Medicines and Medical Devices Bill

Lord Lansley Excerpts

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Wednesday 2nd September 2020 Lords Chamber

[Lord Lansley (Con)]

My Lords, I welcome the Bill. As my noble friend rightly said in a very positive opening speech, it is not only a necessary Bill but one which presents us with opportunities. I hope that, during the passage of the Bill, we will look to realise those opportunities, and I want to refer to one or two.

My noble friend talked about the Delegated Powers Committee’s remarks, which made the very compelling point that, in reproducing the regulation-making powers, we are moving from the power to make regulations to meet EU legal requirements to the ability of Ministers to set down their own legal requirements; these are very different things. What we need to do in the latter case is not to move from where we are now, as my noble friend might have suggested, to something that sets out in primary legislation the detail of these regulations—nobody is intending that—but to something that moves us from a skeleton Bill to a framework Bill. What is the difference? The difference, in my mind, is a very straightforward one. The framework Bill is purposive. It sets out why regulations are being made and gives an ability to look at the primary legislation and ask, “Do these secondary instruments fulfil the purposes of the primary legislation?” During the passage of the Bill, we must look very carefully to meet that test.

I want to make three quick points. First, I think we are already among the best places in the world for medicines innovation. We may be 3% of the pharmaceuticals market but we are 10% of medicines innovation. I want to continue that. One thing the industry has told us, including me, over past years is that it wants to see our NHS take up new medicines and make them available to patients—a point that my noble friend reiterated. There is a commitment in our manifesto that says:

“We will extend the successful Cancer Drugs Fund into an Innovative Medicines Fund”.


I think the time has come for that and I hope that the Bill will make provision for that to happen.

Secondly, the MHRA is a world leader—for example, in the assessment of medical devices—but we have a problem, as the noble Lord, Lord Hunt of Kings Heath, said. We will be accepting CE markings through to 2023. I am pretty sure, unless somebody tells me otherwise, that the EU is not going to accept UK conformity assessments any time soon. So we are in an asymmetric relationship, and we have to think very hard about how we can sustain the MHRA. In the course of that, what the noble Baroness, Lady Barker, said is absolutely right: we must not be pulled between American FDA standards and EMA standards. We should be trying to move everybody to international standards, and that is something we will have to look at hard.

As we put more registries in place, I hope that they will include patient-reported outcomes: that is important. For medical devices, I hope that we will show how we are going to take them up in the NHS as well. On the consultation that ended last year on the medtech funding mandate, the time has come to do it. Ministers have not said that it will be brought into place this year or next. I think that the Bill should bring forward the medtech funding mandate, as the medicines mandate is in place. Finally, on clinical trials, the EU has not implemented its clinical trials information system and is not at present expected to do so until the end of 2021. We need to be in it. The legislation says “corresponding or similar to” but I do not know what “or similar to” means. We are either in it or not in it, and I hope we will be in it.

Covid-19: Response

Lord Lansley Excerpts

Monday 27th July 2020 Lords Chamber

[Lord Bethell [V]]

My Lords, I pay tribute to my colleague Helen Whately, the Minister for Social Care. She has worked incredibly hard and tirelessly on this area, which is her ultimate responsibility. There is a social care team which handles those negotiations, and I thank all those in the social care industry who are engaged. The social care industry is highly fragmented so engaging with the entire industry is a massive challenge. That is why we have put in place new structures, new dialogues, new guidelines and new ways of working to ensure that we are match-fit for the winter.

[Lord Lansley (Con) [V]]

My Lords, a number of countries, including Hong Kong and Austria, undertake testing at ports of entry. Under certain circumstances, that can limit the time that people have to spend in quarantine. Will the Government offer such testing at UK ports and airports?

[Lord Bethell [V]]

My Lords, that is not in the current guidelines. The noble Lord is entirely right that it is incredibly time-consuming and not currently practicable. For the reasons I outlined in answer to an earlier question, a test today does not guarantee that someone will not be infectious either tomorrow or the next day. That is why we have not focused on testing at ports, but we remain open to suggestions. We assess a large number of options and, as evidence and trials emerge that may demonstrate the efficacy of different policies, we will of course consider them and remain open-minded.

