Her Late Majesty Queen Elizabeth II

Lord Kakkar Excerpts

Friday 9th September 2022 Lords Chamber

[Lord Wakeham (Con)]

My Lords, I have only recently come out of hospital, so I hope I can hang on to my stick and keep straight. I particularly wanted to come to this debate, not to say anything very remarkable but to listen to the speeches. The standard of the speeches that I have heard is as high as any that I have heard in this House over many years.

I think I am the Leader of the House of Lords from the longest ago—I was not Leader of the House of Lords the longest, but it is longer ago that I was Leader—and I have very much enjoyed what I have heard today. I will not go into my share of reminiscences. Listening to the debate, I wanted to say just one thing, which I think has not been sufficiently emphasised. Many of us who have been Ministers in the Government have been the slaves of their red boxes for years. I do not know whether it was for 10 or 15 years that I had to deal with my red boxes. I cannot imagine how I would have dealt with them for 70 years, but it was 70 years for which she did that.

A lot of what she succeeded in doing in her life was because she was so well prepared for every event. She was not only well prepared; she knew how to put that across in a way that did not reveal that she might have views of her own. Importantly, she put things across in an impartial way. In the excellent debate that we have had, the thing that I thought had not been emphasised enough was just what a lot of hard work she had to put up with over 70 years.

[Lord Kakkar (CB)]

My Lords, at this saddest of times I join other noble Lords in sending sincere condolences to His Majesty the King and members of the Royal Family. This has been a very moving day because of the remarkable tributes paid by so many noble Lords. They were deeply emotional, reminding us all of the very real loss that our nation has experienced. Although a very strong nation, it will regrettably find it very difficult to come to terms with that for some time to come.

So much has been said about Her late Majesty but I should like to make two observations, one professional and one personal. Her late Majesty was patron of so many medical organisations—medical royal colleges, hospitals and other organisations—and the Queen’s example and her values inspired the professions hugely, as we heard from the noble Baroness, Lady Watkins. That inspiration was vital at many times, particularly so during the Covid-19 pandemic. The Queen was, from the very beginning of her reign, patron of the King’s Fund, and we in the fund were deeply privileged to enjoy that patronage, which had a tremendous impact on the work of the fund over 70 years. Of course, during that period things have changed tremendously: life expectancy has increased and the way that medicine and healthcare are delivered has changed substantially.

The fund was established in 1897 by the then Prince of Wales, later King Edward VII, to raise funds for the hospitals dealing with the poor in London. Its purpose has changed substantially over that period, but in 2008 the fund was privileged to receive its royal charter from Her Majesty, which continued the capacity for us to pursue the work that was so strongly supported. That deep commitment to the work of healthcare professionals was not only reflected in its support of organisations here in the United Kingdom but throughout the Commonwealth, and was vital in ensuring that the values that Her late Majesty so clearly expressed and practised could remain fundamental to the practice of medicine throughout the world.

The second observation I should like to make is much more personal. It reflects Her Majesty’s deep commitment to the Commonwealth and, through that deep commitment and example, the opportunity afforded to so many from Commonwealth countries to come to the United Kingdom. Among those subjects who came from another Commonwealth country to settle here in the United Kingdom were my parents in 1961. I remember, growing up in the 1960s and 1970s, how they were deeply inspired and moved by Her Majesty’s commitment to the Commonwealth and all its peoples, and indeed to those people who decided to come and settle here in the United Kingdom. It was a vital part of ensuring, during that important period in our national history, that subjects of all backgrounds had the capacity to make their contribution, to participate in the life of our country and, in the case of my parents, to contribute to the work of the National Health Service. It was a vital opportunity, afforded by a monarch who understood the importance of the sensitivity, kindness and example that would ensure the integration of those from all over the world in societies and communities across our country, providing the opportunity for them to make their contributions.

I remembered all this at a deeply moving moment in my own time: the day I had the privilege to kneel before Her Majesty and to swear my oath of allegiance on becoming a member of Her Majesty’s Most Honourable Privy Council. I was particularly nervous that day but, as noble Lords have indicated, any audience with Her Majesty was always attended by her determination to ensure that one was put at ease. Kneeling there, I was deeply moved because I understood that it was Her Majesty’s values, her example and the work that she had done over so many decades that provided the opportunity for my family to settle here in the United Kingdom and the remarkable occurrence of my kneeling before Her Majesty to swear that oath. The fine example and the values of service, duty and commitment, always shown with kindness and thoughtfulness, are very powerful qualities that will live in the hearts of every one of Her late Majesty’s subjects. God save the King.

[Lord Taylor of Holbeach (Con)]

My Lords, I am pleased to follow the noble Lord, Lord Kakkar, because I was with him on that very day, when I also took the Privy Council oath.

I start by saying how much I have enjoyed listening to other noble Lords talk about our late Queen and the way in which she has served the nation. We have heard some admirable speeches, as my noble friend Lord Wakeham said. I echo his admiration for her diligence in knowing what the issues are and being prepared to work to acquire that knowledge. Nobody can doubt that she has been a very hard-working and diligent monarch. She has combined that with constitutional integrity, which has been vital for this nation, the developing world and the Commonwealth of which she has been head.

