Pharmacy First

Viscount Waverley Excerpts

Tuesday 6th February 2024 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness. Key to her first point on drug use is obviously the functionality to be able to see the whole patient record— I talked about accessing that earlier. At the same time, the plan for the data flow is to look at what is being prescribed by the pharmacies—before the team gets on my back, I will say that “prescribe” is not quite the right word, because it is patient guidance and they are not formally prescribing. What is issued will go through the same data flow as for GP surgeries so that we can generally measure whether we think pharmacy X is overprescribing—or oversupplying—a certain type of drug versus a GP surgery. The idea is that that will be monitored in exactly the same way. Generally, on the overall experience of Pharmacy First, we commissioned the National Institute for Health and Care Research to review that to make sure it is done.

If I understood correctly, the question behind the palliative care point is, as we said about the other services: can we see them extending more, particularly in terms of out-of-hours use? The beauty of all this—there are things we can learn from the services that Wales and Scotland have introduced—is that, once the principle is established and there is a track record of it working well, there will be all sorts of opportunities such as these to extend it based on capability and, sometimes, convenience, with matters such as out-of-hours care.

[Viscount Waverley (CB)]

My Lords, as time is on our side, I will address, if I may, an issue which may or may not be totally relevant to the subject before us. I apologise to the House if it is not, but it does involve pharmacies. Before I venture forth, I offer the utmost fullest support for the principle of pharmacies playing a critical role in the whole system of patient care. My personal experience is absolutely excellent and that pharmacies provide a thoroughly professional service.

I will address a concern around the cost of purchasing non-medical equipment from pharmacies; it may also have relevance to the cost of living challenges. I went into a pharmacy recently and was charged £23.50 for a packet of four Gillette razor blades—shock horror. Of course, I needed them, and I paid, but I thought it was exorbitant, so I called the wholesaler to ask what was its cost of the same packet. It was £6 to £8. I recognise that pharmacies are a private sector set-up and can charge what they wish, but is there any aspect in this Statement that is relevant to the charges that pharmacies pay? I say this perhaps in support of the point of the noble Lord, Lord Hunt, about having facilities in pharmacies. Of course, they need funds, and pay rent and all the rest for all of the types of facilities that are required, but is there any relevance in relation to the costs that these people can charge? It is no wonder we have a cost of living crisis if people are having to pay those sorts of exorbitant prices.

[Lord Markham (Con)]

My understanding is that what we are really talking about here are the seven areas where they are allowed to supply treatments and courses of drugs. I do not think there is any read-across to other areas such as the pricing of medical instruments. I do not think that will help in this instance, but when I write round on the detail, I will make sure that this is clarified. Right now, I do not think that is envisaged by these measures.

[Viscount Waverley (CB)]

I never anticipated it was; I just thought it was relevant to the general circumstances of what people are being charged in purchasing from pharmacies.

[Lord Markham (Con)]

Again, it goes back to the point that, generally, we all agree that pharmacies offer an important service. Obviously, one would hope that they would be responsible; the vast majority of them are and there will not be such—predatory pricing probably is not the right word—hyper-pricing behaviour. Clearly, where those things do happen, I do not think any of us would support it. That is not the sort of thing we would want to be happening in any retail location, let alone one which is providing vital services.

Social Care: Adults

Viscount Waverley Excerpts

Wednesday 22nd June 2022 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for the question. It is a really important issue that we discussed many times not only during the passage of the Health and Care Bill but subsequently. We have to make sure that everyone in the system is working together to make sure that a hospital knows who it is discharging to and that the carer who will receive or help that person has not only the support but the facilities and capabilities at home, or wherever that person is being discharged to, to work with that person. There are gaps in the system; it is not perfect in all places. We are working with local authorities and others to make sure we improve the system.

[Viscount Waverley (CB)]

My Lords, would the Minister care to associate himself with today’s celebration of the arrival of the HMT “Empire Windrush” in 1948, whereby a statue has been unveiled at Waterloo station to remember that it was Caribbean citizens who, frankly, came to the rescue of the National Health Service? Are there lessons to be learned that the Minister might wish to apply to today’s situation?

[Lord Kamall (Con)]

I am so keen to answer that question because of my own Caribbean background. In fact, my father was part of that Windrush generation. He travelled from Guyana to Trinidad in 1952, and then from Trinidad to the United Kingdom, where he worked first on the railways and then as a bus driver. His brother worked in a post office and his sister was a nurse. That shows the vital contribution that people from the Caribbean made to this country post war.

