Health and Care Bill

Debate between Baroness Barker and Lord Hunt of Kings Heath

Lords Hansard - Part 2 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I have Amendment 176, the second amendment in this group, and two other amendments. I shall start with Amendment 176 which is concerned with the treatment of thyroid patients who continue to be denied liothyronine, otherwise known as T3, as the most appropriate treatment for them. For some patients, the standard treatment is not effective. T3 has proven to be a much better treatment, but tragically, a few years ago the manufacturers grossly inflated the cost of T3 by a massive 6,000%. Understandably, NHS England and its associated prescribing advising machinery strongly discouraged the use of the drug and, as a result, many patients had T3 withdrawn and suffered quite considerably or had to fund it privately or source it from abroad. Happily, the price of T3 has come down by 75%, although it could go down further, but I believe it is no longer categorised as a high-cost drug.

The problem is that clinical commissioning groups still treat it as a high-cost drug, so the situation is still very difficult for patients who need it—those for whom the standard treatment is not appropriate. The current guidance states that T3 can be prescribed to patients who have unresolved symptoms on the standard treatment if it is initiated or confirmed following a review by an NHS consultant endocrinologist. A statement in July 2021 restated NHSE guidance, but it has not been followed by clinical commissioning groups. A survey done recently by UK thyroid charities, to which I pay huge tribute, says that 44% of CCGs have not fully adopted the national guidelines or are wrongly interpreting them.

What are we to do? What is the situation here, where we have clear guidance that is not being followed? This goes back to our previous debates about the various mechanisms being brought in to ration treatments, against national guidance or technology appraisal advice from NICE. It is the same issue. I am not expecting the Minister to issue a direction but I am expecting him to tell CCGs and, in future, integrated care boards to get off their backsides, start implementing the guidance properly and realise that this is no longer such a high-cost drug. I appeal to him to do something about that.

I also hope that the Minister will do something about hospital catering. I confess to your Lordships that I am president of the Hospital Caterers Association, where I work very closely with some great professional staff who have to work with their hands tied behind their back. Often they do not have the resources to provide the high-quality food that everyone wants and expects.

During Covid we saw in many local NHS facilities a determination to do everything possible to improve nutrition for both patients and staff. Miraculously, hot food was made available to staff overnight, which, as noble Lords know, seems to have been beyond the capacity of the NHS for many years. I do not know why I am looking at the former Chief Nursing Officer as I say this; I think it is an appeal for support.

This clause is highly welcome as I believe it will lead to higher standards, but my amendments would enable the caterers to deliver on them. The first key point is this: they need the resources to be able to do it. The amount of money spent on hospital food per day at the moment is simply not sufficient. Secondly, we need more training for staff. The training programmes have disappeared, and we need to get them back in to give staff the opportunity to show what they can do. Thirdly, we need to make sure that NHS trusts and foundation trusts are fully on board with bringing forward these regulations. There is no doubt that the efficiency programmes have taken their toll on the budgets for hospital catering and that, equally, the old-style national training schemes fell away and have not been replaced. The pay grade of qualified chefs and cooks needs to be reviewed to reflect the importance of their role. This issue is important in terms of the standards of food and nutrition for our patients and for the well-being of our staff.

My final amendment in this group is Amendment 264. What links all these amendments is that we need more consultants appointed—a small effort to enable us to improve the efficiency of the system. I remind the Committee of my GMC connections in relation to this. The amendment would add the Royal College of Surgeons of Edinburgh and the Royal College of Physicians and Surgeons of Glasgow, and their associated dental faculties, to the colleges that may be involved in the appointment of NHS consultants. My amendment was inspired by the Royal College of Surgeons of Edinburgh, which noble Lords might be surprised to learn has an office in Birmingham because many consultants who work in the English NHS are members of the Scottish colleges.

