Personal Protective Equipment: Waste

Lord Winston Excerpts

Tuesday 14th June 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Lord is absolutely right that we are paying storage costs, and over the last few months there has been a reduction in storage and the Government have been looking at more cost-effective ways. However, the overall strategy—and why we have two lead waste providers looking at the issue—is to ask how we can sell, donate, repurpose or recycle wherever we can. For equipment where complex chains of polymers cannot be broken down—chemists would understand this better—we are looking at how we can dispose of it in the most environmentally friendly way.

[Lord Winston (Lab)]

My Lords, does the Minister agree that it is not just a question of a knee-jerk response at the very last minute of a new pandemic? Various committees, including the Science and Technology Select Committee, had pointed out that a pandemic was almost inevitable and that exactly such preparations were needed some years before it actually occurred.

[Lord Kamall (Con)]

The noble Lord is absolutely right. If we think back to swine flu in 2009 and the pandemic preparedness for that, there were such suggestions at the time and in subsequent years—we should not blame the particular party that was in power at the time—and the Government were urged to buy more and more equipment. The fact is that, had we bought it, it would have been at lower prices, and the cumulative cost of storage over the years would not have been as much as we spent recently.

GP Access

Lord Winston Excerpts

Tuesday 7th June 2022 Lords Chamber

[Baroness Brinton (LD)]

My Lords—

[Lord Winston (Lab)]

My Lords—

[The Lord Privy Seal (Baroness Evans of Bowes Park) (Con)]

My Lords, it is the turn of the noble Baroness, Lady Brinton.

Long Covid

Lord Winston Excerpts

Monday 23rd May 2022 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for making us aware of that. I know that there has been extensive stakeholder engagement to understand what the particular issues are. I am happy to commit to a meeting with the noble Baroness.

[Lord Winston (Lab)]

My Lords, would the Minister be kind enough to let the House know through which body the funding for this research is being undertaken? Is it through UKRI or some other body? How is it split up between different funding bodies? What has been achieved so far with the research that has been done?

[Lord Kamall (Con)]

The NHS is working with the wider scientific community to better understand both Covid-19 and its long-term health impacts. The £50 million in research is to understand, first, the actual condition—and, as I said earlier, it is not necessarily a medical condition—and how we map and treat it. In addition, we have had 22 research studies to examine the cause of long Covid, to diagnose the condition and to optimise the design of healthcare systems. A lot of this has been done by the National Institute for Health and Care Research, which continues to welcome applications for further research.

Health and Care Bill

Lord Winston Excerpts

Lords Hansard - Part 1 & Report stage
Monday 7th March 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I congratulate my noble friend Lord Howarth on bringing this subject before your Lordships’ House again. I am grateful to noble Lords from all sides of the House for providing their support for embedding the conditions and opportunities for art, creativity and culture in improving public health. These amendments provide something of a focus for action and I hope will be regarded seriously as such.

We know that the practices relating to creative health can be very effective and good value for money. Some 20% to 30% of all visits to the doctor are for non-medical reasons; for example, social isolation or loneliness. Therefore, the potential that we have in the United Kingdom is huge. Indeed, evaluation of the Arts on Prescription scheme suggested an average return of £2.30 for every £1 spent.

These amendments support the idea that art-based approaches can help people to stay well, recover more quickly, manage long-term conditions and experience a better quality of life. I hope that the Minister will be able to take these amendments on board.

[Lord Winston (Lab)]

My Lords, if I may, I will introduce a slightly discordant note, seeing as my name has been mentioned. I did not intend to speak, but I do think we need to be a little cautious about all this. I congratulate deeply the noble Baroness, Lady Greengross, on her remarkable work in this area, and nobody would doubt for a moment that everybody here is speaking in very good faith and for the best of purposes.

However, as medical practitioners, we must say that the placebo effect is very powerful and can cure people or improve their health in all sorts of ways and with all kinds of activities, not only dementia. Feeling well is not a simple matter. One concern is that we might spend much more money than we expect on these activities, without coming to the gist of why and whether they work, rather than something that substitutes for them.

I remind the House of one thing. For many decades, the health service supported homeopathy. Homeopathy—like cures like—has been widely used across the world and many people have great faith in it. There is actually no evidence at all that it has any genuine medical or chemical benefit; it is probably essentially a placebo effect. I am not suggesting for a moment that we should not look at exercise, music and all the other things, but I implore the Government; if we do this on the health service, there is a duty to ensure that research is done as well, because we must have a health service that looks at evidence-based medicine. That is fundamentally important.

[Baroness Penn (Con)]

My Lords, I thank the noble Lord, Lord Howarth, for initiating this debate, and for the work he has done on this issue.

