Pharmaceutical Research and Development Spending

Baroness Bennett of Manor Castle Excerpts

Thursday 13th October 2022 Grand Committee

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Brinton. I thank the noble Lord, Lord Hunt of Kings Heath, for securing this debate, and the noble Baroness, Lady Wheeler, for so effectively introducing it.

I start this debate from a philosophically different position from other speakers. What we in the UK— and the world—need is not just or even primarily the most effective, efficient pharmaceutical research and development; more than that, we need the best possible health research and development, which often may not involve pharmaceuticals at all but instead improving public health by addressing the social and environmental determinants of health, so pharmaceuticals are needed less and can be reserved—saved—for the most essential, important and unavoidable uses, some of which the noble Baroness, Lady Brinton, just outlined. The noble Lord, Lord Goodlad, just focused on dementia, but of course huge and increasing amounts of research show that addressing issues such as diet, exercise and air pollution can have a tremendous impact on reducing the impact of dementia, and we must not forget that focus.

We are now living in the age of shocks. We have already had one pandemic shock in Covid-19, still continuing, both in the spread of the SARS-CoV-2 virus and the huge and little-understood impacts of long Covid, and we know that others threaten, including the avian flu virus that is cutting such a dreadful swathe through our wild bird populations—and the factory farming systems that incubated it.

So, were I to be wording this question, I would rather ask how the UK most effectively contributes to global health, and in pharmaceutical research—with our current academic and industry frames—we certainly play an important part. But some of our role should surely be to promote and support research and development of pharmaceuticals in the global south to strengthen systems there. I will restrain myself from venturing off into the disgraceful state of ODA funding, although I directly ask the Minister what assessment the Government have conducted on the dangers of the UK failing to deliver the support that others do to the Global Fund, given the assessment that the UK’s current plans could put over 700,000 lives at risk and lead to over 17 million new infections across the three diseases it covers?

What I will focus on specifically is influenced by an issue that many may have seen highlighted last week in the New Statesman in an interview with Dame Sally Davies, the first female Chief Medical Officer of England. It focused on antimicrobial resistance, on which Dame Sally said:

“I do wonder how long I have to go on pushing this. Have I failed? Well I haven’t succeeded, have I, or we wouldn’t be sat here.”


I have to warn the Committee that I am planning on pushing hard on this in the coming months, with the assistance of two brilliant senior interns, Julze Alejandre and Emily Stevenson, whose work is supported by the British Society for Antimicrobial Chemotherapy.

So how is this relevant to pharmaceutical research in the UK? As a rich nation with a well-developed health system, we need to provide a framework for drug development and purchase that acknowledges the need not just to look at the immediate impact of a treatment on a patient but its full impact on public and environmental health. How biodegradable is a drug, what is its ecotoxicity, and what will be the complete impacts of its development, manufacture and use? The Environment Agency has just started providing funding to a new research group looking at the impact of biocides and cross-resistance—but that is starting at the other end, after the damage has been done.

If we think of the UK as a place that truly seeks to understand the impact of medicines, both existing and developing, we can look to the pharmaceutical formulary used in the Stockholm region in Sweden, which considers not just the efficacy and safety, pharmaceutical suitability and cost effectiveness of drugs, as does the NHS, but their environmental impacts. Should not the UK, to provide “world-leading” research and treatment, be operating on the same basis?

I turn now to some specific questions, of which I have given prior notice, about the environment for research, development and use of drugs, particularly relating to the Government’s approach to the European Commission’s water framework directive, which sets out a watch list of priority substances. Once they are included on the watch list, EU states are required to monitor these substances, and the inclusion of these compounds helps to raise research interest in these agents, including their AMR selective potential at environmentally relevant concentrations. Until recently, the data used to inform selection of compounds on the watch list determined ecological risk based only on ecotoxicology tests, and it was only in 2020 that AMR selection risk was also considered as an end point.

Featured on the watch list, updated in August this year with five more drugs, are a variety of compounds with a host of essential applications, including antibiotics, antidepressants, synthetic hormones, diabetes maintenance medication and both human antifungals and agricultural fungicides. Can the Minister update me on how this EU update will be treated in the UK, and how talk of sweeping aside regulatory frameworks transferred from the EU to the UK after Brexit that has arrived with the new Prime Minister will be treated in this area of assessing water issues?

In the post-Brexit era and considering the potential risks of these pharmaceuticals on the environment and in terms of AMR, as a proportion of the UK’s pharmaceutical research and development budget, what is the commitment of His Majesty’s Government to ensuring that the monitoring and reporting of these pharmaceuticals will be done in the UK in a more robust, comprehensive and transparent manner? We were after all promised stronger environmental protections after Brexit. In addition, what are the Government doing to ensure that the results of these environmental monitoring assessments are available for researchers and healthcare providers so that they can make informed and wise decisions in choosing and developing pharmaceuticals that have less ecological impact and risk in terms of AMR?

A number of noble Lords will remember that one of the first votes that I called in your Lordships’ House was as a result of sheer exasperation at the Government’s failure to take seriously in the Medicines and Medical Devices Act, as it now is, the environmental, particularly AMR, risks of human medicines, to mirror the terminology in the Bill used for veterinary medicines. The Minister today has the opportunity to reassure me that, with even more concerning scientific research in the area since then, the Government are now taking it seriously.

Health and Social Care Update

Baroness Bennett of Manor Castle Excerpts

Monday 10th October 2022 Lords Chamber

[Lord Markham (Con)]

We live in a time of a very competitive jobs market and such a competitive market brings challenges with it, as the noble Lord says. We need to make sure that people feel that these jobs not only are recognised as important but make sense economically for them as well. We are investing £15 million in expanding our recruitment and resourcing to attract more people into the industry. We also need to look overseas and I think many are aware of our plans to do that. It is not lost on the team over here that we need to make sure that this is an attractive job and career for people to move into.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I join others in welcoming the Minister to his new place. I acknowledge that he has stepped in very late in the piece to pick up this Statement, but we are right to ask questions on it. Unlike the noble Baronesses on the Front Benches, I want to address the issue of the number and supply of doctors, particularly GPs. There are some strong statements here about “setting the expectation” of getting an appointment within two weeks, “opening up time” for 1 million more appointments and helping practices “improve performance”. Think about what GP practices have done in improving performance: there were 4.9 million more appointments in December 2021 than there had been two years previously—a 20% rise. A BMA survey found that nine out of 10 doctors reported that their workload was excessive and dangerous. This Statement says that there will be more and more GP appointments, but where will the doctors needed to provide this service in a healthy and safe manner come from?

[Lord Markham (Con)]

As I mentioned, we have 3,500 more doctors, but the 50 million more appointments target, which we are well on the way to delivering, is from not just GPs but across the piece. It is also from nurses and community pharmacies. I think we would all agree that doctors are our most precious resource. Given the comments on not wishing to overburden them and the stresses of that, we need to make sure that their limited time is focused on the patients that most essentially need that time. We are expanding supply and spreading it among nurses—as I mentioned, from my experience with my mother, they are very capable and willing to pick up a lot—and among pharmacies as well.

