Medicines and Medical Devices Bill

Debate between Lord Kakkar and Baroness Barker

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

[Lord Kakkar (CB) [V]]

My Lords, I very much support what the noble Lord, Lord Sharkey, has just said. In so doing, I support Amendments 4, 42, 52, 63, 69 and 92 in this group.

It seems counterintuitive at the very least for a Government to come forward with proposals to give a Minister powers using a delegated provision to create new criminal offences and, when challenged, to justify the position by saying, “Well, we will limit the sanction to two years’ imprisonment.” This completely misses the point, as we heard from the noble Lord, Lord Sharkey. There is a clear principle at stake here, which has been well described by the Constitution Committee in its report on this legislation. Very simply, it offends liberty and the functioning of our democracy that a Government can propose to create criminal offences that would deny a citizen their liberty for one day, let alone a maximum of two years, and feel that there should not be proper parliamentary scrutiny in the accepted fashion for the creation of criminal offences. Her Majesty’s Government should think very carefully about what they propose to do here and bring their own amendments beyond the government amendments suggested in this group.

[Baroness Barker (LD)]

My Lords, I just want to add to what my noble friend Lord Sharkey said. This is a matter of principle; from the two reports by the two committees that have been cited and from the Second Reading debate, the Government can be in no doubt about the strength of feeling on it. In the light of those, the Government’s response in the government amendments in this group is, frankly, rather pathetic and not at all acceptable.

The Bill represents an enormous upheaval for one of the critical areas of our industry. The pharmaceutical industry is of immense importance to this country. Apart from anything else, to add criminal offences created through delegated powers by means of a Bill that is so spare and lacking in detail does a huge disservice to people who want to continue to pursue not just high-quality but ethical production of badly needed medicines in this country and within international frameworks. If the best the Government can do is to table the amendments in this group, they do the industry a great disservice.

Health and Social Care Bill

Debate between Lord Kakkar and Baroness Barker

Wednesday 2nd November 2011 Lords Chamber

[Lord Kakkar]

My Lords, the noble Earl, in his thoughtful introduction of the Bill on Second Reading, identified the challenges that face all mature healthcare systems such as our own in terms of the changing population demographics, with an older population, more chronic disease and the need to improve clinical outcomes through integration of the new technology innovations and pathways of providing care.

In trying to understand how those important objectives will be achieved by the Bill we need to try to identify potential strategies. One of the most important is to ensure that the health service focuses on integrated care in the future. We know from quite a lot of important experience around the world that integrated care has the opportunity to improve clinical outcomes. We have heard of the patient with diabetes that the noble Lord, Lord Patel, described who ended up with the potentially unnecessary amputation of toes. Integrated care could have improved the clinical outcome in that case by avoiding a deterioration of the patient. Careful supervision in the community and the appropriate integration of different specialties and disciplines could have avoided that outcome. We know that integrated care has the opportunity to drive improved patient experience. We have heard about the potential for integrated care to improve patient safety. The example given by the noble Baroness, Lady Cumberlege, of the remarks made by Martin Marshall with regard to “lost in the system” puts patients at great risk, and the importance of integrated care and enhancing patient safety should not be neglected.

We also know that integrated care can achieve the important objective of taking our system towards a value-based healthcare system where, in addition to improving all the good clinical outcomes and improvement in experience and safety, the healthcare system can also deliver better value and ensure that the vital resources available and devoted by Government to the provision of healthcare can be used most effectively. Therefore, I strongly support the amendments that speak to the need to emphasise in the Bill the importance of integration.

The Bill has the important purpose of ensuring that a legal framework exists for driving forward future provision of the National Health Service, and also provides an important opportunity to set a vision and ensure that those ultimately responsible for implementation have an appropriate focus at the outset and can design the service moving forward in such a way that it achieves the objectives and meets the challenges that the noble Earl set at Second Reading. To ensure that there is a focus on integration is a very important objective. It will help achieve those important challenges. Failure to emphasise integration would run the serious risk of losing the opportunity to drive forward the improvements in healthcare and in the utilisation of resources that the health service desperately needs.

[Baroness Barker]

My Lords, the noble Baroness, Lady Pitkeathley, mentioned that she wrote a book 40 years ago. I wish I had written a book about the experiences of older people in various parts of the healthcare system. Many noble Lords talked about integration at different levels. My view is that integration just within acute hospitals will be ever more complex in future because they will be treating many people with dementia. The treatment of people with dementia in different parts of acute hospitals is a growing scandal. It poses a challenge to health professionals of all kinds, many of whom have never bothered to think about the issue of dementia. They will have to think about it for their own specialisms in future.

I have taken part in this sort of debate many times and come to the conclusion that the debate rests on a single factor: information. It is the sharing and availability of information and data about outcomes. Everything else is secondary. The previous time we had a serious discussion about this was when we discussed the proposals of the noble Lord, Lord Darzi. Some of what he achieved, in particular in improving stroke care in London, rested on the willingness and ability of people just in different parts of the NHS—let us not be too ambitious—to share information. I ask the Minister what the department has learned since the passage of the legislation of the noble Lord, Lord Darzi, about the crucial issue of sharing information about patients and their treatments, and other data on outcomes. Until we address that issue, and until health professionals feel able to maintain client confidentiality while sharing information just with other professionals, everything else will be redundant: we will never crack any of this until we get that right. Therefore, I ask the Minister how the department’s thinking was influenced in the preparation of the Bill by what the noble Lord, Lord Darzi, achieved.