A common theme runs through the comments of noble Lords. The noble Lord, Lord Winston, at the end, talked about evidence and evaluation informing government policy. I hope that we can all agree on that. With regard to Amendment 114, as part of the Government’s plans to roll out social prescribing across the NHS in England, a large evaluation has been commissioned by NHS England and NHS Improvement, through the National Institute for Health Research, which will evaluate many of the points raised. It will seek to find out how social prescribing services operate, how well they work, who does and does not use them, whether they are of benefit to people and a good use of NHS resources, and how cost effective the interventions are. The research will benefit patients by identifying how link worker services can be developed further. It will also study how to help people access social prescribing services and use them effectively, and how to ensure that everyone has access to them, no matter where they live or who they are. Importantly, it will also evaluate the economic sustainability and capacity of social prescribing services.

Furthermore, as part of the cross-government project to prevent and tackle mental ill-health through green social prescribing, another large evaluation has been commissioned to assess models, processes, outcomes and value-for-money of green social prescribing, to inform the scale-up of green social prescribing across England. We are already embedding social prescribing in current non-statutory integrated care systems. In September 2021, NHS England and NHS Improvement published the ICS Implementation Guidance on Partnerships with the Voluntary, Community and Social Enterprise Sector, which outlines the importance of the voluntary, community and social enterprise sector as a key strategic partner in ICSs and provides guidance on how sector partnerships should be embedded in how the ICS operates. This will apply to ICBs in the future, following the successful passage of the Bill. It also describes the importance of embedding social prescribing services, which provide the bridge between health and community by connecting people to local activities and services for practical and emotional support.

Turning to Amendment 184BZ, as of December 2021, there were 1,803 additional social prescribing link full-time equivalent workers in place, and more than 826,000 referrals to social prescribing through NHS primary care. This will make us well placed to reach the target set out in the NHS Long Term Plan of 900,000 referrals by 2023-24 well ahead of time—and this is in addition to other social prescribing schemes across the NHS, local authorities and the voluntary, community and social enterprise sector. Furthermore, NHS England, the National Academy for Social Prescribing and the department worked closely with Music for Dementia to facilitate a series of webinars on creative health and on the publication of guidance for social prescribing link workers and for social workers on music prescriptions for those with dementia.

We will also set out a new dementia strategy later this year. We are working with stakeholders, including people living with dementia, and their carers, and we will be looking at how we can improve the lived experience of dementia. This will include a focus on promoting personalised and integrated approaches to health and care. For some individuals this may include the use of music and arts-based interventions.

The Government are already putting substantial resources into social prescribing. I therefore hope that the noble Lord will feel able to withdraw his amendment.

Government Contracts: Randox Laboratories

Lord Winston Excerpts

Monday 21st February 2022 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Lord for reminding us of the importance of all the companies that supplied equipment or scaled up at pace or were able to meet the initial requirements. It was a time of panic; thousands were dying, and we did not have equipment. This was a time before the vaccine. The department and its officials tried to speak to as many people as possible around the world to find out what was available, what could be done and what the timescales were. Clearly, as the noble Lord said, Randox played an important role in meeting the testing requirements initially.

[Lord Winston (Lab)]

My Lords, the Minister suggests that the Government were panicking. Does he agree that panic in a laboratory or when one is dealing with tests of this kind is not satisfactory? Is not one of the problems that it is clear that Randox’s methods were not satisfactory and would not stand up to absolutely accurate testing? Is it not the case that the Government still cannot tell us what percentage of its PCR tests were inaccurate or in some ways contaminated?

[Lord Kamall (Con)]

I used the word panic because I think everyone was panicking. People just did not understand what was going on. They did not understand the pace of coronavirus; they did not even understand the disease itself and the transmission of it. I was reading over the weekend a couple of books on the history of the virus so far, where it broke out and what people thought it was originally, and some of the reassessments of historical epidemiology. Clearly, we needed testing performance. Randox was the only company at that time, in March 2020, that was able to provide that capacity at the scale needed. As I said earlier, where we identified problems, we made Randox aware of them and it supplied new kit.

Medical Abortion Pills

Lord Winston Excerpts

Thursday 10th February 2022 Lords Chamber

[Lord Kamall (Con)]

I do not think that is in question. There is no doubt that women should have access to abortion services and to the right advice, but as the noble Baroness who spoke earlier indicated, there are some concerns and risks. We have to consider all the factors. Of course, it would be wonderful for some people if it was made easier and was available online; others say you must be prepared for the risks. Whatever happens, if something goes wrong, I am sure that the noble Baroness and others would be back here questioning why we did what we did.