Independent Medicines and Medical Devices Safety Review

Lord Lansley Excerpts

Wednesday 15th July 2020 Lords Chamber

[Lord Bethell]

The noble Baroness is right that regulation is important, but so is culture. I emphasise the importance placed by the Cumberlege report on a change in attitude in the healthcare service as much as on a change in regulation. I cannot guarantee that the EMA and the MHRA will be aligned on regulation in all matters, but I can guarantee that the MHRA will be given the resources it needs to do the job properly.

[Lord Lansley (Con) [V]]

My Lords, as a former Secretary of State for Health, perhaps I may say that I and all my colleagues who have taken responsibility for the NHS over decades should join in expressing our deep regret at the systemic failures laid bare in the report of the noble Baroness, Lady Cumberlege. Will my noble friend reiterate the point about cultural change? It is not just about implementing the recommendations, important as that is, but about achieving cultural change. I direct that point in particular to patient involvement. By that I mean not just consultation, not just a patient voice, not just decision aids but patient-reported outcomes being a central part of the measurement of the performance of our health service and its accountability.

[Lord Bethell]

I completely endorse the comments of my noble friend. To embellish his point, it has been very interesting to see through Covid how patients have had to track their own symptoms, take advice on 111 for themselves and, in millions of cases, look after themselves at home, possibly with telemedicine to support them. This may an inflection point in the attitude of many people to their health. I certainly welcome a revolution of patient power and putting patients first in our healthcare system.

Covid-19 Update

Lord Lansley Excerpts

Wednesday 1st July 2020 Lords Chamber

[Lord Bethell]

The noble Lord is entirely right. I have four children, all of whom have returned to school this week, and they are all attending smaller classes for smaller amounts of time on different days of the week. As a parenting challenge this is considerable, but it has meant that they have returned to both the social and disciplinary aspects of school. I embrace this development and entirely agree with the noble Lord’s prioritising of this important subject.

[Lord Lansley (Con) [V]]

My Lords, will my noble friend the Minister commit the Government to maintaining their financial support for the Covid-19 volunteer testing network? He will know the important work that it is doing.

[Lord Bethell]

My noble friend is right to raise this important subject. I know the volunteer testing network; I value it enormously and am extremely grateful for its support. I am currently looking into its funding, and I would be glad to write to my noble friend to provide a clearer answer on that.

Covid-19: Deep Cleaning

Lord Lansley Excerpts

Wednesday 11th March 2020 Lords Chamber

[Lord Bethell]

The noble Baroness is entirely right to emphasise the importance of personal hygiene. The Government are working hard to drive these messages home. Ultimately, it is up to the public to embrace the messages. A substantial public awareness campaign was launched 10 days ago. From the polling that we have done so far, it appears to have been extremely effective. Based on that polling, we will be launching a further campaign to ensure that everyone is aware of the hygiene protocols the noble Baroness describes.

[Lord Lansley (Con)]

My Lords, the Minister made a good point about timing. Sometimes certain measures require preparation by public authorities and the public before they can be initiated. Does he agree that we may be not too far off a point when we ask those who are elderly and have underlying health conditions not to leave home, and that many public authorities—parish councils, town councils, local government, the NHS and Age UK—might soon want to undertake preparations?

[Lord Bethell]

My noble friend is quite right that measures require preparation. This Government are determined not to be caught on the hoof. In his public statements on Monday the CMO was clear that there are three areas where the modelling suggests there might be a major difference to the delay processes that the House has heard about and understands. My noble friend is also right that the safeguarding of older and vulnerable people would be a likely candidate for that. A substantial amount of time is required though, maybe 10 to 12 weeks or more. It is important that social acceptance of that kind of measure is in place before it is initiated. We are also looking at modelling the kinds of changes which would mean that those who display any symptoms might seek to socially distance themselves or that those who have been tested think about ways of putting space between themselves and their families. These are the kinds of illustrative examples that the CMO has already discussed publicly, and the Government are preparing for those kinds of scenarios at the moment.

