequate co-ordination and oversight of older people’s health and medication. Will he ensure that the department and the NHS do more to address this?

My second point refers to the committee itself. The whole document treats older people as a problem and a burden, but what about the contribution and value that they—or perhaps we—bring to society? One may say that is not within the scope of what the committee was looking at, but I have seen a lot of evidence that having a meaning and purpose in life is good for your health. However, being undervalued and seen as helpless—as most of us are reduced to being helpless when in the health system—or not being in control, which is a vital part of one’s health and self-esteem, is bad. We should not forget that whole range of issues. They are susceptible to good evidence, good policy and good thinking that recognises the role and contribution of older people. There is an admirable focus in the report on the causes of ill health, but there needs also to be thought about the causes of health. There needs to be more research in that area.

I shall also pick up a point that the noble Viscount, Lord Ridley, raised, even though he is not in his place. I do not disagree with him on the importance of research but this is about research and society; it is not one or the other but both. Research is vital but he caricatured public health as being about advising young people to do healthy things. That is not often going to work; I suspect I agree with him. Having said that, just by chance this morning I was on a webinar Zoom call with Everton Football Club, which is doing remarkable things to teach young people about health using that very strong force of role models, so that area is not a guaranteed failure.

A good public health approach is much more about enabling people to have a good life, in the sense of making sure that they are secure. Love comes into this, as does education, opportunity and all the things that enable people to be all they can be. It is what Aristotle referred to as eudaimonia and is normally referred to as human flourishing. The public health aspect of dealing with inequalities, but going wider than that, is really important. This committee is right to have picked up both the biological science in research and the society aspects.

Let me pick up one final point. In its last chapters— I think it is recommendations 20 to 23— the report presses the Government on how serious they are about this challenge and how determined they are to do it. Have they got somebody in charge of it? Is there going to be the impetus, energy, support and mobilisation to make something happen? Those are really important issues. Again, I thought the government response on this was bland, at best. There was no indication of the energy and importance of this issue in the way that it needs to be taken forward. Will the Minister reassure the Committee that it is not only about whether the grand challenges are going ahead in this form, but that these issues around health, ageing, science and technology are to be picked up in the appropriate fashion?

World Health Organization: Pandemics

Lord Crisp Excerpts

Tuesday 9th March 2021 Lords Chamber

Asked by

[Lord Crisp]

To ask Her Majesty’s Government what plans they have to strengthen the role of the World Health Organization to support the management of future pandemics.

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

My Lords, the UK is a strong supporter of the WHO and an advocate of reform to ensure that it further strengthens its ability to respond effectively to health emergencies. The UK is taking a leading role on reform through our seat at the WHO Executive Board and our G7 presidency. We are working with international partners to push for a stronger early warning system, reduced risk of zoonotic diseases through better surveillance and improved compliance with international health regulations.

[Lord Crisp (CB) [V]]

My Lords, I am delighted that the UK Government are providing support to the World Health Organization, contributing to COVAX and taking this very important role of reform. Further to the Independent Panel for Pandemic Preparedness and Response report, which talked about the World Health Organization being

“underpowered to do the job expected of it”,

will the Government ensure that this is discussed at G7 and that the world will commit to doing whatever it takes to ensure that the WHO is able to respond even more effectively to pandemics in the future?

[Lord Bethell (Con)]

My Lords, the Government are extremely committed to pandemic preparedness. We support the principle of a pandemic preparedness treaty, and we have laid out at UNGA a very clear programme for enhancing global pandemic preparedness. We look forward to the publication of the Independent Panel for Pandemic Preparedness and Response report shortly, and I reassure the noble Lord that this is top of the agenda at our G7.

International Year of Health and Care Workers

Lord Crisp Excerpts

Monday 1st February 2021 Lords Chamber

Asked by

[Lord Crisp]

To ask Her Majesty’s Government what plans they have to celebrate the World Health Organization’s International Year of Health and Care Workers in 2021.

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

My Lords, to celebrate the work of health and care workers, there are symbolic interventions, such as the social care workforce CARE brand for shared identity and our powerful recruitment advertising, which highlights the remarkable contribution of health and care workers. However, the most important celebrations are tangible: the investment in new recruitment, the £30 million fund for those seeking mental and occupational health support, and the people plan, which is addressing the practical and cultural challenges that workers face in the workplace.

[Lord Crisp (CB) [V]]

I thank the Minister for that very positive response and I agree with him about concrete measures. The World Health Organization has adopted the slogan “protect, invest, together”, which is very powerful and sets out the priorities very well for this year. The Minister will no doubt be aware that there is discussion at the World Health Organization and elsewhere about the need for a new societal compact with health and care workers to whom we owe so much, perhaps similar to the military covenant. Would Her Majesty’s Government support the creation of a compact or covenant setting out our responsibilities to health and care workers, which mirror and match their professional responsibilities and duties towards us? If they have not considered this, will they do so?

