Future Immigration

Lord Patel Excerpts

Wednesday 19th December 2018 Lords Chamber

[Baroness Williams of Trafford]

As I say, this is purely the beginning of a journey, which is the consultation process. These measures will not come in until 2021. Of course, we will be working with the construction sector and others towards the implementation of the immigration system.

[Lord Patel (CB)]

My Lords, I welcome the Statement saying that international graduates will be allowed to work in this country, but it is disappointing that it does not say whether or not there will be a cap on how long they can be employed. Perhaps we will hear about that later. I am encouraged by the Minister saying that the minimum salary level of £30,000 is for consultation. I hope that the Government will listen to the consultation and not ignore it. I say this because, like the construction industry, the professional organisations in science research, such as the Royal Society, the Wellcome Trust, Cancer Research UK, the MRC and many others, have grave concerns about our ability to recruit technicians—who do not earn £30,000. They are crucial to research. The same applies to PhD students and post-docs, who are the workhorses of biomedical research. If this is implemented, our science research will be absolutely devastated.

[Baroness Williams of Trafford]

I totally get the point that the noble Lord makes about technicians, particularly in research and science, because they are traditionally paid a lower salary. We will work through all this in the next year in getting towards the final suggestion for the salary level which, as I said earlier, is a suggestion from the MAC and not an intention from the Government at this stage. Regarding graduate students, if an undergraduate secures a graduate job the salary will of course be lower. At the moment, I think it is about £20,600. That remains the case but I hope that in the course of the consultation next year it will all be worked through. Please do not take it as a figure set in stone, my Lords.

Security and Policing: Facial Recognition Technology

Lord Patel Excerpts

Thursday 1st March 2018 Lords Chamber

[Lord Patel (CB)]

My Lords, I thank the noble Baroness, Lady Jones of Moulsecoomb, for initiating this debate. Your Lordships may wonder why I am speaking in it. It is true that my interest in facial recognition is more linked to medicine in identification and progression of disease, but that is not why I am speaking today. I am speaking because of another interest, which is that my university, the University of Dundee, has a strong forensic science department, analysing all aspects of biometrics for both crime detection and human identification. I am also chairman of the Science and Technology Committee of your Lordships’ House, which conducted a brief seminar on the use of forensic science in the detection of crime and elsewhere, and may well conduct a more detailed inquiry on the subject.

Facial recognition comes under the purview of the Forensic Science Regulator, which is not a statutory authority, but also the Biometrics Commissioner and the CCTV commissioner. Research in this area is therefore very police-needs driven, and a commercial element has therefore crept into software provision. Three areas of work have lately raised questions about facial recognition. The first relates to so-called super-recognisers. This concerns research out of Greenwich, and although there is strong evidence to suggest that some people are indeed better at recognising faces than others, there is some evidence that they are not the golden bullet that everyone hoped for.

A second issue concerns the ethics associated with retention of images when the person has either been released without charge or been found innocent of charges. Facial images are taken routinely in custody, and at present, as has been mentioned, there is no mandate for them to be deleted from the police national computer. This may come in due course, but the suggestion that someone may have to apply to have their images deleted cannot be satisfactory.

The third is linked, and is about using faces of known persons of interest when scanning crowds to find those individuals. As has been mentioned, this was employed at the Notting Hill Carnival and more recently at one of the 6 Nations rugby matches. The police state that widespread awareness notices are used in such places, that they check only against faces that they are looking for, and that no others are stored. This is an issue of questionable ethics and is currently under discussion, with the issue of covert versus overt collection of faces highly relevant.

We need to: define clear legal roles for collection of data; limit the type and amount of data stored and retained; limit storage to only one biometric in a single database, not all biometric data; define clear rules for the storing and sharing of data; impose strict security procedures to prevent improper access and data compromise; use mandatory notice procedures when technology such as I mentioned is used at Notting Hill and on other crowds—clear notices that the technology is being used—and define and standardise audit trail accountability and independent oversight of the use of data. I hope that the Minister will comment on that.

Zika Virus

Lord Patel Excerpts

Tuesday 2nd February 2016 Lords Chamber

[Lord Patel (CB)]

My Lords, the virus, having been found in 1947 with low infectivity to humans, has now gradually spread to larger populations. Three things are important. The first is surveillance: what surveillance measures need to be undertaken to identify where the disease is spreading? The second is vector control. It is a daytime mosquito, so insecticides and self-protection are important. However, in the long term, the vector itself must be controlled and this is where Britain has an important role to play. While vaccines will take a long time to develop, modern techniques of gene editing and gene modification of insects are the way forward. Britain leads the world in this science and Brazil is the next country that has expertise in it. The two countries can work together to produce, in a very short time, modification of these mosquitos so that the incidence of the disease is reduced. Will the Ross fund be used to help our scientists do this?