Urgent and Emergency Care

Baroness Bennett of Manor Castle Excerpts

Tuesday 6th September 2022 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for his question. We have a debate this week tabled by the noble Lord, Lord Patel, on reform of the health system. One thing the noble Lord believes, as do a number of other practitioners and noble Lords who have worked in the health service, is that it is time to reform the old model of seeing your GP, getting five or 10 minutes if you are lucky, and then being referred to secondary care elsewhere. In this day and age, we need such reform. We need to take advantage of data and new technology but also to look at work processes. Some of the stuff that was being done in secondary care until recently can now be done at primary care level. Even in primary care, it does not always have to be the doctor who sees the patient; it can be a practice nurse, a physiotherapist or a local civil society group.

Clearly, there is a need to look at the model of the NHS and how services are provided; all parties recognise that there are areas for reform. It would be great if we could get consensus but, sadly, this issue is too much of a political football. When I speak with my friends from other parties, we say candidly that something has to change and that there has to be reform, but it is clearly too tempting to bash any Government. I know that, when we were in opposition, we would have bashed the Government of the day on health. It is, sadly, too tempting a political football.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I follow on from a point raised by the noble Baroness, Lady Merron. The Statement refers to the new contract with St John Ambulance—I join others in welcoming that—and to recruiting call handlers, paramedics and social carers. There is no reference to the acute crisis we have regarding doctors, nurses, midwives and associated health professionals.

To pick up on the question of whether we need a royal commission and systems change, the underlying situation is that the UK has 2.8 doctors per 1,000 people and 7.9 nurses, which is the second lowest in the OECD. Our number of hospital beds per head of population is on average lower than everywhere in the OECD but Denmark and Sweden. We simply have an acute lack of resources, which is independent of systems and is putting enormous pressure on services. We are now seeing huge pressure being put on medical professionals. Being a specialist in A&E is an acutely difficult and challenging task. The issues of ambulance response times and the queues of ambulances outside A&E are clearly putting huge pressure on people.

The Minister referred to the fact that, as we speak, we have a new Secretary of State. Surely it is time to acknowledge the contribution that those doctors, nurses and other medical professionals are making, through some kind of new, big gesture from the new Secretary of State to say, “We have to keep you. We really value you.” We are recruiting new people but others are walking out of the door as quickly or more so. This has to change. Surely a recognition of the care and service that has been given and continues to be given would help.

[Lord Kamall (Con)]

The noble Baroness makes a very important point which noble Lords across the House will agree. We should pay tribute to the hard work of medical staff in our system of care; there is no doubt about that. I take the point that this is about not just the ambulance service but other parts of the health service. In fact, had my right honourable friend the former Secretary of State stayed in post, he would have issued subsequent Statements on what we are doing about the GP workforce and some of the other issues that noble Lords have raised.

It is clear that one of the issues is retention. The NHS has its people plan, published in July 2020. We understand that people are leaving and, yes, there are newspaper headlines, but what are the issues behind those headlines? There is a very difficult issue around pensions and, particularly for some of the wealthier GPs, whether it is worth their while, having built up a massive pension over the years. There has been a bit of discussion and to and fro with the Treasury over that. However, it is quite clear at trust and workplace level that we have to make sure there are well-being courses and that we are looking after staff. We also have to look at the individual decisions as to why people may want to leave.

No doubt many staff are exhausted after the last couple of years. An amazing amount of pressure has been put on them and, as the noble Baroness says, it is right that we find ways to send a strong message that we value them and want to keep them as well as recruit new staff. We also have to look at this against the wider picture. We have more doctors and nurses than ever before. The question is: why, despite that, do we have this pressure? It is because the demand is outstripping supply.

We are now aware of far more health conditions than we were, say, five, 10 or 20 years ago. When preparing for a debate on neurological conditions the other day, I asked my officials to list them all. They said, “We can’t do that, Minister—there are 600.” Let us think about that. We were not even aware before of all those conditions. How many staff does that require? Or let us think about mental health: 30 or 40 years ago, it was not taken seriously; it was all about a stiff upper lip and pulling yourself together. Now we take it all seriously, and have mental health parity in the health Bill, which will need more staff. We will have more staff—more doctors and nurses—but the demand will outstrip supply. That is why a proper debate is needed across parties.

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[Lord Kamall (Con)]

I thank the noble Lord for sharing that personal story—the good and bad side of it. I was on a visit to a hospital a few months ago where they showed us a nice, new scanner, which they were very proud of. The question was: how much is that used? Does it sit empty at weekends? With more networks and being more connected, we can find out where there is capacity in the system. If there is equipment, why are there not staff available? It could be for staff absence reasons. If it is not there, where can people go? With more community diagnostic centres, you will find lots more diagnosis facilities and scanners, so if the acute place does not have it, there should be availability in the community.

On the wider question about being “radical”, the noble Lord will know that, while we may have candid conversations as friends from different parties, sadly, health is too tempting to use as a political football. There are some issues that people feel very strongly about. Some of the points about charging that the noble Lord mentioned would be seen as too radical by some, or as undermining the very ethos of the NHS. I think we have to be prepared to be radical and think the unthinkable, but, sadly, this is the formal, political debate that we have got, and we have to work within the remit of that debate. Why should it be, for example, that millionaires could not pay a little bit more to help—not through taxation, but maybe direct?

Some local trusts have tackled this issue. For example, my local trust has set up a private arm, but the money paid for private diagnosis or surgery is reinvested into the hospital to help NHS patients. I know that more than one trust has done that. That might be an interesting way of raising more money and making sure that people value the service and care they get.

On the specific issues, one of the reasons we are having this discussion is because the former Secretary of State was looking at all the issues that need to be tackled now, both in the short term and the long term.

[Baroness Bennett of Manor Castle (GP)]

My Lords, the noble Baroness, Lady Brinton, referred to overseas recruitment of doctors and nurses. The Statement refers to the “international recruitment task force” for social care. I am not sure if the Minister is aware of the report prepared by the Rights Lab at the University of Nottingham, The Vulnerability of Paid Migrant Live-in Care Workers in London to Modern Slavery. If not, I ask him to assure me that the department will be looking at this. The report highlights real issues about the treatment of migrant care workers, particularly in live-in situations. It is a cross-departmental issue, looking also at immigration issues like being tied to one employer where migration status is a real problem. It also looks at the need for a registration system for recruitment agencies. Can the Minister assure me that the department will look at that?

[Lord Kamall (Con)]

I thank the noble Baroness for the question. I am not aware of that report. If the noble Baroness would be happy to send a copy to my parliamentary email, I will happily forward it to officials in my department and see if we can get an answer to that.

Health Improvement and Food Production

Baroness Bennett of Manor Castle Excerpts

Thursday 7th July 2022 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I thank the noble Baroness, Lady Walmsley, for securing this debate and her excellent introduction. I particularly thank her for focusing on the work of Bite Back, which is a powerful demonstration of how the whole process of governance needs to listen much more to young people, who are getting more engaged in politics and political campaigning. We need to think about how we can get that to have more influence on decision-making.

