Sudan

Baroness Masham of Ilton Excerpts

Tuesday 11th February 2014 Lords Chamber

[Baroness Uddin (Non-Afl)]

My Lords—

[Baroness Masham of Ilton (CB)]

My Lords, have other aid organisations also been banned? It is most extraordinary that the Red Cross has been banned as it is a non-religious, non-political organisation.

[Baroness Northover]

We are hoping that the ICRC will be able to deliver the humanitarian relief that it was delivering before. Negotiations are at a delicate stage. A number of other international organisations are working with enormous difficulty in the area, some with greater reach than others. Some are still there, but a number have had to pull back.

Animal Welfare: Methods of Slaughter

Baroness Masham of Ilton Excerpts

Thursday 16th January 2014 Grand Committee

[Baroness Masham of Ilton (CB)]

My Lords, I declare an interest as I breed sheep. I have to admit that I try to shut out the fact that some of them have to go to market for slaughter. I feel this is something that the general public do not think much about, as long as they have their burgers, steaks and chicken tikka masala. I take part in this short debate on behalf of the animals. I ask that religious leaders—who have traditions—look at the welfare of the animals that give them food. I ask them whether the practice of killing the animals is the best that can be done to relieve the suffering. Animals must sense a horror of going to a slaughterhouse, as has been shown when some animals make violent attempts to escape.

I have been involved with the legislation concerning female mutilation—circumcision. This is a barbaric practice of mutilation of young girls without anaesthetic, all because of some people’s traditions and customs. Animals which are hung upside down and have their throats cut without stunning or anaesthetic must also be terrified. Do the proprietors of these customs realise the cruelty they are inflicting?

The Jewish method of slaughter, shechita, requires animals not to be stunned before slaughter. Recent data collected by the EU Dialrel project show that 100% of the animals and birds slaughtered by the UK abattoirs service for the production of kosher meat were slaughtered without prior stunning. At four establishments, 1,314, or 3%, of cattle and calves were slaughtered by the Jewish shechita method, with 10% of these stunned immediately after bleeding. Does that mean they are still alive after bleeding? These figures were published by the Food Standards Agency in 2012. The National Animal Welfare Advisory Committee of New Zealand recommended a dispensation for kosher slaughter in 2001, but the new code does not allow any exemptions. Among the countries which have banned shechita are Iceland, Norway and Sweden. I hope the Jewish community will see the light—that the animals which give us so much need respect when they have to die.

Global Fund to Fight AIDS, Tuberculosis and Malaria

Baroness Masham of Ilton Excerpts

Tuesday 3rd December 2013 Lords Chamber

[Baroness Northover]

My noble friend is absolutely right. Cambodia, for example, which was highlighted in the programme, has seen an 80% decline in malaria deaths, a 45% fall in TB and a 50% decline in HIV cases. I pay tribute to what my noble friend has done to highlight the challenge of HIV/AIDS and to his fight for the global fund, which has been transformative in this area.

[Baroness Masham of Ilton (CB)]

My Lords, does the Minister agree that it is in the interests of the world to prevent these conditions? I congratulate the UK on what it has done, but will the noble Baroness encourage other countries to do more?

[Baroness Northover]

The noble Baroness is right in terms of the impact. Yesterday, President Obama pledged $5 billion to the global fund. The US has said that it does not wish to contribute more than one-third to the fund. In other words, it wants to bring in other partners. Other countries, including Canada and the Nordic countries, have put in money and are coming forward in an encouraging fashion.

International Development: Diseases of Poverty

Baroness Masham of Ilton Excerpts

Wednesday 24th July 2013 Lords Chamber

[Baroness Northover]

Indeed, the United Kingdom is extremely strong in this field. The Wellcome Trust is a major player in this regard and we have the strengths of the London School of Hygiene and Tropical Medicine and the Liverpool School of Tropical Medicine, so we contribute significantly in this area. I pay tribute to what the MRC does.

[Baroness Masham of Ilton]

My Lords, is the Minister aware of the organisation here in London called Find and Treat? It has a mobile X-ray unit and goes out to homeless people in hostels and other places to X-ray them for TB. Its X-ray unit is now on its last legs and it desperately needs a new one. Could she ensure that money is available here because TB is just as bad here as it is in third-world countries?

[Baroness Northover]

I remember colleagues being tested in one of those centres locally. I will take this back to the Department of Health and get an answer for the noble Baroness. It is obviously important to address TB here, where it is an increasing problem, as well as in developing countries.

