Smoking Cessation: Prescription of E-cigarettes

Lord Rennard Excerpts

Tuesday 2nd November 2021 Lords Chamber

[Lord Rennard (LD)]

My Lords, e-cigarettes are undoubtedly part of the way forward to achieving a smoke-free Britain. But why has it taken so long to get to this point and to begin fulfilling what was in the 2017 tobacco control plan and to adopt the recommendations of the 2018 Select Committee, chaired by Sir Norman Lamb, which highlighted the significant benefits of having medicinally licensed e-cigarettes which could be prescribed? How do we know that licensing will now proceed in a timely manner?

[Lord Kamall (Con)]

The MHRA has been quite clear that it wants to be in a position to license a product as soon as possible—it says 18 to 24 months. Noble Lords may well want to push the MHRA on that, and that is part of your Lordships’ role. But it is important that we make sure that, when we license a product, both consumers and public health experts can have faith in it.

COVID-19: Type 2 Diabetes

Lord Rennard Excerpts

Thursday 21st October 2021 Lords Chamber

[Lord Kamall (Con)]

I am beginning to wish I had eaten a full breakfast. With any strategy or programme, we always have to be careful about unintended consequences. As we focus more on obesity and make more people aware of healthy living and healthy eating, it is important to have the right balance and to be aware of the impact this can have, so that we are not creating more problems, concerns and anxieties for those who suffer from eating disorders.

[Lord Rennard (LD)]

My Lords, one in three deaths during the first period of the pandemic were among people with diabetes. Obesity accounts for most of the risk of developing type 2 diabetes and, even without the problems of the pandemic, a type 2 diabetic, such as me, at my age, is expected to put on one or two kilos every year. Will the Minister now look to reverse what the King’s Fund says is, in real terms, a £1 billion cut in local authority public health budgets since 2015, and at providing even more support for programmes such as GP referral to fitness classes, which can help people manage their diabetes more effectively?

[Lord Kamall (Con)]

As well as looking at the important role that funding can play, it is important to do better with the money available. There are many things we can do to make sure that the programmes we have are more effective, but I repeat that we have to make sure that they work and we have to look at the evidence. When discussing the evidence internally in the department, I have been told that many of these programmes will be reviewed after five years to make sure that they are effective and do not lead to unintended consequences.

Folic Acid

Lord Rennard Excerpts

Monday 26th April 2021 Lords Chamber

[Lord Bethell (Con)]

I hear the frustration loud and clear and reassure the noble Baroness that we are working on this at pace.

[Lord Rennard (LD)]

My Lords, in response to numerous questions and debates on this subject over the years, no Minister has ever produced a satisfactory explanation of why we do not add folic acid to flour. Would it have made any difference if the folic acid suppliers had had the Prime Minister’s mobile phone number?

[Lord Bethell (Con)]

No.

Alcohol Harm Commission: Report 2020

Lord Rennard Excerpts

Thursday 22nd April 2021 Grand Committee

[Lord Rennard (LD)]

My Lords, introducing minimum unit pricing for England was a key recommendation of the commission. A strong evidence base for this was provided by a wide range of organisations, including the Children’s Society, the Association of Directors of Public Health, Cancer Research UK, the British Medical Association and several local authorities. A 50p minimum unit price in England has been estimated to lead to almost 22,000 fewer hospital admissions and 525 fewer deaths per year when in full effect. This would save the NHS £1.3 billion annually. As hospitals deal with the consequences of Covid-19, freeing up capacity is essential. People who live in poverty are more vulnerable to the effects of alcohol abuse. It is estimated that nine in 10 lives saved by minimum unit pricing would be from low-income groups. Yet the spokespeople for some business groups and right-wing organisations oppose minimum unit pricing, citing their previously rarely expressed concerns about poverty, when their real concerns are simply about profits. We need to remember that alcohol has a major impact on the public’s health.

Alcohol can cause over 200 conditions including cancer, heart disease, liver disease, stroke and mental health problems. When I asked a Question about this issue three years ago, the noble Lord, Lord O’Shaughnessy, then the Health Minister, cited evidence that

“in 10 years, minimum unit pricing could on an annual basis reduce alcohol-related deaths by 356, alcohol-related hospital admissions by 28,515, and crime by 34,931 crimes.”—[Official Report, 28/2/18; col. 654.]

But we were told to wait for more evidence from Scotland and elsewhere. We now have that evidence. The policy is working in Scotland; it is being introduced in Wales. We should not have to wait any longer in England.