[Lord Bethell (Con)]

My Lords, I applaud the WHO’s values of “protect, invest, together”. One of the commendable things during this awful pandemic has been the way in which British society has reconnected with the values of the healthcare community. It has rediscovered the contribution of nurses, doctors, healthcare workers and those in social care. A new relationship has been forged between civic society and healthcare; this is commendable and we should build on it. On the idea for a compact, it is not something that we are working on at the moment as far as I am aware, but I would be glad to take his idea away and find out whether we can develop it any further.

Covid-19: Vaccinations

Lord Crisp Excerpts

Wednesday 13th January 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am enormously grateful for my noble friend’s kind words. I think that, as a Government, we would prefer to be judged at the third act of this important performance, so I think it is probably too early to take too much praise, but I would like to say a massive thanks to the British nation.

In three ways, the nation has really stood up. The amount of collaboration between different groups—I alluded to it in my previous answer—between the Army, industry, the NHS and local authorities has been enormous. At the beginning of this pandemic, there were arthritic elements to the way in which Britain is governed that meant that different parts of our political and administrative machinery did grind into action slightly slowly, but, my goodness, over the vaccine deployment it has been absolutely athletic, and I take my hat off to every part of the machinery of government. On the union, this has been such a strong example of a national solution: all of Britain has come together in order to purchase and deploy the vaccine. Lastly, I would observe the resilience of the British public. It makes me enormously proud that the country puts the elderly and the infirm first and stands by and celebrates the weakest and most vulnerable in our society being put first in the queue. That is a national quality we should all be proud of.

[Lord Crisp (CB) [V]]

My Lords, I congratulate everyone concerned in the progress being made with the vaccinations, while recognising that there are issues to be addressed, not least that of accelerating the whole process. In passing, I note that I would be very happy to be vaccinated at 4 am if it sped things up. I will ask about testing and vaccination for a particularly vulnerable group; children excluded from school are the among the most vulnerable in the country, and I pay tribute to the approved alternative education providers and others working with them during the pandemic. I have been contacted by one of the directors of one of these providers, who tells me that, unlike schools, they are not being provided with lateral flow tests to help them protect children in school and staff. If I write to the Minister, will he take the matter up? Can he ensure that all such approved providers receive the tests and that their staff are given a high priority for vaccination—at least as high as that for teachers?

[Lord Bethell (Con)]

I am grateful to the noble Lord for flagging this important issue. He is entirely right that those who are sometimes overlooked by society and fall between the cracks are often those who either suffer from the disease or are vectors of infection. It is a public health priority to ensure that people such as those excluded from schools are not overlooked or in any way left behind. I would be very grateful if he could write to me with the details.

Medicines and Medical Devices Bill

Lord Crisp Excerpts

Report stage & Report stage (Hansard): House of Lords & Report: 1st sitting & Report: 1st sitting: House of Lords
Tuesday 12th January 2021 Lords Chamber

[Baroness Walmsley (LD) [V]]

My Lords, I support this amendment. When we discussed this issue in Committee, I raised the matter of Section 57A of the Patents Act 1977 and the Minister pointed out that compensation needs to be awarded to a patent holder for any loss of profits as a result of the use of a Crown use licence and argued that this should be set against the potential savings that purchasing more affordable generic alternatives enabled by a Crown use licence could bring about. Tonight, I repeat that this has never been tested in court.

The noble Baroness, Lady Sheehan, and the noble Lord, Lord Alton, mentioned Orkambi. The fact is that if the Government had issued a Crown licence and Vertex had decided to take the Government to court for compensation, the Government would probably have won the case, because they had a very strong case. Any reasonable person would have concluded that three years of failed negotiations showed that Vertex could not make the case that the NHS would definitely have bought the product from them had a Crown use licence not been issued. Had they taken the thing to court, the Government would probably have won the case, and the fact that they did not means that they really missed an opportunity to set a useful new precedent by fighting an interpretation that would render the entire Crown use provision next to useless.

I shall add just a few words about the Covid-19 pandemic. Many countries, such as Germany, Hungary, Canada and Australia, have made alterations to their patent laws to make issuing a compulsory licence easier, in the interests of public health. That is because, in those countries, it is accepted as a valuable tool that can help overcome pricing and manufacturing barriers to accessing crucial vaccines, medicines and diagnostics which could help save millions of lives. Will the UK Government follow this example, set a precedent, next time the opportunity presents itself, and make the necessary changes to our law to make it easier, not more complex, to use our legal right of issuing a Crown use licence to protect public health?