Care Bill [HL]

Baroness Masham of Ilton Excerpts

Wednesday 12th June 2013 Lords Chamber

[Baroness Jolly]

My Lords, I welcome the debate on the duty of candour. It almost seems as though we are rewinding to 18 months ago, when we had similar debates during the passage of the Health and Social Care Bill. Although I would not have wished the events at Mid Staffordshire Hospital on anybody, I am really pleased that as a result the Francis report recommended a duty of candour. I therefore welcome the Government’s intention to implement that duty. However, as we have seen over the past 20 minutes, nothing is as straightforward as it first seems, so a lot of hot-towel work needs to be done to get this right.

I shall not detain the Committee long, but there are two sets of choices that the Government have made and I am curious why they made them. The first is whether the duty of candour is on the individual or on the organisation. The second, to which the noble Lord, Lord Warner, has just referred, is whether it is going to be in the Bill or in secondary legislation.

The duty of candour will cause a large change in people’s behaviour and it should be a game changer in lots of ways. As an aside, I think that complaints will fall. If somebody turns around and says, “I’m sorry”, people are less likely to complain. Certainly, those of us who have been involved in complaints will know that on many occasions patients just want someone to say that they are sorry and to explain why and how it went wrong, because they do not want it to go wrong in the same way for anybody else. So there might be an unintended consequence there.

When the Minister sums up, I would like to know why the decision was made not to put the duty in the Bill. Is that decision irrevocable?

[Baroness Masham of Ilton]

My Lords, I support Amendments 76B and 77. There has been so much said that there should be a change in the culture in the NHS after the scandal of Mid Staffordshire Hospital. Amendments 76B and 77, dealing with the duty of candour, might help to do this. For years, relatives of patients who have died or been badly damaged have not always been treated in an honest and open way; many times, the causes have been covered up and there has been much suffering by those who need to know the truth and have an apology. It is also terrible that when people who fear for patients’ safety speak out to warn of unsatisfactory and dangerous situations, they are silenced and gagged. Surely, we should do something about that. It is our duty to speak out now and make patients’ safety a reality.

One elderly Member of your Lordships’ House told me yesterday that she was frightened in case she might have to go to hospital. How many people throughout the country must feel like that? The culture of fear and neglect must be changed. I hope that the Government understand that.

[Lord Campbell-Savours]

My Lords, I have considerable reservations about the whole question of the duty of candour, as I was saying to colleagues earlier today. I want to put to a counterargument to the House.

Recommendation 177 of the Francis report says:

“Any public statement made by a healthcare organisation about its performance must be truthful and not misleading by omission”.

Therefore I presume that, under a duty of candour arrangement, there would be a requirement to admit negligence, if there was negligence.

After my last visit to the accident and emergency department at Wexham Park Hospital in Slough, I left the car park and saw a huge sign on a van at the side of the main road, which said, “If you believe you’ve been a subject of medical negligence, please ring the following number”. I worry that with the way in which this whole issue is being addressed, under the conditions of the duty of candour, which in principle I would like to support, those people who put up those signs may well make rather a lot of money out of it. They will find a basis on which to start bringing more and more actions against the National Health Service. I do not know the way round it, because if that is what is happening, and there are so many people out there who are prepared to bring legal action, if they believe that they have the remotest chance of winning such an action, the duty of candour will be used as a means to bring about those actions.

I cannot see how we can stop it. That being the case, I believe that we are going to find that, irrespective of this duty, people will, to put it bluntly, continue not necessarily to tell the truth when responding to complaints that are being made by members of the public over their healthcare. I am sorry to dissent slightly from my own Bench on this matter, but I have a concern here and I think that the Minister, in winding his up, should be far more open in this discussion about the possibility of litigation arising out of the introduction of the duty of candour. As I say, I would like to pursue it and I support it in principle, but I am worried that it may lead to more actions.

What would I do as an alternative? In the contribution that I made on Monday, I concentrated on what I thought were the problems from which complaints arise. These are, essentially, simple complications that arise on the ward through minor negligence or lack of concentration by healthcare assistants or nurses. I think that we have to go back a stage from this whole process of candour, litigation and complaint systems, to what is actually happening on the wards so as more effectively to police the way that treatment is carried out more.