Noble Lords have mentioned her human qualities. Perhaps that is an important dimension because that was how she was able to relate to many noble Lords here present who have had opportunities to get to know her, to work with her or to accompany her in particular activities.

I do not know whether I should declare an interest, but I want to talk about my family horticultural business. For 37 years, we have been the warrant holders, as bulb growers, to Her Majesty the Queen. Some people may say that is not a particularly proud boast, but I personally take great pleasure from it and it has preceded all this other stuff, of red Benches and the rest of it, and is probably more important in real terms than anything I have been able to do here. Although gardening does not compete with horses or dogs, it comes a very close second, and you have only to go round the royal gardens of royal properties at Balmoral, Windsor and Buckingham Palace to get an idea of how seriously Her Majesty took gardening. It was not just visits to Chelsea and scant things like that.

That has provided me with some common link. Perhaps I may end with a little bit of an anecdote from my political life, because I was a Lord in Waiting, which was for a number of us a great deal of fun and enjoyable, although it involved duties. I see colleagues here who are Baronesses in Waiting; they will know that it is a great honour but also interesting. One of the great things that the monarchy has done in this country is to make working with it interesting, with everybody feeling that it is a worthwhile thing to be doing.

Commonwealth Heads of Government Meeting 2018

Lord Kakkar Excerpts

Thursday 22nd March 2018 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I join in congratulating and thanking the noble Lords, Lord Ahmad of Wimbledon and Lord Howell of Guildford, for the splendid way in which they introduced this important debate. I also join other noble Lords in congratulating the noble Lord, Lord Geidt, on his excellent maiden speech. In so doing, I remind noble Lords of my own entry in the register of interests, particularly in the area of healthcare, and my association with the Commonwealth Enterprise and Investment Council and the Queen’s Commonwealth Trust.

The set theme of the summit—to focus on issues of fairness, sustainability, security and prosperity—might well be addressed in some measure through trying to achieve universal access to healthcare throughout all Commonwealth countries. There is a substantial burden with regard to disease, which is different, of course, in different parts of the Commonwealth because of the different economies and geographical locations, but the reality is that there is great disparity. In parts of Africa, the average life expectancy is under 50 years; in Australia, it is some 82 years. A lady in Sierra Leone is 300 times more likely to die of the complications of childbirth than one in Singapore. When one looks at the availability of healthcare resource, one sees that the number of doctors per 100,000 of the population is 300 times greater in Malta than it is in Tanzania. There is much to be done.

An initiative in which I had the privilege of being involved was an attempt—regrettably, it did not go forward—to utilise the Commonwealth family, through the good offices of the Commonwealth Secretariat and its new capacity through the Commonwealth Hub cloud mechanism, to bring together a global community of healthcare professionals among the 53 Commonwealth countries to share all that we currently know. There is a huge store of knowledge and information already available to be applied to the best practice of medicine and the best provision of healthcare. That, appropriately and responsibly shared across 53 Commonwealth nations, providing the opportunity for front-line staff and those responsible for the delivery of the healthcare system to learn from what is already known, would have had the capacity to be transformational. That community—globally—of healthcare professionals, privileged to be responsible for the care of one-third of the world’s population, would have been quite remarkable. That might happen in the future.

There are, however, as we have already heard in this debate, important and impressive examples of a focus on healthcare delivering substantial outcomes for Commonwealth citizens. One of the most important is the work of the Queen Elizabeth Diamond Jubilee Trust and its relentless focus on the question of eye disease, improving eye health and improving healthcare education in that area. The remarkable work has focused principally on the elimination of avoidable infectious eye diseases that lead to blindness, such as glaucoma. It also makes use of very impressive technology through an organisation called Peek Vision to screen the eye health of children in its first iteration in Kenya, but now proposed for all children in Botswana, performed principally using a smartphone and the good offices of teachers to assess the eye health and intervene early in respect of those children where there is a risk of vision loss. That is a very impressive achievement of the diamond jubilee trust. There has also been an impressive focus on education through the London School of Hygiene & Tropical Medicine, which has developed programmes of education across the Commonwealth to deal with community eye health and, of course, the prevention of eye diseases.

As part of the Commonwealth Summit week we have the Commonwealth Business Forum, where there will be a session on life sciences and the potential application of other technologies across Commonwealth nations to achieve the greatest impact on driving healthcare opportunities, improving access to healthcare using technology and, of course, important opportunities for education. That, coupled with the impressive initiative of the Queen’s Commonwealth Trust to focus on driving opportunities for young people to come forward with projects and to drive change, opportunity and improvement for the lives of their fellow citizens in their own communities, provides an important chance to bring together technology and the enthusiasm of the young in their individual communities, and to apply technology not only to deal with established illness but to use the whole area of health tech to drive improvements in the capacity of those communities to protect their own health. Through doing that, achieving better health and more equitable access to healthcare across the Commonwealth nations, and sharing what we have learned through decades of research and application successfully in our own remarkable healthcare system, the National Health Service, but also in healthcare systems in other mature Commonwealth economies, we have the greatest opportunity to make a contribution, not only to the sustainability and prosperity of communities but to the very security of those communities and, of course, fairness.

