Health Protection (Coronavirus, Restrictions) (England) (Amendment) (No. 3) Regulations 2020
Lord Rennard Excerpts(4 years, 5 months ago)
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Lord Rennard (LD) [V]
My Lords, the Minister will recall that my major concern about these changing regulations is about the credibility of government advice and growing public reluctance to do what it says. Pictures of crowded beaches and incidents such as the large gathering in south London last night, which required police intervention, suggest that many people are not staying alert or staying safe, and such behaviour is putting many more people at risk. The Minister makes a valiant defence of the Government’s position, but why does he think people are increasingly using their own judgment? Has he continued listening in recent weeks to Radio 4’s “More or Less”, with its weekly demolition of government statistics, and does he still feel that he could prove the programme wrong? Does he accept that the Government have lost credibility? Why is this?
We know that the Chief Nursing Officer was excluded from a press conference when she would not toe the line about Dominic Cummings. Yesterday, the Guardian listed eight occasions on which Professor Chris Whitty’s advice has diverged from that of Boris Johnson. The Prime Minister said, for example, that judgments about what could have been done better are premature, but the Chief Medical Officer says that there is a long list of things that we should look at very seriously. He highlights the failure to speed up testing very early on. Should we not learn the lessons of what could have been done better before we face the risk of further spikes?
Social Distancing: Two-metre Rule
Lord Rennard Excerpts(4 years, 6 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]
The noble Baroness highlights an incredibly important consideration in the review on the two-metre rule. Clearly, those who are vulnerable or in social care deserve the best protection necessary. SAGE has been extremely clear that two metres provides emphatically more protection than one metre, and the protection of our vulnerable people will be an important consideration in any review.
Lord Rennard (LD) [V]
My Lords, yesterday a Health Minister in the Commons repeated the mantra that advisers advise and Ministers decide. But trust in government has diminished greatly in recent weeks, so people need to know what is advised before accepting what Ministers decide. Can the Minister assure us that the advice to be provided by the Government’s scientific and medical advisers to this review will be published as it is written and submitted by them, independently of any government pressure, so that we will know whether or not any proposed change really is based on scientific and medical advice? There is a consensus that the Government were late on lockdown, late on face masks and late on testing and tracing, so we do not want to be premature in reducing the two-metre distance rule. Should we not be sure that we have a full track and trace system in place before considering easing the distance rules?
Lord Bethell [V]
I do not recognise the contention of the noble Lord. Having been in many meetings with our scientific advisers, I deny the suggestion that scientists are open to being pressured by politicians. The advice that they have given is clear-cut and it is for us to consider its value. The noble Lord does scientists no favours by implying that they might be changeable under pressure.
Health Protection (Coronavirus, Restrictions) (England) (Amendment) (No. 2) Regulations 2020
Lord Rennard Excerpts(4 years, 6 months ago)
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Lord Rennard (LD)[V]
My Lords, my main concern about these regulations is whether there can be sufficient public confidence for people to respect them. Debates such as this have shown how government advice and regulations about how we should all respond to the Covid crisis have been inconsistent: inconsistently applied and inconsistently based on scientific advice. Government statistics, on which policy is based, have been regularly challenged.
I asked the Minister some weeks ago if he listened to the excellent Radio 4 programme “More or Less”. He said that he did. If he has been listening recently, he will have heard a weekly demolition of government statistics. On Friday, we learned that England’s chief nurse was dropped from a Downing Street press conference because she would not back Dominic Cummings. Yesterday, we read in the Sunday Times that the Government’s Chief Medical Officer and Chief Scientific Adviser are both on resignation watch. Tonight, we saw the Foreign Secretary standing alone at the Downing Street press conference, without advisers.
The impression has been constantly given that political pressures to create headlines have sometimes taken precedence over protecting people’s lives. To help regulations such as these gain respect, can the Minister please tell us why the daily Downing Street press conferences should not be replaced by Statements in Parliament where they can be properly scrutinised, and by regular press conferences, at which journalists are allowed us to pursue questions where they are not answered satisfactorily and scientific advisers are able to speak freely?