It is a great pleasure to follow the noble Baroness, Lady Jenkin of Kennington. Your Lordships’ House will probably think she and I are entirely co-ordinating this because my speech focuses on exactly the same theme as hers—ultra-processed food—but, in practice, we have not exchanged a word in any form.

The practical reality is that there is a reason for this and a reason why we can see two opposite sides of the House arriving at the same point: this Government are failing to catch up with the science and the reality of what is increasingly happening around the world. The focus on foods that are high in fat, sugar and salt is simply not adequate to capture the reality of ultra-processed foods, as identified by what is known as the NOVA classification system.

Of course, the Government often like to talk about how they are world-leading. Well, they have some catching up to do with the Welsh and Brazilian Governments and other Governments around the world. Indeed, in researching this speech, I noted that the next set of dietary guidelines for Americans, for 2025 to 2030—they are now being drawn up—are expected to contain a new emphasis on the damage done to health by ultra-processed foods. So the Government have a small window here at least to catch up with the Americans; they could be doing so.

The extra theme that I want to introduce into my speech, in addition to what the noble Baroness, Lady Jenkin, said, is the impact of economic and regional inequality. This should be feeding into the Government’s levelling-up agenda. The disparities in our deeply unequal society, where levels of inequality are speeding past the Edwardian and heading back towards the Victorian—another time when we were very concerned about the impact of food on the health of the nation—are really having an impact. If we look at some of the people who are the most deprived, according to research by the Social Market Foundation and Kellogg’s from 2018, 1.2 million people live in food deserts. Research by Dr Megan Blake, from the geography department at the University of Sheffield, points out that living in a food desert

“can mean having to carry … food shopping a long distance, a struggle that many older people living in food deserts experience.”

I would go further than that. If we think about people with disabilities, who are one in five of the working-age population, or people caring for young children, carrying food long distances will tend to bias them towards ultra-processed food, which is lighter because it contains less liquid than fresh food. In that study, 41% of respondents did not have a car, but there is also the problem of financial barriers—something that we know is becoming more of an issue with the cost of living crisis. The latest ONS data from March 2022 showed that nearly a quarter of adults reported that it is difficult or very difficult to pay their household bills.

It is also worth thinking about the fact that people debating this issue often talk about choice. However, the type of food that we have access to and eat affects us in many ways, both obviously and subtly. When people have access to fresh produce, they can readily select the ingredients for the meals they want to prepare, whereas people relying on ultra-processed food, ready meals and takeaways are under the manufacturers’ control. Those who talk about choice need to look at who is in control in this relationship.

There have been detailed studies on this issue. A recent Japanese study showed that children who frequently eat instant food have significantly higher rates of inadequate nutrient intake and excess nutrient intake, while children who eat more take-out food had significantly higher levels of inadequate nutrient intake. Another study from Luxembourg showed that:

“On controlling for age, sex, socio-economic status and lifestyle factors, daily consumption of ready-made meals was found to be associated with higher energy intake and with poor compliance with national nutritional”


standards. A study by the American Journal of Clinical Nutrition in the past month showed that children aged three to five who ate more ultra-processed foods had lower locomotive skills, while children aged 12 to 15, again eating more ultra-processed foods, had higher levels of obesity.

Beyond the macronutrient considerations, it is worth thinking about what impact the consumption of ultra-processed food has on the human microbiome—something that we are increasingly coming to understand is crucial for physical and mental health. As Dr Rodney Dietert points out in his book The Human Super-Organism, many additives that are now common in our foods have been shown to dramatically alter the human gut microbiome, often leading to inflammation and disease. One example that he cites is the emulsifiers polysorbate 80 and carboxymethylcellulose, which show effects such as thinning the mucus layer and increasing inflammation, eventually leading to inflammation-driven disease in mice. A US National Institutes of Health report in 2015 shows that common food emulsifiers disrupt the gut microbiome and provide pathways to non-communicable disease, including inflammation-driven obesity.

These are issues that the Government have been told about, and of course they have to cite the excellent Dimbleby review of the national food strategy. This picks up the point from the noble Baroness, Lady Walmsley, that we are talking about not just human health but the health of nature. An agricultural system focused on producing commodities to put into this ultra-processed food has terrible impacts. As the Dasgupta review—another government report—said,

“the agricultural system has completely wiped out the natural system”.

So the food that we are producing causes enormous damage to both the environment and human health. Mr Dimbleby referred to “the junk food cycle”, saying:

“We will not be able to educate our way out of that feedback loop. It needs strong government intervention on commercial interests.”


Because the Motion focuses on food production, I want to pick up and focus on the point that farmers produce what the system has forced them to produce. We know that farmers are getting only about 8p in the pound of the cost of food. This is a situation where the Government urgently need to act to provide different options and different kinds of food system that provide a good living for farmers while ensuring healthy food for people.

The noble Baroness, Lady Walmsley, referred to the crucial and final government decision to introduce a land-use strategy. I propose, as I proposed during the passage of the Agriculture Act a couple of years ago, that it needs to focus on how we use land for food production for the best possible nutrient production per hectare, which without a doubt would mean huge amounts more vegetable and fruit production and much less grain and oil—which, incidentally, is what is recommended in the recent Sustainable Food Trust report, Feeding Britain. I urge the Minister to speak to his colleague, the noble Lord, Lord Benyon, who I know was at the launch of that report, which looks at the intersection of food production and health. I know that may not seem to fall within the remit of the Minister’s department, but it is something that he really should take a look at.

Of course, not all food has to be produced by farmers and growers—people operating commercially. We are seeing the NHS increasingly focus on green prescribing and looking at how people can be given access to healthy food but, even better, how people can grow healthy food for themselves. I will focus here on the work of the excellent Incredible Edible, founded in Todmorden but now a movement around the world. Let us see our green spaces producing food that is accessible and free to all. That is one way in which we can grow a much healthier diet.

When the Government talk about innovation in the food system, they like to focus on things such as gene editing—people in labs with test tubes. Some of the finest, most important and leading innovation is the kind of social, economic innovation that looks at how to produce food in different ways. When thinking about how we help farmers, growers and communities to produce that healthy food—we have been working on the infrastructure Bill—what could be a better addition to the UK’s infrastructure than an excellent system of research, support and advice, working with farmers and growers to produce a healthier food system? It would also need to focus on distribution systems—the ways in which food reaches people.

My final thought is on how often this debate drifts back into, “We can’t have a nanny state; people make choices for themselves.” Marie Antoinette was castigated for saying, “Let them eat cake.” What we have is far worse. The supermarkets, the multinational food companies, seed and chemical manufacturing, and fast food companies control what we eat, saying, “Let them eat extruded, moulded, milled, additive-rich food with added sugars, starches, fats and artificial colours, flavours and stabilisers. Let them eat this ultra-processed pap.” Indeed, people are not being given any choice but to eat this ultra-processed pap.