Commonwealth Heads of Government Meeting

Lord Kakkar Excerpts

Thursday 17th December 2015 Lords Chamber

[Lord Kakkar (CB)]

My Lords, it is a great pleasure and privilege to follow the noble Baroness, Lady Featherstone, and to congratulate her on a powerful, thoughtful and compassionate maiden speech. Her remarkable contribution to this Parliament in the other place and her service in two government departments, the Home Office and the Department for International Development, are highly regarded, and her further contributions on many important issues that are deeply held in your Lordships’ House will be greatly welcomed in the years to come.

I also thank my noble friend Lord Luce for introducing the debate, and in so doing I declare my own interest as chairman of the advisory board of the Commonwealth Health Hub within the Commonwealth Secretariat and as chairman of the Healthcare Business Group of the Commonwealth Enterprise and Investment Council. I should also declare an interest as chairman of UCL Partners because some of our organisations are involved in the work of the Queen Elizabeth Diamond Jubilee Trust.

The recent Heads of Government meeting reaffirmed the importance of a focus on healthcare in the Commonwealth. There is great disparity in what is currently achieved. Life expectancy in Lesotho is 48 years while in Australia it is 82 years. A woman is 300 times more likely to die of complications in childbirth in Sierra Leone than she is in Singapore, and in Malta there are 300 times as many doctors per 100,000 population than there are in Tanzania, so there are great opportunities. It is reassuring to see how the Commonwealth is now mobilising itself to address this vitally important issue, one that is of significance to every Commonwealth citizen.

Within the secretariat, the health hub has now created a platform that will provide the opportunity for communication and contact across the largest single grouping of healthcare professions in the world. Those professionals are serving a population of some 2 billion people. But it is thanks to the support of the noble Lord, Lord Marland, and the Commonwealth Enterprise and Investment Council that a further group has been established to bring forward a broader base of partners to address important Commonwealth opportunities. This group of partners, which is drawn from Government, the independent commercial sector and the charities sector, will address four important issues as agreed at the recent Commonwealth Business Forum. These are to develop new methods for financing healthcare projects across the Commonwealth nations, to aggregate those opportunities for development into large enough pools that independent finance can be brought to bear and is attractive to those who are prepared to make long-term commitment, to ensure that appropriate methods of regulation of healthcare systems are achieved across the Commonwealth nations, and to ensure that opportunities for education and training are delivered to a similar standard in order to drive improvements in outcomes and thus improve the long-term prospects of all Commonwealth citizens.

Trade and Investment

Lord Kakkar Excerpts

Monday 15th June 2015 Lords Chamber

[Lord Kakkar (CB)]

My Lords, from these Benches I join in welcoming the noble Lord, Lord Maude of Horsham, to his new ministerial position, and congratulate him on a marvellous maiden speech. In so doing, I declare my own interest as one of the UK’s business ambassadors for healthcare and life sciences and as chairman of University College London Partners Academic Health Science Partnership.

I shall confine my remarks to the sectors of healthcare and life sciences. The provision of effective healthcare plays a vital role in our economy, because a healthy workforce can potentially deliver much more in terms of efficiency and productivity to the economy. Since the National Health Service’s inception, it has played an increasingly vital role in social cohesion in our country, and has stimulated the creation of a remarkable ecosystem around itself. Some four out of the top 10 biomedical universities in the world are here in the UK, as are two of the top 10 leading pharmaceutical companies in the world. We have some 3,500 small and medium-sized enterprises in the med-tech and biotech sectors, 500 of which are actively exporting.

The contribution to exports by the pharmaceutical industry is some £21 billion a year. Over the past 15 years that sector has consistently contributed surpluses to our balance of trade position, with some £1.1 billion contributed by the pharmaceutical industry in the last year for which records are available. It is an important sector in terms of the employment that it provides, with some 150,000 people employed in 100 countries around the world, and the contribution that it makes to research and development—some 25% of all R&D expenditure provided by the private sector is in the fields of healthcare and life sciences.

With regard to the med-tech and biotech industries, in the period between 2009 and 2014, when economic growth was difficult in our country, on an annual basis the med-tech sector saw a 5.8% increase in revenue growth and the biotechnology sector some 4% increase in revenue growth. In terms of employment, some 300,000 people are employed in the science and technology sector, which consistently since the turn of the century has seen a 3.7% increase in employment, frequently in very high-skilled and high-technology jobs.

It is important as we look to the future to recognise that healthcare expenditure globally is set to increase by some 5.6% per annum between 2014 and 2027. Some of the most important markets that we have strong trading relationships with will see even greater rates of growth in healthcare expenditure: for instance, in India some 15% per annum is expected over that period, China some 12% and the Middle East some 8%, so there is a huge opportunity for our nation, and for the healthcare and life sciences sectors, to contribute to meeting those important demands across the world.

The opportunities have been addressed to some extent through the work of government agencies. I declare a further interest in my role as a UK business ambassador, sitting on the board of Healthcare UK. Healthcare UK was set targets in the last financial year to achieve business wins of some half a billion pounds a year, principally focusing on those important markets of India, China and the Middle East, but was able to surpass that assistance to industry in that area, achieving business wins of £749 million in that year.