[Lord Winston (Lab)]

My Lords, I declare an interest as a fellow of the Royal College of Obstetricians and Gynaecologists and of the Academy of Medical Sciences. Have the Government considered the evidence from Imperial College London—indeed, from my own laboratory—showing that most human embryos are born with abnormalities which are potentially lethal, and they usually die? They are then aborted by the same process which this Bill causes, only at a later stage of pregnancy. This method of natural abortion, which occurs all the time, is mostly without symptoms to the woman: they do not even know that they have lost an embryo. It is safe and does not cause the medical complications which invariably happen with a late abortion, which a woman is then committed to. What are the Government going to do about this, firmly, to make it avoidable in future?

[Lord Kamall (Con)]

I am grateful to the noble Lord for informing me about that—it is something I have learned today. I will take it back and consider what he has said. To return to the Question, when we made this measure it was clear that it was supposed to be temporary. Will have consulted and will look at the consultation and decide what we will do. If we do go back to what it was like before, we will make sure there is a sufficient period to ensure there is no cliff edge.

Health and Care Bill

Lord Winston Excerpts

Lords Hansard - Part 1 & Committee stage
Wednesday 9th February 2022 Lords Chamber

[Lord Winston (Lab)]

My Lords, I am very reluctant to intervene in this long debate, but I have travelled down from Manchester specifically for this group of amendments. I have not been involved with this Bill previously, partly because of my own ill health, and also because of my teaching outside London, but I will make a short intervention here.

My noble friend Lord Hunt has raised the very important issue of the nature of interaction between human beings, which is absolutely essential in considering some of the issues raised by the noble Baroness, Lady Greengross, and others. I am not going to advocate music therapy, dance therapy, exercise therapy or art therapy here, because, speaking as an academic, one of the problems here is that we simply do not understand the truth of the interaction that makes these things work. One of the big problems is that really good randomised controlled trials are still very much lacking.

I am reminded, for example, of a very good randomised controlled trial, by Dr Nair in Australia, of quite a large number of demented people in a care home to whom he played music. From his results, there was no question but that the music, which was extremely tranquil baroque music from sixteen different composers, actually made them more disturbed, more sleepless, more angry, less able to eat their food and more likely to come into conflict with the nursing staff.

So it is very unclear what is actually happening in the brain. During the debate today we have heard claims made about changes in brain structure, but the truth is that we have not done sufficient research to really be clear about this. The research is very expensive, and one of the problems is that it involves very complex things such as time on scanning machines, for example—functional MRI. There is simply not enough research going on into the dementias—whatever they are—to fully understand the nature of what we are talking about.

I am not suggesting that we do not do music therapy but, speaking with my interest as an ex-chairman of the Royal College of Music, I say that we have seen that some of the things we do simply do not work or, if they do, it is not understood how. One of the things with music therapy, for example, is that you see individual patients interacting with somebody else, and it may be that the interaction is more important than the actual music. For example, watching musicians play in person may be better than watching them on a screen or just listening to music. There is a lot of work that needs to be done here before we can make big claims.

These are important amendments that are well made and well put, but we need to be really clear in debating this legislation that, until we understand the mechanisms—the phenotype—of what we are discussing, we have to recognise also that much more money is required for research into the dementias. That is really critical and there is a risk here of making legislation that will not fundamentally change the real problem that we are facing.

[Lord Desai (Non-Afl)]

My Lords, I rise to say that Amendment 297A is obviously very desirable. But, as an economist, I have to say: if we implement this, who will be deprived? GPs’ time is limited and GPs’ numbers are limited, as we all know. Through much of my life in the NHS, all that the GP did for me was prescribe what I needed. It took about five minutes, and the GP did not even have to talk to me; they could look at the computer to find out who I was and what I was doing. It is, quite rightly, only people over 65 who need a caring GP, so we have to devise a system for those who do not need extensive consultation and familiarity with the GP but can be dealt with in a summary fashion. Perhaps we could have junior and senior GPs, so that we could release the senior GPs for this sort of work and have other people for prescriptions and simple tasks.

Ageing: Science, Technology and Healthy Living (Science and Technology Committee Report)

Lord Winston Excerpts

Wednesday 20th October 2021 Grand Committee

[Lord Winston (Lab)]

My Lords, it was a huge pleasure to have the noble Lord, Lord Patel, as our chairman yet again for this inquiry, which was conducted with some challenging difficulties that were faced. He was, as usual, remarkable in his leadership and what we did. As the noble Lord, Lord Browne, and others have just emphasised, the findings show very clearly that the biggest single problem with ageing in the UK is widespread deprivation, which means that the Government are failing to reach their targets of trying to extend longevity.