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

My Lords, I also congratulate the noble Baroness, Lady Walmsley, on securing this debate. I am also grateful to all noble Lords for their considered and thoughtful contributions. It is a self-evident truth that we all need food to survive. However, as with many things in life, it is not enough simply to restate this. As noble Lords have rightly said, there are many factors to be considered. How is the food produced? Is it done sustainably? How affordable is it, and what is its impact on our health?

We know that access to good-quality, healthy food is essential to achieving our ambition to halve childhood obesity by 2030, to reduce the gap in healthy life expectancy and to reduce the number of people living with diet and weight-related illnesses. The Government are committed to supporting the production and availability of good food to help improve the nation’s health.

As noble Lords have referred to, our recently published food strategy puts food security at the heart of our vision for the food sector. Our aim is to maintain broadly the current level of food that we produce domestically and to boost production in sectors where there are the largest opportunities. It sets out our ambitions to create a sustainable and accessible food system, with quality products that support healthier and homegrown diets for all. Our farming reforms are designed to support farmers to produce food sustainably and productively and in a more environmentally friendly way, from which we will all benefit. I am sure we all want to see a sustainable and healthy food system, from farm to fork and catch to plate, seizing the opportunities before us and levelling up every part of the country so that everyone, wherever they live and whatever their background, has access to nutritious and healthier food.

We all know that the food we consume plays a role in our overall health. Covid-19 highlights the risks of poor diet and obesity, driving home the importance of better diets and maintaining a healthy weight. As noble Lords have referred to, the Eatwell Guide outlines the Government’s advice on a healthy, balanced diet. It shows the proportions in which different types of food are needed to have a well-balanced and healthy diet, to help meet nutrient requirements and reduce the risk of chronic disease. We know that too many of us are eating too many calories, too much salt and saturated fat and too many large portions, and are snacking too frequently.

While some parts of the food and drink industry are leading the way, by reformulating products or reducing portion sizes, and I think we should pay credit to those parts of the industry that have done so and sometimes met targets in advance of target dates, the challenge to go further remains.

We know that obesity does not develop overnight. When you look at the behavioural contributions, it builds over time through frequent excessive calorie consumption and insufficient physical activity. It is not the stereotype of Billy Bunter stuffing his face with 75 cream cakes. Even eating small amounts of excess calories over time can add up for both adults and children. It catches up with many people over time.

As noble Lords have rightly said, obesity is associated with reduced healthy life expectancy. It is a leading cause of serious non-communicable diseases, such as type 2 diabetes and heart disease, and it is often associated with poorer mental health. We also know now that it increases the risk of serious illness and death from Covid-19.

Helping people to achieve and maintain a healthy weight and a heathier diet is one of the most important things we can do to improve our nation’s health. We all have a role to play in meeting this challenge: government, industry, the health service and many other partners across the country. As a government, we can play our role in enabling healthier food choices by making a greater range of healthier food more accessible; by empowering people with more information to make informed decisions about the foods that they eat; and by incentivising healthier behaviours.

As noble Lords have acknowledged, the food industry supplies most of the food and drink that we consume. Therefore, it plays a critical role in supporting the aims that we want to see, such as selling healthier food and drink. Through our reduction and reformulation programmes, we are working with the food industry to encourage it to make everyday food and drink lower in sugar, salt and calories. The programme applies across all sectors of the food industry: retailers, manufacturers, restaurants, cafés, pubs, takeaways and delivered food. We have seen some progress since the publication of chapter one of the childhood obesity plan in 2016, with the average sugar content of breakfast cereals and yoghurts decreasing by 13%, and drinks subject to the soft drinks levy decreasing by 44% between 2015 and 2019. These statistics are very welcome, but we know there is more to be done.

However, we also need to be careful about the unintended consequences. As an example, when the sugar content of Irn-Bru was reduced, customers complained about the taste. How did the company respond? By claiming to rediscover an old recipe from 1901, which contained even more sugar. It was a huge hit with Irn-Bru drinkers. How do we address these unintended consequences?

[Baroness Bennett of Manor Castle (GP)]

I thank the Minister for giving way. He referred to “everyday food and drink” and the formulation thereof. Will he acknowledge that, if we are talking about everyday foods, we should not be talking about formulation? You do not talk in that way about fruit and vegetables, and unprocessed food.

[Lord Kamall (Con)]

The noble Baroness makes an important point, but we have to recognise the reality: not where we want to get to, but where we are at the moment. People do eat food that will need to be reformulated if we want to make it healthier. Of course, we know that fruit and vegetables are healthy, but not everyone, as we help them transition, will eat fruit and vegetables, or make stuff from the raw products. They will buy products in supermarkets, and therefore if they are buying them, we have to make sure that they are healthier and reformulated. We do not yet live in that ideal world where everyone buys fruit and vegetables, and cooks everything for themselves.

Given that, we also need new regulations on out-of-home calorie labelling. As we know, many people go to restaurants, buy takeaways or have their food delivered. It is important that we have calorie labelling for food sold in large businesses, including restaurants, cafés and takeaways, which came into force on 6 April 2022. As noble Lords are aware, there will be further legislation, on restricting the promotion and advertising of products high in fat, salt and sugar, which will come into effect in the next few years. I know that many noble Lords disagreed with the Government’s views on delaying some of those measures. We will continue to have the end-of-aisle promotion on the target date, but others, such as “buy one, get one free”, are delayed because of the trade-off with the cost of living crisis, but will come. It is delayed, but we have set target dates.

Once again, we have to be open—

Nursing: Staffing

Baroness Bennett of Manor Castle Excerpts

Thursday 16th June 2022 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a great pleasure to follow the right reverend Prelate the Bishop of London who, together with the noble Baroness, Lady Tyler of Enfield—whom I thank for securing this debate on the report—have covered clearly the huge issues that it raises. I want us to take a broader, global view and then look at some of the structural issues behind the immediate reality in that report.

On the global view, the World Health Organization tells us that there is a shortage of 5.9 million nurses around the world; that is nearly a quarter of the current global workforce of almost 28 million. The biggest shortfalls are in low and middle-income countries, notably in Africa, Latin America, south-east Asia and the eastern Mediterranean. I agree with the noble Lord, Lord Lilley, that we in the UK should not be taking people from other countries, particularly ones with a nursing shortage. We should be training in the UK more nurses than we need. As a wealthy country, that should be our responsibility.

The International Council of Nurses says that behind this shortfall are many structural problems, including low pay, poor conditions and—remembering we are talking about the global scale—inadequate training availability. I note that McKinsey & Company did a study which found that, in five of six nations surveyed—the US, the UK, Singapore, Japan and France—one-third of nurses said that they were likely to quit in the next year. This is not a problem simply contained within the UK.

Of course, Covid is a huge factor here; the WHO estimates that about 180,000 healthcare workers died from Covid, many of them no doubt occupationally exposed between January 2020 and May 2021. Many others would have been harmed by long Covid, burnout and mental ill-health from the difficult conditions they were facing. Looking back to 2021, a long-term study by JAMA, a US research network, found that female nurses were twice as likely as women in the general population to commit suicide. That is a very disturbing statistic.