At the end of last year, I and a colleague in the Commons conducted interviews with many people involved in healthcare about the problems on wards in hospitals. I drew the conclusion that we should have on every ward a very clear set of entitlements set out on large boards whereby patients and their relatives may understand their entitlements. Instead of being hesitant about going to complain within a ward about the way that they were being treated, they would be able to point to a document and say, “Look, Sir or Madam, this says that that is my entitlement”. If we can get across the fact that people have entitlements, and that they have a right to higher standards of healthcare on wards, there will be fewer complaints in those circumstances and so less incidents of complaints that, in the responses, must rely more on this duty of candour, if it were to be introduced.

I am concerned. I think that we are looking at this problem from the wrong end. We should go right back to the ward and deal with the problem there. They say that ward problems are about leadership on the ward. I am not altogether convinced of that. You cannot have someone on the ward running around telling everyone what to do all the time. You have to have a process of accountability for those who work on the ward to the patient and to the patient’s relative, being their representative. I will not go into my idea about these signs on wards in great detail tonight, but perhaps I will at another stage in the Bill.

I will however deal in detail with one area under Clause 81. An offence is defined as follows:

“A care provider of specified description commits an offence if … the information is false or misleading in a material respect”.

So that is an offence. The care provider is defined under subsection 3(b) as,

“a body (other than a public body)”—

in my view, that means a private body—

“which provides health services or adult social care in England pursuant to arrangements made with a public body”—

that might well be the commissioning body—

“exercising functions in connection with the provision of such services or care”.

I understand that to mean that you could have a private nursing home with an NHS contract to provide continuing care where the moment that they receive their first patient under continuing care arrangements—an NHS patient in a private nursing home—then that nursing home then falls under the provisions of subsection 3(b). Have I got that wrong? That means that the commission of an offence, if

“the information is false or misleading in a material respect”,

would apply to a nursing home where just one person is in receipt of care paid for by the National Health Service under a contractual arrangement, as against a nursing home next door where there are no NHS patients under a continuing care contract and all the patients are privately funded. There, that offence would not necessarily apply. That is how I understand what is said in that clause. I hope that the Minister will clarify the matter.

Global Fund to Fight AIDS, Tuberculosis and Malaria

Baroness Masham of Ilton Excerpts

Tuesday 4th June 2013 Lords Chamber

[Baroness Masham of Ilton]

My Lords, I thank the noble Lord, Lord Fowler, for having secured this debate on the global fund. I declare an interest as a member of all-party parliamentary groups on HIV/AIDS, tuberculosis and malaria.

The global fund has been supported by the UK, which knows how important the fight against these and other emerging diseases is. Recently, the funding model of the global fund has been made more flexible on timing, better on engagement with partners and more predictable on the level of funding available. The new funding model allows countries to better plan over time, to increase domestic funding as global fund financing decreases. The World Health Organisation states that there are 440,000 new cases of multidrug-resistant tuberculosis every year, causing at least 150,000 deaths. Many of these people will also have HIV.

There is an urgent need for rapid diagnostics for killer infections. An expert in respiratory tract infections, Alimuddin Zumla, tells me that the absence of rapid, accurate diagnostic tests for pulmonary tuberculosis was further compounded by the widespread inability to screen for drug-resistant bacteria. An ideal diagnostic test for RTIs should be rapid, cheap, easy to use, sensitive and specific and should screen for many micro-organisms and their antibiotic resistance. The diagnostic platform should be transferable, robust and, ideally, run on solar power for use in the remote healthcare settings in developing countries. I am pleased to say that I have a cousin who is a professor of microbiology in Australia. His team have developed a mobile unit that is called a “lab without walls”. They take it to projects in developing countries, so it is exciting that progress is being made by dedicated people. However, to achieve this across the world, physicians, scientists, biotechnology companies, funding agencies and Governments need to work together to drive the development of improved diagnostic tests for both developed and developing countries.

MDR-TB and extensively resistant TB are an increasing problem in Asia, Africa and eastern Europe. Global fund money is only for supporting programmes in developing countries. There is a need for part of this money to be used for research. Good research would result in better treatment outcomes—money well spent, rather than just supporting programmes. Without research, progress will not be achieved. The global fund has done much to help. I hope that it will continue to do so with renewed efforts from our Government and other countries to increase this valuable work. With modern travel, many people have access to the world. Health infections should be everyone’s business.

Healthcare: Support Workers

Baroness Masham of Ilton Excerpts

Monday 28th January 2013 Lords Chamber

[Baroness Northover]

I can assure my noble friend that all options will be considered when we receive the Mid Staffs report.