Covid-19: Response
Lord Rennard Excerpts(4 years, 7 months ago)
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Lord Bethell
My Lords, the noble Earl is stretching my scientific knowledge with his question. All I can say is that different vaccines work in different ways. Anyone with antibodies who has beaten the disease has the capability of beating the disease, but vaccines ensure that that capability lasts longer, hopefully for life.
Lord Rennard (LD)
My Lords, does the Minister listen to the excellent BBC Radio 4 programme “More or Less”? If so, he may have heard the total demolition of the claim that 100,000 tests were being conducted each day by the end of April. Much doubt has also been cast on claims that care homes were always included in government figures. Trust in government is vital at the moment, so does the Minister think that a body such as the Office for National Statistics should be given the role of vetting figures that are quoted in the daily Downing Street press conferences?
Lord Bethell
My Lords, I do listen to “More or Less”. I absolutely love it, and it is a shame that I did not hear the episode to which the noble Lord refers because I would have reprimanded them greatly. The 100,000 tests a day are done very clearly. I would be glad to take the noble Lord, Lord Rennard, to visit our Lighthouse Labs to see the remarkable automation and robotics that achieve that remarkable effect. On the care home figures, we work hard in order to create prompt, immediate, daily figures. Those are then verified and put into the official national figures that are curated by the ONS. Having operational figures that are delivered quickly is important for decision-making. Having figures officially verified by the ONS to audit those results is an entirely appropriate way of doing things. It is a system that works, and we currently have no intention to change it.
Drugs: Methadone
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Baroness Blackwood of North Oxford
I thank the noble Lord for his question. He will know that the DHSC does not collect data on the costs of supply of methadone centrally, as he has asked this question. However, I reassure him that Public Health England carried out an evidence review in 2017 on the effectiveness of drug treatment across the UK, which found that our outcomes are as good as or better than those internationally, including on effectiveness and value for money. However, we recognise the challenge of drug deaths and drug treatment across the UK and the challenge to local authorities. There will be an effective review of drugs policy, which will include Carol Black’s review of drugs.
Lord Rennard (LD)
My Lords, what consideration has been given to extending the Swiss model of heroin-assisted treatment, with addicts attending clinics under supervision and injecting safely, given that there is clear evidence of the success of this model in improving the health of addicts and reducing both the number of overdoses and levels of crime?
Baroness Blackwood of North Oxford
Heroin-assisted treatment can be an effective way of treating individuals for whom other opioid substitutes have not been effective. It is open to local areas under the existing legal framework, but given that funding decisions on drug and alcohol treatment have been devolved, it is for them to decide whether to commission HAT services based on their assessment of local need.
Queen’s Speech
Lord Rennard Excerpts(5 years, 2 months ago)
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Lord Rennard (LD)
My Lords, I am delighted to make the first contribution to this debate since the defeat of the Government’s programme Motion in the other place.
It is a long time since the last Queen’s Speech in June 2017, but now we have this one and another is due shortly. It is like waiting a long time for a bus and then seeing two of them come almost at once. However, this Speech is more manifesto than legislative programme. It promises that,
“Measures will be brought forward to support and strengthen the National Health Service”.
But those words may be just an election slogan, because the NHS long-term plan is under threat in several ways, and I will outline just three of them.
The first is the obvious lack of a specific funding plan to tackle the social care crisis. We were told in the gracious Speech that proposals will be brought forward to,
“reform adult social care in England”.
However, we were told in the 2017 Speech that:
“My ministers will work to improve social care and will bring forward proposals for consultation”.
Almost two and half years later, we are still waiting. Unless any new proposals are bold, and recognise what we need to pay for, then most, if not all, of the promised extra resources for the NHS will be taken up by looking after people in hospital who really should not be there. These people should be looked after in ways that they prefer, with greater independence and cost-effectiveness, at home or somewhere else outside hospital.