The noble Baroness, Lady Tyler, set out very clearly that we have a problem in the UK; the Government have stepped up recruitment, but it is not even keeping us at the levels of staffing we have now. There are aspects of this job that are enormously, immensely difficult. There will always be people needing care at all hours and on weekends. It is not possible ever to make this a nine-to-five job for many people.

Nurses and midwives have to deal with tremendously difficult situations. I think of a student midwife testifying about being on a work placement in a delivery room which had just had a stillbirth. She was left, as a student, comforting the mother while other professionals in the room looked after the medical needs that needed to be cared for. Think about the fact that that student midwife is now paying to be in that situation. To study as a student midwife, that is what you do: you pay.

My thesis, which I want to explore a little today, is that the underlying structural issue is that nursing and midwifery as professions are profoundly undervalued. That is why we find ourselves in this long-term global situation. I am drawing on another Royal College of Nursing report from last year, titled Gender and Nursing as a Profession: Valuing Nurses and Paying Them Their Worth. I note that in the UK—I think this is broadly reflected around the world—this is one of the most gender-segregated professions; only about 10% of nurses are male. As this report notes:

“Nursing suffers from a historical construction as a vocation”.


Individuals, usually women, were seen to enter it because they had a calling, and the salary was almost incidental; it enabled them to keep pursuing that calling as it was just enough. We know that many nurses feel this and that, through the pandemic and at all times, they display huge amounts of good will, working far beyond their paid hours and in very difficult conditions, often without financial reward.

We have to go further even than thinking about the gendered construction of nursing. The question here is the gendered construction of care. As the RCN report I am citing says, care is seen as

“a naturally feminine skill or characteristic”

that sits opposed to professional skills and qualifications. But being able to care for anyone in even the most difficult situation is an emotional labour. This should not be taken for granted. It should be properly recognised and remunerated.

In the UK we are in a position to provide potentially global leadership. The Government should like this, as I will say that we were historically world-leading in the nursing profession, with Mary Seacole, Florence Nightingale and many other names I could cite. We helped establish the global pattern for nursing as a profession. Of course, the NHS as a large single employer has the potential to turn this situation around and truly acknowledge the contribution nurses and midwives make.

Yet over recent years we have seen austerity suppress wages. Our heavily suppressing the ability of trade unions to act in the UK has also had a huge impact on wages. It is interesting that, as the RCN report notes, there is very

“little variation in earnings across the nursing workforce”—

among registered nurses—

“despite the wide range of roles and responsibility”.

There is a huge undervaluing of all levels, but particularly the highest levels.

I am out of time. I wanted to comment on how, although only about 10% of the profession are men, they occupy 20% of the highest-paid roles, but I will leave the exploration of that for another day. I finish with a little thought experiment for your Lordships’ House. Bankers are paid an awful lot more than nurses. Why?

Health and Care Bill

Baroness Bennett of Manor Castle Excerpts

Consideration of Commons amendments
Tuesday 26th April 2022 Lords Chamber

[Baroness Altmann (Con)]

My Lords, I follow the noble Baronesses, Lady Brinton and Lady Campbell, and will confine my brief remarks to social care, which I have long worked on. Sadly, the measures in the Bill will not rise to the challenge as required to sort out the social care system in our country.

I accept and congratulate the Government on the concessions that they have made. I am delighted to see Motion C on modern slavery. However, as far as social care is concerned, I would like to understand from my noble friend, on workforce planning, whether private care homes and non-state care home staff will be assessed as to adequacy. At the moment, there are horrendous staff shortages, and the current immigration policy does not seem to include carers—an essential element of the workforce—because of the pay structures. If he could explain what the social care workforce elements of the Government’s proposals are for the non-state social care sector, I would be most grateful.

I am not planning to vote against the Government on Motion D1, but I am afraid that I cannot support them. I put on record that I agree with everything that has been said about the Government’s changes to the social care cap. I believe that the measures are regressive; they will damage the least well off—or the lower end of the middle range of people, shall we say. They may be better than the current system, but they are not a solution and are not satisfactory. We will end up having to revisit the support for social care. Having said that, and in view of the fact that this is financial privilege, I will not vote against the Government on Motion D1.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I rise very briefly to offer Green support for both Motions A1 and D1. Motion D1 has already been very amply covered, most notably by the noble Baroness, Lady Campbell of Surbiton, so I will just address my remarks to Motion A1.

I know that many Members of your Lordships’ House feel as though we do not want to be political about things—I might have thoughts about that—but this is not a political amendment at all. As the noble Baroness, Lady Merron, said, more than 100 of our major healthcare organisations have expressed support for this workforce planning approach. Just a couple of hours ago, and this addresses your Lordships’ House directly, the British Heart Foundation put out a press release saying that, without this amendment, it is

“unclear how ambitious targets laid out in the Elective Recovery Plan and other NHS delivery plans can be met.”

The chief executive said that

“the Government has missed an open goal by failing … to address the workforce shortage”.

In addition, just yesterday the King’s Fund put out a report saying that the Government—they can welcome this—are “on track” to meet their target of “50,000 extra nurses” by 2024. However, the King’s Fund points out that the level of vacancies is still the same as it was when that promise was made. Just plucking figures out of the air and going, “Hey, we’ve got this great figure”, is not enough; we need to plan for the future. That is why this amendment is absolutely crucial for our NHS.

[Baroness Harding of Winscombe (Con)]

My Lords, I rise very briefly to speak to Motion A1. I will first thank my noble friend the Minister for his fantastically collaborative approach on the Bill. I am particularly delighted to see the Government’s proposals on reconfigurations, so I thank him very much for them.

On workforce, I fear that there is almost nothing more to be said. Throughout the passage of this Bill, at every stage in this House and across all sides, we have all been clear that if we do not resolve the workforce issues—the people issues in the NHS—everything else is for naught. Yet we come to end of this process and there have been no changes at all. It is with great sadness that I speak today because I feel that, despite the great work that has been done and all the best intentions, things will not improve. I would love to believe that I am wrong, that my noble friend the Minister is right and that the workforce elements of the Bill are sufficient, but I am afraid that the evidence of the last 20 years is that they are not.

Health and Care Bill

Baroness Bennett of Manor Castle Excerpts

Consideration of Commons amendments
Tuesday 5th April 2022 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I support Motion B1 in the name of the noble Baroness, Lady Cumberlege. I will be brief and not repeat what others have said. However, it is worth noting that in the Statement on the Ockenden report, the Secretary of State for Health said:

“I am also taking forward the specific recommendations that Donna Ockenden has asked me to. The first is on the need to further expand the maternity workforce.”—[Official Report, Commons, 30/3/22; col. 819.]


That phrase could be repeated for every part of the NHS and social care workforce, so I believe that has changed the situation since the other House debated this issue.

The public are asking what the national insurance levy is for if not to increase the number of professional staff in training. We are turning away people who want to be paramedics and nurses, as my noble friend has just said, who want to train locally. Of course we should undertake ethical overseas recruitment as well, but we need both. I firmly believe that this amendment needs the full support of this House.

