Health and Care Bill

Debate between Baroness Finlay of Llandaff and Lord Rooker

Consideration of Commons amendments
Tuesday 5th April 2022 Lords Chamber

[Lord Rooker (Lab)]

My Lords, in our debate on 31 January, I made the point at some length that it was not possible to trust accreditation of products based on paper and supply chains. I assume that the Minister has been briefed on this. After that debate, on 3 March, he wrote a long letter to me and the noble Lord, Lord Alton, and towards the end of it raised my point about the supply of cotton-based products.

I had explained that it is possible, using the techniques of element analysis, to take a product and find out where the cotton was grown. You do not need paperwork to do that, or trusted supplier chains. The technique and the technology are there. You can find out whether it was grown in Xinjiang, another part of China, or another part of the world. The Minister said in his letter that bidders to the NHS supply chain will have to certify that they are better-cotton-initiative certified. That is the very thing that we need to avoid. You cannot trust paper-based systems of supply. You must use the technology to find out where the cotton is grown.

In the government amendment that has come from the Commons, paragraph 3 specifically refers to cotton-based products—so, given the final paragraph of the Minister’s letter, saying that the NHS supply chain does not have a contract to use the element-analysis services supplied by Oritain, what has happened since? Has there been any contact between the Department of Health and the NHS supply chain with the company that has the technology? I have no interest to declare here. I made it absolutely clear in the debate that this came out of a “long read” in the Guardian way back in September. The technology is there, not just in cotton but in other issues. Here I am just using it for cotton—the uniforms, the mattresses and the products. In subsection (3) of the new clause proposed by Amendment 48A, the Government are going to assess cotton. Have they done anything since our debate in Committee to make arrangements to use the technology, on the basis that you cannot trust paper-based supply chain accreditation? It is a simple question, and I would like an answer.

[Baroness Finlay of Llandaff (CB)]

My Lords, I rise very briefly to support Amendment D1, tabled by the noble Lord, Lord Blencathra. Last night I was part of a BMA web conference mounted by the Ethics Committee, of which I am an elected member, looking at the powerful evidence coming out of Xinjiang province in China. The concern is that, if we are purchasing products from there, we are complicit in the appalling human rights abuses that we were shown evidence of in this webinar. Therefore, I hope the House will support that amendment.

I return to the very important Amendment B1, tabled by the noble Baroness, Lady Cumberlege. This is not just a static situation. It is worsening. All that we have done is not just more of the same; we are actually sliding downhill rapidly. I want to give a little bit of data to the House to support that statement. There are now 1,565 fewer GPs than in 2015, meaning that there is a shortfall of 2,157 against the target that was set by the Government in their manifesto promise, in terms of where we are tracking to date.

The number of fully qualified GPs by headcount has decreased by over 600, so there are now just 0.45 fully qualified GPs per 1,000 patients in England, down from 0.52 in 2015. This means that each GP is responsible for about 300 more patients than previously. In terms of physiotherapy—I declare an interest as president of the Chartered Society of Physiotherapy—the model shows that 500 new physios are needed each year for multiple years to meet demand. There needs to be a trebling of the 6,000 NHS physio support workers. In nursing, the district nursing numbers have dropped from 7,055 in 2009 to 3,900 in 2021, which is a 45% drop. This is all going in the wrong direction. From the data that I could obtain, it looks as if three-quarters of nursing vacancies are filled by temporary staff.

This amendment, tabled by the noble Baroness, Lady Cumberlege, is crucially important. It would be a dereliction of our duty to ignore supporting that amendment, given all that we know and all the work that has gone on. That is not to be critical of the Minister and his team at all, because I am sure that it is not his personal wish that we do not have this in place—but we certainly do need a completely new approach to workforce planning.

Domestic Abuse Bill

Debate between Baroness Finlay of Llandaff and Lord Rooker

Committee stage & Committee: 2nd sitting (Hansard) & Committee: 2nd sitting (Hansard): House of Lords
Wednesday 27th January 2021 Lords Chamber

[Lord Rooker (Lab) [V]]

My Lords, I absolutely agree with the noble Baroness, Lady Burt, but it is not simple. I live in Ludlow, 10 miles from the Welsh border. As far as I can see, this amendment applies only to England. There will be people who live in the north of England, close to the Scottish border. There will be people who seek sanctuary in different places. It is not always something you can control if you are on the move and fleeing. What happens to children who are moved from England to Wales or Scotland, or, in rare but not impossible cases, as I recall from the experiences of my constituents, people who flee back to Northern Ireland?

