Health and Care Bill

Lord Lexden Excerpts

Lords Hansard - Part 3 & Committee stage
Tuesday 18th January 2022 Lords Chamber

[The Deputy Chairman of Committees (Lord Lexden) (Con)]

My Lords, in the next group of amendments, the noble Baronesses, Lady Brinton and Lady Masham, and the noble Lord, Lord Howarth of Newport, will be taking part remotely.

Amendment 47

Moved by

--- Later in debate ---

[Baroness Finlay of Llandaff (CB)]

My Lords, to state the obvious, everyone will die. On average, one person dies every minute, and every 22 minutes a child loses a parent. Dying patients are seen in every part of healthcare, and the vast majority will have some level of palliative care need. I declare my interest as a specialist in palliative medicine over decades, and my roles with different relevant hospice and palliative care charities and being employed through the Velindre Cancer Centre.

Amendment 47 would introduce a specific requirement for clinical specialist palliative care services to be commissioned by integrated care boards in every part of England. Amendment 52 is to inform the debate as it draws on the World Health Organization definition of specialist palliative care. These amendments are strongly supported by Marie Curie, Hospice UK, Together for Short Lives, Sue Ryder and the Alzheimer’s Society.

Let me be clear; this is about specialist clinical services. General basic palliative care should be a skill of every clinician. But, until it is recognised as a core specialty, generic services will continue to view it as an extra and learning will not be integrated across all areas. Educating and training are crucial duties in upskilling others. In the pandemic, palliative care has been propelled centre stage as a driver of good practice. Specialist palliative care is a relatively new specialty, which is why it was not included in the early NHS legislation. The other truth, that everybody is born, was recognised by requiring every part of the UK to have maternity services. That has been reiterated in legislation and in Clause 16 of this Bill, along with dental and other services.

The hospice movement grew up outside the NHS, spearheaded by Cicely Saunders, who realised that bringing about change within the NHS was painfully slow. This has meant that a patchwork of services has developed in the wealthier parts of Britain. In some areas great, innovative integration with community social care is happening. But other areas of enormous need are left with almost no service, or no service at all. Now we depend on fundraising events for people to get expert support for pain and other symptoms, and for psychosocial distress. No one would advocate to have a cake sale so that a woman in obstructed labour can have a caesarean section, so why turn a blind eye to ways to improve the quality of life of those with serious and life-threatening illnesses and support their families? Debate in the other place suggested that palliative care is aftercare; it is not. It is not an add-on just before death. It must be an integral part of care so that problems are dealt with in a timely way, not left to escalate into a crisis.

In Section 3 of the NHS Act 2006, clinical commissioning groups had the same general duties as in this Bill, yet significant gaps in specialist palliative care services persist between clinical commissioning groups. Some populations fare particularly badly: people who are homeless or in prison, BAME groups, Gypsies and Travellers, LGBTQ+ people, people with learning disabilities and those living in poverty, alone or with dementia. Yet the way a person dies lives on in the memory of those left behind.

Marie Curie’s freedom of information requests to English CCGs revealed an average spend last year of as little as £19.02 per person aged over 65. Only 35% of CCGs responding offered specialist palliative care services in all care settings overnight and at weekends, yet such services are known to reduce pressure on NHS services and achieve savings by reducing the number of hospital bed days occupied and unplanned admissions.

Research from King’s College London and supported by Marie Curie reveals that of the 23 integrated care systems in England with published strategies, only six identified palliative and end-of-life care as a priority area. Five mentioned broad bereavement support and only three identified relevant measures of success, such as reduced hospital admissions.

In the pandemic, many hospices hit financial instability head on as fundraising dried up. The government bail-out was essential, and I think that everyone was very grateful. In 2008, Wales had tackled this problem head on, aware that if a hospice folded, the clinical core service would still be needed. With just over £2 per head of population investment, we moved to provide core specialist clinical palliative care through an agreed funding formula, moving to seven-day services and 24/7 advice to any health or social care professional with a patient needing help. These services cover hospitals, hospices and community, with increasing integration reaching areas where no services existed. We instigated a paediatric service and an all-Wales unified patient record across the NHS and voluntary sector providers, which I described last week.

The outcomes that we achieved warrant consideration. To quote one nurse:

“The patients have access to specialist palliative care nurses, advice and experience on the weekend, which is great, and if we weren’t there, they wouldn’t have that, and they’d suffer for it. Unfortunately, people deteriorate and die out of hours. They don’t all die Monday to Friday, nine to five.”


At the south-east Wales cancer centre, specialist palliative care is now embedded in the acute oncology service, whose audit revealed that almost three-quarters of the patients presenting to acute oncology had a level of unmet need in palliative care but were unknown to any services at the time. The majority then had same-day, face-to-face palliative care review or were referred to their local team. In the community last year, there were more than 3,700 patient contacts, over 1,000 being face to face. I remind the Committee that that covers a population of about 1.5 million. Many families have “just in case” boxes to make sure that medication is available, and the ambulance service can link in too.