Wuhan Coronavirus

Lord Lansley Excerpts

Tuesday 11th February 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right. We are aware that there are British nationals on board the “Diamond Princess” in Japan and that six more people have tested positive for coronavirus, none of whom is a British national. We have offered consular assistance to those British nationals—we have been in touch with the “Diamond Princess”—including one who is in hospital. We obviously pay tribute to the work being done in trying to contain the situation there. I identify myself with the thanks and tribute paid to the work of the CMOs, who are doing an extraordinary job right now to make sure that the UK is prepared.

We are one of the first countries in the world to have an effective test; it is working well. Now that the protocols have been sent to the devolved Administrations, testing centres in Glasgow, Edinburgh, Cardiff and Belfast have started testing already. Labs in Cambridge, Bristol and Manchester have started testing today and Birmingham, Newcastle and Southampton will come online shortly. I hope that reassures the House about the capability already available within the NHS.

[Lord Lansley (Con)]

My noble friend’s appreciation of what is being done in contact tracing and the urgency that has been invested in that and other aspects of containment of the disease is welcome. I share the appreciation that there is across the House for that.

I am sure my noble friend agrees that the effort put in now to try to contain the virus is not disproportionate, even if it includes the powers under the new regulation, because it buys us time. She referred to buying time for research into a potential vaccine. I have not seen any reference to other antiviral treatments that might be identified and be of use. For example, if a new flu-like virus was circulating we could use our stockpiles of Tamiflu. Have any viral treatments been explored for this particular virus?

[Baroness Blackwood of North Oxford]

As ever, my noble friend is astute on this issue. Contact tracing has been hugely effective, particularly for the 1,466 passengers and 95 staff who arrived in the UK on direct flights from Wuhan between 10 and 24 January. All those have now passed through the incubation period and none of them was a confirmed case. Of the remaining cases that we have found, a number are linked to contact tracing. We should be very proud of the effectiveness of our system.

On the question of antivirals, work and research is ongoing in regard to a particular HIV retroviral which has been used in this measure. That is being considered. There are three projects which aim to advance the vaccine candidates into clinical testing as quickly as possible. We are also looking at some correspondence from both diagnostic kit manufacturers and potential end users, and we are considering whether we can also improve the diagnostic kit.

Health: Eating Disorders

Lord Lansley Excerpts

Tuesday 7th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Lord, as ever, is quite right to delve into the detail of the 2017 survey into the mental health of children and young people in England. It found that eating disorders were identified in 0.4% of five to 19 year-olds—the spread was 0.7% of girls and 0.1% of boys—but it rose to 1.6% of girls aged seven to 19. Obviously, we want to understand what this rise in admissions means. There could be a number of reasons, which we hope are linked to earlier and better diagnosis, but of course we need to understand it better. We have a much better understanding of the data through the NHS mental health dashboard, which tracks down to CCG level what is happening with it, but we need to make sure that this work is properly funded and properly tracked in order to lead to better and more effective policies and provision of commissioned services.

[Lord Lansley (Con)]

Does my noble friend recognise that sometimes the point at which young people with severe eating disorders are able to meet the criteria for admission to an in-patient bed is so severe that some of the potential benefits from an earlier admission are lost? I ask my noble friend to return to the number of in-patient beds. We have a deficiency. What is the Government’s estimate of the extent of that deficiency, and what steps are being taken to commission additional in-patient beds?

[Baroness Blackwood of North Oxford]

We are increasing the number of commissioned in-patient beds up and down the country, but we are doing it in a way that recognises that it is better to have earlier diagnosis—prevention of the need to admit—and ensures that we do not wait until patients are at the stage where they need admission, which is the primary aim. My noble friend is absolutely right that we need to make sure that we have the right balance between those two. At the moment, we are doing a thorough assessment, and I will be happy to write to him on that issue.

NHS: Bullying

Lord Lansley Excerpts

Wednesday 5th June 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The CQC takes this extremely seriously. One proposal in the people plan is for the CQC’s scorecard to include a proper measure of a sustainable workforce, so that the new staff engagement metrics for the NHS oversight framework can be taken into account in the CQC’s well-led assessments during inspections, and that includes questions about bullying.