[Baroness Masham of Ilton]

My Lords, is the Minister aware that, without registration of these care workers, they can go anywhere and work anywhere, when they are dangerous and not suitable for work because they cannot be tracked?

[Baroness Northover]

As the noble Baroness knows, employers have a responsibility to make sure that those whom they employ are suitable and do not have the kind of record that she has indicated. We also know that regulation per se does not necessarily mean that good care is given; therefore, a proportionate and intelligent response is needed if we are to ensure that the care given is of the consistency, safety and quality that we all wish to see.

Health: Neurological Services

Baroness Masham of Ilton Excerpts

Tuesday 20th November 2012 Lords Chamber

[Baroness Masham of Ilton]

My Lords, I thank the noble Baroness, Lady Ford, for asking this important Question. There are an incredible number of neurological conditions, some very rare, all of which are important to the individual. I have a niece who has epilepsy and I know how important continuity of good-quality care is.

I stress the importance of specialist nurses for conditions such as epilepsy, Parkinson’s disease, stroke, multiple sclerosis and continence care. The withdrawal of specialist nurses would have a negative impact on services to patients. They are the consultant’s right hand. They co-ordinate care and training for other professionals and give support to patients who, without them, could deteriorate and have to be admitted to hospital.

I take this opportunity of bringing to your Lordships’ attention the vital needs of people with motor neurone disease. They have to be addressed urgently, as the condition can so often move on very quickly.

Drug development is extremely expensive. It can take more than 10 years and cost more than £1 billion to bring a new drug to market. Will the Government’s life sciences strategy, launched in December 2011, help speed up the drug approval process?

No new drug has been developed for motor neurone disease in more than 20 years. MND robs people of the ability to walk, talk, eat normally and ultimately breathe, but they know everything. Some 5,000 people in the United Kingdom have motor neurone disease, and about 1,500 of them die each year—that is about five a day.

A new campaign, founded by Les Halpin, a remarkable person who has motor neurone disease, has been set up to highlight the patient voice in this debate. It is called Empower: Access to Medicine and is focused on accelerating the drug approval process for people with life-threatening illnesses. Les Halpin has the strong support of his constituency MP, Geoffrey Clifton-Brown, and addressed a gathering of parliamentarians in June, when I met him. He has also met the noble Earl, Lord Howe, to discuss the campaign in more detail.

Genetic Alliance UK carried out a survey of patients with rare disease earlier this year and asked them for their views on trying drugs before they are fully approved. One patient replied: “If I was in a plane and offered a parachute with a 90% chance of failing, I would refuse it unless that plane was spiralling out of control towards the ground, in which case I might well be glad of it”.

Motor neurone disease—MND—is a rare condition that progressively damages the nervous system, causing the muscles to waste away. A medication called riluzole can extend the lifespan of people with motor neurone disease but it is only moderately effective. Empower: Access to Medicine is a new platform created to open the debate around the lack of drug development for patients with rare or life-threatening conditions. The discussion is not focused on one particular illness but is interested in any life-threatening illness which has a lack of drug development across the whole of the patient body. Given how long it takes to find the right combination of drugs to treat life-threatening conditions, Empower: Access to Medicine is keen to harness this collaboration to ensure that patients and doctors across the world share their experiences in an effort to improve knowledge and accelerate the timescale within which new drugs are developed and approved.

Speeding up the development and availability of drugs that treat life-threatening diseases would benefit everybody in society. The current testing and development process is long, cumbersome and expensive. In fact, a recent report by the Office of Health Economics found that it takes five years on average after launch for a new drug to win NICE approval. This timescale can be more than doubled when added to the time taken for a new drug to go from the development stage through to Phase 3 and beyond. As an example, no new drug has been approved for motor neurone disease since riluzole was approved 20 years ago.

The Empower: Access to Medicine campaign is a unique one, created for patients by patients. It is a powerful voice, rarely heard, but one that I believe could have a real impact on how pharmaceutical companies, regulators, politicians and the general public view drug development. As the director of the Oxford Centre for Accelerating Medical Innovations said:

“I am delighted to be involved in this campaign. Opening up the discussion around the lack of availability of effective drugs for rare and life threatening diseases is a vital first step on the path towards accelerating new innovative drugs”.