The All-Party Parliamentary Group on Global Health, of which I am treasurer, is about to publish a report that looks at the global footprint for healthcare for our country. That is an important point, because it demonstrates opportunities for the standing of our nation beyond the straightforward question of trade and investment. For instance, if one looks at contribution through overseas aid, the United Kingdom is the second-largest contributor to bilateral investment in, or contribution to, development in health around the world. If we look at our charities, there are some 6,500 charities in the healthcare, life sciences and medical research sectors, which invest some £7 billion abroad in projects, driving improvement of health but also promoting important research programmes and projects.

Then we have our university and academic sectors. As I mentioned, four of the top 10 biomedical universities in the world are based here in our country, and some 46,000 overseas students study medicine and dentistry in our 33 medical and dental schools, contributing substantially to the economy and providing opportunities for future growth as those institutions start to look abroad to deliver training and education in other countries. I declare a further interest as professor of surgery at University College London, which is actively involved in that kind of activity.

On research, in biomedical research our nation represents 1% of the world’s population, but we are responsible for 12% of all cited outputs in biomedical research around the world, and 62% of the top publications from UK institutions and authors are done in collaboration with institutions and colleagues abroad. That demonstrates the very global nature of our contribution to biomedical research and how our nation sits at the heart of many important medical research programmes and projects in healthcare around the world.

As regards the future, one of the important opportunities that might be explored is the potential for further trade and investment with regard to healthcare and life sciences with Commonwealth nations. One-third of the world’s population live in Commonwealth countries, and a recent report published by the trade policy division of the Commonwealth Secretariat has looked at the broader question of trade within the Commonwealth. It has identified that trade among Commonwealth nations at the moment accounts for some $680 billion a year, but by 2020 that will have grown to $1 trillion. There must be substantial opportunities to focus on trade with regard to healthcare and life sciences. That same analysis has demonstrated that the cost of doing trade if both partners are from Commonwealth nations is 19% less than it otherwise would have been if parties were not Commonwealth members, based on the fact that we have many common legal systems, share a language and frequently have a similar way of doing business.

All that has been achieved through the support of successive Governments; the last Government had a number of important initiatives. The Treasury report The Plan for Growth in 2011 identified healthcare and life sciences as a sector that could benefit from a more streamlined approach to regulation to open up opportunities for potential trade and investment. The Department for Business, Innovation and Skills report into life sciences, its Strategy for UK Life Sciences, and the support through the announcement by the Prime Minister in December 2011 of a joined-up life sciences strategy for our country, identified that the areas of healthcare and life sciences were particularly attractive for future investment and future government attention, because they generate very frequently high-tech, highly skilled jobs and disproportionately were in a position to contribute to growth in the economy.

Then we have the Innovation, Health and Wealth report from NHS England and the subsequent NHS Five Year Forward View, which have identified partnership between universities, the NHS and pharmaceutical, med-tech and life sciences sectors in driving growth opportunities more broadly for our economy, while ensuring that our country remains the most favoured nation in the world for inward investment in healthcare and life sciences, and bringing innovation rapidly to our population and potentially improving outcomes in the NHS.

What approach will this Government take towards the many different strands of activity and initiatives that have now been initiated by government to bring them to a single, co-ordinated place so that the real benefits that could be achieved through effective targeting of investment by Her Majesty’s Government to promote trade and investment in healthcare and life sciences can be achieved during the lifetime of this Parliament? What view do Her Majesty’s Government have on focusing, particularly in the Commonwealth, on opportunities in trade and investment in healthcare and life sciences?

Queen’s Speech

Lord Kakkar Excerpts

Thursday 28th May 2015 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I congratulate the Minister on the very thoughtful way in which he introduced this debate following the gracious Speech. I intend to focus principally on the impact of our relationship with the European Union on the delivery of healthcare in our country. In so doing, I declare an interest as professor of surgery at University College London and a member of the General Medical Council.

Before turning to that important issue, I will just touch on the interesting issue of the forthcoming referendum on our membership of the European Union and what the basis of the franchise for that referendum might be. Her Majesty’s Government have announced in the last few days that the franchise should be the same as that for elections to the Westminster Parliament, which seems an intuitive place to be. Since we are a parliamentary democracy, it is for the representatives of citizens—constituents—to come to the other place, represent the views of those constituents and exercise their judgment in determining how to vote on the vast majority of issues. Seldom in our parliamentary system do those representatives of their constituents feel the need not to exercise their own judgment but to return to those who have sent them to the other place to seek the views of those electors. Under the circumstances, therefore, it seems appropriate that those who voted for Members of the other place should be those providing their views about how the House of Commons should respond to the question of our future relationship with Europe. Therefore, seeking the opinion of constituents able to vote in national elections seems an appropriate course.

That appears to be the approach taken by the 27 other European member states. Each of them restricts participation in national referendums to those citizens who are entitled to vote in national elections. The only other European nation that addresses the issue of participation in national referendums on a case-by-case basis, as is the habit in our own country, is the Netherlands. It is not identical but in a similar situation in 2005, when the Netherlands put to its own people the question of whether the European Union constitution should be adopted, it chose to proceed with a franchise restricting participation in that referendum to the citizens of its own country eligible to vote in national parliamentary elections.