There are many processes that we looked at which are associated with ageing. Multimorbidity, of course, is one of the key issues, where these processes between organs have a connection and are often responsible for what is happening. Unfortunately, there are not enough specialists doing regular connected medicine. This is one of the things that needs to be looked at in the health service. How many geriatricians who are specialised are available for this service in the United Kingdom at present? Do the Government feel that, given the manifestations of ill health, which are so interconnected, there should be more people of this kind? Perhaps that could be confirmed at the end of this debate.

An important aspect of this report was the science behind ageing. It is complex and surprising. I remember 35 years ago in my own lab we found that a human embryo, just three days after fertilisation, showed processes of ageing and that cells were changing and being destroyed. As we age, that process is not so efficient, so abnormal cells often appear in the adult human.

The committee identified a wide range of other mechanisms, including mutations in mitochondria—the battery packs of nearly every individual cell—which are an important aspect of ageing, the shortening of chromosomes, changes in DNA and in its repair, the loss of stem cells and, importantly for many of us in this Room, the process of inflammation, to which older people are much more susceptible. These and other issues are reported in the excellent chapter 3 of the report. I recommend that people read it because one of the most important aspects is changes in the immune system; of course, this aspect has been absolutely relevant during the Covid pandemic. We learned a great deal more about ageing, rather supporting some of the things we have been looking at. It turns out that these things are critical in all aspects of ageing in nearly all tissues and most organs, but they are not understood.

I should declare an interest that I have not declared before and which is not listed in the committee’s report: that of my own recent experience. Before the pandemic, I knew that I had cataracts in both eyes. An optician did not see anything else wrong with my eyes. I was therefore happy to continue reading on my computer without thinking about it, and I felt that my general processes were not impaired when I was doing stuff in Parliament; of course, your Lordships may have other views of my efficiency in that respect. I found that, while reading continuously on my computer, I was able to see films and re-read Dickens, Hazlitt, Hardy and many other authors. I did not really read newspapers.

In the past few weeks, however, I have suddenly found that I cannot read newsprint and am increasingly unable to read a printed book. In fact, I cannot read a printed book. I also cannot see road signs—I do not drive, obviously—and I do not recognise people. At the recall of Parliament, the only way I could identify noble Lords—even those on the same side of the division between the two major Benches as me—was by the sound of their voices. I realised that something was seriously wrong, particularly when I looked at my computer and saw that horizontal straight lines were no longer straight but wavy and often changed; I also saw black spots, of course, and colours such as green and red were all rather entrancing but very different. It seemed that something rather serious might be going on.

Of course, not being able to recognise your Lordships by sight and not being able to read a speech is really a blessed relief. I must say, if a few more noble Lords were in the same position, it might be quite good for the Chamber, but there we are. Unreadable speeches are not a great thing. At least when the noble Lord the Whip comes to say that I have been conducting myself too long, I will not recognise what is happening and so can go on wittering in this way.

I rapidly turned to Moorfields hospital and was very fortunate to meet Professor Adnan Tufail. He happens to be a notable international expert in retinal disease—oddly enough, particularly in my rare manifestation of age-related macular degeneration, which is quite common. My condition—seeing as I have not written a speech, I say this for the purposes of Hansard, because I like to tease them—is called reticular pseudodrusen age-related macular degeneration. Unfortunately, it seems to be a rare genetic kind of this disease and is particularly aggressive. Anyway, I was immediately sent for treatment by Professor Tufail, who was amazing. I had a treatment that noble Lords may have seen in “Un Chien Andalou”, a surreal 1929 film by Buñuel, where things are injected directly into the eye—although in my case, it was a monoclonal antibody, not a knife. It was done efficiently and without pain, but that treatment will have to be continued for some time.

To cut a long story short, I went to the lab and was able to see exactly the problems that they face. They are doing a huge amount of research at Moorfields—it is internationally recognised—and so many of the chemical processes that they are looking at, which are extremely complex in the eye, particularly in the retina, are exactly the same processes in the rest of ageing.

Multimorbidity with eye disease is one of the problems because people who are really short-sighted tend to fall down and break limbs, and are much more likely therefore to have other health problems as a result. Some become isolated, of course, and may not be able to get their brain in motion; dementia is therefore much more likely.

This is a massive problem because age-related macular degeneration, which may in different circumstances be very different, is still the commonest cause of blindness in the United Kingdom. We are not doing a great job, particularly among deprived people who, unlike me, do not have access to medical care in the same way because they are not medically qualified. What number of age-related macular degenerations are seen in the United Kingdom? What is the possible cost of this, both with and without treatment? How might we do something about this?