There seems to be a lacuna in the current regulations. According to the National Health Service (Appointment of Consultants) Regulations 1996 and subsequent guidance issued by the department in 2005, only the Royal College of Surgeons in England is permitted to review surgical consultant job descriptions and send a royal college representative to the advisory appointment committees when it comes to the appointment of consultant surgeons. Other elements of my amendment apply to the appointment of physician clinicians, and the Royal College of Physicians of Edinburgh and the Royal College of Emergency Medicine are also supportive. Although the process and guidance apply only to NHS trusts, foundation trusts are encouraged to follow it.

The Minister has yet to accept any amendment to the Bill. The usual line from the Government is, “We will do this when legislation is available to do so.” Here is a great opportunity for the Minister, as we are here on day 6 of Committee, to get up and say that he is going to accept my amendment.

[Baroness Barker (LD)]

My Lords, in following the noble Lord, Lord Hunt, I declare an interest as the patron of the National Association of Care Catering, a position that I took over from the noble Baroness, Lady Greengross. I admit that, when I had this great honour thrust upon me, I had little idea what I was getting into—and I have discovered a world of highly dedicated, professional people whose contribution to the health of the nation is very much overlooked. I managed to attend their national conference in Nottingham last October, and I have to say that it was one of the most harrowing afternoons I have spent, as they talked about what they had gone through as the people who supply catering not only in hospitals and acute hospitals but in care homes, as well as doing meals on wheels.

I will pick up one point that the noble Lord, Lord Hunt, made, on training. He is absolutely right that this area has suffered a great deal because of various changes not just to training in the NHS but to the training in higher education. We do not have a recognised qualification in care catering in this country, yet these are people who have to produce food for people who have dysphagia, multiple food intolerances and dementia, people who quite often are suffering from malnutrition when they come into hospital, and people who have allergies and often suffer from dehydration. The people who have worked in this field, and some of them have worked in it for many years, suffer a deep sense of frustration, which is that when young people in school or college show an aptitude for or a willingness to go into the world of catering, they are directed towards restaurant catering, because that is where the teachers and lecturers think the money is to be made. Actually, catering for people with difficult medical conditions is a lot more complicated.

I say to the Minister that I am also really impressed by the specialist companies that work in this field—those that produce specialist menus and enable people to order ingredients for complicated menus in complicated settings, as well as those that manufacture cutlery and crockery and vessels that can be used by people whose interaction with that sort of thing is hampered. These can bring a dignity and focus to something that is much overlooked—but talk to dieticians and you will increasingly understand the importance that food plays in maintenance of health and recovery.

I do not know whether or not this will make it into the Bill, but will the Minister go back to the department and ask whether his officials might meet some of the people who do a remarkable and much overlooked job, day in, day out, and who these last two years, perhaps more than anybody else in the NHS, deserved the clap, if only people knew what they had done?

Health Protection (Coronavirus, Restrictions) (Steps etc.) (England) (Revocation and Amendment) Regulations 2021

Debate between Baroness Barker and Lord Hunt of Kings Heath

Tuesday 14th September 2021 Grand Committee

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very glad to follow the noble Lord and to speak to these regulations. They were laid two months ago and, once again, we are debating regulations that in a sense have been superseded by the various announcements made over the last 24 hours. I realise that this week we will probably debate at least two of the Statements, as well as looking forward to a lot of activity when we return.

I will focus on the instruments. At the time they were brought into force, the Government stated:

“The vaccine deployment programme continues successfully … Evidence shows vaccines are sufficiently effective in reducing hospitalisations and deaths in those vaccinated”


and that confidence in vaccine effectiveness against the delta variant has increased significantly. I hope the Minister can update us on that.

Can he confirm the number of adults who have not yet been vaccinated? I think there are figures in the winter plan that I have just seen. Does he agree that, while one should applaud all the efforts of those who have made the vaccination programme possible, it is still striking that so many adults have irresponsibly decided not to vaccinate? I know we will debate the issue of children aged 12 to 15 later this week, but I for one feel very uncomfortable that, even with just one jab, there will be a small risk to those taking it— particularly some boys—partly because of the selfishness of adults in not taking the vaccine. I personally think there are some ethical issues and am not surprised that the JCVI found this a very difficult decision. What else does the Minister think can be done to encourage adults to take up the vaccine?