Indeed, when we have had national referendums in our own country—such as in 1975 when the question of our ongoing membership of the European Economic Community was put to the people of our country—the franchise chosen was the national electoral franchise for Westminster constituencies. Indeed, when we had the referendum on whether we should change the voting system in our country—the AV referendum in 2011—once again the Westminster franchise was chosen, with the addition, of course, that Members of your Lordships’ House were able to participate in that vote.

Although there are to be vital major treaty negotiations in the coming two years with regard to our future relationship with the European Union, very important issues remain to be addressed, with regard not to major treaty change but important potential regulations that could have a profound impact on the delivery of healthcare in our country. It is vital that those important discussions about more minor areas rather than major treaty changes continue to be addressed in the most robust fashion.

There is no doubt that there have been and continue to be very important advantages through the opportunity for our country to participate actively in the European Union, both in the delivery of healthcare and in biomedical research. Only last week my noble friend Lord Rees of Ludlow, with a number of other very distinguished scientists, pointed out in a letter published in the Times the important opportunities afforded for research generally and biomedical research in particular by our relationship with the European Union. At this stage, I reiterate my interest as professor of surgery at University College London. My institution is eligible to apply for European Union research funding and, indeed, is very successful at doing so. I also served in the previous Parliament on your Lordships’ European Union Sub-Committee B, which undertook an investigation into research and innovation funding—the Horizon 2020 programme—from Europe.

In the previous funding round—2007 to 2014—our country was second only to Germany in the funding it received for research from Europe, with some €7 billion, and was the largest recipient nation in funding to academic institutions, with some €5 billion. In the area of healthcare, some €560 million came to our medical research programmes, making us the largest recipient among European Union member states. But in parallel with that, we have seen proposals around the European data protection regulations. The former proposal put by the Commission seemed reasonably sensible but, as modified by the European Parliament, is now a matter of further negotiation. Those regulations, if imposed as a result of qualified majority voting, would have a detrimental impact on medical research in our country. They would make it practically impossible to undertake cancer registries or to fully exploit the UK Biobank—a massive programme involving some 500,000 of our citizens donating biological materials and their personal data to allow us to have long-term longitudinal research studies—and of course the 100,000 Genomes Project would also be severely undermined. I wonder what progress Her Majesty’s Government have made in ensuring that the application of the data protection regulations does not undermine the future of biomedical research in our country.

There is also the very serious concern about the decision taken by the President of the European Commission to dismiss the independent scientific adviser. This is a very serious matter that was raised in your Lordships’ House in the previous Session of Parliament. There was an independent scientific adviser available to ensure the appropriate assessment—or the mechanism for the appropriate assessment—of applications for European Union funding. That was vital. What progress have Her Majesty’s Government made with ensuring that independent scientific advice continues to inform decisions taken by the European Union in science, technology and medical research?

There is no doubt that we have become increasingly dependent in our National Health Service on the large numbers of doctors, nurses and other healthcare professionals who have come to work in our country. However, we have also seen detrimental impacts with regard to the European working time regulation on the delivery of healthcare in our hospitals and, increasingly now, beyond them in community care as well. It is now well recognised that the working time regulation, originally a measure on health and safety at work, has had a detrimental impact when applied to those working in the health service. It is now seen to have had a detrimental role in ensuring continuity of care in our hospitals, and therefore a detrimental impact on patient safety. Where it was thought that it might not impact on the training of junior doctors, increasingly it is seen to have been detrimental—particularly in the training of those in craft specialties, such as my own as a surgeon. There is also the cost element associated with the need to pay more and more locum agency doctors to help our hospitals ensure that rotas for 24-hour cover are European working time regulation-compliant. Have Her Majesty’s Government made an assessment of what proportion of the £3.2 billion spent last year on agency staff in the National Health Service can be attributed to the fact that the working time regulation continues to be applied, and therefore that we need to employ many more locum and agency staff to ensure that hospitals have compliant rotas?

Finally, there is the question of how those from Europe wishing to practice medicine or undertake their professional obligations as healthcare professionals in our country should join the various regulatory registers. I again remind noble Lords of my declaration of interest as a member of the General Medical Council but I do not speak for the council on this occasion. In the last Parliament it finally became possible, where there were concerns about doctors coming from the European Union, for the General Medical Council to test their language skills. That was not previously the case, although the council was able to test the language skills of those doctors coming from outside the European Union. Last September, the council announced its aspiration to introduce a single national licensing exam, which every person wishing to join the general medical register would have to sit. It would apply to our own UK medical graduates as well as those coming from around the world—from the United States, Australia, Canada and many other countries. However, there is some doubt whether the national licensing exam could be placed before those coming from European member states and wishing to join the general medical register. If that turned out to be the case and if the council were to come forward with a proposal for the introduction of a national licensing exam, are Her Majesty’s Government able to confirm that their position would be to ensure that all doctors joining a register, including those from the European Union, were subject to that examination?

Trade Balance

Lord Kakkar Excerpts

Thursday 11th December 2014 Lords Chamber

[Lord Livingston of Parkhead]

I certainly confirm that that is a key priority: both extending the single market to services, which we are pushing for in the EU, and the trade and services agreement, which is a plurilateral agreement between many countries. The UK is championing that. As such a large producer of services, we certainly support both those measures to increase trade.