[Baroness Verma]

My Lords, as I have said, the Ross fund will be used for research and development. On the noble Lord’s point about doing research with Brazil, only last week the UK announced a £400,000 Newton fund Zika research project between Glasgow University and Fiocruz in Brazil, which is in the hotspot area of the outbreak.

Neglected Tropical Diseases

Lord Patel Excerpts

Monday 1st February 2016 Lords Chamber

[Lord Patel (CB)]

My Lords, I am going to concentrate mainly on strategies to develop treatment for neglected tropical diseases. I am a doctor by background, as everyone knows. I was born in Tanzania and I visit there often in relation to charity. Last year, I was bitten extensively by the flies that carry sleeping sickness and every time I doze off I wonder if I caught it, so I am concerned about finding treatments.

Effective control against NTDs can be achieved if several public health approaches are combined, guided by local epidemiology and the availability of appropriate detection, prevention and control measures. Due to the nature of many of the parasites that cause NTDs, it has proved very difficult or impossible to develop vaccines that are suitable for mass administration. Other approaches are therefore required, and we are familiar with them, including: vector control, such as spraying to kill insects; strategies to reduce contact with insect vectors, such as bed nets; improved hygiene, housing and new drugs; and, more recently, as the House of Lords Science and Technology Committee report suggests, the genetic modification of insects, and today’s news about gene editing, which can also apply to insects.

To reduce the burden of NTDs using drugs, we must address three main urgent issues. First, many current drugs to treat NTDs are extremely toxic and difficult to administer. Secondly, many drugs now simply do not work because parasites have become resistant, for a variety of reasons. Thirdly, disease diagnosis remains challenging. Additionally, the development of new treatments for NTDs is hampered by a historic lack of systemic drug discovery, due to the lack of a commercially viable market for drugs and insufficient understanding of parasite biology, resulting in a lack of validated drug targets—that is, good approaches to develop drugs.

Three years ago my university, the University of Dundee, made a commitment that by 2020 it would try to find cures for some of these diseases. To tackle those issues, the university has combined renowned scientists with expertise in NTDs with professional drug discovery within its drug discovery unit, mainly recruited from pharmaceutical industry and led by Professor Paul Wyatt. I declare an interest: not only have I been an associate of the university since I went there as a medical student, but I am now chancellor of the university. With support from organisations like the Wellcome Trust and the Gates Foundation, Dundee has been making good progress across the areas. A new and exciting antimalarial compound has recently been developed, with the potential not only to cure but to prevent and block the transmission of malaria with a single dose, and it is now going to clinical trials.

These are some examples, but the main thing is that, with support from the Gates Foundation, the university has made available a set of 70,000 compounds to initiate new drug discovery programmes for multiple NTDs. The new team is using cutting-edge technologies to determine the mechanisms by which drugs kill parasites. I hope that such strategies will lead to finding cures for many of the NTDs. To quote Richard Horton, editor-in-chief of the Lancet, in praising Dundee University’s effort:

“Something very special is taking place in Dundee … a drug discovery unit for parasitology … has torn down disciplinary walls to put chemists next to biologists, industry scientists beside academics. The result is a portfolio of promising new medicines for malaria”.

I hope that the Ross Fund will be used to fund clinical trials when the time comes, because there will be no other way of doing so.

Sierra Leone

Lord Patel Excerpts

Monday 29th June 2015 Lords Chamber

[Lord Patel (CB)]

My Lords, I thank the noble Baroness, Lady Hayman, for securing this debate. She has already said much of what I might have said, so I will deviate from what I was going to say and pick up some of her points and hope to enlarge on them.

One lesson we must learn from the Ebola crisis is that whatever we did in the past to support poor countries to build their health systems and their societies has not worked, otherwise this would not have happened. I repeat the noble Lady’s commendation of the volunteers who went from this country and others, at great risk to their own health, when the death rate from this infection was 90%. They took that risk and they need to be commended on it. Mostly, they were young people.

The noble Lady also mentioned the WHO response, which was initially poor. It did not have enough experts on the ground to do the necessary surveillance. It was slow in declaring an international emergency. It may have been preoccupied with the damage that the crisis might do to the economies of these countries, rather than declaring an emergency, which would have protected citizens. Yes, the death toll could have been higher if it had not been for the international response, including the United Kingdom’s, which was immediate. None the less, the WHO failed in that, so the first thing we need to ask the Minister is, what are the Government now doing to work with the WHO and the expertise that we have in the United Kingdom and countries such as the USA to help the WHO build in future a more resilient system of surveillance?