[Lord Lansley (Con)]

My Lords, I hope that my noble friend will agree that good leadership in the NHS is critical to removing a bullying culture. In that respect, might the Government support the NHS Leadership Academy to the extent that all aspiring chief executives in the NHS should themselves have gone through its Aspiring Chief Executive programme?

[Baroness Blackwood of North Oxford]

My noble friend, as ever, makes a very good point. Obviously there are a number of routes where leadership has been shown on this issue. In 2016 the Social Partnership Forum, which is chaired by Ministers but works across the system, gave a call to action, tasking employers and trade unions in all NHS organisations with working in partnership to create positive workplace cultures and to tackle bullying. In addition, recognising that no one organisation has the answer, royal colleges and others have joined together to create an alliance to tackle workplace bullying. They concluded that:

“Bullying behaviour is unacceptable. It is unprofessional and unnecessary. It affects the wellbeing of individuals and the teams within which they work”.


My noble friend’s proposal is another part of the picture. We need to come together across the system to tackle a completely unacceptable set of behaviours in the NHS—one that needs to be stamped out entirely.

Tessa Jowell Brain Cancer Mission

Lord Lansley Excerpts

Monday 13th May 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank my noble friend for his comments and in particular for the leadership he showed in responding to Tessa’s call to arms to improve outcomes for those with brain cancer diagnoses. I can absolutely give him the commitment that the Government’s commitment to the mission will not waver, and there is a very good reason for this. The outcome we are already seeing is so significant; over the last 12 months there has been the launching with partners of the mission and the making available of funding that has resulted in 24 brain cancer research proposals—the highest number ever—with a further four under active consideration. In addition, progress has been made on moving towards new service and staffing models, with commitments in the long-term plan and the life sciences sector deal. This will deliver exactly what my noble friend is talking about: namely, better care and support for patients, targeted to the kind of diagnoses they have, which is exactly what the brain cancer mission has recognised, and exactly the specialist advice which government needs to tailor care for patients in the most appropriate way when they most need it.

[Lord Lansley (Con)]

My Lords, the update is most welcome. I will say two things to my noble friend. First, as part of the update, would she be able to update us on outcomes, particularly one-year and five-year survival rates, which are what we most want to see moving consistently in the right direction? Secondly, my noble friend will recall that about eight years ago we in the coalition Government agreed a programme for investment in positron emission tomography—PET—scanners. One of the particular reasons we did so was that patients in this country through the NHS were not accessing a form of radiography that would be particularly relevant for those with brain cancer, because of the minimisation of collateral damage to tissue around the tumour site. What my noble friend was saying about the identification and targeting of tumours is true not just for surgery but for radiography. Can she update us also on the availability of PET scanners through the NHS?

[Baroness Blackwood of North Oxford]

I thank my noble friend for his question. He is absolutely right that we want to focus on outcomes. That begins with earlier diagnosis, shorter waiting times and access to treatment. However, when it comes down to it, we want to know that we have better survival rates. Cancer is a priority for the Government so that we can improve that, and the quality of care for patients. I am pleased to report to the House that survival rates are at a record high: since 2010, rates of survival from cancers have increased year on year. However, we know that there is more to do, and we will never have any measure of complacency about this. That is why in 2018 the Prime Minister rolled out a package of measures to see three-quarters of cancers detected at an early stage by 2028—the current figure is just over half. The plan is to radically overhaul screening programmes to provide new investments in state-of-the-art technologies to transform the process of diagnosis and boost R&D. My noble friend is absolutely right that one of the areas that we must focus on is ensuring that treatment has the lowest burden of side-effects possible. The proportion of cancer survivors living with long-term disabilities as a result of treatment is high, so having more targeted treatment is absolutely a priority within our cancer strategy. I will be delighted to write to my noble friend with a specific update on where we have got to with PET scanners.

Antimicrobial Resistance

Lord Lansley Excerpts

Thursday 2nd May 2019 Lords Chamber

Moved by

[Lord Lansley]

That this House takes note of Tackling Antimicrobial Resistance 2019-2024: the UK’s five-year national action plan.