Vaccination: Condition of Deployment

Viscount Waverley Excerpts

Thursday 3rd February 2022 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for her question. I will be frank with her: I was not aware that the Government intend to stop publication, so I will have to go back to the department and double-check whether that is indeed true or whether it is a qualified statement. I commit to write to all noble Lords, given that it seems to be what we have heard. Clearly, as we are told, we follow the evidence, and the scientists continue to follow the evidence, so I would expect that data to continue to be collected. The best answer I can give at this stage is that I will go back to the department and investigate, and will write to noble Lords.

[Viscount Waverley (CB)]

This might be another point that the Minister will wish to write to us about. Beforehand, the selfless manner by which the British people have risen to the challenge represents nothing short of the finest traits of Britishness. Would the Minister care to say a word about the benefits, advisability and practicality of receiving a fourth jab?

[Lord Kamall (Con)]

I agree with the sentiments expressed by the noble Viscount. Sometimes it takes the worst of times to bring out the best in people. It was an incredible response. It was also a very sad, emotional response. People lost loved ones, friends and relatives, and we were unable to contact people. I still have not seen my mother since January 2019 and my father died in September 2020, and I have not seen his grave. We have all been through incredibly emotional times and lost loved ones. On the fourth jab, we are continuing to review this—for example, we know that Israel has gone for a fourth jab. The briefings I get say that it is too early to tell whether there will be a fourth jab. It depends on whether immunity wanes, and whether the immunity that people now have responds to new variants, for example. In the longer term, if we have to live with this virus, will it almost be like the flu, with people having to take annual jabs? It is too early to give a definitive answer on that, but as soon as the evidence suggests one way or the other, we will notify noble Lords.

Covid-19: PCR and Lateral Flow Test Providers

Viscount Waverley Excerpts

Monday 13th December 2021 Lords Chamber

[Viscount Waverley (CB)]

My Lords, one might imagine that laboratories would give a reasonably consistent price. This is really all about consistency and fair pricing. That is the issue that needs to be taken into account, and I commend my Cross-Bench colleague for the point she made about the NHS. Given that the written word is often in the eye of the beholder, would it be helpful to have more flow chart-type messaging on the GOV.UK website? The perception is that what is on there is extremely complicated to understand.

[Lord Kamall (Con)]

The noble Viscount makes an important observation. When I looked at the website myself, I saw how confusing it was. When I discussed this with the people responsible, they said that they had changed it over time; for example, it now has minimum prices—one of the suggestions I made was that perhaps it should also have maximum prices. There is also the question of how you categorise, because there are different tests; some can be turned around in 24 hours, while others take a few days.

Covid-19 Update

Viscount Waverley Excerpts

Monday 29th November 2021 Lords Chamber

[Viscount Waverley (CB)]

My Lords, I too generally find the GOV.UK website wanting in the detail. Frankly, it is very confusing and is never kept accurate enough in a timely manner; I encourage the Minister to pay regard to that. May I drill into one particular issue on a point which other Peers have touched on? What is the rationale for the emphasis on testing after arrival into the UK, rather than catching those with Covid before departure?

[Lord Kamall (Con)]

The noble Viscount raises a good question; I am afraid that I will have to double-check the answer.

Covid-19

Viscount Waverley Excerpts

Wednesday 15th September 2021 Lords Chamber

[Lord Bethell (Con)]

I am very grateful for the questions and I will take them one at a time. I am enormously grateful for the advice of SAGE; the work it does is invaluable. However, it is not regarded as the key medical adviser to the Government—that is the role of the CMO, who advises the Government on medical matters.

On the circumstances for moving to plan B, that is a reasonable question. We do not have a specific formula or algorithm, because it is extremely uncertain how things will play out. Undoubtedly, pressure on the NHS is one of the biggest drivers of that decision, and if we were to see a spike in hospitalisations, severe disease and deaths, and beds being used up and capacity being drawn down to an extreme level, that would be one of the key drivers. But we have to also look at variants of concern, other diseases and the state of the NHS in the fightback, as well as at the flu epidemic that may or may not come. Therefore, I cannot give an easy and simple answer to that question—there is not a “four tests” type of answer to it—but we are looking at it extremely carefully.

On the criticism on speed, I remind the noble Baroness that, at the beginning of this year, the Government laid out a very clear steps process, whereby we left the last round of regulations. That was extremely well considered; there were at least five weeks between each step, and it was done in a proportionate and empirically based manner, and I think noble Lords would recognise that it was a thoughtful and reasonable way of doing things. To characterise the Government’s approach this year as being behind the curve is not reasonable. As I said, we are trying to accept the risks that we have in front of us, and Covid is only one of them: there are other pressures on the NHS, including the huge catch-up that we need to do, and the possibility of flu and other epidemics on the horizon. We cannot just focus entirely on this.