The noble Lady’s next remarks were about the health system. The health system in that country, which was fragile to start with, has now collapsed. She referred to maternity services. The maternal mortality rate in Sierra Leone is 1,100 per 100,000. Last year 1,200 women died during childbirth. Neonatal mortality is 49 per 1,000. Under-5 infant deaths are running at 160 per 1,000. The maternal mortality rate has gone up by 20% due to the complete collapse of emergency obstetric services. She mentioned the Centre for Maternal and Newborn Health at Liverpool School of Tropical Medicine which is helping to build assistance and which needs to be supported. So does the Royal College of Paediatrics and Child Health, which is trying to build services and train doctors, who are now very few—200 health workers have died, some of them doctors, and others have left the country. We need to support these organisations.

Health systems are linked to the economy of the country. Sierra Leone spends $25 million on health and $32 million on education. It gives away 10 times the health budget in tax incentives to overseas companies, some of them British. These are dollars that it could use for building health and education systems, but it does not have it. Is it not perverse that while people die in these poor countries, companies from richer countries seek tax incentives? Should not part of our help in assisting Sierra Leone now to recover include some advice and assistance in the ability to use its own domestic resources, including help with tax policies, so that the country can have better financial resources to support its health system?

The noble Baroness referred to the fact that more deaths are now occurring because of the collapse in the health system due to tuberculosis, malaria and HIV/AIDS. Referrals to doctors and the health system have completely failed. Fewer than 20% of pregnant women now seek help during pregnancy or attend antenatal classes. If this is not stopped, maternal mortality will keep rising, as will stillbirths and neonatal deaths. I ask the Minister about our response to the WHO, our help in building health systems and our help in building the economy of Sierra Leone.

Developing World: Maternal and Neonatal Mortality

Lord Patel Excerpts

Thursday 15th January 2015 Lords Chamber

[Lord Patel (CB)]

My Lords, I join the noble Baroness, Lady Hayman, in the tribute that she paid to DfID for the work that it has done and continues to support in areas of reducing maternal and child mortality. I emphasise that in the hope that DfID will not now stop but put extra vigour in joining other partners in delivery until we achieve the goals.

As has already been said, the statistics—which will be cited by others—are horrendous. A woman giving life should neither die nor go through childbirth only to have the heartbreak of losing her child at birth or in infancy. The noble Baroness, Lady Hodgson, described her experiences, which I well understand. Yet for many mothers and their children this is a reality. Three hundred thousand women die every year during pregnancy. For children, the statistics are worse. There are 131 million births a year; of these, 6.3 million children die before the age of five. That is 17,000 deaths of children every day. One million babies are stillborn. Two million die in the first week of life, and for 1 million babies the day of their birth is the day of their death. While progress in reducing maternal and infant deaths has been significant over the past two decades, many millions continue to die, and 223 million children under five died between 1990 and 2013. Four out of five deaths of children aged under five occur in sub-Saharan Africa.

While the number of deaths of children under five has declined, the decline in the number of deaths around birth and in the first month of life is not so striking. Neonatal deaths now account for 44% of deaths of children under five. There has been no noticeable reduction in neonatal deaths. Some interventions focused on the 24 hours after birth hold great potential for reducing maternal and neonatal deaths. We know the causes of death and how to prevent them, but we have not succeeded in delivering health interventions widely and consistently throughout the world or in developing sustainable health systems.

Two-thirds of neonatal deaths occur in 10 countries, and 48%—nearly half—occur in four countries: India, China, Nigeria and Pakistan. Two-thirds occur in only two countries, India and Nigeria, and both of them are capable of developing health systems that would stop them, so what must we do to encourage them to strengthen their health systems?

The causes of neonatal deaths are pre-term births, complications at birth, infections and sepsis and congenital abnormalities. Basic, cost-effective care in the first hour after birth results in significant reductions in maternal and neonatal mortality. For example, breastfeeding in the first hour of life reduces deaths by 40%, yet only 50% of newborns are breastfed in the first hour of life, particularly in vulnerable parts of the world. Skilled attendants at birth and the use of a maternal and neonatal checklist which includes simple tasks, such as cord care, dramatically reduces neonatal mortality, yet 44% of women in some countries do not have skilled attendants, and even when there are attendants at birth, simple interventions are not delivered. For example, only 10% of babies delivered by skilled attendants received seven key neonatal interventions, so we must ask why, even when there are skilled attendants, they do not happen. Hence, we have developed a checklist for maternal and child health at the time of birth to try to make sure that those interventions, including breastfeeding, can be delivered.