[Lord Lansley (Con)]

My Lords, it is my privilege to move that the House takes note of this government publication. I am very grateful for the opportunity to secure this debate and, in my case, to return to the issue of antimicrobial resistance. I was fortunate enough to have a debate on this subject about three years ago, and indeed other noble Lords have also initiated debates on it. It is important that we do so. Today is a powerful illustration of where we can give ground to the climate change debate. However, there is more than one issue on which it is really important that we have these opportunities for debate, not least because they give us the chance, over a slightly longer period, to realise the complexity and multifaceted character of the challenges we face and the need for us to work intensively and consistently to deal with them.

I am grateful to noble Lords for participating in the debate. It is evident from conversations I have had and communications I have received that, for every one of us here, there are two or three more who would have liked to be here and to have contributed. I hope that future opportunities will offer themselves.

It is not in the custom of this House to say so but, if it had been down to me, I would have been “taking note with approval” of the Government’s national action plan. I say that very straightforwardly. My purpose is not to criticise the national action plan but to commend the initial five-year plan and the refresh published in January. The timeliness of this debate was further illustrated by the fact that on Monday the United Nations Interagency Coordination Group on Antimicrobial Resistance reported to the Secretary-General with a document that said:

“Unless the world acts urgently, antimicrobial resistance will have disastrous impact within a generation”.


In many debates we have understood the scale of the threat that we face. Indeed, when I was in the coalition Government, we included, for the first time, AMR as one of the top-tier risks in the national risk assessment and we understood its character. I was proud of the fact that shortly after I ceased to be Secretary of State—although none the less the work had begun—we saw the publication of the first five-year action plan, which ran from 2013 to 2018.

An illustration of the nature of the problem we face is that UK data—the Minister may refer to some of it later—clearly shows that there has been a significant reduction in antibiotic prescribing for animals and there is clearly some reduction in the extent of drug-resistant infections that animals for food production are harbouring. In human health, there has been something like a 6% reduction over five years in the prescribing of antibiotics, which compares with about a 6% increase in the preceding five years. None the less, the burden of infection and antibiotic-resistant infections among the human population in the United Kingdom is not going down. It is at best stable and some specific drug-resistant pathogens are increasing.

That tells us—it is something that I think we all know—that we are dealing not with a static problem but with a dynamic threat. The problem is that bacteria are rapidly evolving and adaptable, and the number of drug-resistant pathogens will rapidly increase. They have the capacity to swap DNA, so they will be able to acquire resistance to new antibacterial agents. We are also seeing the emergence of some drug-resistant pathogens; they are resistant to a number of antibiotics. Indeed, I noted that about three and a half years ago America was particularly worried about the presence of a pan-resistant infection. I think it was resistant to about 21 different antibiotics. Therefore, it is not simply a case of increasingly having to combine antibiotics and other treatments to deal with these drug-resistant infections; we have to try to ensure that we reduce the threat.

The UN document, published on Monday, also said:

“The challenges of antimicrobial resistance are complex and multifaceted, but they are not insurmountable”.


That goes to the heart of this debate. From looking at the list of speakers, I know that this afternoon we will understand that there is a range of approaches, all of which have to be pursued. I do not for a minute say that the issues I propose to focus on are more important than others on which we have to work. Antimicrobes in the environment and so on are very important but I do not propose to dwell on them. None the less, it demonstrates that the original national action plan published in the United Kingdom and the international work that has been done have focused on a one-health approach. However, it is terrifically important that we understand that we have to work across the environment, animal health and human health to make progress. The joint publication by the Secretary of State for Health and Social Care and the Secretary of State for Environment, Food and Rural Affairs demonstrates the Government’s commitment to working on a “one health” basis.