[Lord Kakkar (CB)]

My Lords, as business ambassador for life sciences and healthcare, may I ask what assessment Her Majesty’s Government have made of the contribution of the life sciences industry to the UK economy?

[Lord Livingston of Parkhead]

First, I thank the noble Lord for his contribution to life sciences, which is very much appreciated. The life science sector is hugely important. From pharmaceuticals onwards, the UK has a very strong position. The appointment of George Freeman as the Minister responsible shows how important it is, and the measures taken on R&D allowances and tax relief on the exploitation of IP in the UK will carry on supporting this industry. I was in Boston recently, talking to a number of life science companies that are thinking of coming to the UK.

European Union (Referendum) Bill

Lord Kakkar Excerpts

Friday 10th January 2014 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I congratulate the noble Lord, Lord Dobbs, on the thoughtful way in which he introduced this Second Reading. In listening to the noble Lord, it reminded me of something that was said to me many years ago: that in life, to be successful, you must answer the exam question before you. The question before your Lordships’ House is not one today of whether our country should remain part of, or leave, the European Union but simply whether the people of our country should have a say by way of a referendum in determining the answer to that question.

Whatever one’s views about whether the Bill is appropriate, wise or necessary, your Lordships need to be sensitive to the circumstances in which we have received the Bill. We have heard already in this important debate that in the other place—the place that is composed of the elected representatives of our fellow citizens, sent to that Chamber to exercise their judgment on behalf of the citizens—that the Bill passed through its various stages either unopposed or with very substantial majorities, reflecting public opinion on this matter of whether the people more generally should have their say by way of a referendum.

Having said that, there is of course a clear constitutional responsibility that this Chamber has, in a bicameral Parliament, to undertake thorough and appropriate scrutiny and revision of legislation. Indeed, this whole question of the role of the second Chamber was debated at length in the last Session as part of discussions and debates generally on the House of Lords Reform Bill, so it is very clear that we have this constitutional responsibility. Although the Shadow Foreign Secretary, Douglas Alexander, speaking at Third Reading in another place stated that members of the Labour Party had provided an appropriate level of scrutiny in all stages of the Bill, both in Committee and on Report, your Lordships’ Constitution Committee identified areas where further scrutiny might indeed be advisable and necessary but also stated very clearly that there are implications in that revision and scrutiny. It suggested ways in which much of that might be dealt with through undertakings provided by the ministerial response to questions raised in your Lordships’ House.

It is vitally important that we come back to the question of how your Lordships should exercise the substantial powers that they have with regard to the conduct of their constitutional responsibilities. In the short time that I have had the privilege of sitting among your Lordships, I have come to understand that we have substantial powers but we show maturity and considerable restraint in the exercise of those powers. The question of Europe and our country’s future role in Europe is important, and one which has been fraught with considerable political disagreement. However, the situation would be made considerably worse if, in addition to the important debate on the future relations of our nation with Europe, the debate were to be attended by a further accusation. That accusation might be that those who have the privilege of sitting in your Lordships’ House and therefore the opportunity for their individual voices to be heard on every issue, apart from questions of supply and confidence, were to deny our fellow citizens the opportunity for their voice to be heard at the ballot box on the question of our future membership of the European Union, particularly when their elected representatives, sitting in another place, have made it very clear that it is their judgment that our fellow citizens should be given a voice.

EU: Reform

Lord Kakkar Excerpts

Thursday 9th January 2014 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I join in thanking the noble Lord, Lord Dykes, for having secured this important debate, and, in so doing, declare my own interests as professor of surgery at University College London and a member of the General Medical Council.

The area of health and delivery of healthcare was not an area originally anticipated as having any competence at European Union level, specifically in the treaties. The delivery of healthcare and the allocation of healthcare resources along with the development of health policy were described as an area in which member states and national governments maintained absolute competence. The Department of Health balance of competence review, necessitated by the fact that, inadvertently, much European legislation and many directives have impacted on the delivery of healthcare, determined broadly that, in those areas where European regulation and directives have impacted on the delivery, it was positive. However, it identified a number of important areas where there were unintended detrimental consequences resulting from European regulation.

I shall concentrate on two areas that were highlighted in that competence review and in the third report of Session 2013-14 of the Science and Technology Committee of the other place. The first is the question of the European working time directive, which has been debated extensively in your Lordships’ House. I return to that because the directive continues to have a very important impact on the way that we are able to organise and deliver healthcare in our country and because the unintended consequences of its impact have been substantial.

The working time regulations have affected the quality of care. Although initially it was anticipated that restricting working time to 48 hours per week for trainees would promote patient safety and improve quality, regrettably that has not been the case in this country. Indeed, where the question of the duration of working hours for junior doctors has been studied carefully, particularly in the United States, it is clear from prospective evaluations that have been undertaken over a period of time that such a restricted period of working each week has a detrimental impact on patient safety.

There has clearly also been a detrimental impact on our ability to train junior doctors.

[Lord Davies of Stamford]

I am most grateful to the noble Lord for giving way. I greatly recognise and admire his expertise and experience in this area, but can he perhaps tell the House why our continental partners, in France and Germany and so on, do not seem to have had the same problem with the delivery of healthcare that he suggests we have had as a result of the directive?