One of the key problems we are facing today in overcoming the lack of drugs for rare or orphan diseases is the challenge for industry in achieving a return on investment. Major drug companies have been cutting back on their research budgets because the R&D process has hit a wall of cost, time and failure rate. It is a staggering figure worth repeating: to bring a new drug to the market can cost up to £1 billion. Seriously ill patients are quite understandably more willing to try different combinations or new drugs. Because these drugs may improve their quality of life or even stop the progress of their disease, they are willing to accept the risk of possible side effects. We need to involve them more fully in the decision-making. This is a societal issue and all stakeholders must work together. We must be willing to rethink regulation, especially for rare and life-threatening diseases. The European Medicines Agency has an objective to pilot a new approach along these lines which goes under different names—for example, “adaptive licensing” and “progressive authorisation”. We must find ways for patients to access drugs more quickly.

I end by saying that there is currently no national guidance for MND. This is a huge gap. MND is rare, complex and progresses rapidly, so health professionals need clear guidance on how to care for people with this disease. Will the Minister please help to expedite the National Institute for Health and Clinical Excellence —NICE—to produce guidance and quality standards for MND? Both have been referred to NICE for development but the timescale for the guidance to start has not yet been determined. How long have they got to wait?

Global Fund: AIDS, Tuberculosis and Malaria

Baroness Masham of Ilton Excerpts

Wednesday 4th July 2012 Lords Chamber

[Baroness Masham of Ilton]

My Lords, the worldwide emergence of multidrug-resistant tuberculosis is a major and most important threat to global tuberculosis control. The continued spread of extensively drug-resistant tuberculosis throughout Asia, eastern Europe and southern Africa is an ominous sign. There are two issues regarding multidrug-resistant TB. There is a lack of diagnostic tests, and new diagnostic technologies for detecting drug-resistant TB are now available but are expensive and constrained by round 11 of the grant of the Global Fund. There is lack of access to second-line TB drugs for drug-resistant TB and the Global Fund should invest more in provision of adequate TB drugs. In Africa, 70% of TB patients are co-infected with HIV. A large percentage of TB and HIV cases remain undiagnosed. More proactive routine screening needs to be introduced at all points of care. All receiving countries should account for their funds so there is no malpractice.

Decades of the use of anti-TB drug treatments have resulted in the growth of multidrug-resistant tuberculosis strains. The highest ever prevalence in the world of MDR TB was found in Minsk, Belarus. MDR TB was found in 35.3% of new cases and in 76.5% of those previously treated. In addition, extensively drug-resistant TB was found in 14% of MDR TB cases. This is much higher than the global average. We must not be complacent. I think of the unfortunate 15-year-old girl who died of TB in Birmingham having not been diagnosed by her GP or four different hospitals. She had had TB in 2009 and was struck down again in 2010. I hope lessons will be learnt from this tragic case. Eastern Europe has the highest level of infection, but London has the highest TB rate in any European city. I am pleased that WHO has praised the UK’s Find and Treat service, which uses a mobile X-ray van to screen homeless people and drug addicts in London for TB. I too think that it does a splendid job: its vital work must always be supported.

Health and Social Care Bill: HIV/AIDS Programmes

Baroness Masham of Ilton Excerpts

Wednesday 21st March 2012 Lords Chamber

[Baroness Northover]

The local authorities will commission the prevention and testing services. They have a public health outcomes framework that they need to address to drive up the situation across the board in public health. There are incentives within that for them to try to improve the health of their populations. Local authorities are best placed to understand the public health pressures, which are not just in this area, on their local populations.

On prevention and treatment, the emphasis in recent years—under the previous Government, as under ours—has been on the high-risk groups, particularly gay men and people from the sub-Saharan region. Those are the groups at greatest risk. However, a sexual health policy document is being worked on at the moment. If it is felt that it is important to feed into it that there is a need for nationwide emphasis on this matter, now is the time to emphasise it.

[Baroness Masham of Ilton]

My Lords, will the Minister assure the House that there will not be fragmentation in regard to this very complicated condition? Will there be NICE guidelines? The drugs for HIV are very complex and there is a fear that there might be resistance.

[Baroness Northover]

As with every other area, this will kept under close review to make sure that things are suitably joined up and that we have high-quality prevention and treatment. As for NICE guidelines, the British HIV Association produced clinical guidelines for HIV treatment in 1999. They were taken forward and are widely accepted by clinicians and commissioners. The association is currently revising its guidelines and we will see what it suggests.