Could the Minister also say a little about the unknown risks of vaccine effectiveness in high-prevalence environments where transmission pressures are high? I will also ask about the relationship between the booster jabs, which I think the Chief Medical Officer recently announced are to happen, and the flu vaccine programme. I understand that there is concern that immunity to the virus is low, leading to fear that flu, together with other winter viruses, could put the NHS under extreme pressure. Could he also comment on the likely effectiveness of the flu vaccine, which I gather is pretty low?

May I also ask about face coverings? These regulations remove the requirement for people to wear face coverings when using public transport services and in relevant indoor settings. The rationale for that was that the success of the vaccination programme meant we could move away from strict legal restrictions towards personal responsibility and informed judgment. Last week we debated this to an extent and the Minister pointed to data that his department had showing that this had not had much impact on people’s behaviour. From talking to noble Lords, I note that there is some surprise about this, because to the visible eye mask-wearing has dropped off considerably, particularly among men. I wonder about the extent to which this is being monitored and whether we need to step up some programmes about why it is still to be encouraged.

Finally, I will ask about local authority powers. These regulations enable local authorities to take action where an outbreak or risk of outbreak is linked to premises or an event, with local authorities retaining powers to respond to local serious and imminent public health threats. That is a very sensible provision. The Government then describe those regulations as continuing

“to act as an important public health tool for local authorities”.

Could he update me on the use of these regulations since they were passed?

[Baroness Barker (LD)]

My Lords, I am speaking in this debate because my noble friend Lady Brinton cannot be in her place to take part. We have the technology to enable remote participation in debates in the Moses Room, but the House authorities have not yet permitted that for contributions in Grand Committee, so virtual participation in these proceedings is unfortunately not possible, even though we have seen in this last week that the very few participants who need to take part remotely can be managed very effectively without recourse to extensive speakers’ lists.

It is also a loss to the Committee, because my noble friend Lady Brinton cannot take part for one very important reason, about which she has been quite public: she is clinically vulnerable, and one thing she cannot do is travel on public transport, which she cannot do because people are not wearing masks. Of all people, she should have been able to be here to make that point.

Yet again, these SIs were tabled very late. They came in just before the recess in late July, so yet again we are back to debating things that are long in the past. We have repeatedly asked the Government to respect the House and timetable SIs when they are not genuinely urgent. However, these are, as the noble Lord, Lord Hunt of Kings Heath, said, quite pertinent in view of the Statements being made this week.

This statutory instrument mostly deals with the revocation of statutory instruments on 21 July, which confirmed a number of the changes in the Prime Minister’s so-called freedom day. However, there is one extension, in Regulation 4, to the expiry date of the Health Protection (Coronavirus, Restrictions) (England) (No. 3) Regulations, which are now to end on 27 September. The Explanatory Memorandum says that this

“will ensure that local authorities retain powers to respond to local serious and imminent public health threats as a result of the spread of coronavirus. The No. 3 Regulations will continue to act as an important public health tool for local authorities in their local coronavirus outbreak management, compliance and enforcement activities. This is particularly important in light of the revocation of the other restrictions mentioned above”.

As we have said all the way through this pandemic, it is important that local authorities have the power to manage local outbreaks. Simply extending that power in law, but not making sure that they have the resources, will not work. As epidemiologists have said to us in terms, there will inevitably be points when it is important to close all the pubs in a certain area, simply because an outbreak has to be contained. While we welcome that, it behoves the Minister to say something about local authorities such as Croydon, which is insolvent, and how it will have the resources to manage this significant and enduring public health problem.

We regret the removal of face coverings on public transport and other crowded venues. I can say, as somebody who travels on the London Underground every working day, that fewer and fewer people are wearing masks and, as more and more people are on the Tube, I am certain we will see a spike in infections as a result. I also point out to noble Lords that the bad messaging on this does not help. There is genuine confusion. One of my colleagues was on a train to Scotland in the summer and, when it got to the border, there was an announcement that the law now required everybody on that train to wear a mask, and they did, as they should have done all the way.