This looks simple and the aim is absolutely bang on. It must be the case that children do not suffer, but we do not have a national health service, do we? We call it the National Health Service, but it is not national; it is devolved. How do we get around the problem of children who have crossed to one of the devolved Administrations? That is the only point I wish to make on this amendment.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, we should all be grateful to the noble Baroness, Lady Burt, for moving this amendment, and it is a pleasure to follow the noble Lord, Lord Rooker. I bring to this amendment my experience as a clinician some time ago in paediatrics—where, sadly, I admitted several abused children who had been caught in a complex cycle of domestic abuse—as well as my later clinical experience.

When children have experienced or witnessed abuse, some of them then move to live with kinship carers, or they move with the escaping parent, often to a different health provider area. They have to start all over again with schooling and health support. They may change GPs or move from one hospital referral list to another. There are waiting lists across the majority of specialty services required for many different types of support and intervention these children may need and for which they have been referred.

Trade Bill

Debate between Baroness Finlay of Llandaff and Lord Rooker

Committee stage & Committee: 3rd sitting (Hansard) & Committee: 3rd sitting (Hansard): House of Lords
Tuesday 6th October 2020 Grand Committee

[Lord Rooker (Lab) [V]]

My Lords, I have added my name to several of these amendments, but I shall stick to dealing with Amendment 20—indeed, part of Amendment 20. If it was being redrafted, Defra should be added to the list of bodies in paragraph (a): the Department of Health, the Food Standards Agency and Food Standards Scotland. It is not generally appreciated, but in 2010, when there was an attempt to abolish the UK-wide Food Standards Agency, the consensus in government was to remove aspects of its work to the Department of Health—nutrition and one or two other issues—and labelling and country of origin went to Defra. In fact, it was as a direct result of that action that Food Standards Scotland was set up, because the Scottish Government were perfectly satisfied with the way that the UK-wide FSA was operating. That is a minor point, but I want to concentrate on paragraph (b), which deals with the mechanism and the bodies charged with the enforcement of standards of food safety and quality, to make sure that they have the capacity to deal with the extra work.

It is worth pointing out, by the way, that although it is not politically sexy, the definition of food generally encompasses food and feed—feed being food for food production animals. That has not been taken very seriously in the past by the enforcement authorities. They are, generally speaking, local government. In the main, the Department of Health, the Food Standards Agency and Food Standards Scotland use local authorities for that role. Some issues they run themselves—the FSA runs the Meat Hygiene Service directly—but local authorities and environmental health officers are the unsung heroes of food safety and standards for the public.

The Government give us bad news in that respect. In the UK, local authority food hygiene interventions include hygiene inspection audits, sampling visits, verification and surveillance, advice and education and intelligence-gathering. It is absolutely crucial, but all of it will be under pressure with extra work from trade deals. Between 2010-11 and 2018-19, the total number of interventions in the UK reduced by 11%. They went down from 431,852 to 383,494. In England, the fall was from 331,000 to 305,000. In Northern Ireland, the fall was from 21,000 down to 14,000—a huge decrease. In Wales, interventions dropped from 31,000 to 25,000, and in Scotland, they went down from 47,000 to 38,000. I appreciate that with more modern risk techniques and technology, there can be reductions in certain checks, but these reductions are so substantial over that period that the position will be serious if extra pressure is put on because of the work from these trade deals.

I shall give just one local authority example to illustrate how serious the situation is in terms of people checking on our food safety. In Uxbridge in London—I just took it at random—there are 263 food business operations. Twenty-one of them, 8%, have not even been inspected. Thirty of them, 11%, have a food hygiene rating score of zero, one or two. Those are the three scores, of course, that are less than satisfactory, so nearly 20% of the food business operations in one local authority area are definitely a cause for concern. So, the issue in sub-paragraph (b), which aims to make sure that

“the Secretary of State is satisfied that … bodies charged with enforcement”

have the resources to do it, is quite serious, and is the one I want to concentrate on, because I do not want to repeat what others have said.

[The Deputy Chairman of Committees (Baroness Finlay of Llandaff) (CB)]

I remind noble Lords to switch off devices while we are in Grand Committee. It is quite disturbing and disruptive.

Trade Bill

Debate between Baroness Finlay of Llandaff and Lord Rooker

Committee stage & Committee: 2nd sitting (Hansard) & Committee: 2nd sitting (Hansard): House of Lords
Thursday 1st October 2020 Grand Committee

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, the noble Baroness, Lady Thornton, and my noble friend Lord Patel have very eloquently spoken to these amendments. They are incredibly important, and I strongly support them. We have to protect the NHS and publicly funded healthcare services across the UK from any control from outside the UK. To do otherwise would cost us dearly and would, in the end, prevent us looking after our own, because we would be told what to do from outside.