[Viscount Waverley (CB)]

My Lords, quite rightly the Minister is in popular demand this evening. This is nothing against Boots the Chemists, which by the by does an excellent job, but with not shy of 2,000 eligible candidates on the parliamentary estate, could not the testing facilities on the estate be designated as official testing areas for flying purposes and for any other reason that tests are required? Furthermore, notwithstanding the announcement to which the Minister referred, which may or may not address this point, why, oh why, do we need day 2 testing, having had a valid test 48 hours prior to arrival in the UK from, for example, the continent?

If the Minister is minded, given that I do not think that another noble Lord is going to ask a question, could he possibly also say a word about the issue of mixing and matching booster vaccination types? Can the flu jab, to which the Minister referred, be taken at booster stage?

[Lord Bethell (Con)]

Like the noble Viscount, I pay tribute not just to Boots—an excellent chemist—but all the other pharmacies, which have contributed so much in this epidemic in looking after the communities that they serve, not only in trying to provide essential services during lockdown but in their contribution to the vaccine rollout programme. It really has been a demonstration of the enormous amount of value in big and small chains and community pharmacists across the board.

As for the testing provisions here on the estate, those are of course LFD asymptomatic testing provisions, and for flying purposes you need a PCR test, so I am not quite sure whether it would necessarily read across directly.

[Viscount Waverley (CB)]

My Lords, just from first-hand experience— Sorry, I apologise for intervening.

[Lord Bethell (Con)]

It is an interesting and creative idea, and certainly one that would be worth looking at.

On day 2 testing, I recognise that it is inconvenient to do the follow-up testing if you are travelling but, for the protection of this country, it is an important part of our border public health measures.

The pre-flight testing regime is helpful; it catches some disease, but in no way could it be thought of as a reliable barrier to infection into the country. I am afraid that there is simply, as I am sure noble Lords know, too much variance in the quality of that testing regime, to put it politely. Our estimate is that it catches between 10% and 20% of disease, but we know from our own testing in this country that it certainly does not catch all of it. In fact, most people will not travel if they are blazingly ill, so almost all travel infection is asymptomatic. That is why we look to day 2 testing, because it has the benefit of catching those people who might either have asymptomatic disease or are incubating the disease and would not be caught even by a PCR test.

The day 2 test is an effective way of catching those with the disease; it is an essential part of our surveillance. We would not know how much disease was coming into the country, what VOCs were coming into the country or which countries had disease, because so few have sophisticated testing, let alone genomic sequencing. It is literally the only way we know what is coming into this country and where the threats are from around the world. That is why it has played such an important part in our testing regime to date. The Secretary of State for Transport will be making announcements tomorrow and I look forward to his update on that.

On mixing and matching, one of a great many surprising medical outcomes from this disease is the idea that you might have one vaccine one day and another one three months later. When that was first posited to me, and when I first made that suggestion in this House, it was greeted with surprise and with some concern, but actually they somehow provoke different parts of the immune system, they somehow complement each other and there is strong and growing evidence that this is a very effective and complementary way of administering programmes. They work for different types of people in different ways, and different mixes and matches complement each other in a strange Rubik’s cube of complicated arithmetic. I would have to leave it to JVT, the deputy CMO, to explain it in more detail if noble Lords would like more information on that.

Covid-19

Viscount Waverley Excerpts

Thursday 15th July 2021 Lords Chamber

[Lord Bethell (Con)]

I thank the noble Lord for that very touching personal testimony about his neighbour who passed away. It is an important account of many who have put themselves at risk. The PHE report on high mortality groups includes bus drivers, taxi drivers and many who perform an important public service that puts them in front of the general public and therefore at risk from this virus. We absolutely support the wearing of masks. Published guidance will continue to recommend that wearing a face covering will reduce the risk not only to yourself but to others, particularly in enclosed and crowded spaces. The noble Lord asked about whether mandation should be in place and for whom, and I do not wish to duck his point The mandation of masks on public transport is best left to those who run it, which is why we have moved away from legal rules to an approach that enables personal judgments and the intervention of businesses and local leaders.

[Viscount Waverley (CB)]

My Lords, much uncertainty and changing dynamics surround travel—Malta and the EU have already been mentioned. To flip that around, can the Minister kindly explain the rationale as to why government advice has belaboured ad nauseam travelling from the UK, yet my wife is able to travel to the UK from Portugal?