[Lord Crisp (CB) [V]]

My Lords, I am very pleased to add my name to the amendment in the name of the noble Baroness, Lady Sheehan. I shall be brief and limit myself to one central point, because the arguments have been put so well by noble Lords who have already spoken. At its heart, this amendment is about achieving the right balance between the public interest and private interests. In this particular context, it is clear to me that the Government should commit themselves clearly to safeguarding the public interest and to taking action on—let me stress this—those rare occasions when it will be necessary.

This is particularly vital, as other noble Lords have said today and on earlier occasions, because, sadly, there is a history of price gouging and exploitation of the public. There has also been lack of transparency and, of course, one should also note that the development of many treatments and vaccines have benefitted from public investment. I hope the Minister will be able to make the commitments that the noble Baroness, Lady Sheehan, has requested.

[Baroness Jolly (LD) [V]]

My Lords, the purpose of this amendment, tabled by my noble friend Lady Sheehan, with cross-party support, is to ensure that fair and affordable access to medicines for all must be a consideration when regulations are made with respect to human medicines. This is key for two reasons. The first is to ensure that medicines, including on the NHS, are available at a fair price. We know that the NHS buys medicines at an industrial scale and is very able to be tough in its bargaining to get a good deal for the taxpayer. The second is that the British Government used to play a pivotal role, through DfID, in helping many across the world in the eradication of polio and other life-changing or life-threatening diseases. Will the Minister outline what criteria are used now that DfID has been subsumed by FCDO?

On Covid-19, collaboration on the production of vaccines is critical. What is being done by the Government to collaborate in this life-saving mission? Time is of the essence. Can the Minister tell us where we are now and outline what support is going to those who have neither the contacts nor the money to fund these vaccinations? Our economy has taken a serious hit, but we have a moral duty to support those with no industry, and so no income. I endorse all the comments from the noble Lord, Lord Crisp, who has many years’ experience of these issues—many more than I have. I would be grateful if the Minister could answer my questions.

Medicines and Medical Devices Bill

Lord Crisp Excerpts

Committee stage & Committee: 2nd sitting (Hansard) & Committee: 2nd sitting (Hansard): House of Lords
Monday 26th October 2020 Grand Committee

Many of us complain about the hardships resulting from the lockdowns associated with Covid. The African Union’s Dr Ngozi Okonjo-Iweala told our Select Committee that fears across developing nations were not about lockdowns, but about being locked out—locked out because of monopolies, vested interests and self-interest. Compared with countries that have been capitalising and profiteering on the back of Covid-19, the United Kingdom has values and a reputation of which we are justifiably proud. The amendment in the name of the noble Baroness, Lady Sheehan, gives us an opportunity to demonstrate that that reputation is well deserved.

[Lord Crisp (CB) [V]]

My Lords, I support Amendment 19, which would have been important at any time, but is, of course, as we have already heard, particularly important at the moment. I will speak briefly, and I can do so thanks to the eloquent contributions by the noble Baroness, Lady Sheehan, in moving the amendment and by my noble friend Lord Alton.

There are points of principle here, and practical points. I start with the points of principle. First, the UK signed up to the International Covenant on Economic, Social and Cultural Rights in 1976, which guarantees access to medicines as part of the right to the highest attainable standard of health. This should be integral to all our medicines regulation.

Secondly, as we have heard, the World Trade Organization’s TRIPS Agreement explicitly included public health standards, giving countries the right to grant compulsory licences and to determine where there is a national emergency, and the freedom to establish a regime of exhaustion of intellectual property rights—in other words, taking control of access to medicines on behalf of their populations. Both these principles are underpinned by the basic responsibility that Governments have for maintaining, protecting and improving the health of their people, but also by the wider points that my noble friend Lord Alton just talked about on our interconnectedness and responsibilities to our fellow citizens of the world, in our own self-interest as well as from other motivations.

However, as the noble Lord and the noble Baroness said, in addition to principles there are very practical issues that should guide our thinking on this. The first is that there is good precedent. The UK and other Governments have used, and/or threatened to use, these rights on several occasions over the years with good effect for the benefit of their people. They are useful and viable measures, and should be at the front of our minds at this time, because—here the point is being made again—the response to Covid is bringing with it a frankly unprecedented number of new treatments and vaccines in a relatively short period of time. It is vital that these are made available as quickly, widely and cheaply as possible, not just in the UK.