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a great pleasure to follow the noble Baroness, Lady Watkins, and to ensure that full support for Motion B1 has been presented from all round your Lordships’ House, including the Government Benches. The Green group also supports Motion C1 particularly strongly, and Motions D1, F1, G1 and L1, but I will speak briefly only to Motion B1 because it is so crucial.

In introducing this group the Minister spoke, as the Government often do, about the record numbers of staff in the NHS. I do not think anyone has yet mentioned the NHS staff survey conducted between September and November. Just 21% of nurses and midwives thought that there were enough staff in their unit to do their job properly and provide an adequate standard of care; almost 80% thought there were not enough. The noble Baroness, Lady Tyler, referred to the Ockenden report: that helped to highlight that, despite the fact that the Government have been trying to recruit more midwives, in the last year the number of midwives has actually gone down.

We really have to ask ourselves why the Government are so opposed to this amendment when there is such strong support for it around this House and among all the key bodies around the country. It may be that the Government have an ideological objection to the word “planning”, or that the Minister does, but this is about the future of our NHS and all the evidence says that this is an essential amendment. Surely the Government are not going to let ideology stand in the way of the future of our NHS.

I finish by commenting on the typically wonderful introduction to this group from the noble Baroness, Lady Cumberlege, who referred to the strong civil society campaign. The hashtag for it on Twitter is #StrengthInNumbers, and that says so much. We need the numbers and the facts so that we can get the numbers of staff in the NHS.

--- Later in debate ---

[Lord Alton of Liverpool (CB)]

My Lords, I made my substantive points when we debated this on Report, so I will not be tedious in repeating all those arguments about the nature of abortion, why I feel there should be a more thorough consideration of the way the law works in Britain today and why there have been 9 million abortions—one every three minutes. That does not suggest a lack of access to abortion in this country. But I support what the noble Baroness, Lady Eaton, said to us about the lack of safeguards in the amendment that we passed, against the wishes of Health Ministers, during the tail end of the Report stage consideration of the Bill.

If the noble Baroness, Lady Sugg, was right that there had been substantive discussion, I would feel easier about this, but she will agree that there was no discussion of this at Second Reading or in Committee here, and there was no discussion of it in another place. When this was voted on in another place, there was a relatively close majority at the end of a very short debate—215 votes to 188. This demonstrates that this question is not settled.

If one winds back the clock to 1967, only 29 Members of the House of Commons voted against the Abortion Act 1967. That demonstrates that not only is this not settled but there are deep concerns about the way that this public policy has been enacted. That is why I pleaded, on Report, that rather than making policy on the hoof, it would be far better if—despite our differences of opinion, some of them fundamental, on the substantive issue—at some point, there is a review of the legislation, in which we can at least talk to one another, in a civilised way, about the best approach.

That brings me to this amendment, which was introduced with such sensitivity and compassion by the noble Baroness, Lady Eaton, and which deals with safeguarding issues. I will not repeat the quotation that was just given to us by the noble Lord, Lord Morrow, but it comes from a royal college. The royal colleges may be divided about this too—I do not dispute that—but that is exactly the sort of thing that should be laid before a commission of inquiry or a Select Committee of this House to examine the workings of the legislation.

We have heard the quotation about the safeguarding, well-being and physical needs of children from the Royal College of Paediatrics and Child Health, but I was also struck by what a designated doctor for child safeguarding said in a briefing which many of us have been sent by the National Network of Designated Healthcare Professionals for Safeguarding Children. Dr Helen Daley says:

“The considered expert position of the NNDHP is that all children (i.e. those under 18) and looked after individuals under the age of 25, should be seen face-to-face when applying to take both sets of abortion pills at home so as to prevent coercion, child sexual exploitation and abuse, and so that clinical assessments can be made to check the risk of an inadvertent mid- or late-trimester abortion.”


I note what the noble Baroness, Lady Barker, said about specific individual cases. I do not know about the individual cases, other than that one was cited, and one is enough. It struck me, as a parent and someone who has worked with children with special needs, some of whom had significant emotional problems, to think how it would be if, in a home abortion, someone was to abort a late-trimester baby and the children in that household saw what happened. I think that would remain with them for the rest of their lives and it could have a deeply distressing and traumatic effect on them. That is why we should listen to Dr Helen Daley when she says

“We have very real concerns about the harm”


that this amendment to the Bill

“(which would allow girls to take abortion pills at home without a prior face-to-face consultation for any early abortion) will do to children.”

There is one other point, which was not referred to in our early debates. There is evidence about the physical effects on women. For me, this is not a choice between the unborn child and the woman—both lives matter. One in 17 women, or 20 a day, who had taken at least one abortion pill at home in 2020 needed hospital treatment for side-effects. This evidence was provided through a freedom of information request by the previous global director of clinics development at Marie Stopes International. There are significant risks.

I plead with your Lordships: when we make laws on issues such as this, let us always be respectful of each other’s opinions, attitudes, beliefs and principles, and listen to each other carefully, which we are doing in this House tonight; bluntly, I think we are a very good example to others about how this debate should be conducted. When the noble Baroness, Lady Verma, talks about the risks of, for instance, sex-selection abortions, we must take that seriously, because there have been examples of it and we know to what it can lead; we have seen that in other jurisdictions and countries. When the noble Baroness, Lady Eaton, tells us there could be risks to children over safeguarding, we must take that seriously. I promised to be brief and will now sit down.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I rise very briefly, having contributed quite significantly to the debate on Report. I support the Government’s amendment, which is not a position I find myself in very often. I respectfully disagree with the noble Lord, Lord Alton of Liverpool, who said this was not settled. As the noble Baroness, Lady Sugg—who has been such a leader, working on this issue in the House with great tenacity and determination to defend the well-being of patients—said, it has been settled in both Houses of Parliament and has been debated extensively.

The point the noble Lord, Lord Alton, just made about the sex-selection question was comprehensively answered. The dates do not work; we are talking about early medical abortion and you do not know by that stage. We have to come back to the evidence. We had an unintended experiment as a result of Covid, which showed us that telemedicine not only reduced the rate of abortion complication but increased the level of safeguarding disclosures. It is really important that we think about an equalities issue here. Access to telemedicine is medically preferable and results in more safeguarding disclosures. We do not want to deny that to young women where it is judged that it is medically appropriate.

I note that the National Network of Designated Healthcare Professionals for Safeguarding Children is working with the Royal College of Obstetricians and Gynaecologists to develop standards. It says that this should not be subject to discrimination in the law, as the safeguarding standards and guidelines are adequate. If we think about this as an access issue, this minimises the risks of young people going to provision outside the healthcare system. This is a crucial equalities issue.

Health and Care Bill

Baroness Bennett of Manor Castle Excerpts

3rd reading
Wednesday 23rd March 2022 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

From these Benches, I very briefly thank the Minister, the noble Baroness, Lady Penn, the noble Earl, Lord Howe, the whole Bill team and all the officials who have worked with them for the way that they have listened—repeatedly listened—as we made our points over and again and as they sought sometimes to try to understand what we were trying to get across and why. I also thank everyone across the House, on all the Opposition Benches, the Cross Benches and the Government Benches, who have worked with us as Cross-Benchers in a very collaborative way and made their own offices available for background support to all of us.