I will focus on one sentence from page 74 of the Government’s January report, which relates to the development of new therapeutics. The report says that one of the Government’s objectives is the development of “alternative strategies” to try to ensure that we can bring forward new therapeutics to deal with and combat antibiotic resistance. Part of that means that we therefore need to understand how we can develop new therapeutic agents. Part of that is academic research; it is not just about therapies, but diagnostics—I think in the last debate the noble Lord, Lord Rees, instanced the Longitude Prize which Nesta was pursuing. That continues, four years later, with the objective of delivering additional diagnostics. Prizes for academic research seem to be stimulating a range of teams to try to respond. Not only do we have to promote and fund academic research but pull the fruits of that initial academic work through to therapeutic agents we can deploy in practice for human health.

We seem to be going backwards on this. I think three major pharmaceutical companies have ceased their antibiotic research activity in the last 18 months—including Novartis, which is notable given its scale and reputation. In America a start-up company was developing a therapy that was given FDA approval in July 2018 for the use of plazomicin in complex urinary tract infections. This company filed for bankruptcy in early April. Over the course of last year, it secured no more than about $1 million of business. What is happening here? A new drug is approved for use and there is no revenue to support it. This is exactly the problem for antibiotics. Novel antibiotics such as these get a relatively narrow indication for use, because antibiotics are not broad-spectrum—they are very targeted. Also, as they come into use, they are pretty much a last-line therapy for use in rare circumstances, so they do not get bought very much. This company, like many pharmaceutical companies starting out, could be supported across the so-called valley of death by the funding support of CARB-X, only to find that there is a desert. There is no funding to make this happen.

That is where the Government in this country are looking to develop a new business model that helps bring through those new therapies, but that is a way off. A project team is being established and it will probably be something like another 18 months beyond that before we see what this business model may look like. We need more urgency. We need to think about what this model looks like, and at least put preparations in place, even if we have to add data and specifics to it as the work goes along.

The noble Lord, Lord O’Neill of Gatley, published a seminal review and report on this. First, he said that we want play and pay. That is, those in the pharmaceutical industry should be either engaging in this research—that is, playing—or paying. Frankly, I do not think that will work. It will just be treated as a tax on the pharmaceutical industry. He now seems to have said that he is rather giving up on this and that therefore the Government should take it over. I am afraid there is no evidence to support the proposition that Governments are better at innovation than the private sector. We need to combine in public and private partnerships. In that context, we need, as I think the Government intend, to recognise that this is about giving those bringing forward new therapeutics the confidence that they will be paid for. From the Government’s point of view, that has to be a proportionate and reasonable amount, and it has to be attractive.

The UK represents 3% of the global drugs market. We will not be able to do this on our own. That is why I return to the point in the Government’s national action plan that we have to work internationally—not just as the Government do with the Fleming Fund, promoting national action plans and better prescribing globally, which is absolutely right and very valuable, but through the richest countries coming together. They have to establish, effectively, a global fund. We have a global fund for HIV/AIDS and tuberculosis at the moment; perhaps they could enhance and add to that— it would be a substantial enhancement—to pull through the new therapies that will enable us to combat antibiotics.

That will require action from America, Japan and ourselves. I should declare an interest as chair of the UK-Japan 21st Century Group, and I particularly mention Japan because it has the presidency of the G20. In Osaka at the end of June, for the first time Health and Finance Ministers will meet together shortly before the Heads of Government do. Health and finance should be talking together, because in so many contexts the economy and the health of the nation fundamentally depend on each other. That is a moment. I know my counterpart in Japan—who, as it happens, is a former Japanese Health Minister—and his colleagues would be very interested in working together through the G20 in Osaka to launch an initiative that would enable us to deliver on a major programme for issuing prizes for research and determining the price that will enable us to pull through new therapeutics for the future.

With apologies for the many other issues that need to be covered—I know that many noble Lords will want to raise them—I will focus on that one. I hope the Government will use the global leadership that the United Kingdom has already demonstrated, not least with the marvellous work done by Professor Dame Sally Davies, who is due to retire in the autumn—knowing her, I do not think she will be letting go of this at all. We will welcome her to Cambridge in the autumn, but I suspect that she will continue to travel the world pushing this issue forward. We have the research, the capacity, some of the resources and the ability to take a lead internationally to bring new therapeutics and diagnostics through to the marketplace, and demonstrate that we can stem the tide of antibiotic resistance. I beg to move.

