Childbirth: Black Women

Baroness Walmsley Excerpts

Wednesday 3rd May 2023 Lords Chamber

[Lord Markham (Con)]

My noble friend is right. I was speaking to Minister Caulfield about this very subject this morning. She pointed out that a lot of the reasons for the differences are underlying health conditions and factors such as smoking, weight and alcohol consumption, as well as diabetes. Education is a key part of this, as is continuity of care, and making sure that there is prenatal and postnatal care is absolutely a focus.

[Baroness Walmsley (LD)]

My Lords, the NHS published equity and equality guidance in September 2021 aimed at improving maternal health for mothers and babies from black and other ethnic groups and those from the most deprived areas. However, no implementation plan or scrutiny mechanism has been developed, so how will implementation and adherence to these strategies and guidelines be assured? Who will report on progress, or the lack of it?

[Lord Markham (Con)]

First, through its local maternity and neonatal systems, every ICB is responsible for publishing an equity and equality plan. It will then be the job of both the CQC and the maternity surveillance system to measure them against that plan and make sure it is being kept up. Every area is different, but each needs a plan to address this issue.

Patient Deaths: Ambulance Waiting Times

Baroness Walmsley Excerpts

Tuesday 14th March 2023 Lords Chamber

[Lord Markham (Con)]

I am convinced that the ICS will make the best decisions for that area. I am very familiar with Sir Jim Mackey’s plans, which advocate setting up so-called hot and cold sites. It is often better to specialise in A&E in one area and “cold” elective treatments in another, in order to have more efficient treatment in both. I imagine that is very much part of the plan, which will see improvements in both A&E and elective services.

[Baroness Walmsley (LD)]

My Lords, may I ask about dissemination of good practice? Some trusts are improving ambulance response times but others are not. I accept that they are working in different geographies with different demographics, and have different A&E capacity in each area, but how are the Government making sure that proven best practice is being disseminated across the country?

[Lord Markham (Con)]

The noble Baroness is absolutely correct. Some 50% of all wait times—I have used this statistic before and I will correct it if I have not got it exactly right—come from I think 20 trusts. Clearly, there is a focus on working on those areas. That is starting to bear fruit, with each of those trusts having specific plans to ensure that they use best practice. We have tried to pick the best practitioners in an area— I have done this on two occasions recently—and bring them into the centre to help us advise across the board. That really is making a difference.

Communications Act 2003 (Restrictions on the Advertising of Less Healthy Food) (Effective Date) (Amendment) Regulations 2022

Baroness Walmsley Excerpts

Monday 27th February 2023 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Bull, who set out so clearly that we have to get away from blaming individuals for the fact that we have, as a society, a deeply damaging and disastrous relationship with food. Perhaps going even further than the noble Baroness, I stress that what is behind that is a broken food system—that what is supplied into the system is deeply unhealthy and damaging in all kinds of ways. It is both what is presented to people and what comes into the system that are problems.

It might be fairly said, as the noble Baroness just did, that tonight we are talking about partial, inadequate measures—and I offer the Green group’s support for both these regret Motions—but they are, at least, measures to do something. We can look at another partial, inadequate measure that has come into effect and we are starting to see the results of: the Soft Drinks Industry Levy Regulations 2018. It is very small and partial, but a recent study published in PLOS Medicine showed that we have seen an 8% reduction in obesity in girls aged 10 and 11 as a result of that. There is a gender aspect that I do not think anyone yet fully understands. It is a limited state of progress, but it is better than heading in the opposite direction.

Looking where we are now, here is one figure that is truly shocking: last year, 660 under-fives were admitted to hospital with obesity given as the primary cause of their admission. That is what our broken food system is doing. Restrictions on advertising were hard fought for and much discussed during the Health and Social Care Bill, and I remember sitting in your Lordships’ Chamber over what I suspect was many hours. Yet here we are today, and I cannot help reflecting on an earlier discussion in your Lordships’ House in which it was suggested that the Scottish Government were bringing in the bottle return scheme far too quickly. That was a three-year delivery from the regulations being passed to them being implemented. That was something Westminster could not imagine.