It is now clear that the Government, and in particular the Prime Minister, have been so desperate to place emphasis on the vaccination programme as our primary defence that they have forgotten to look at the role of other mitigations against the disease. Although we support the passing of these regulations, we need to make the messaging clearer as a matter of urgency, so we can avoid the confusion that is now prevalent among people in England.

Medicines and Medical Devices Bill

Debate between Baroness Barker and Lord Hunt of Kings Heath

Committee stage & Committee: 1st sitting (Hansard) & Committee: 1st sitting (Hansard): House of Lords
Monday 19th October 2020 Grand Committee

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am glad that the Minister said that he was listening, and his amendments are important, particularly the one that makes the principle of the health and safety of the public the key consideration when making regulations under the parts of the Bill relating to human medicines and medical devices. He will be aware that concern was expressed by patient groups, in particular, about the Bill as originally drafted and the implication of the attractiveness provision. That concern takes us back to our first debate on “whither regulation in future”.

If we are not going to be aligned to the European Medicines Agency and are to plough it alone, the UK pharma industry will be at a huge disadvantage unless the Government offer an incentive. It may be a bung—the debate about state aid is very relevant to that—or much faster regulation. Otherwise, it is very difficult to see why the industry would continue to invest in R&D in this country. Its position could be as vulnerable as is the motor car industry as a result of the bumbling ineptitude of the Government in their Brexit so-called negotiation.

It is not far-fetched, it is a legitimate question to ask what on earth the Government really want from medicines and medical devices regulation. They may have issued all sorts of draft regulations, but we are clueless about what they are actually seeking to do. The MHRA is clearly not allowed to talk to anybody about this. I remember when the MHRA would talk to politicians and debate these things. It has clearly been given an instruction not to talk to anyone. We are absolutely clueless about the future direction of regulation. None the less, the amendments are clearly helpful, and no doubt we will consider them between Committee and Report.

I would, however, like to ask the Minister about Amendment 2 and its relevance to Northern Ireland. I understand that, exceptionally, it will be moved in Grand Committee because legislative consent takes three months to get through, which impacts on the Bill’s process. I understand that, but, as Parts 1 and 2 of the Bill affect Northern Ireland, does that similarly affect any amendment to Part 1 or 2 passed on Report? What is then the impact on Northern Ireland legislation?

Overall, however, most of the amendments are a constructive improvement, but we will obviously consider them further between now and Report.

[Baroness Barker (LD)]

My Lords, we must consider the whole Bill as building the foundations for the future of the medicines and pharmaceutical industry in this country. We do so in the knowledge that we have had a perhaps pre-eminent role in the world in pharmaceutical development because of the coming together of a number of factors—the European medicines regulations and all the conventions to which we are party, plus the existence of the NHS and the potential it offers for clinical research and our long tradition of working in the life sciences and biosciences sector.

The Minister definitely listened at Second Reading to the many voices of concern that perceived the Bill as it came to us as a weakening of the many factors that underpin our success in this area. He understood entirely, I think, that if we were to take away the pre-eminence of the health and safety of the industry, we would fatally undermine the whole basis of the construction of this very important sector for our economy.

The Minister has listened but not quite hard enough. I agree with the noble Lord, Lord Lansley, that Amendment 2 is an improvement, but it still leaves the decision-making on whether something promotes health and safety to the Secretary of State. I much prefer the construction in Amendment 5, to which my noble friend Lady Jolly has added her name.

My main concern in this group is with Amendment 51 on regulation for veterinary medicines. In his introduction, the Minister pointed to the fact that medicines for animals can work back into the food chain and to humans. I understand the interplay between taking into account things that are done to improve human well-being, animal well-being and the environment, but he will understand that, when people see the amendments, it will not be immediately apparent to them that human welfare is pre-eminent in the list. It says that the regulations must promote “one or more” of the three. I agree that the Minister has moved on the first set of amendments, but he has not gone anywhere near far enough on the regulations on veterinary medicines, so we may well need to come back to that at a later stage.