--- Later in debate ---

[Baroness Thornton (Lab)]

My Lords, this has been a fascinating debate and revealed again the depth and breadth of the knowledge and passion your Lordships’ House has on this issue. I thank the noble Lord, Lord Lansley, for initiating the debate and the Library and many other organisations for their helpful briefings. I feel I should declare that I am a member of a CCG. I say that because it is rare to see a subject that is the victim of as many acronyms as the NHS, but this field certainly challenges that, combining as it does health, farming and the environment, the research and science communities, pharma businesses and international organisations. I was very grateful for the list of acronyms at the front of the Government’s five-year paper.

As noble Lords have said, we know that AMR currently results in 700,000 deaths globally every year, that by 2050 that could be 10 million, and that it threatens to turn back the clock on a century of medicine, rendering modern surgery, organ transplantation and chemotherapy too dangerous to use. Preventive treatment is needed, as the report says, to curb the spread of bacterial diseases requiring antibiotics. As the noble Baroness, Lady Walmsley, said, vaccines are the most effective preventive health tool in human history. We therefore need to expand the use of existing vaccines to have a better impact.

One of the most serious issues in the fight against AMR, which almost every noble Lord mentioned, is that no new class of antibiotics has been introduced for more than 30 years. Antibiotics are quite unlike any other category of drug, because every dose of antibiotics poses the risk of encouraging bacteria to adapt and develop resistance. That was illustrated by the noble Baroness, Lady Masham, in her description of the fight she has been having, which we have discussed on several occasions over the past year.

The Government’s five-year action plan is indeed an impressive document and a step along the road. I join the noble Lord, Lord Lansley, in saying that we may not be moving as quickly as we should. That has been echoed across the Chamber. Of course, it is not the complete solution, and serious questions have been asked in the debate. I join the noble Baroness, Lady Miller of Chilthorne Domer, in saying that the plan is disappointing in that it fails to give a clear commitment to incorporate into domestic law the European Union’s recently agreed legislation that bans routine preventive use of antimicrobials. It is a pertinent question at this point. Article 107.1 provides:

“Antimicrobial medicinal products shall not be applied routinely nor used to compensate for poor hygiene, inadequate animal husbandry or lack of care or to compensate for poor farm management”.


That is not being incorporated into UK law, as far as we can tell. I agree with the noble Baroness that the answers given to questions in the Commons were ambiguous, to put it mildly. Perhaps the Minister could take this opportunity to clarify the issue.

When I discussed the five-year plan with my noble friend Lord Winston, who regrets that he cannot join us this afternoon, he said two things to me. The first was that meeting this challenge will be well-nigh impossible given the dearth of lab, technical and science staff in the NHS at this moment. Secondly, he said that investment in research needs to be much greater and the follow-through more effective. My noble friend would have put those points more eloquently and, probably, more forcefully than I have, but neither of those issues is new; they have been articulated in your Lordships’ House over a long period.

Part of the NHS long-term plan talks about the delivery of the five-year plan we are discussing today. Will the staffing review address technical staff, of which there is a terrible shortage? They are essential for the delivery of both the NHS long-term plan and this plan. We know that the issue of research is not just about funding to deliver ground-breaking research. The UK does a great job in training PhD students, but loses a lot of talented people because the post-doctoral period is so unstable. We need continued support for interdisciplinary networks to strengthen research and develop capacity. Does the strategy address that issue as robustly as the emergency that we are facing requires?

Many noble Lords mentioned market failure, which the noble Lord, Lord Lansley, dwelled on in his opening remarks. According to Professor Dame Sally Davies, the reason for that is in part that the easy wins have been made and there is now a fundamental failure of the market for new antibiotics. Given the growing threat of AMR and the need to conserve and use current and future antibiotics carefully to preserve their effectiveness for as long as possible, it is clear that pharmaceutical companies are aware that any new antibiotic they bring to market will be prescribed only very sparingly rather than as a first-line treatment during its patent life, thereby reducing its profitability. I found that idea very dispiriting because it seems that we must address market failure. The report of the noble Lord, Lord O’Neill of Gatley, also recognised and addressed this issue.