I echo the questions from the noble Baroness, Lady Sheehan. I will be interested to hear the Minister’s response about our participation as a country in the global sharing and the global effort.

It was good to hear my noble friend Lord Alton’s description of the situation in Africa and of the imperative need for us to bear that in mind in our policy-making here in the UK, while also bearing in mind the great reputation that we have had over several years for doing so. On Friday, I got in touch with the World Health Organization in Africa. Some of the figures that the person I spoke to talked about, regarding the impact of the pandemic on wider health issues, were formidable indeed. I was told that we have lost the gains of 25 years in the past 25 weeks—an extremely depressing statement.

Just as depressing, as both noble Lords mentioned, is the fact that we are already seeing signs of the way in which some pharmaceutical companies will approach this extraordinary period of new vaccines and treatments in what is happening with remdesivir, with shortages and treatment rationing here in the UK, let alone anywhere else.

This amendment is absolutely right in asserting that the UK should reaffirm its position and its rights to protect the health of its population. We should adopt it. The future will be difficult, as will the negotiations on this issue, but no one should be in any doubt about the UK’s firm position. We should support not just the UK’s position for the population of the UK directly but a global effort to deal with these important matters.

[Baroness Walmsley (LD) [V]]

My Lords, the Government take an enormous number of powers to make regulations in the Bill.

In the light of the paucity of parliamentary powers to check these, particularly prior to them coming into effect—as demonstrated by the recent Covid-19 regulations —the only way in which Parliament can influence these regulations before they are even drafted is by inserting into the Bill those things to which Ministers must have regard. That is why my noble friend Lady Sheehan seeks via Amendment 19 to insert two important elements into the Bill after the priorities of safety, availability and so-called attractiveness. I support her amendment and look forward to the Minister’s answers to her questions.

Proposed new paragraph (d) would ensure that the Government have regard to the International Covenant on Economic, Social and Cultural Rights of 1996, which the UK ratified 10 years later. This affirms a citizen’s basic human right to access medicines without discrimination, which means that they must be both affordable and available. We have committed ourselves to that.

Proposed new paragraph (e) reaffirms the international protections conferred by the WTO’s TRIPS Agreement. It recognises that these intellectual property rights protections have been misused and abused by big pharma; that resulted in the WTO’s Doha declaration of 2001, which reaffirmed public health safeguards for citizens of all nations. The details are in the amendment.

The amendment is absolutely crucial as the world awaits new tests, treatments and vaccines for Covid-19, as other noble Lords have mentioned. In particular, the pandemic demonstrates the importance of paragraph (e)(ii): the right to determine what constitutes a national emergency. The Government have used that.

However, the track record of big pharma does not bode well for equitable distribution of medicines, and this demonstrates the importance of the right to issue a Crown use licence. Drugs to treat cancers, HIV/AIDS, hepatitis C, cystic fibrosis and toxoplasmosis have all been withheld from citizens while Governments were held to ransom during negotiations with pharmaceutical companies. The NHS has had to ration necessary drugs because of price gouging. The threat of using a Crown use licence, and the actual issuing of one, has been helpful in such negotiations, and several countries have used the powers to great effect.

The issue of compensation, however, needs to be clarified. This section of the law has not been tested in court. Will the Minister commit the Government, therefore, to review Section 57A of the Patents Act to ensure that it does not block the use of the crown use licence provision? Countries such as Australia, Canada and Germany have revised their patents laws for this purpose, and other countries have taken action. Will the UK Government do the same? This power could be needed to ensure access to Covid vaccines and treatments, so time is of the essence. Will the Government act now and not just stick to business as usual?

Social Care Workers

Lord Crisp Excerpts

Wednesday 7th October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I echo the tribute paid by my noble friend to those working in social care during the pandemic. Naturally we have a huge amount of concern about those in social care during the pandemic. However, it is amazing how much hard and committed work those who work in social care have put into the arrangements and how effective many of those arrangements have been. The numbers that she cites are really impressive. I cannot make the commitments that she asks of me right now, because the deal for social care workers has not been written, but I completely acknowledge the suggestions that she makes; those are very much on the wish list and the agenda for any social care reform when it happens.

[Lord Crisp (CB) [V]]

My Lords, is the Minister familiar with the work of the Tribe Project? It was set up by a successful digital entrepreneur and is now being used by six local authorities to predict the needs for care, match people with carers, and, very importantly in this context, support professional carers in setting up independently as microenterprises. This reduces overheads and therefore both improves care income and reduces costs. Does he agree that this approach could be very useful in helping with this crisis, and will he explore it further?