Looking to the general public, one of the things I have found again and again on that issue and issues tackling obesity is that people say, “We heard the government announcement, but it does not seem to have happened.” People think that once the Government have announced something it is happening, and the Government use that, announcing things again and again that never get delivered. It really is past time that we should be seeing the delivery here. I will finish with a question to the Minister: what is the higher priority here, the health of the nation or the profits of broadcasters?

[Baroness Walmsley (LD)]

My Lords, I am afraid I am a weary veteran of discussions about these regulations. As your Lordships know, the House’s Secondary Legislation Scrutiny Committee has absolutely slated them and the information provided with them. It mentions:

“The Explanatory Memorandum (EM) states that in 2019”—


that is a year after the industry was first warned that this sort of ban was going to be implemented—

“under current voluntary restrictions, children were exposed to 2.9 billion ‘less healthy food and drink TV impacts and 11 billion less healthy food and drink impressions online’”.

That is 13.9 billion hits. That was four years ago. In the four years between the measures first being announced and us legislating for the ban last summer, there were 13.9 billion every year, coming to 55.6 billion hits for unhealthy foods, which is an existential scale of influence on children’s food choices. Now we are being told there is going to be another three years of it; at the same rate, that is another 41.7 billion hits to persuade children to eat unhealthily. That comes to 97.3 billion adverts—a figure 12 times the population of the world. There cannot be a child in this country over that period of time who has not seen hundreds and thousands of adverts persuading them to make the wrong food choices.

We are told that the industry needs longer to prepare and the Government need longer to consult. The Government are consulting on simple technical issues that should not take many weeks, let alone another three years. Indeed, I understand there is an idea of changing the definition of these foods, but we already have a clear mechanism for deciding what these foods are. It is called the nutrient profiling model, and the industry knows it perfectly well, because since 2007, it has not been able to advertise those foods around children’s television programmes. So why do we have to wait another three years? How on earth do these delays line up with the Government’s strategy to halve childhood obesity by 2030? These things simply do not match up.

Bread and Flour Regulations 1988

Baroness Walmsley Excerpts

Tuesday 7th February 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord, who has been a tireless campaigner on this issue. Again, a benefit of this position is getting to learn new subjects, and this is one of them. I can see why he campaigns so hard on it. I am delighted to say that we are getting there, albeit that it could be argued that maybe it could be quicker. At the same time, industry is seeing that, and the good news is that it is already adjusting. The majority of breakfast cereals are now fortified and a lot of the rest of the industry is responding. We are making a difference, and I thank the noble Lord again for his campaigning.

[Baroness Walmsley (LD)]

My Lords, does the Minister consider that too low a dose would leave people believing that fortification does not work? Is he aware that the Royal College of Obstetricians and Gynaecologists believes that the proposed level of folic acid fortification will prevent only about 20% of neural tube defects? It recommends that fortification be set at a level that is sufficient to prevent four out of five neural tube defects, which is 1 milligram per 100 grams. Will the Minister consider that?

[Lord Markham (Con)]

I am very aware of the range of scientific advice on this. I am also aware that the official results of the consultation, which will come out, are not clear cut. A sizeable number of people, 40%, are anti-fortification. As ever, it is about trying to get that balance right. We completely agree on the direction of travel. There is some scientific advice that at too high a level there is a potential masking of pernicious anaemia in the elderly. This is the first step. Let us get all the evidence. The critical thing is getting that first step right.

PPE Expenditure

Baroness Walmsley Excerpts

Wednesday 25th January 2023 Lords Chamber

[Lord Markham (Con)]

Absolutely. As ever, we want to learn the lessons. That is why we have set up the Covid inquiry. Yes, supply arrangements are in place. At the same time, as per the answer to the previous question, holding high levels of stock does not make sense. It is cheaper in this case to dispose of it while making sure that the supply lines are in place so that we can rapidly respond to any future event.

[Baroness Walmsley (LD)]

My Lords, I understand from the Minister that it is the department that paid the cost of this useless material, and for its storage. How many doctors, nurses and ambulance staff could be given a decent pay rise if that money had been given to the NHS?