That is even more discouraging when one realises that, over the past five years, we have seen pharmaceutical companies withdraw further and further from the development of antibiotics. In June last year, the latest company, Novartis, exited the market, bringing the total number of companies involved in antimicrobial drug development to six. The issues of market failure and disinvestment are incredibly important; therefore, the Government’s scheme to delink the price paid for antimicrobials from the volume sold is also crucial.

Even more depressingly, Professor Dame Sally Davies argued that the industry needed to step up and act in a socially responsible way, pointing out that tackling AMR was also in its interest. In her evidence to the Commons Select Committee, whose report I found extremely useful, she said:

“I am disappointed by the number of them”—


pharmaceutical companies—

“who have said quietly over a drink, ‘Well, Sally, we know you’re going to solve this. The Government will have to pay, so we’re waiting until you pay’”.

Where is the social responsibility? What terrible short-sightedness. To go back to the point about losing modern medicine, what is the point of developing the world’s greatest cancer portfolio if there are no antibiotics to rescue the patients? Yet industry expects us in government and the public sector to fund this, or that it will happen through somebody else being corporately responsible.

This market failure might lead to catastrophic consequences, as referred to on pages 74 and 76 of the five-year plan. It rightly states:

“The UK cannot solve such market failures alone”.


I question that because I should not like to think that the idea that we cannot solve this alone because we are 3% of the world market means that we do not try to do things in this country to turn this round. Our NHS has huge purchasing power: it pays billions of pounds to pharma, which makes billions in profit from these sales, for the drugs and treatments we need. We must have some leverage here. I ask the Minister: if a UK university or small pharma company found a new antibiotic, surely our Government would find a way to make sure that it was developed and brought to market. They would not wait for this to happen on the world stage, would they? I really want to hear that we will not have a repeat in the UK of the situation described in the MRC report, as referred to by the noble Lord, Lord Lansley. I received that report; the story of Achaogen was a graphic one of market failure in developing a new antibiotic. However, the noble Lord did not ask something that I wish to ask: what will happen to that drug? Achaogen developed a drug that can treat the most serious superbugs; therefore, it is not much needed so the company did not make enough money and went bankrupt. Where has that drug gone? What has happened to it? That is an important question.

[Lord Lansley]

As I understand it, the company is up for sale so, effectively, people would buy the patent and the drug.

[Baroness Thornton]

Let us hope that the people who buy it are public-spirited enough to know that they need to develop it and that that can be done. That puzzled me when I read the fascinating article, which I recommend to noble Lords. I thought, “A new antibiotic is out there and it is not available to us, for goodness’ sake”.

I congratulate the Government on the five-year plan. It is important, however, that the impetus behind it works, that the incentivisation schemes unlock investment in AMR, that we do not face the same issues being faced in America, and that implementation of the plan is speeded up.

--- Later in debate ---

[Lord Lansley]

My Lords, I thank the Minister for her excellent response to a really good debate. I am very grateful. I said at the outset that I hoped that the debate would bring forward a range of expert views relating to the “one health” concept, and it did exactly that. I am most grateful to all those who contributed to enable that to happen. The debate demonstrated the complex and multifaceted character of the problem. I share the Minister’s hope that it is indeed surmountable.

I shall say just a couple of things. First, on growth promotion and trade, the issue is that only now are some countries beginning to recognise that they have to stop antibiotic use in growth promotion and its widespread prophylactic use in animals. That happened in Europe in 2006, but it happened in 2017 in America for growth promotion and only now are the Indian Government bringing forward proposals in this respect. There is an international aspect that we need to work on.

My final point is that I entirely understand what the noble Baroness, Lady Thornton, said. The point of the national action plan is to be the best in the world—the best in class—and to demonstrate what can be achieved. If we can achieve those targets, it will be fantastic, but it has to happen elsewhere. Not only turning a national action plan into its equivalent in other countries but creating international global action, which was the burden of my contribution, will be central to a more effective response overall, which we all want.

Motion agreed.

House adjourned at 4.37 pm.