A second threat to the NHS plan is the Government’s lack of commitment to funding public health initiatives to address issues such as obesity, overconsumption of alcohol and tobacco smoking. The OECD estimates that obesity shortens lives by an average of 2.7 years and cuts GDP by 3.3%. It cites specifically the effectiveness of tackling the problem of obesity with measures such as the sugar tax, but this has been branded a “sin tax” by our Prime Minister.
So far, the Government are also failing to follow the successful lead of Scotland by introducing minimum unit pricing for alcohol. In fact, we are going in the opposite direction. Studies conducted using the University of Sheffield’s alcohol policy model suggest that cuts in alcohol duty over the last six years have resulted in not just the loss of £1.2 billion per year in revenue but over 60,000 additional hospital admissions. The additional costs to the NHS are estimated to be around £341 million.
Government funding is also being denied for cost-effective advertising campaigns which promote ways in which people are helped to quit tobacco. The amount spent on these campaigns in 2018-19 is less than half of that spent in 2015-16 and just 10% of the amount spent 10 years ago. Smoking remains the leading cause of preventable, premature death in the UK, killing around 100,000 people every year, which is around 300 people per day. The Government have committed to considering a “polluter pays” approach for the tobacco companies. Although there is no reference to this in the gracious Speech, I hope that they will now act on this principle to help deliver the additional national and local tobacco control activity needed to achieve their own target of a smoke-free England by 2030.
Thirdly, the greatest threat to the long-term sustainability of the NHS may be Brexit itself. The Government are clearly running away from producing an impact assessment of their Brexit deal. They know that our economy will be significantly smaller outside the EU than if we remained within it. Goldman Sachs estimates that the damage already done to the economy by Brexit over the last three years has been around £600 million per year. Brexit means less funding for the NHS and certainly not the additional £350 million per week that was promised. The economic facts contradict the claim painted on the side of that infamous red bus, which was probably the greatest lie of the decade. The NHS has serious staff shortages and Brexit is already causing some of the people we need to leave it.
It is astonishing that all this can be considered a price worth paying for changing our relationship with the EU from one in which we have a voice, a vote and a veto into one that means we will, like other neighbours of the EU, have to spend the rest of our lives negotiating with a much weaker hand than we have at present, accepting much of what we do not like in order to do business.
One reason for supporting Brexit is given by the tobacco lobbyists. They do not like the EU regulations to which we have agreed, which have successfully helped reduce tobacco consumption. Will the Minister confirm that, even if we are outside the EU, the Government will remain committed to maintaining exactly this kind of regulation and achieving the goals set out in their tobacco control policy?
Asthma
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Baroness Blackwood of North Oxford
As ever, the right reverend Prelate is insightful on this matter. Children going into school with identified respiratory illnesses should have care plans to assist the school in caring for them. Asthma UK has indicated that many children are slipping through the net and remaining on long-term oral steroids in primary care. This results in repeated trips to A&E with no referral to specialist centres. We are working with NHS Improvement and others to ensure that we support them with training in the use of medication and improving the use of smart inhalers, which can track the management of their care and reduce referrals to secondary care.
Lord Rennard (LD)
My Lords, I am grateful to the NHS for the fact that as a diabetic I do not pay prescription charges, but other people in England with long-term conditions have to pay such charges. In Scotland, Northern Ireland and Wales, all prescription charges have now been scrapped. Is this not somewhat anomalous? Is it not unfair that the 2.3 million adults with asthma have to pay these charges?
Baroness Blackwood of North Oxford
The noble Lord will already have heard me answer his question in reply to the opening Question. I have already met Asthma UK on this issue and discussed its concerns about the balance of prescription charges. We are not in a position at the moment to review prescription charges as a whole, but I will be working with that organisation to make sure that the system works as effectively as possible for asthma patients and that they get access to the exemptions that are in place.
Lung Health
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Baroness Blackwood of North Oxford
My noble friend is right that poor air quality is one of the largest environmental risks to public health in the UK. That is exactly why we brought forward the air quality strategy, which has been identified by the WHO as an example for the rest of the world to follow. But he is right that it will not work if we do not also tackle variation across the country. That is exactly what we intend to do and why we will also look at air pollution as part of the Green Paper, which is due imminently.