I echo the words of the noble Baroness, Lady Thornton: this Bill leaves us better. It has been a genuine pleasure to work on it. Some of us have worked on previous Bills, and I have to say that this was a more enjoyable and rewarding experience because the dialogue involved a better interchange at many points.

We have made some points of great significance, one of which was over palliative care, which has been dear to my heart. Palliative care has come of age. I think the House will be pleased to know that, on Friday morning, the annual meeting of the Association for Palliative Medicine has a specific session dedicated to understanding the changes and what it now needs to do in the light of those. The word goes fast from here, and that is very welcome.

I hope that I have not forgotten anybody in my thanks, which are open and sincerely expressed.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I rise very briefly, with the Green group having made quite a large contribution—certainly in hours—to this Bill.

This House has improved the Bill, but I feel I need to say that I have received in the last few days a significant number of emails. They are not part of a co-ordinated campaign; they are cries from the heart, many from long-term NHS campaigners who I have known for a long while. I quote just one of these, which says that:

“The Bill is still not in the interests of the public or indeed of the NHS itself as a comprehensive, universal public service”.


That is an expression of feeling that I am hearing very strongly. I hope that the Minister will listen to that and understand that there are very grave concerns out there among the public about the direction of the NHS.

The improvements that we have at least delivered, as other noble Lords have said, should stay, but the Government really need to safeguard this universal public service.

Down Syndrome Bill

Baroness Bennett of Manor Castle Excerpts

2nd reading
Friday 18th March 2022 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I must begin with a tribute to the noble Baroness, Lady Hollins, who works so hard for people with learning disabilities and other disabilities in your Lordships’ House, as I see in person very often, and I was privileged to see recently in a late-night—or possibly early-morning—stroll up Whitehall during the Health and Care Bill to get some more information one-to-one.

The right honourable Liam Fox—I note he is listening to our debate today—said of this Bill in the other place:

“it is about people who deserve the same ability to demand the best health, education and care as the rest of our society.”—[Official Report, Commons, 26/11/21; col. 579]

Of course, nobody could disagree with that aim, but it is true for people with other chromosomal abnormalities, people with learning disabilities and many other people with special needs in our society. The fact is that our society is profoundly discriminatory. People are disabled by the barriers society puts in their way. Physical barriers, as we have just heard from powerful testimony from the noble Lord, Lord Touhig, are attitudinal barriers which are frequently still, sadly, awful.

There are 1.5 million people with learning disabilities in the UK and about one in 50 babies are born with a chromosomal abnormality. As the noble Baroness, Lady Hollins, has often drawn the House’s attention to, men with a learning disability have a life expectancy of 66 years—14 years below that of the general population —and females 67 years, which is 17 years below the general population, reflecting some of that discrimination that I referred to.

It was not my intention to speak on this Bill—your Lordships’ House may know that I have rather a large number of Bills on my plate—but I received large numbers of representations from people concerned about it, which is what led me to be in your Lordships’ House today. Some of those concerns reflect what the noble Baroness, Lady Jolly, just said. When I looked into this, I was quite surprised that in a press release about the Bill, the Down’s Syndrome Association said that it had not been

“invited to be involved in the development”

of the legislation. That very much provoked me to think of the phrase that the noble Baroness, Lady Jolly, just used: nothing about us without us. If the noble Baroness is going to table an amendment along those lines, I would certainly be interested in supporting it.

The first concern that families and groups of parents with children and adults who have Down’s syndrome have come to me about is that the Bill will have no substantive effect on the rights and lived experience of people with Down’s syndrome and their families because the duties in it are narrowly drawn; demand very little of public bodies; crucially, attract no new funding; and provide no meaningful mechanisms for enforcement or redress.

There is a really serious concern that the Bill implies that a diagnosis predicts how a person’s needs should be best met, rather than people’s personal, individual and unique needs, characters, gifts, talents and aspirations, and the idea that it is possible to generalise about a highly diverse group of people based directly on diagnosis alone. The families have said to me that they are concerned that this approach risks reinforcing rather than overcoming prejudice and discrimination, while undermining decades of progress in moving towards personalised support across the fields of education, health and social care.

I note—the noble Baroness, Lady Hollins, addressed this in her introductory remarks—that it has been argued that the Bill offers a model for others to follow to address other conditions and people in other circumstances, but it is very hard to imagine that we could see a whole procession of Bills addressing people with different health needs and disabilities along this model. Surely it would be better to make sure that people’s needs as an individual, whatever diagnosis they might have, are addressed.

At this point, I should declare my position as vice-chair of the LGA and NALC. The crucial issue here, surely, is resources. I am aware that the Bill was put forward by the noble Baroness, Lady Hollins, but there are questions I would like to put to the Minister if the Government are backing it. How do we know that it will have the intended impact? How will it be enforced? We talked about ensuring that there was full consultation on the guidance, but what role might Parliament play in producing the guidance? Crucially, without further resources, how could public bodies conceivably implement this new guidance?

I come to one final area of concern, looking at the discussion of the Bill in the public realm and the way it has been discussed in the press and online, about what people advocating for it or pinning their hopes on it believe it is designed to achieve, particularly around issues concerning maternal health and reproductive rights. The Bill, of course, very directly addresses the needs of people with Down’s syndrome, which legally applies only to people who have been born and therefore does not relate to the needs of pregnant women who may have received an antenatal diagnosis but do not themselves have Down’s syndrome. So I ask either the Minister or the noble Baroness, Lady Hollins, to confirm that, in the Department of Health and Social Care, the intention of the Bill is not to plan to develop new guidance or amend any existing guidance concerning antenatal care and existing reproductive rights as a consequence—save as it may apply, of course, to the needs of women who have Down’s syndrome.

Health and Care Bill

Baroness Bennett of Manor Castle Excerpts

Lords Hansard - Part 2 & Report stage
Wednesday 16th March 2022 Lords Chamber

[Lord Russell of Liverpool (CB)]

My Lords, I was happy to add my name to this amendment to give it a bit of cross-House balance. Like the noble Baroness, Lady Brinton, I am an officer of the all-party parliamentary group on coronavirus. In the last two years, we have had a bellyful of coronavirus; we have heard ad nauseum about the problems and the tragedies that it has created and encompassed, and that is partly what leads to this amendment.

It is self-evident that the United Kingdom, and most of the rest of the world, was unprepared. Countries that had experienced SARS, particularly in south-east Asia, had a better idea of what they were getting into. Frankly, however, for most of us in the West, it was the blind leading the blind. Looking in the mirror today—and accepting our failings, and the unease that we in the developed world should surely feel for largely having prioritised looking after our own—is for me, certainly, distinctly uncomfortable.

The aim of Amendment 174 is very simple: equitable access to affordable health technologies for all. One of the biggest challenges is how to deal with the exclusive intellectual property rights that exist in the healthcare sector. Only 7% of people in low-income countries have been double vaccinated. Only an additional 14% have had one dose.

