Grenfell Tower: Toxins

Debate between Lord O'Shaughnessy and Countess of Mar

Monday 15th October 2018 Lords Chamber

[Lord O'Shaughnessy]

The Government are of course very concerned about all the consequences for mental and physical health that may result from the Grenfell fire. As the noble Lord will know, there has been a huge concerted effort to try to ameliorate those.

The noble Lord asked about environmental monitoring. Since summer 2017, monitoring has been ongoing, with weekly reports published by the London Air Quality Network, which is operated by King’s College London and is, therefore, at arm’s length from government. The reports provide information on the levels of particulates, asbestos and other contaminants in the air. The London Air Quality Network has found no evidence that the levels are above average for London, but monitoring continues. Public Health England is in discussions with the local authority and the local NHS trust to make sure that any signs of public health threats, from whichever area they emerge, are looked into seriously. However, we have not yet had those findings from the professor, and Public Health England is very keen to see that information as soon as possible.

[The Countess of Mar (CB)]

My Lords, the concentration has been on the chemical effects of the tower cladding. Does the Minister appreciate that thousands—and I mean thousands—of chemicals are involved in furniture and furnishings being burned? While the air may be clear, I understand that the soil has been contaminated, and it is not just by inhalation that people can be poisoned but also by skin absorption. Will the Minister please ensure that GPs and others treating people from this area are closely monitored? It is not necessary for them to have blood tests but, if their health deteriorates, as much as possible must be done to help them.

[Lord O'Shaughnessy]

I completely agree with the noble Countess that toxins can be found in different media, soil and air being two of those. That is why Public Health England is keen to see the results from Professor Stec’s work. She has said that it is not yet finished, and we need to see its outcomes. It is one of many pieces of work going on to make sure that, if there are any concerns about the near environment, they are spotted and dealt with before they turn into public health threats.

Brexit: Food Standards Regulations

Debate between Lord O'Shaughnessy and Countess of Mar

Tuesday 4th September 2018 Lords Chamber

[Lord O'Shaughnessy]

I should like to clarify that, in the case of food safety, Ministers in the Department of Health would make risk management decisions on the basis of a risk assessment. This is one way in which any concerns about conflict of interest would be overcome. Clearly, we will be making technical changes to the role of the FSA to make sure that the regime is operable following our exit from the European Union. These will reaffirm the FSA’s independence and its role in providing that consumer protection.

[The Countess of Mar (CB)]

Will the noble Lord assure the House that there will be sufficient funding for the Food Standards Agency and for local authority environmental health officers—who act as its agents—to check that the law is being observed and, where it is not, to enforce it?

[Lord O'Shaughnessy]

I can tell the noble Baroness that we will do everything necessary to make sure we maintain the same high standards of protection that we have now.

Brexit: Food Standards Agency

Debate between Lord O'Shaughnessy and Countess of Mar

Thursday 26th April 2018 Lords Chamber

[Lord O’Shaughnessy]

The Food Standards Agency has the resources, the expertise and the powers it needs to make sure that it can guarantee safety, as the noble Baroness has described.

[The Countess of Mar (CB)]

My Lords, the Food Standards Agency is very reliant on local environmental health officers for enforcement. In the light of the poverty of local authorities and the cutting back in the number of environmental health officers, are the Government sure that enforcement can take place as it should?

[Lord O’Shaughnessy]

In preparing for the Question today, I looked at local authority spending on enforcement. It is stable at around £140 million a year and has been for a number of years, so local authorities are continuing to prioritise this, as indeed is their responsibility. We want to make sure that we bring new forms of assessment into the food standards regime so that we have an even more robust picture of the risks that are involved in food production.

National Child Obesity Strategy

Debate between Lord O'Shaughnessy and Countess of Mar

Monday 26th February 2018 Lords Chamber

[Lord O’Shaughnessy]

Health inequalities and their reduction are a core part of it and in talking about them I would focus, to pick one example, on breakfast clubs. We know that having a good-quality breakfast—indeed, having any breakfast as some children go without it, which causes problems, too—is important. About £26 million is being spent on extra breakfast clubs in 1,500 schools in opportunity areas and disadvantaged areas.

[The Countess of Mar (CB)]

My Lords, does the Minister consider that there is an elephant in the room? There are thousands of endocrine-disrupting chemicals that children and young people have been exposed to since they were in the womb. Nobody seems to be looking at the effects of endocrine disruptors on appetite and obesity.

[Lord O’Shaughnessy]

I must confess that I am not completely aware of the specific issue which the noble Countess talks about. I think I will have to write to her. It may be something that our obesity research unit can have a look at.