[Lord Markham (Con)]

Again, I would take issue with the words “useless material”. It was bought based on a projection of how the pandemic could progress and what would be required. The fact that it did not progress that far was thanks a lot to the work we did in being the quickest country to vaccinate in the world. So, we did not need that level of PPE; that was a good thing. We bought for a worst-case scenario and, thank goodness, we did not require it because of the action we took to get on top of it all. Now, we are dealing with the surpluses bought for that worst-case scenario and quickly disposing of them.

Respiratory Syncytial Virus

Baroness Walmsley Excerpts

Thursday 19th January 2023 Lords Chamber

[Lord Markham (Con)]

My noble friend is correct in that, for the vast majority of people—infants in this case—it is mild, flu-like symptoms at most. At the same time, it is responsible for 35,000 hospitalisations and 20 to 30 deaths a year, so it is a serious thing that we need to get on top of. We are looking for the best of both worlds. That 90% of two year-olds will have had RSV and so will have that natural protection is a good thing. But in the most serious cases—the risk groups are those with congenital lung or heart disease or spinal muscular problems—these new treatments really will help and are very important.

[Baroness Walmsley (LD)]

My Lords, the innovative vaccines and treatments mentioned by the noble Lord, Lord Patel, all require UK clinical trials. The number of clinical trials initiated in the UK declined by 4% between 2017 and 2021. What are the Government doing to reverse this decline so as to bring valuable industry money back into the NHS and cutting-edge treatments, such as RSV vaccines and treatments, to patients?

[Lord Markham (Con)]

The noble Baroness is correct. In fact, my maiden speech was in a debate about how we can bring life sciences to bear more. The point about NHS clinical trials and the fact that we are not using this massive potential asset was very much a feature of that. It is key to the work we are doing—I had a meeting on it just this week—so I agree with the noble Baroness and hope we will see improvements in this space.

Food (Promotion and Placement) (England) (Amendment) Regulations 2022

Baroness Walmsley Excerpts

Tuesday 6th December 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, the regret Motion standing in my name, and also that standing in the name of the noble Baroness, Lady Walmsley, are critical of the Government’s handling of the Food (Promotion and Placement) (England) (Amendment) Regulations 2022. These regulations introduce measures designed to limit the ability of retailers to promote the purchase of products classified as high in fat, salt and sugar; the intention of the regulations was to help address the high prevalence of obesity in this country.

It is worth reflecting that on 29 September 2022, just a day before the regulations were due to come into effect, the Government of the then Prime Minister Liz Truss introduced these regulations to facilitate a delay to the “multi-buy” components of the regulations—multi-buy promotions are the “buy one, get one free” on products high in fat, salt or sugar. This was passed via a negative procedure without debate, whilst the location-based restrictions came into effect as planned on 1 October this year. That brought into play restrictions on the placement of unhealthier food products near to supermarket checkouts at aisle ends and store entrances.

The motivation, if I can put it that way, for this regret Motion is that the House of Lords Secondary Legislation Scrutiny Committee strongly criticised the Government’s handling of this issue, particularly with regard to the Government’s justification for the delay, and the lack of parliamentary scrutiny for the amendment. It is the report of the committee that has formed the basis for these regret Motions, and I certainly do agree with the observations that the committee made.

Let me summarise for the purposes of your Lordships’ House the concerns encapsulated in this regret Motion. First, the Government have not brought forward sufficient evidence to justify their decision. Their stated rationale for the delay was the “global economic situation”. I suggest to the Minister that this is a somewhat cursory comment; one sentence is not enough. It is quite unclear what the Government feel the “unprecedented global economic situation” is. Are we referring to the post-pandemic situation, the war in Ukraine, high gas prices or something else? In other words, this is hardly a full description that one might expect. The Secondary Legislation Scrutiny Committee concluded that there was insufficient

“justification for delaying the start of a measure intended, over time, to accumulate public health benefits including significant savings to the NHS.”

The Government’s decision to take this still further goes directly against their own impact assessment for these policies, which states:

“Although price promotions appear to be mechanisms to help consumers save money, data shows that they increase consumer spending by encouraging people to buy more than they intended to buy in the first place.”


The impact assessment further states that

“the monetised benefits greatly outweigh the costs on a ratio of around 14:1”.