Lord Rennard (LD)
My Lords, 6.1 million people in this country still smoke. The NHS long-term plan is good at encouraging further measures to reduce the prevalence of smoking. At the same time, 50% of local authorities have had to reduce funding for smoking-cessation services, even though smokers trying to quit are four times more likely to succeed if they can benefit from such services. Is it not essential to reverse cuts in funding to Public Health England and spend money cost effectively on further advertising campaigns to reduce the prevalence of smoking among adults in this country?
Baroness Blackwood of North Oxford
The noble Lord is right to praise the success that we have had in smoking cessation in this country. We now have the lowest rates of smoking that we have ever had, some of which is because of the work of local authorities and PHE. He is right to identify the need to target the variation and inequalities. We are targeting this through the prevention Green Paper and we identify the need for a sustainable funding settlement through the spending review allocation.
Atrial Fibrillation
Lord Rennard Excerpts(5 years, 7 months ago)
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Lord Rennard (LD)
My Lords, the noble Lord, Lord Black of Brentwood, is to be congratulated on securing this debate and on his personal tenacity in pursuing this issue through many other debates and questions and through the activities of the all-party parliamentary group. I have been pleased to take part in some of these, including the one to which he referred, in 2015, which focused on detection of AF. His Question today refers to the Menu of Preventative Interventions published by Public Health England in 2016. This communicated an ambition to increase optimal management of people with atrial fibrillation from 74% to 89% over the five years to 2021.
As the noble Lord said, AF is the root cause of one in five strokes, and people with the condition are five to six times more likely to suffer a stroke than those with a regular heartbeat. Aside from the human cost and many indirect costs, strokes directly cost the NHS more than £2.2 billion each year, but the risk of an AF-related stroke can be substantially reduced by providing effective anticoagulation therapy to prevent the formation of clots. Too often, however, AF remains underdiagnosed and undertreated. In 2014, NICE estimated that around 250,000 people in the UK have undiagnosed atrial fibrillation, and the King’s Fund says that a huge proportion of those who have been diagnosed with AF are not receiving the correct anticoagulation medicine to prevent stroke.
Better diagnosis and treatment could prevent around 7,000 strokes, prevent more than 2,000 people suffering severe disability and prevent 2,000 premature deaths each year. With an ageing population, AF prevalence is likely to grow, so why are we not identifying the condition and treating it as effectively as we might? Much of the problem is that there are significant gaps and inequalities in our health system, as shown by the rates of AF detection and access to therapies and treatment for stroke. Cardiovascular disease is one of the conditions most strongly associated with health inequalities, and if you live in England’s most deprived areas you are almost four times more likely to die prematurely than someone in the least deprived. Cardiovascular disease is also more common where a person is male, older, has a severe mental illness or is south Asian or African-Caribbean in ethnicity.
Action to address health inequalities, as proposed in the recent NHS Long Term Plan, is of course very welcome. The plan states:
“Early detection and treatment of CVD can help patients live longer, healthier lives. Too many people are still living with undetected, high-risk conditions such as high blood pressure, raised cholesterol, and atrial fibrillation”.
A new return on investment tool confirms that savings can be made from better identification and management of patients. This suggests that more than 14,000 heart attacks and strokes could be prevented each year through earlier identification, diagnosis and effective management of AF. However, we are not doing what we could because suboptimal treatment of AF is widespread, particularly through the prescribing of aspirin monotherapy.
The National Institute for Health and Care Excellence recommends that people with AF who are at risk of stroke should be offered either warfarin or a non-vitamin K oral anticoagulant, known as a NOAC. NICE also makes explicit that people with AF should not be prescribed aspirin on its own for preventing stroke, as the bleeding risks outweigh the clinical benefits. This is reiterated in the NICE AF quality standard, QS93:
“Adults with atrial fibrillation are not prescribed aspirin as monotherapy for stroke prevention”.