Medicines and Medical Devices Safety Review

Debate between Lord O'Shaughnessy and Countess of Mar

Thursday 22nd February 2018 Lords Chamber

[Lord O’Shaughnessy]

I thank my noble friend for those points; she highlights some very important issues. Medical devices are regulated differently from medicines: they have to go through a safety procedure and they are not licensed in the same way as medicines are. They come onto the market, they are used and safety assessments are made as time goes on. We are now in the position with mesh that we will have a registry, so that every time it is used we will know what the consequences are. That will also give us a comparator, as will the audit, for effectiveness against alternative procedures. As I have said, there is still a view in the medical and regulatory communities that, when used according to guidelines in the appropriate way, it can be transformative for women. However, it can also be the wrong thing and NICE has been very clear that in some cases, in some surgeries, the risks outweigh the benefits, in which case it should not be used. It is important that there is absolute conformity with those guidelines and that is part of what the registry will ensure.

On the issue of trade, under no circumstances will our trade relationships with any country in the future dilute the regulatory rigour that we apply and have always applied in this country. We have a very well regarded regulatory system in this country but we also know that we can do better and it is absolutely our intention to continue to strengthen it.

[The Countess of Mar (CB)]

My Lords, I am very grateful to the Minister for repeating the Statement but I put on the record my severe reservations about the safety of HPV vaccines. The noble Lord knows of my concern. I have had meetings with the MHRA but it seems to think that mañana is quite rapid enough to be dealing with it. The situation he described for those patients dealt with in the Statement is exactly the same as that of young girls and their families who have suffered bad reactions to HPV vaccines. Will the Minister ensure that the MHRA deals with some rapidity on this matter, as at the beginning of the Statement?

[Lord O'Shaughnessy]

I thank the noble Countess for raising that point. We have met to discuss this issue and she has been a great campaigner on medicine safety issues. That dialogue is going on. As she knows, that view concerning the safety is not currently shared by the regulators. But I want to stress that the work that my noble friend Lady Cumberlege will be leading will try to set up a process which deals equitably, objectively and compassionately with these concerns when they arise. One of the problems in the past has been, frankly, that we have not dealt with these things in the same way. It is dependent on the strength of the lobby group, the type and strength of the Government and what is on their agenda at any one time. That is not good enough. We need a consistent and compassionate approach to listening to concerns, scrutinising them properly and dealing with the consequences, which may entail no further action or could be anything up to a full public inquiry. That is what my noble friend will be dealing with and that will be a huge step forward. It will be precisely that kind of process to which any concerns about HPV or anything else should be directed.

Children: Oral Health

Debate between Lord O'Shaughnessy and Countess of Mar

Monday 4th December 2017 Lords Chamber

[Lord O'Shaughnessy]

I do not have that exact comparison in front of me. I understand that areas that fluoridate have much better oral health than others, which is why, as I said to my noble friend, we encourage all local areas to look at the evidence and make decisions accordingly.

[The Countess of Mar (CB)]

My Lords, does the Minister realise that, in order to get children to be seen by a dentist, their parents have to take them, and many parents are not happy themselves about going to the dentist? How can that be overcome?

[Lord O'Shaughnessy]

Probably not by giving out lollies to say well done for coming. The noble Countess makes an important point, but some 7 million under-18s were seen by a dentist in the last year for which data is available, which is an increase on previous years, so I think that things are improving.

Veterans: Mental Health

Debate between Lord O'Shaughnessy and Countess of Mar

Tuesday 7th November 2017 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health (Lord O'Shaughnessy) (Con)]

My Lords, the majority of those serving in the Armed Forces have a positive experience, but it is our duty to make sure that veterans with physical or mental injuries continue to receive the best possible care. The Good Psychiatric Practice report from the Royal College of Psychiatrists states that clinicians must,

“be competent in obtaining a full and relevant history that incorporates developmental, psychological, social, cultural and physical factors”.

Veterans, like all other patients, should be diagnosed in that way.

[The Countess of Mar (CB)]

My Lords, I am grateful to the Minister for that reply, but there is a very serious problem. I think particularly of the antimalarial Lariam, which is issued to members of the military without the normal warnings you get when given a drug. In some cases there are recognised psychotic results. Unfortunately, when these men become veterans they are referred to their GPs, who often have very little knowledge about the drug or its effects and who may well treat the patient for PTSD. Does the Minister recognise that there is a severe danger of these men being given drugs that will increase their psychosis and cause them to end up in prison?

[Lord O'Shaughnessy]

I reiterate the point I made in my Answer: NICE guidance on the treatment of post-traumatic stress disorder is clear that clinicians should take into account a range of factors when seeking to make a diagnosis. That should include the patient’s detailed case history, including medicines taken and under what circumstances. Regardless of whether the person is treated while serving or afterwards, that should be on their patient record, be accessible for anyone giving them direct care, and influence any prescriptions of treatments given. I also point out to the noble Countess that veterans’ issues are now in the training curriculum for all GPs. That came out of the Armed Forces covenant.