The Secondary Legislation Scrutiny Committee then outlined a number of procedural criticisms of the Government, the most significant of which include that appropriate parliamentary time was not given for scrutiny of the legislation. After all, as I have already mentioned, the statutory instrument was introduced just one day before the regulations were due to come into effect, without the standard 21-day period normally expected to allow for scrutiny by Parliament through the negative secondary legislative procedure. Of course, the statutory instrument was also laid without a full analysis of the public consultation being published, making it impossible to assess the views of the sectors affected by this decision.

There are a few questions arising from this that I invite the Minister to address when he replies. Why were the Government not able to bring forward sufficient evidence to justify their decision? Why do their claims about the impact of this policy on the cost of living contradict their own evidence presented in the impact assessment? Could the Minister say whether the consultation responses will be published, even at this stage?

I also seek reassurance from the Minister that similar procedural issues will not arise with future legislation. I make this point in particular reference to the fact that the Government will be bringing forward secondary legislation to delay the upcoming restrictions on the advertising of products high in fat, sugar and salt on TV and online, before they are due to come into effect on 1 January. I hope that we will not see a repeat of the failure to provide the requisite amount of time to allow for parliamentary scrutiny of legislation when we come to that statutory instrument. There should not be an attempt to bypass Parliament by not giving it the opportunity to discuss and examine the regulations.

This debate would not have been needed had the Government explained everything clearly in their Explanatory Memorandum, and had they allowed Parliament the opportunity to scrutinise, as is normally required. I say to the Minister that the Explanatory Memorandum is important. It is not just about how parliamentarians understand regulations; it is also about the public, industry and third-sector stakeholders. We all look to understand regulations by these means. I hope the Minister will take that point away and emphasise to the department the importance of providing the right supporting materials for often complex—and sometimes highly challenging—government policies. With that, I beg to move.

[Baroness Walmsley (LD)]

My Lords, my regret Motion regrets these delay regulations because they damage public health and are against the Government’s previously stated policy. When the legislation for the ban, which these regulations delay, went through your Lordships’ House in the Health and Care Act 2022, it was supported enthusiastically from these Benches. We are keen on measures to prevent ill health, save patients distress and save the NHS money, and the evidence provided by the Government in the impact statement at the time was compelling.

However, during Report, the Government introduced an amendment to allow them to delay the implementation of this measure and others in the Bill. I distinctly recall being extremely sceptical and rather suspicious about this, because of the robust opposition to these and other measures from some Members on the Government’s own Back Benches and certain lobby groups. I felt that the Government were trying to keep their troops happy and ditch the measures by stealth.

In response to my concerns, I clearly remember the noble Baroness, Lady Penn, who was leading on this amendment for the Government, assuring me that the delay power was needed only in case of a very short delay being necessary as a result of consultations on implementation. I was not convinced then and I am not convinced now. I believe that the delay power was put into the Act at the behest of lobbyists who have their own interests at heart, rather than the health of the nation, in order to allow the measures to be kicked down the road indefinitely and quietly buried.

Last week, the Government announced £20 million of funding for research to develop new medicines and digital tools to help people shed 20% of their weight. Although this will be welcome to those living with obesity, it is closing the door after the horse has bolted. In addition to spending all this money on helping people lose weight, why not promptly implement some of the measures already in legislation to help prevent obesity in the first place? By its own figures, obesity costs the NHS £6 billion annually, and this is set to rise to over £9.7 billion each year by 2050 unless effective preventive measures are taken.

As the noble Baroness, Lady Merron, said, in its 15th report, the Secondary Legislation Scrutiny Committee criticised the Government robustly on this regulation. It reminded the House that, in the impact assessment to the original instrument setting up the ban, the Government said that

“the monetised benefits greatly outweigh the costs on a ratio of around 14:1”.

That is pretty good value. Of course, the costs would have been borne by the manufacturers, retailers and advertisers of these unhealthy foods, and the benefits would have been felt by patients and the NHS, but clearly that did not suit those who lobbied the Government to introduce this delay.