[Lord Kakkar]

I thank the noble Lord for his intervention. That is because the application of the working time directive in those countries has been different from our rather fastidious application of the directive here in the United Kingdom. It is also due to the fact that the organisational structure for the delivery of healthcare is very different in France and Germany from the way that we deliver healthcare in our country.

Particularly in the craft specialties, such as my own specialty of surgery, trainees have found it increasingly difficult, within the restriction of 48 hours and the restricted period of time now available for specialist training, to develop the skills necessary to deliver independent consulting practice, which is very much a feature of the delivery of healthcare in our NHS but is rather different from countries such as France and Germany, where they tend to have larger departments with a much more hierarchical structure.

There has also been a substantial cost impact from the adoption of the working time regulations. In the first full year after their application across the National Health Service, an extra £200 million was spent on the provision of locums to fill rotas necessary to cover the provision of out-of-hours care within the NHS. Indeed, just for surgical specialties, the Royal College of Surgeons has assessed that an additional £60 million was spent to provide locums to cover surgical rotas. The Royal College of Surgeons estimates that, because of the application of the working time regulations, some 40,000 surgical hours are lost per month. Again, that has had a detrimental impact on ensuring that access to services can be adequately delivered to meet workload demands. Most worrying is the fact that, on a number of occasions, coroners have included in their narrative verdicts reference to the working time regulations as having had a detrimental impact on the care of individual patients.

Her Majesty’s Government recognise that this is an important challenge. Indeed, in 2010, the then Health Secretary and the Business Secretary announced that they were to initiate negotiations with our European partners not on withdrawing from the working time directive as it applies to healthcare but on ensuring greater flexibility, which would allow us to develop training schemes to meet the specific needs of the NHS in England in the training of our trainees. That resulted in the process being pursued through the mechanism of the social partners, but regrettably that negotiation has failed and the question has now been returned to the European Commission.

Clearly, this is an important area where action is required. As I have said, we need not to withdraw from the working time directive but to allow the necessary flexibility to allow working hours to increase from the current level of 48 hours to 56 or 65 hours, depending on what point trainees are at in their training and on what specialty or discipline they are training in. Can the Minister confirm that this might be a priority area in any further negotiations with our European partners?

The second area is the question of clinical research. Our country has a very distinguished heritage in terms of its contribution to biomedical research globally. The citations for research undertaken in our country are substantial. Some 12% of global citations for biomedical research are derived from research conducted in our country, a substantially greater proportion than in any other country in the world. Much of this is based on our distinguished history in delivering important clinical research. In 2001 6% of all patients entering clinical trials in the world came from the United Kingdom. By 2006, after application of the clinical trials directive, that had fallen to 1.4% and in the period 2007-11 there was a further 22% decline in the number of patients entered into clinical trials from our country.

The clinical trials directive has not only impacted on clinical research in our own country, it has affected all other European member states in terms of their competitiveness globally to deliver clinical research. The Medicines and Healthcare Products Regulatory Agency, which registers new clinical trials, identified in 2007 some 1,207 new trials registered. By 2011 it was down to 943. Clearly, the clinical trials directive is having a detrimental impact. It has, indeed, been renegotiated and a clinical trials regulation was agreed in 2012 by the European Parliament, due for application in 2016. The third report of the Science and Technology Committee of the other place identified ongoing concerns even about the newly drafted clinical trials regulation, concerns that were raised in evidence the committee received from the Academy of Medical Sciences and from the Wellcome Trust, a major funder of clinical research in our country.

In the area of clinical research, I suggest not that we withdraw from the clinical trials directive or the future clinical trials regulation, because there are important benefits to having a certain standard across the European Union, but that we should be able to ensure that flexibility provides for the specific environment in which we undertake and deliver clinical research in our country, with the strong national clinical governance mechanisms that we have in place, rather than find that the directive and the future regulation have had a detrimental impact on our ability to remain competitive in the life sciences area. The life sciences are an important feature of national activity, both in terms of ensuring excellence in our health service and in terms of the economic impact that life science industries have for our country.

Commonwealth

Lord Kakkar Excerpts

Thursday 17th October 2013 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I, too, join other noble Lords in thanking my noble friend Lord Luce for having secured this important debate and, in so doing, declare my own interest in the register with regard to healthcare but particularly as a serving officer of the All-Party Parliamentary Group on Global Health and the UK business ambassador for healthcare and life sciences.

We have heard that the Commonwealth is uniquely diverse in geography, ethnicity and stages of economic development. That represents an important challenge in terms of the delivery of universal healthcare, an objective which must be attuned ideally with the objectives or one of the themes of this year’s Heads of Government meeting, with growth and equality defined in terms of equality of development.

It is clear that the 54 current member states of the Commonwealth are diverse also in access to healthcare, the burden of disease that the populations of those nations experience and the outcomes. It is quite striking, for instance, that although 40% of the world’s population lives in Commonwealth nations, the Commonwealth carries 60% of the burden of HIV and AIDS.