As the noble Baroness, Lady Thornton, has shown, all aspects of the NHS and social care must be protected from trade agreements at every level. We need to maintain the option of reversing the privatisation which has already occurred, if that is what we decide to do in the future, and we must be free to create collaborative health and social care. Trade agreements must not drive us into some kind of locked-in increased privatisation of the NHS or, indeed, force any such change in the devolved nations. The health and social care sectors must be excluded from the scope of all future trade agreements, otherwise we will find that the NHS is irretrievably undermined.

On maintaining quality, we are world leaders in pharmaceutical research and development, yet access does not always match innovation. The Association of the British Pharmaceutical Industry has pointed out that in the first year of a new medicine being launched, only one-fifth of eligible patients in the UK get access compared to those in France and Germany. Our ability to regulate and maintain the quality and safety of medicines and medical devices must not be undermined by some small sub-paragraph in a trade agreement that slips by almost unnoticed.

In addition, medicines and medical devices must remain affordable in the UK. The Royal Pharmaceutical Society highlighted the huge extra cost to the NHS after Essential Pharma disclosed plans to cease production of Priadel, its cheapest lithium carbonate product, due to restrictions on permitted pricing. The suggested alternatives for bipolar disorder owned by the same company can cost at least 10 times as much.

So this is not only about who runs the NHS today. As the noble Lord, Lord Patel, said, our NHS databases are extremely valuable. They are a resource for our future research and development and, from that, for our future economic development. If we lose them through a trade agreement, we will irretrievably damage our future economic development.

I now turn briefly to Amendment 75, which ensures that the Government can uphold the right of citizens to access medicines under the International Covenant on Economic, Social and Cultural Rights, as part of the right to the highest attainable standard of healthcare. Modern free trade agreements are used increasingly as vehicles to further pharmaceutical industry interests ahead of public health needs. They increasingly include clauses on intellectual property, pharmaceutical regulatory processes and investor-state dispute settlement mechanisms that affect price and decrease access to medicines. To secure affordable access to medicines, the Government must be able to grant compulsory licences, deal with exhausted intellectual property rights, strengthen patentability criteria and determine what constitutes a national emergency, as laid out in subsection (3) of the proposed new clause. The Covid pandemic has shown why we must always be able to make technologies available quickly, widely and at the lowest cost. As the noble Lord, Lord Fox, pointed out, generics are not always cheaper in a complex market that can easily be manipulated.

Our NHS database is extremely valuable, and its value is increasing. It cannot be thrown away. There are times when short-term industry profits are not good for patients and delay access to affordable medicines and health technologies. These amendments aim to secure our healthcare for the future. I agree with the noble Lord, Lord Fox, that informed patient consent requires a patient to know whether data is held, what it is used for and how it can be manipulated, even when it is anonymised. They would rightly be outraged if that data is allowed to put profits in the pockets of other countries, knowing that it will never be ploughed back into the NHS—certainly not at 100%.

[Lord Rooker (Lab) [V]]

My Lords, I will intervene only briefly, initially to support my noble friend Lord Bassam in some of the examples he gave. Dispute settlement in trade deals is pretty important as is what is put into the deal. I am not clear about—but I hope I am—whether “public services” includes critical infrastructure. As far as I am concerned, the two go together. I would cite energy, for a start, because one can see the problems we are going to have with energy in this country with the collapse of the nuclear deal. We must have a mix. There is a good chance that the lights and the gas may go out and the Government may want to move at some point to take monopoly control of the service. They ought to be able to do that, but there are too many sticky fingers for my liking in the issues involved and therefore I think the idea behind the amendment by my noble friend Lord Bassam is very good.

I want to make a brief point about Amendment 51 on the health service. I thought the speech by the noble Lord, Lord Patel, was devastating with its list of companies. Do not get me wrong, I have no objection to the NHS or other public services using the best available management tools, techniques and individuals to provide services but making use of them is not the same as handing over ownership. That is where one has to draw the line. The noble Lord, Lord Patel, made a very fair point. The public do not care who is providing the service as long as it is there when they need it, free at the point of use. He went on to say that they will care when their taxes go up. That point is when someone, such as the Prime Minister, will say, “You can avoid that by buying some insurance.” It is the slippery road to push us down the insurance route. I know we are all nice people in the Lords but frankly I do not trust the Prime Minister.