But some healthcare professionals still believe that aspirin is an effective alternative to other NICE-recommended therapies. This practice puts a significant number of patients at unnecessary increased risk of stroke. The most recent national audit for stroke reveals the extent of suboptimal treatment with aspirin monotherapy and the impact on patient outcomes. In 2017-18, approximately 2,400, or 14%, of AF-related stroke patients were being prescribed aspirin on its own when they were admitted to hospital. This issue can be addressed with better education for healthcare professionals, particularly in primary care, to prevent aspirin on its own being prescribed when new cases of AF are diagnosed. Just as importantly, local GP practices and the new primary care networks can take proactive steps to ensure that existing AF patients are appropriately anticoagulated by identifying and reviewing those currently prescribed aspirin alone for AF-stroke prevention, as a priority.
At a population health level, addressing inappropriate treatment in individuals whose clinical risk factors are suboptimally managed provides the opportunity for every health economy to improve AF-stroke prevention at scale in a short timeframe. This can be achieved by undertaking a systematic audit of primary care data to identify AF patients being treated with aspirin monotherapy, and offering them more effective long-term treatment with a NICE-approved anticoagulant therapy such as warfarin or a NOAC. The new NHS Long Term Plan included a commitment to support the creation of CVDprevent, a new national cardiovascular disease prevention audit, to support healthcare professionals in primary care to improve the identification and management of patients with high-risk CVD conditions, including AF. It is critical that this system incorporates metrics to systematically identify patients with AF currently treated with aspirin monotherapy.
There are a number of questions to consider. How close are we to having regular systematic audits in every GP practice? The guidance on risk assessment and stroke prevention for atrial fibrillation, known as the GRASP-AF tool, can help to identify people at risk who are not anticoagulated or who are suboptimally anticoagulated. How far is this tool being used to help GPs assess the risk of AF-related stroke and provide for effective management of AF in patients? Can the Minister tell us what new measures are being taken to ensure that new and existing patients with AF are not prescribed aspirin monotherapy for preventing stroke, in line with NICE clinical guidelines? In addition, can we know the timelines for implementing the CVDprevent primary care audit programme?
We look forward to hearing what steps are being taken to enable local NHS services to identify AF patients who are being suboptimally managed, and then supporting them to obtain the right treatment. We would like to know how local NHS clinical commissioning groups and providers are using the national audit for stroke to improve atrial fibrillation management. For example, what training is being made available to medical personnel and health staff, including pharmacists, to encourage pulse checks in routine check-ups, and in non-clinical settings, to detect AF?
Finally, I draw attention to how researchers at the University of Birmingham have developed two apps that help patients and clinicians manage atrial fibrillation more effectively. Funding for this research came in part from Horizon 2020, the EU framework programme for research and innovation. Will this kind of funding be guaranteed in future?
Tobacco Harm Reduction
Lord Rennard Excerpts(5 years, 8 months ago)
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Baroness Blackwood of North Oxford
I thank the noble Lord, who has expertise in this area, for his intervention. He is absolutely right that we need to target a reduction in lung cancer rates. Cancer Research UK states that smoking tobacco is the biggest cause of lung cancer in the UK, with seven out of 10 lung cancers caused by smoking. The NHS Long Term Plan has a very heavy emphasis on prevention, including smoking cessation services. One of the first interventions from that plan to be rolled out is the innovative targeted lung health check, which will provide an easy-access gateway to lung health and smoking cessation services. I hope that he is reassured by that answer.
Lord Rennard (LD)
My Lords, Sweden has banned the advertising of tobacco products, introduced clean indoor air laws and increased the price of cigarettes. Together with the properly regulated promotion of e-cigarettes, have not these measures been shown across the world to be the best methods of tobacco control? Is there not a real danger with products such as snus that tobacco companies want to promote their dual use, pushing potentially dangerous tobacco products in clean air environments and continuing to push traditional tobacco smoking products elsewhere?