There is a real need to do more research. I must say, I found that there was very little public research at Moorfields. It was mostly from venture capital and other commercially derived areas. This is not good for widespread research, which can be immediately available to medicine. I commend Tufail’s team for carrying on. Finally, how much money is available from the Medical Research Council for retinal disease and cell therapies to treat those diseases?

Covid-19 Update

Lord Winston Excerpts

Thursday 8th July 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the noble Baroness is entirely right to make the connection between Covid and flu. We regard the winter as presenting two pandemics, and we will treat them with equal energy. Flu and Covid have the same net effect on the healthcare system, which is to be a huge drain on resources. So we are putting a huge amount of effort into the vaccine and boosters for Covid and the vaccination against flu. They can be taken together, and the advertising and promotion distribution to identify priority groups will be extremely energetic. That is the most important thing we can do to protect the NHS. Our second priority, though, is getting the beds to which the noble Baroness referred used for elective surgery. We do not want to see the NHS heaving under the pressure of Covid and flu. We want to see it addressing the backlog.

[Lord Winston (Lab) [V]]

My Lords, to return to my noble friend Lady Thornton’s first question, given the continued rise of the variant mutations and increasing infections, can the Minister report on a simple biological issue? What rapid mathematical calculations are in the Government’s possession to assess and predict the increasing risk of further new variants evolving that may escape the current vaccines or are more virulent? If he is unable to answer this question now, perhaps he will be kind enough to write to me.

[Lord Bethell (Con)]

My Lords, I cannot promise to have a simple algorithm to make the calculation that the noble Lord refers to. I will ask the system if such a thing exists, but I have never come across such a thing. The challenge he alludes to is entirely right: the vaccine pressure on the virus will create the circumstances in which variants are possible. That is why we are investing heavily in sequencing, not only here in the UK where everyone positive is now sequenced thoroughly and studied, but also offering that around the world through NVAP—the new variant assessment platform—to try to understand what is going on in markets around the world. To date, we think that we have tracked down all the current routes that the virus is taking, and we are satisfied that they are met by the vaccine, but we keep our eyes peeled.

Health Protection (Coronavirus, Restrictions) (Steps and Other Provisions) (England) (Amendment) (No. 2) Regulations 2021

Lord Winston Excerpts

Wednesday 16th June 2021 Lords Chamber

[Lord Winston (Lab)]

My Lords, many of you will remember going past Westminster station last week to see a crowd of people shouting about freedom—young, intelligent people, many of them properly educated, not wearing masks, crowded together in a mass. Indeed, those of your Lordships who travel on the Northern line, as I have done today and all this last week, will have seen numerous young people not wearing masks, as there is no enforcement of that. They are a risk to other people, young and old. Nothing is being done about it because it is not being enforced. There is nobody on the Tube to enforce it.

I listened to the noble Lord, Lord Robathan, with great interest, as I always do. His wide and extensive knowledge of medicine and science does not need to be explained to the House, nor indeed his undoubted expertise in statistics. That is admirable. Indeed, I have listened to him with great interest in this Chamber and on the Long Table from time to time. I also recognise that he will very much understand the issue of human ethics. As a distinguished soldier, he will remember the paramount issue for all people, including soldiers: we try at all times, above all, to protect human life.

Therefore, it is important for us to consider that this is a very difficult situation. As a practising soldier, the noble Lord will know the difficult choices that are made in order to protect life. I suggest to him that, although extensive, his knowledge is not likely to be as extensive as that of those expert advisers giving advice to the Prime Minister. I have no doubt at all that the Government have made very many mistakes, but we are not here to discuss those mistakes. They are undoubtedly riding high on the output of vaccines. They have been very lucky, and we are glad that they have been lucky because we could been very unlucky, whichever Government had been in power.

The fact is that the Government have succeeded, and it is really important, at this moment of national tension, when people are still not fully prepared to accept what is necessary to regulate us, that people respect what the Government are doing. To challenge the Government at this moment is a shocking risk. It is an ethical risk to do that because these people will be damaging lives. We see those people in the streets and I will see them on the Tube when I go home tonight. Even if I told them to wear a mask, they would be abusive at the very least and I would possibly do it at my own risk.

We have to recognise that there is a need for us to be supportive, not to undermine Parliament and this instrument. To do so would bring this measure into disrepute and bring more distrust and concern. What the Government need to do is to communicate better. I do not say to the noble Lord, Lord Bethell, that that is easy, as he knows that very well, but the communication we have all done has not been good enough. We need to find a way somehow to encourage those young people to think about their responsibilities to their parents, grandparents and other people in our community.