[Lord Bethell (Con)]

My Lords, our intention is that, later in the summer, those who are fully vaccinated will not have to quarantine when arriving in England from an amber list country. This will benefit the noble Lord’s wife, and I hope she will take advantage of it. When it comes to travel, caution is still the principle because travel exposes us to proximity to people in very confined areas. It also raises the possibility that variants of concern will come back with travellers returning from abroad. We have worked so hard and done so much to keep those VOCs out of the UK that it is not just right to give up these efforts now. Those arrangements are under review and will change if the risk assessment changes.

Covid-19

Viscount Waverley Excerpts

Thursday 11th February 2021 Lords Chamber

[Lord Bethell (Con)]

I do not agree with my noble friend on this in any way—fraud is fraud. If you put people in danger, you deserve to serve the consequences. It will be up to either the magistrate or the Crown Court to determine the sentence. The sentence is laid out in law, not by me or any new measure. Those who put the entire nation at risk by bringing variants of concern into the country should be aware that the courts may take an extremely dim view of their actions.

[Viscount Waverley (CB)]

My Lords, I am going to pass the baton to the next speaker as the points I wished to raise have already been addressed. However, I commend the noble Lord, Lord Bethell, whose performance as a torchbearer at the Dispatch Box is exemplary by anybody’s standards. I have recently been jabbed myself, and the whole vaccination process from start to finish is commendable for being conducted with efficiency and courteousness, making one proud to be a Brit. We will be on to a winner if we replicate that in global Britain.

[Lord Bethell (Con)]

I am extremely grateful for the noble Viscount’s kind remarks. They are rightly directed at those responsible for the deployment of the vaccine. The NHS itself has been a central player in all that, as have our academic colleagues, particularly at Oxford University but also Imperial, as well as others who have contributed. I will take his remarks back to the Department of Health and Social Care. It has been a very tough year, and I am extremely grateful for his remarks.

Covid-19: Variant

Viscount Waverley Excerpts

Wednesday 13th January 2021 Lords Chamber

[Lord Bethell (Con)]

My noble friend asks a very challenging question. The honest truth is that we have to look at the systems whereby that data is exchanged. CMOs around the world have extremely regular contact with each other, and a lot of the data is exchanged through the formal links of the scientific community. But I think that there is a case for more structured intergovernmental exchange of data about the new variants, because this will be the major challenge of the year ahead.

[Viscount Waverley (CB)]

The Minister mentioned a number of countries. Is there sufficient exchange between all of them or could more be done in that regard? Is there anything that the public could usefully know about the new variant’s transmission traits—whether it is airborne, for example?

[Lord Bethell (Con)]

The exchange of information between the scientific community has worked extremely well during this pandemic and epidemic, and I pay tribute to it for the open-hearted and transparent way in which it has exchanged data across political, cultural and national boundaries. In terms of transmission, the noble Viscount alludes to something that is very difficult to pin down. It is not clear what proportion of the disease is transmitted through the air and what proportion by touch and manual transmissibility. That is a very frustrating conundrum. The CMO guides us to believe that there is more transmissibility through the air than by touch, but it is absolutely essential that people keep their distance and wash their hands.

Covid-19 Update

Viscount Waverley Excerpts

Tuesday 15th December 2020 Lords Chamber

[Lord Bethell (Con) [V]]

The noble Baroness is entirely right. The vaccine is a great success story for the union and for the United Kingdom. We have had a four-nation approach and the distribution of the vaccine shows the union at its best. She is right to say that the work done at Porton Down is on behalf of all the nations of the United Kingdom and that the communication to the WHO was on behalf of the whole country. That communication demonstrates that our approach to the vaccine is to put transparency first and that we have moved extremely quickly to share this insight with our colleagues overseas.

[Viscount Waverley (CB) [V]]

My Lords, I am reliably informed that only two of the 14 passengers in a carriage on the 5.48 am Southeastern train from Gravesend to the London terminus this morning were wearing masks, so clearly the message is not getting through. Adding to the words that the Minister offered to the remarks of the noble Lord, Lord Winston, on the challenges that have appeared this morning of the long- awaited test release scheme, I ask: why not resolve this in part by passengers obtaining a test evidencing a negative result within 72 hours of travel into the UK? Further, if they have received a vaccination abroad or a negative test result abroad, will official confirmation from an appropriate authority from abroad be acceptable to the United Kingdom?

[Lord Bethell (Con) [V]]

If I have heard the question correctly, that is exactly how the test release scheme works. Travellers are invited to sign the appropriate forms and after some days they can be released from isolation early by taking tests. That scheme has been signed off by the Chief Medical Officer and data from the test is transmitted to Public Health England. We currently have a UK-only testing regime and we do not take tests from overseas, but we are keeping the scheme under review.