Mental Health Services: Children and Adolescents

Debate between Lord O'Shaughnessy and Countess of Mar

Monday 17th July 2017 Lords Chamber

[Lord O'Shaughnessy]

The transition from CAMHS is now one of the mandatory national indicators in what is called the Commissioning for Quality and Innovation scheme which provides incentives for performance, so I can reassure the noble Baroness on that. She is also quite right to highlight the issue of severity. That is why, under the plans that we have set out for CAMHS, by 2021 the service will be able to see 70,000 additional children per year for evidence-based treatment.

[The Countess of Mar (CB)]

My Lords, I declare my interest as the chairman of Forward-ME and a patron of the Young ME Sufferers Trust. Many young people with ME are believed to have a mental illness, and despite what the noble Lord said two weeks ago and what other Ministers have said—that ME is not a mental condition—how do we persuade professionals that these children would probably be much better off if they were left to allow their bodies to heal themselves rather than having cognitive behaviour therapy and graded exercise imposed upon them?

[Lord O'Shaughnessy]

I know that the noble Countess feels passionately about this issue, but she will know that it is only right for me to say that we need to be guided by evidence that is collected in clinical reviews. A review is being carried out by NICE at the moment and we shall wait to see the results of that before deciding what needs to happen as a consequence in terms of the kinds of treatments that are appropriate for those suffering from ME.

Health: Medically Unexplained Symptoms

Debate between Lord O'Shaughnessy and Countess of Mar

Tuesday 4th July 2017 Lords Chamber

[The Countess of Mar]

To ask Her Majesty’s Government who is responsible for ensuring the implementation by Clinical Commissioning Groups and hospital providers of the Guidance for commissioners of services for people with medically unexplained symptoms, published by the Joint Commissioning Panel for Mental Health.

[The Parliamentary Under-Secretary of State, Department of Health (Lord O'Shaughnessy) (Con)]

My Lords, the Joint Commissioning Panel for Mental Health is not a government body and implementation of the guidance that it published is not mandatory. Regarding the classification of chronic fatigue syndrome and myalgic encephalomyelitis, or CFS/ME, the Government accept the World Health Organization’s classification of the illness as a neurological condition of unknown origin.

[The Countess of Mar (CB)]

My Lords, I am grateful to the Minister, although I am disappointed that we cannot pin anyone’s foot to the floor on this. There is no definition of medically unexplained illnesses in the paper mentioned in my Question, but in interpreting it, hospitals and other providers have somehow made CFS/ME a medically unexplained symptom and have recommended graded exercise and cognitive behavioural therapy as treatments. Graded exercise in many cases is known to make people sicker and to damage them, the scientific reasons for which are also known. Cognitive behavioural therapy has been shown to work for only about six months. The PACE trial which recommended cognitive behavioural therapy and graded exercise is now discredited, and NICE is reviewing its guidelines on it. Who is responsible for worsening the condition of patients who are advised or coerced into taking cognitive behavioural therapy and graded exercise?

[Lord O'Shaughnessy]

I congratulate the noble Countess on the important work that she does through Forward-ME on behalf of the illness’s sufferers. On who takes responsibility for the care of those suffering from CFS/ME, it is of course clinicians. They work to evidence of best practice, which is guided by NICE. She alluded to the fact that the NICE guidelines are being reviewed to make sure that we have the best possible understanding of what is effective in the treatment of the illness, but I reiterate to her the point that the Government’s acceptance of the WHO classification of it as a neurological disease has not changed.

NHS: Sustainability and Transformation Plans

Debate between Lord O'Shaughnessy and Countess of Mar

Monday 20th March 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is right to point out that the four-hour target is critical for the NHS and it is committed to making sure that that target is hit. Some A&E closures have been mooted but only seven areas, according to the Health Service Journal, have clear proposals, and that is before there has been any public engagement and any application of the reconfiguration test. I point the noble Baroness to the comments of Simon Stevens about the importance of demonstrating alternative provision and that it cannot be a case of closing beds without that being in place.

[The Countess of Mar (CB)]

My Lords, I ask the Minister not to forget people living in rural communities, who are already disadvantaged regarding social care because their carers are not paid for their travelling. If hospitals are to close it will mean that they and their relations will have to travel further. It is therefore important, first, that they do not have to go into hospital unless it is absolutely necessary and, secondly, that they have the right sort of care.

[Lord O'Shaughnessy]

The noble Countess is right. Additional funding in the Budget will mean that local authorities and the NHS have more resources to account for things such as travel costs and unit care costs for care workers. Some of the STPs are dealing with urban areas and some with more rural areas. All the plans within those configurations have to take account of public engagement. As I have said, there cannot be changes without meeting the reconfiguration tests that we have set out, which must account for local circumstances.