[Lord Bethell (Con)]

My Lords, I am extremely grateful for the noble Lord’s recommendation. The project that he describes is incredibly interesting. I am not aware of it today, but I will definitely seek it out and try to find out more. I emphasise the broader point that the noble Lord is making: fresh thinking, digital innovation and the work of entrepreneurs to try to create new ways of working—to pool, for instance, the efforts of teams of people and to use platforms like the one that he describes—can make a massive difference in the area of social care. We are very supportive of digital entrepreneurs bringing fresh thinking to this important area of work.

Covid-19: R Rate and Lockdown Measures

Lord Crisp Excerpts

Tuesday 9th June 2020 Lords Chamber

[Lord Bethell [V]]

The work is being undertaken at the moment. Rather than focusing on local lockdowns, we are focusing on local action plans with a wide variety of measures, perhaps including behavioural changes as well as clinical and diagnostic interventions. It is only by working across the piece that local actors, such as local authorities, directors of public health and local infection directors, can implement the right array of measures. That holistic approach is the one we are pursuing.

[Lord Crisp (CB) [V]]

My Lords, many academics are warning of the likelihood of a second wave of the virus, and there is some evidence that it is already happening in other countries. I appreciate that the Government seek to avoid that, but what is their assessment of the likelihood of a second wave, what lessons have they learned from their first experience of lockdown, and what planning are they doing for a second wave nationally and regionally?

[Lord Bethell [V]]

The fear of a second wave is profound. We have seen what happened in Singapore and we remain vigilant. However, enormous progress is being made against the epidemic, as the noble Lord will have seen from recent figures. We have put in huge infrastructure to protect ourselves in the winter, which is the moment of greatest anxiety. That includes Europe’s biggest testing programme, stockpiling medicines, upgrading NHS capacity, the recruitment of returning staff to the NHS and—as I mentioned to the noble Baroness, Lady Brinton—the implementation of a local action plan regime which will give teeth to our measures on a local basis.

Nursing and Midwifery

Lord Crisp Excerpts

Thursday 30th January 2020 Lords Chamber

Asked by

[Lord Crisp]

To ask Her Majesty’s Government what plans they have to celebrate Florence Nightingale’s bicentenary and the World Health Organization’s Year of the Nurse and the Midwife in 2020.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the Government are working with the Chief Nursing Officer for England on plans to celebrate the bicentenary of Florence Nightingale and those in the nursing professions. Plans includes supporting the Nursing Now campaign across the NHS in England. The Chief Nursing Officer is also working in partnership with the Florence Nightingale Foundation to plan many activities, culminating in an international conference organised by the foundation and the Burdett Trust for Nursing in October 2020.

[Lord Crisp (CB)]

My Lords, I thank the Minister for that reply. This year is a chance to celebrate the legacy of great nurses and midwives of the past such as Florence Nightingale, notably, but also great figures such as Mary Seacole and others in this country and elsewhere. It is also a chance to celebrate today’s nurses and midwives, and thank them for what they do. In passing, I am delighted to be wearing a piece of the new nursing tartan, designed by Scottish nurses and commissioned just last month. However, this is also an opportunity to look again at nursing and midwifery, recognising how far the professions have developed in recent years and that they perform a very wide range of roles, all with customary care and compassion.

Nurses are true health professionals in their own right, no longer handmaidens to doctors—if they ever were—and have the potential in the future to do even more. With that in mind, I ask the Minister two questions. First, what plans do the Government have for investing in training and increasing the numbers of advanced nurse practitioners? Secondly, what plans do they have for reversing the decline in community nurses, school nurses and health visitors in this country, who will play such a vital role as services move more towards the community?

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his important question. I am envious of his tartan and I definitely identify with his praise for nurses, who work long hours and serve the most vulnerable at the moments of their greatest need. To answer his specific questions, as part of the NHS people plan, we are committed to supporting career development for nurses, which includes supporting a diverse range of careers. An example would be the advanced practitioners within multi-professional teams. This is an important point that the noble Lord raises. We are also developing a plan for district and community nurses to work with healthcare providers, practitioners and higher education institutions. The plan will set out how we will grow the community nursing workforce, which includes mental health and learning disability nurses, and it is expected to be published later this year.

National Health Service Infrastructure

Lord Crisp Excerpts

Thursday 9th January 2020 Lords Chamber

[Lord Crisp (CB)]

My Lords, given that the NHS is seeking to shift to being a more community and primary care-based organisation, can the Minister say more about what investment is going into community and primary care in capital terms?

[Baroness Blackwood of North Oxford]

We have been looking at providing additional funding and support to councils to meet the rising demands and to continue to stabilise the social care system. We announced access to an additional £1.5 billion of funding for adults and social care, and we will be considering this further in the spending review.