ONS: UK Life Expectancy

Lord Rennard Excerpts

Thursday 17th December 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I cannot give an answer in the round and explain every element, but we have to face up as a nation to the fact that some of our habits are unhealthy. In some communities smoking rates are extremely high, and the difference between different communities is profound—1.6% in west London, compared to 25.7% in Blackpool. Our obesity, BMI and consumption of high-calorie food is just too high. This is not the sole explanation, but as a nation we have to face up to some of our behaviours.

[Lord Rennard (LD)]

My Lords, half the considerable difference in life expectancy between the richest and poorest in our country is entirely accounted for by smoking. At present, the Government are spending considerable amounts of money on advertising campaigns which tell people how to keep safe during the Covid pandemic. In the future, will the Government reinstate advertising aimed at promoting smoking cessation, to meet their own target of making Britain a smoke-free country and helping to improve the health and life expectancy of the poorest in our society?

[Lord Bethell (Con)]

The noble Lord makes his point extremely well: smoking rates in this country are far too high. The huge amount of Covid advertising at the moment has squeezed out a lot of our public health messages, and I reassure him that we will return to them—including the smoking campaign—when normal business resumes.

Cancer Task Force

Lord Rennard Excerpts

Tuesday 20th October 2020 Lords Chamber

Asked by

[Lord Rennard]

To ask Her Majesty's Government how the new cancer taskforce will operate; and what funding that taskforce will be able to direct towards reducing any backlog in identifying and treating cancer patients.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, the Cancer Recovery Taskforce’s role is advisory, to oversee the development of a national cancer delivery plan due to be published later this autumn. The task force is chaired by Professor Peter Johnson, the national clinical director for cancer. It met for the first time in September and is due to meet again on Thursday. Membership is drawn from across the cancer community, and I thank all of those involved. NHS Improvement has recently confirmed annual funding allocations of £153 million for 2021 to the cancer alliances in England.

[Lord Rennard (LD) [V]]

My Lords, I refer to my interests as in the register. Cancer Research UK and Macmillan have reported that 2.4 million people are now waiting for screening, tests and treatments for cancer services. The Commons Health Select Committee has reported that the number of MRI and CT scans to diagnose the disease has plummeted by 75%. Given that the Government spend on average half as much on capital in healthcare compared to similar countries, what is the scale of the investment over the next year that will be specifically allocated for the latest technologies and additional staff to deal with the backlog of cancer diagnosis and treatment?

[Lord Bethell (Con)]

My Lords, the situation raised by Cancer Research UK and others causes concern, but I reassure the noble Lord that we are doing more than a million routine cancer appointments and operations per week to catch up with the backlog. Urgent two-week waits for GP referrals are back to almost 85% of pre-epidemic levels and we have a massive plan to address this, which includes the creation of Covid-secure environments, switching to new drugs for those who cannot make it to hospital, the judicious use of radiography, targeted messaging to those who may suffer from the symptoms of cancer, the use of rapid health diagnostics, an alliance with charities, a cancer recovery plan and enhanced monitoring on a single version of truth basis of our progress on this important issue.

Health Protection (Coronavirus, Local COVID-19 Alert Level) (Very High) (England) Regulations 2020

Lord Rennard Excerpts

Wednesday 14th October 2020 Lords Chamber

[Lord Rennard (LD)]

My Lords, there is possibly nowhere else in the country more lacking in confidence and trust in Boris Johnson’s Government than Liverpool. Previous Conservative Governments spoke about “managing Liverpool’s decline”—but Liverpool fought back, and what the city needs now is a managed recovery from the Covid pandemic. Almost everyone in Liverpool recognises that, with intensive care units at 95% capacity in the main hospitals, saving lives is paramount. The question is how best to do this, and people know that saving livelihoods is vital for the long term, too. As the Echo said yesterday:

“Many of us will feel frightened, isolated and lost amidst the tangle of seemingly contradictory rules and support packages—barely providing a sticking plaster to cover the deep wounds to our region’s economy.”


The problem is that there is simply no confidence that Boris Johnson’s policies are soundly based on science or that there is a proper plan for making sure that lockdown measures do more than just postpone the spread of the virus and ensure that people’s livelihoods are protected. The Government expect to be trusted but they have not trusted local authority leaders or local public health services, which could have done a much better job with test and trace.

People see Boris Johnson’s Government as incompetent and uncaring. They sense a whiff of corruption as contracts are inexplicably awarded to friends of those in government without normal transparency rules. They hear from journalists about briefings from a “senior government source” and assume that this must mean the man who goes to Barnard Castle for an eye test. There should be an end to such anonymous briefings.

People in Liverpool feel singled out. They feel that they are being told to walk alone, but the people in Liverpool never will.