What is the Government’s justification for it? The unprecedented global economic situation. What I would like to ask the Minister to explain to the House is this: whose pocket do they think they are saving by delaying the ban on this kind of price promotion? Is it that of the shoppers who are trying their hardest to put food on the table after they have paid the vast increases in their energy bills and mortgages thanks to the Government’s economic mismanagement? Or is it that of the large, profitable organisations that make, sell and advertise these foods? I am not convinced that the global economic situation is going to cause these companies to go bust, but I am convinced that continuing to allow this kind of promotion will do harm to the average shopper. Why do I say that? For the very simple reason that the Government themselves, in their own impact statement, said:

“Although price promotions appear to be mechanisms to help consumers save money, data shows that they increase consumer spending by encouraging people to buy more than they intended to buy”.


So now we know: the big manufacturers, retailers and advertisers of unhealthy foods have won, and the patients and shoppers have lost.

Nursing: Recruitment

Baroness Walmsley Excerpts

Wednesday 26th October 2022 Lords Chamber

[Lord Markham (Con)]

Indeed, and towards that aim we have set up the nursing associate role, which is a stepping-stone to allow people to ease in and have qualifications on the way to becoming a fully trained nurse. The overall point I make, as before, is that by putting in a £5,000-a-year grant for student nurses, we are recruiting the numbers. I reiterate that 72,000 is a big pipeline but also that it is an uncapped pipeline. The more we can attract, the merrier—whether domestically or, as in the fine tradition of the NHS, from overseas sources.

[Baroness Walmsley (LD)]

My Lords, is the Minister aware that the percentage of nurse vacancies is much higher in community care than in any other part of the sector? What is the department doing to ensure not only that we have enough nurses but that they are in the right places?

[Lord Markham (Con)]

That is an excellent point. One thing I probably should have said is that the number of 36,000 leavers includes people who have left NHS trusts and gone into community care, working in GP surgeries. We do not catch that number who come back in again, so the real number is less than 36,000, but the basic premise of the question—making sure we are attracting nurses to the right place—is absolutely the right one. I believe that is the plan in place, but I will check on that and make sure we are doing as requested.

Pharmaceutical Research and Development Spending

Baroness Walmsley Excerpts

Thursday 13th October 2022 Grand Committee

[Baroness Walmsley (LD)]

My Lords, I thank the noble Baroness, Lady Wheeler, for introducing this important debate so comprehensively. There is no doubt that the R&D and manufacture of new medicines already contribute in a major way to our economy, but it is also clear that there is considerable potential for improving that contribution in the interests of patients, the levelling-up agenda and the economy. However, as the noble Baroness said, over the past 25 years there has been a manufacturing capacity reduction of 25%, while other countries, such as Ireland, have seen an increase. We also saw how India produced a lot of our vaccines during the Covid pandemic.

Pharmaceutical companies can choose where they make their medicines, since they sell them all over the world, so what are the factors that they consider when deciding where to invest their capital and create well-paid jobs? Access to skills is important, as is the supply chain infrastructure, the regulatory environment, the attractiveness of the fiscal environment and upfront capital grants. Importantly, at this time of economic crisis, I should mention the importance of stability. In the past, companies have chosen the UK on that factor alone, even when other factors might have been better elsewhere.

There are many things we can do to make us more competitive. Ensuring that local communities have the right skills to attract these companies is vital and, at this time of pressure on public spending, the last thing we need to see is a cut in further and higher education opportunities, particularly in the poorer demographic areas.

As far as capital grants are concerned, the life sciences innovative manufacturing fund, £60 million over three years, is a small step in the right direction compared with our international competitors. This fund is vastly oversubscribed but could contribute to the Government’s growth ambitions. Are there any plans to increase it? The returns in increased profits, wages and taxes would surely pay for it in a few years. We must also encourage companies to increase their own capital investment in manufacturing capacity here. If capital expenditure were to be recognised within the R&D tax credit system, it would encourage them to invest more of their own money in the UK.

We need to get this right in the interests of patients, since UK manufacture of clinical trial medicines, for example, would get innovative medicines to patients quicker. It is really important that we do everything possible to speed up the time it takes to get new medicines to patients, because we are not doing very well at the moment. UK patients have lower access to innovative medicines than those in other countries, as my noble friend Lady Brinton said. For example, 43% of positive recommendations made by NICE between 2015 and 2019 were for a narrower population of patients than other regulators. Even when medicines are cleared by NICE, five years after they are approved for the NHS they are reaching only 64% of the patients reached by other nations. This could be because we spend less on medicines than other countries—9% of the healthcare budget, the lowest in the G7, compared with the average of 14% to 18%.