Noble Lords should remember where the variants have come from. The exception, of course, is alpha, for which global Britain is responsible, so that is something that we can be proud of. Beta came from South Africa, gamma from Brazil, delta from India, and omicron is truly global because it started in about 10 countries simultaneously. The two countries that went it alone, rather proudly, in developing their own vaccines—China and Russia—have produced manifestly inferior vaccines, which have not been subject to proper, clinical peer scrutiny.

I give two examples of the problem we face. First, Pfizer’s new antiviral treatment excludes most Latin American countries, and generic versions—unless Pfizer does something about relaxing its intellectual property—may not be available in those countries until after 2041. Secondly, Tocilizumab, an antiviral manufactured by Roche, which is based on UK government-funded research, is unable to be manufactured in countries with established production capacity because Roche is enforcing its patents in these countries. There is a global shortage of this particular treatment.

Tackling the complex world of healthcare intellectual property is not easy. In my past career as a headhunter, I worked with clients that were large, complex, well-funded, international pharmaceutical companies, so I know full well the level of intellect and resource that they put into their intellectual property defences. We must apply ourselves in a disciplined and determined way at an international level; this is a chance for Great Britain to prove that it is indeed global. As an aside, during Oral Questions this morning, some of us on the Cross Benches were playing a game where, every time somebody from the Government Front Bench mentioned global Britain, another notional £10 clinked into the pockets of the Cross-Bench Christmas drinks fund; this afternoon, we had a particularly fruitful Oral Questions. As a mantra, it is meaningless unless it has real content behind it.

We need to develop a rapid response plan for the next pandemic. We will demonstrate that we have intellectual and moral myopia if we fail to do it. In a nod to Amendment 170, which we debated earlier, we should not show that we are content to let the less-developed world suffer from what I would describe as unassisted dying. That is unacceptable.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I rise briefly to offer Green support for this amendment, which I would have signed had there been space.

The noble Baroness, Lady Chakrabarti, referred to today’s report that a watered-down version of the India-South Africa proposal for a TRIPS waiver looks likely to go through the WTO. I quote Max Lawson, co-chair of the People’s Vaccine Alliance:

“After almost 18 months of stalling and millions of deaths, the EU has climbed down and finally admitted that intellectual property rules and pharmaceutical monopolies are a barrier to vaccinating the world.”


Bouncing off the comments of the noble Lord, Lord Russell, I think that the Cross Benches might find an even larger drinks fund if they go for “world-leading” as the key phrase to identify. The comment from Mr Lawson shows that, collectively, the world has done very badly throughout the Covid pandemic and done very poorly by the global south. If the Government want to be world-leading, they could leap in right now and accept the noble Baroness’s amendment.

[Baroness Thornton (Lab)]

My Lords, I congratulate my noble friend Lady Chakrabarti, the noble Baronesses, Lady Lawrence and Lady Brinton, and the noble Lord, Lord Russell, on supporting and promoting this amendment. Its explanatory statement says:

“In the event of a public health emergency of international concern, this new Clause requires the Secretary of State to support domestic and international knowledge-sharing, to combat the emergency.”


I cannot see why anybody would object to that.

I would like to say one more thing. The former Prime Minister, Gordon Brown, has led this country on how one should respond to a global pandemic with his work at the World Health Organization on the importance of sharing knowledge, vaccines and technology across the world. This amendment is about the pandemic that is coming down the track as well as the one we are dealing with at the moment, so we on these Benches certainly support it.

--- Later in debate ---

[Baroness Stowell of Beeston (Con)]

My Lords, it gives me great pleasure to follow the noble Baroness, Lady Finlay, whose contribution reflects her extensive wisdom and knowledge in this area. I just want to say that I commend my noble friend Lady Sugg for her leadership in bringing forward the amendment. I, too, will listen to what the Minister says in reply this evening, but instinctively I support what my noble friend is seeking to achieve.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I rise briefly to support Amendment 183. My background in this goes back to March 2020, in those difficult, scary, early days of the pandemic, when your Lordships’ House was operating on a skeleton crew. That led to me, as very new Peer, moving the amendment to the coronavirus regulations that would have allowed for telemedicine. I thank the noble Baroness, Lady Barker, who I note has signed this amendment, for supporting me through that process, because I had little idea about what I was doing in terms of your Lordships’ House. It is worth noting that we were doing that in part in acknowledgement that women would not otherwise have access to the necessary medical service of an abortion, but also because we knew that NHS resources were going to be enormously stretched. We are still in a situation where NHS resources are enormously stretched. Earlier we were talking about the Ukrainian refugees whom we will be welcoming here and the medical services that they will need.

Of course, we want to say that, in this area of medicine, we should be putting resources into all the NHS services that women need, but the evidence is overwhelming that telemedicine abortion is giving women a better service. I pick up the point made by the right reverend Prelate that there may be safeguarding concerns. There is evidence, particularly from MSI Reproductive Choices, reporting a major uplift in safeguarding disclosures, including from survivors of domestic and sexual abuse, with telemedicine.

On the medical side of this is a simple clear fact: since telemedicine has been introduced, complication rates from abortion have fallen by 20%. You do not have to listen to just me on this; permanent provision of abortion telemedicine is supported by eight royal colleges and medical societies, including the Royal College of General Practitioners, the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives and the British Medical Association. I also point out that abortion telemedicine is going to continue in Wales and Scotland, based on the evidence. The arguments are simply overwhelming: this is the best option.

[Lord Sentamu (CB)]

My Lords, I was not going to speak on this, but I listened to the noble Baroness, Lady Finlay, and that encouraged me to stand up and speak, together with other noble Lords who are a bit cautious about all of this. I was a vicar of an inner-city parish in which there were a lot of teenage pregnancies, and those who made them pregnant tried to force them to have abortions. The only person they felt they could tell was the vicar, not their parents, because their parents would hit the roof. Some of them would get corporal punishment as a result. I found myself in difficult, tricky situations, but I was fortunate, because in the congregation we had midwives and doctors. I simply said, “I listened to what you are saying to me, but I am not medically qualified to give any advice. We have experienced people who can give you that advice.” I was grateful that those midwives and doctors were able to accompany these teenage girls and help them come to a more sensible position.

I speak as somebody who is not against abortion, because the welfare of the mother and her rights need to be protected, but I am concerned about a measure that was brought in because of extreme circumstances. The Government were right, during the pandemic, to allow the kind of arrangement that was set up. But I am with the noble Lord, Lord Bethell, that we should not change overnight a tradition and circumstances that were accepted by the majority who see the right of abortion. We should not say that we will now go down this almost administrative route as the norm. Most people would be very concerned if we were going down a particular route.

I strongly believe, because of my experience of those teenage pregnancies in Tulse Hill, that the role of doctors, specialists in counselling and others is absolutely vital. You cannot do away with that because it is easier at the end of a telephone. You may not believe it, but young boys who had made girls pregnant would put pressure on them to have these abortions, for no reason other than that they wanted to move on to the next young girl. I still find that unacceptable.