The charity, SafeHands, of which I am a patron, as is the noble Baroness, Lady Kennedy of The Shaws, who is not in her place, tries to use education using visual media in rural villages in Ethiopia and other countries to deliver messages about the importance of basic care and attendants at birth, which can have dramatic effects.

What of the future? The world needs to fulfil the promise made to the children of this world in 2000. The MDG 4 target will not be met in 2015. At the current rate, it will not be met until 2026. We need a new commitment, not just the targets of 2015, even if we could meet them in 2026. We need a new commitment to children going beyond MDG 4 that by 2035 every country will see a neonatal death rate of 10 per 1,000 births and a stillbirth rate of 10 per 1,000 births. The challenge could be 20 by 2035, to mothers and their babies underpinned by helping to establish sustainable health systems.

The UK Government have done so much to advance these causes and lead the world. What commitment will they make beyond 2015 towards efforts to reduce maternal and childhood deaths?

Ebola

Lord Patel Excerpts

Thursday 8th January 2015 Lords Chamber

[Lord Patel (CB)]

My Lords, I, too, thank the noble Lord, Lord Fowler, for initiating this debate. I thank him also for his brilliant speech and for his great concern for those who volunteer to do this work. I associate myself with the comments that he made about Pauline Cafferkey and I wish her a speedy and complete recovery.

I want to speak on four issues as far as the lessons learnt are concerned. Could the crisis have been spotted earlier? Was the UK’s response timely and appropriate both in scale and support? What needs to happen to cope with future pandemics? Did the UK have appropriate safeguards for NHS and other volunteers who went to Sierra Leone, including on their return?

Peter Piot, in his book No Time to Lose, described the dramatic effects of Ebola infection since its outbreak in 1976 and warned us to be prepared. Previous outbreaks were controlled by prompt notification, deployment of specialist teams, quarantining of exposed individuals and isolation of patients, but the lessons were not learnt. The current outbreak started in Guinea at the end of 2013. Despite hundreds of deaths, neighbouring countries did not take any notice. Surveillance systems were not effective and warnings from organisations such as Médecins Sans Frontières were ignored. Official agencies were either complacent or did not have the resources or personnel in place to monitor the outbreak. Hundreds died. Worse, in countries where health workers were in poor supply, several hundred health workers died.

Did the WHO botch its response to the developing crisis in Sierra Leone and Liberia? The answer is most likely yes, but the question is why. Africa office representatives were not filing Ebola reports to the head office. There are lessons here as to how the WHO, the only global health agency, should operate in the future and how its performance could be improved. There is no doubt that its effectiveness was weakened by decades of policy failures and budget cuts by wealthy nations trying to fund their deficits. Wealthy nations need to restore their funding of the WHO. The Ebola crisis has confirmed a new reality: that we live in a shrinking world. To cope with future pandemics—which are sure to come and might be worse than the current pandemic—strong international organisations working with national organisations is absolutely necessary.

My second point relates to the UK response. Here I can do nothing but congratulate the UK Government on the speed with which they responded, with both personnel and finances—the second-highest donor nation after to the United States—and commend the continuing effort that DfID and WHO are making to bring this crisis to an end. We need to learn lessons as to whether we could have done better—it is always possible to have done better—but, hitherto, I have nothing but praise for our Government.

This leads to my third, and important, point—already mentioned by the noble Lord, Lord Fowler, and other noble Lords: what should we do about future pandemics? Why were countries such as Guinea, Sierra Leone and Liberia not able to cope with the crisis, when countries such as Nigeria curtailed it very quickly? The answer is very poor health systems, as has been mentioned: lack of facilities or equipment, deficit of a health workforce, lack of appropriate public health measures, and lack of surveillance and controls. Both Larry Summers, the previous Treasury Secretary of the US, and Bill Gates, when he spoke in the Robing Room, asked for help in developing health systems in those countries.

Larry Summers’s report, Global Health 2035, published in the Lancet, identifies that we will need some $30 billion a year for the next decade. Building health systems requires time and money, and the richer nations of the world need to come up to the plate to develop that. Otherwise, we will continue to have such crises, which will begin to affect us even more than they do now. The UK can take a lead in building health systems. We are the right country to do so because we have demonstrated that we can have effective influence.