I now turn to clinical trials, which are so important to getting cutting-edge medicines to patients. In the last four years the UK has slipped down the international rankings for the number of clinical trials and the number of patients taking part, despite the Government’s declared ambition to make us a go-to country. The number of patients involved has almost halved during that period. This represents a cost to the NHS of around £447 million in the last financial year alone. Given that we heard from NHSE’s chief financial officer than the NHS is now short of £20 billion per year simply due to inflation in the cost of goods and services unless it can make serious cuts, surely the opportunity to save money by hosting more clinical trials is almost irresistible.

However, one of the problems is capacity. We have lost thousands of beds over recent years, as recognised by the Government recently in their announcement of 7,000 new ones. We have lost thousands of staff and are not training enough to take their place. Without adequate numbers of health professionals, we will not be able to host these beneficial clinical trials. That is why your Lordships focused so hard on the need for effective workforce planning during the passage of the Health and Care Act 2022.

The effect of this on patients is central to why we must improve their access to potentially life-saving treatments—but it is actually diminishing, partly because the setting-up time of trials is so slow. This also discourages companies, of course, despite the attractiveness of the NHS with its enormous cohort of patients. Relevant to the levelling-up agenda is the discrepancy between patients’ access to clinical trials in different parts of the UK. Cancer Research UK found that cancer patients in west London were 71% more likely to have opportunities to take part in research than patients in Cheshire and Merseyside.

I share the concern of the noble Lord, Lord Goodlad, about Alzheimer’s and dementia research. There is huge potential here for the UK to become a global leader—but again we are lagging behind. Over the past five years we have seen a decline in the number of dementia clinical trials taking place in the UK, and the number of participants. Since 2020, the number of phase 3 trials has increased in Germany, France and Italy but fallen here. So can I ask the Minister whether the Government are still committed to the £160 million of funding promised in their manifesto and recommitted to in August this year? Will the Government adhere to the recently announced national dementia mission? I ask because they have dropped so many other very important health-related measures which had been agreed by Parliament. I refer to the mental health Bill, the anti-smoking strategy following the Khan review, the health disparities White Paper and all the anti-obesity measures in the Health and Care Act—which we appear to have wasted our time on.

Looking forward, there are several other areas of research that show great promise and in which we have an opportunity to lead the world. My noble friend has talked about advanced gene and cell therapies. Those should be made and trialled here to make the most of the economic opportunities as well as the benefits for patients.

Health and Social Care Update

Baroness Walmsley Excerpts

Monday 10th October 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness, Lady Finlay, for those excellent points. I have to declare a further interest: my wife is not only a dentist, she is a dentist originally from the Dominican Republic who practised in Spain for 20 years before coming here. So many of the excellent points the noble Baroness made are well recognised here. I am in the market for good ideas, so I will meet with the noble Baroness with pleasure to understand and discuss some of the ideas she spoke about.

[Baroness Walmsley (LD)]

My Lords, the health service is suffering from inflation in the same way as the rest of us. Julian Kelly, NHS England’s chief finance officer, told the board recently that it will have to find £20 billion in efficiency savings over the next three years because of the increased cost of goods and services that it buys. He said that

“clearly you have to completely revisit investment in cancer and mental health, primary care … diagnostic capacity and you would have to look at what it meant in total for what the NHS could deliver.”

With that situation, could the Minister say how on earth we are going to deliver the plan for patients?

[Lord Markham (Con)]

As I mentioned earlier, yes, there are inflationary pressures, but as a percentage of our national wealth—our GDP—we are investing more than ever before, at around 12%. That level is very high compared with most other OECD countries. So, the investment and the staffing are there. I think the correct challenge, which I have heard from a number of Members today, is whether we are getting the best performance out of that money and investment. Again, that is very much where I have been brought in—to make sure that we are taking those areas that are performing well and disseminating that good practice. That is where I would like to focus my attention, to make sure that we really are getting the maximum output possible from this record level of investment.