In terms of access to healthcare, there is a 300-fold difference between Malta and Tanzania, for instance, in the figure for doctors per 100,000 of population. In terms of outcomes, a woman is 300 times more likely to die from complications during childbirth in Sierra Leone than in Singapore. There is therefore much to do. Focusing on the delivery of healthcare is an important opportunity for the Commonwealth to demonstrate to each individual citizen the real benefits of being part of an organisation and entity as diverse as the Commonwealth.

A focus on healthcare, in terms of education, innovation, research and the delivery of high-quality care, is nothing new for Commonwealth nations; indeed, throughout its 64-year history there have been important exchanges of medical practitioners and other healthcare professionals between Commonwealth countries. So many citizens, doctors and nurses of Commonwealth countries have come to serve in our own NHS and have returned to their own home countries, having learnt much and applied it, and taken on leadership roles to develop healthcare in those nations. Our own practitioners and doctors have gone to other Commonwealth countries and been able to learn much and bring it back to improve the delivery of healthcare in our own country.

How do we take these opportunities forward? How do we ensure that, with modern technology, and a focus on high-quality education, innovation and reverse innovation, healthcare is better for all Commonwealth citizens? I had the privilege of addressing the Health Ministers of the Commonwealth earlier this year at their annual meeting and was able to propose the creation of something known as Common Health—a hub for exchange of educational materials, best innovative practice and life-saving information, made available at the fingertips of every healthcare practitioner across the Commonwealth through modern communications technology. If this initiative were able to go forward—indeed, it was endorsed to do so—it would provide an opportunity to ensure that everything that we have learnt and that has been validated in each Commonwealth country, having been shared among the learned societies and professional organisations for healthcare practitioners in those countries, could be shared broadly across a community of practitioners, numbering possibly some 2 million doctors and some 15 million other healthcare professionals. That would be unique and it could provide the opportunity to change in a material way the lives of every Commonwealth citizen. Will Her Majesty’s Government’s consider such initiatives, focusing on the provision of improved healthcare, as an important objective of our contribution to the activities and work of the Commonwealth?

EU: UK Isolation

Lord Kakkar Excerpts

Monday 22nd April 2013 Grand Committee

[Lord Kakkar]

My Lords, I, too, join other noble Lords in congratulating the noble Lord, Lord Dykes, on securing this important debate. I wish to confine my comments to an area where there have been unintended consequences of European legislation—in the delivery of healthcare here in our own country. This is a vital issue. As we move forward, there may be an opportunity for British people to become isolated because they feel that there is an impact on the delivery of healthcare that was unintended and is having a detrimental effect. Before doing so, I declare my own interest as Professor of Surgery at University College London, and as a member of the General Medical Council.

A number of issues have been raised with regard to European legislation and directives that relate specifically to healthcare. They relate to the area of professional qualifications and the free movement of labour within the European Union. There has been important progress with the issue of language testing. The General Medical Council, it is proposed, will now be allowed to test the language skills of all doctors who wish to be registered by the council in the future, including those who come from the European Union. That is an important achievement.

However, there is still concern about the ability to test professional qualifications and the nature and structure of the postgraduate training that has been delivered to healthcare professionals throughout the Union. This is an important issue because doctors coming from other parts of the world are subject to that kind of rigorous testing before they are allowed to join the register.

The issue that I would like to focus on is the European working time regulation. In 2010, when the coalition Government was formed, the then Health Secretary committed to begin negotiations with the European Union on ensuring that working time regulations could be applied in a more flexible fashion with regard to working in our hospitals to reflect the fact that the nature of the delivery of healthcare—the structure of our hospitals and broader healthcare environments—is somewhat different from other European countries, and a degree of flexibility would be important. I recall that the then Health Secretary and the Business Secretary were to commence discussions in January 2011 on this matter, but all seems to have gone quiet because of the broader review of competences that is currently taking place.

We need to be very sensitive to this issue. Recently we have started to see coroners’ narrative verdicts starting to cite European working time regulations as a contributory factor in patient death. We have seen in the Francis report into the problems that were experienced at Mid Staffordshire hospital that the working time regulation was identified as a potential contributor to an inability to provide continuity of care within the hospital system. These kinds of descriptions in coroners’ verdicts and in important reports, such as the Francis report, can cause unnecessary anxiety.

With increasing pressure in the healthcare system, we need to be sensitive to problems identified by, for instance, the Royal College of Surgeons, which estimates that 400,000 surgical hours a month are lost from the healthcare system as a result of the application of the working time regulation to surgical rotas and that some £750 million a year is now spent on locums to ensure that locum doctors can fill gaps in those rotas. Equally, the Royal College of Physicians has identified this whole area as a major issue for the delivery of healthcare.

Therefore, I should like to ask the Minister what progress is being made with regard to the discussion about the working time regulation. This was identified as important on the basis of patient safety and the need to ensure continuity of training to a high standard for our trainees, who will lead the healthcare system in the future. It seems to have become mixed up in the broader question of competences and of bringing them back from Europe. If this issue is not addressed, there could be major problems in the future that will be attributed to it and this could have a detrimental impact on the public perception of Europe, because health was never an issue of competence and this matter is specific to the delivery of healthcare in the United Kingdom. Is the Minister able to guarantee that this important discussion, which started long before, will be continued in a timely fashion?