My fourth point relates to whether the UK’s support for our NHS volunteers has been appropriate. It is important that we make sure that people who volunteer to go to affected countries are in a safe environment, are able to work safely and can return home safely afterwards. Comments that we have seen in some of the media, particularly social media, demonising those who return from such work, are unacceptable. Sarah Wollaston, MP for Totnes and chair of the Health Select Committee wrote a very good article about this in the Telegraph. I was disappointed to learn—if accurate—that some BBC staff feel that they can no longer interview in person people who come back from west Africa, and therefore that a telephone interview would be more appropriate. Brave BBC workers have reported from there, but such comments from the media—if correct—are also inappropriate.

Ebola

Lord Patel Excerpts

Thursday 6th November 2014 Lords Chamber

[Lord Patel (CB)]

My Lords, I join other noble Lords in praising our volunteers who are currently working in west Africa, and also our Armed Forces who so rapidly constructed the first hospital in Sierra Leone. I congratulate our Government on their rapid response once it became obvious that this Ebola infection was out of control.

There is a lesson here. Infections will continue to come—that is the history of developing viruses in that area. Humans have been infected by four strains of Ebola virus so far, and there remains only one strain that has not yet infected humans but has already been found in pigs in the Philippines. If it goes from pigs to humans, it might become even worse. Marburg virus is just waiting on the sidelines.

What can we learn from that? To control infections we need good health systems and that has been the major failure. The current health systems in west Africa are not adequate and for all the investment we made in AIDS, we have not hitherto helped build good health systems. To control infection we also need to identify and care for patients. We are now beginning to grasp that by building hospital facilities but for Sierra Leone we will probably need 4,800 beds. Currently they have 236. Secondly, we need treatments such as vaccines or drugs. Vaccines are in development; the first is being trialled in Mali and two more—one developed in Canada and another in the US—will start trials soon, but it will be months before we know whether they are effective. There are drugs in development, and I hope that our Government, through Porton Down laboratories, are supporting trials of some of the drugs that are produced by our small biotech companies. Drugs might not directly kill the virus, but they may stop the chain process of replication, so I hope our Government will support that.

I congratulate the Government on their initial effort. We have not yet begun to control this infection, and yesterday’s news of Sierra Leone having 30 corpses appearing in one small area which was supposed to be free of Ebola proves the point.

India

Lord Patel Excerpts

Thursday 17th July 2014 Lords Chamber

[Baroness Northover]

I agree with my noble friend that growth is essential for reducing poverty. As he will know, Mr Modi has a record in this regard. What he is doing at the moment by investing in that growth, stabilising prices and investing in infrastructure is encouraging because that is how he is most likely to relieve poverty.

[Lord Patel (CB)]

I return to the point that my noble and right reverend friend Lord Harries of Pentregarth made. The poverty is related significantly to discrimination against a group which is a minority but is comprised of a large number of people: the Dalits. What will the British Government do to help India understand that and reduce the poverty among this group of people?

[Baroness Northover]

I quoted what the President said at the opening of Parliament in that regard.

Female Genital Mutilation

Lord Patel Excerpts

Wednesday 4th December 2013 Lords Chamber

[Lord Patel (CB)]

My Lords, it is a privilege to follow the four noble Baronesses who have spoken before me with such feeling and passion. I thank my noble friend Lady Cox for securing this debate today. She is quite right to focus on the key issue: what are we doing, apart from legislation, to stop this horrible, horrific procedure being carried out in the United Kingdom? Through the work I do with a charity, mostly in Africa, I have seen the results in many of these women. I work with a charity that trains doctors and nurses in Africa to help women who have obstetric fistula. There are 2 million such women. FGM contributes to these women having difficulty in labour and the resulting fistulas. It also contributes to them having a higher incidence of postpartum haemorrhage and to them dying because of it. FGM, therefore, does not just cause horrific suffering: it causes death.

Why, after the series of legislation championed by the noble Baroness, Lady Rendell, have we not had any prosecutions in the United Kingdom? Is it because those who are involved—members of the family, those who carry out this procedure and even the health professionals—do not fear this legislation, or are they ignorant of it, or both? The fact that there have been no prosecutions must make them feel safe. I know that my own college—I am a fellow of the Royal College of Obstetricians—and other colleges have produced guidance and asked for more policies to stop this procedure being continued in the United Kingdom.

The noble Baroness, Lady Cox, said that we needed a joined-up approach to this; that all the agencies, including the NHS and the child protection agencies, should work together. We now need leadership from the Government, and I hope that the Minister—who I know feels passionately about this—will indicate some new policy measures from the Government to help stop this. Everybody who has spoken and will speak today, and others who have spoken previously in recent weeks when we have had debates and Questions relating to this, have all felt that something must be done in the United Kingdom to stop this horrific process going on. The noble Baroness, Lady Rendell, quite rightly asked that we start that process in 2014. I think that she is being generous: we should start tomorrow.