Health Care: Guidance

Lord Rennard Excerpts

Monday 21st September 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Baroness is right that half of consultations have been done by telephone or on the internet. Some of those have been successful, but I agree with her that we have to keep GP surgeries open for those who either choose or need face-to-face consultations. That is why the NHS chief executive has written to CCGs and trusts urging them to be open and to have fair access to face-to-face consultations where necessary.

[Lord Rennard (LD)]

My Lords, I refer to my entry in the register of interests. Older people are more vulnerable to complications from the virus. Many more of them will have diabetes, and many more will feel that they need cancer treatment urgently. So why are so many older people still worried that they might be treated less favourably by the NHS due to their age? In particular, will the Minister explain how the backlog in treating cancer patients will be dealt with?

[Lord Bethell (Con)]

The noble Lord is entirely right that there is a large amount of concern among patients—existing patients who are on existing programmes and patients who think to go to the NHS. We are launching a “Help Us Help You” campaign at the beginning of October, which will be a substantial marketing campaign to reassure patients who might be concerned that the NHS is open and there to help them.

Anti-obesity Strategies

Lord Rennard Excerpts

Monday 14th September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am not sure I agree with the premise of the question. It is not my belief that the anti-obesity campaign will generate massive negative repercussions. The NHS’s work in this area has developed immensely and we are putting a huge amount of money into it, including through our mental health strategy. I support the strategy we are applying.

[Lord Rennard (LD)]

My Lords, the need for psychological support for people with such eating disorders is often identified through face-to-face meetings with GPs. Is the Minister satisfied that it is possible, in safe conditions, for people to obtain such meetings at the moment and that, if such a need is identified, sufficient psychological support is available for them?

[Lord Bethell (Con)]

The noble Lord is probably aware that a letter has been sent to GPs inviting them to step up to their responsibilities for face-to-face meetings. Everyone should have a face-to-face meeting if that is what they require and need. One of the surprising and interesting outcomes of the Covid epidemic is that many mental health services have been successfully delivered through video links. It has meant that people who may feel vulnerable about attending a GP’s surgery or mental health clinic have had the opportunity for consultations. We will look at how to expand that kind of interaction.

Medicines and Medical Devices Bill

Lord Rennard Excerpts

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

[Lord Rennard (LD) [V]]

My Lords, the Bill is necessitated by Brexit but, as many noble Lords have said, it does not provide the detail required to address the concerns about protecting patient safety, promoting innovation and helping British businesses at such a difficult time.

Soon after the Brexit vote, I attended a meeting convened by the MHRA involving many of the trade associations representing businesses in the healthcare sector. There was a strong feeling that the best way of addressing some of these issues would be for transitional arrangements to continue for quite some time, if not indefinitely. This case has been strengthened by the Covid crisis.

The UK has been a powerful player within the licensing framework for European medicines and medical devices for many years. The crucial role played by our scientists has been greatly appreciated across the EU and has benefited everyone, so the principle of dividing scientific expertise into two camps, one covering the UK and one covering 27 EU member states, is not a good one.

The case for the UK becoming an independent regulator of medicines and medical devices has never really been made convincingly and we have yet to see any real evidence that the risks and difficulties are likely to be outweighed by any benefits. Patients in the UK may find themselves accessing the latest innovations significantly later than patients in the EU. Businesses are told that they may benefit from different licensing arrangements in future, but if they are different, approval may well still be needed for export to the EU or to other countries which have learned to rely on EU standards. Likewise, patients who might benefit from new products licensed by the EU may not be able to get them until the UK has also approved them.

Two sets of licensing processes will mean two sets of applications, two sets of costs and two potential sets of delays, with the consequence that businesses may be less inclined to invest in innovation than they are under present arrangements. In future, we really need closer alignment in regulation between the UK, the EU and other international standards bodies.

The government case is that the UK will now be able to give more of a lead and to deal with approval processes more expeditiously, but the Bill lacks any detail showing how this could be the case. We might hope that in future greater emphasis will be placed on regulating areas of emerging and cutting-edge science where the UK has significant expertise, such as cell and gene therapies. We may aim for the UK to be seen more widely as a destination for the regulation and trialling of innovative and advanced medicines.

We should want the UK to be an attractive place for companies to undertake research and launch new products and therapies, but we have no real evidence yet that the UK will be able to achieve any of these things alone, and everything appears to be left to government Ministers to decide how things will be done at a time when confidence in some Ministers is very low. Greater detail and greater provision for parliamentary scrutiny may provide greater hope of progress on some of the worthy aspirations that have been outlined.