For cancer centre in-patients, the palliative care audit showed that nine out of 10 symptoms improved during the patient’s stay, including pain, breathlessness, constipation and weakness, and nausea scores fell to zero by day seven. Multifactorial drowsiness persisted in some whose disease was progressing rapidly to death.

In England during the pandemic, specialist teams were in place. They have shown that they can facilitate discharge, support staff having difficult ethical and communication dilemmas, and support patients and families, but a Marie Curie survey of carers of people who died at home during the pandemic found that 76% said that their loved one did not get all the care and support they needed, 64% did not get pain management and 65% did not get the out-of-hours care.

This Bill arrives at a critical moment for improving care. In 20 years’ time, 100,000 more people will die each year in the UK. Demand is set to increase rapidly as our population ages and more people live for longer with multiple and complex conditions. The number of people dying with a need for palliative care is projected to increase by up to 42% by 2040. This cannot be left unaddressed, and the solution is at hand. I hope that the Government will finally recognise that they can improve care without increasing overall cost by adopting Amendment 47, to explicitly require the commissioning of specialist palliative care for local populations.

The NHS promised to support people from the cradle to the grave, and it can now realise that promise. I beg to move.

[The Deputy Chairman of Committees (Lord Lexden) (Con)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite her to speak.

[Baroness Brinton (LD) [V]]

My Lords, I thank the noble Baroness, Lady Finlay, for laying these amendments and pay tribute to her for her tireless work in the palliative care sector and in your Lordships’ House. I also thank Marie Curie, Hospice UK, Sue Ryder, Alzheimer’s Society and Together for Short Lives for their very helpful briefing.

Clause 16 provides integrated care boards with duties to commission hospital and other health services for those for whom they are responsible. While specific services are highlighted in the clause, there is still nothing for specialist palliative care as currently drafted. There should absolutely be a fundamental right to access palliative and end-of-life care and support services for everyone who needs them. It is vital to restate that palliative care and end-of-life care are not always the same thing.

Hospices, homes and special services at home help children and adults for more than just those last few days. However, far too many people already miss out on palliative care, as the noble Baroness, Lady Finlay, set out; estimates suggest that while as many as 90% of people who die may have hospice and palliative care needs, only around 50% will actually receive it. Like many others, I am afraid I know family and friends who were desperate to move to a hospice in their last few days but ended up dying in hospital. In my stepfather’s case it was because of the bureaucracy of the hospital—at the point at which they said it was possible to move him, they said it was too late.

If we can reduce unplanned and potentially avoidable hospital admissions, it would be considerably less distressing for the patient and their families and would also reduce pressure on our hospitals.

With people in the last year of their life in England accounting for some 5.5 million bed days, it is estimated that the total cost of these admissions is over £1 billion for our already pressed acute hospital trusts. I have a friend currently receiving end-of-life care who is also stuck in a hospital. The real problem is the lack of understanding of where and how the specialist services can be provided. That is vital, because otherwise people end up in hospital and cannot get out again.

During debate on a similar amendment in Committee in the Commons, the Minister of State for Health, Edward Argar, indicated that the Government’s view is that everything is covered by aftercare. As the noble Baroness, Lady Finlay, said, this is not aftercare. If you have ever seen the brilliant work of palliative care specialists, you will understand that it is real care at a vital time in people’s lives.

I mentioned Together for Short Lives in opening. I have a particular interest in children’s palliative and end-of-life care. One of the things that worries me most at the moment is that people often do not understand that respite care for families looking after young children with very serious illnesses and disabilities has been a vital way of ensuring that they can have some sort of break. They often work 18, 19, 20 hours a day, sometimes with help at home but often, during the two years of the pandemic, with no help at all.

Take the example of my local children’s respite centre, Nascot Lawn. The parents took the CCG to the High Court twice and won, but it closed down. It was not the first. Part of the problem we have with our hospices and other forms of provision is that they rely utterly on public fundraising. The last two years have been a particular problem. For children’s respite and palliative care, it is an absolute tragedy—far too many units are closing down around the country.

In addition, despite a version of the language used in Clause 16, on aftercare, having been in place since the 2012 Act, many CCGs do not currently commission sufficient specialist palliative care. Worse, in the case of Nascot Lawn, the entire onus was put on the local authority because, it was said, it was about personal care. One of my concerns is a muddle between personal care and aftercare, when all these children required specialist nursing.

It is vital that the funding element is looked at. The noble Baroness, Lady Finlay, is right that the NHS always proudly boasted that it was there for people from the cradle to the grave. Sadly, at the moment this is not true. It is the hidden gem of our public health system and we must find a mechanism to make it not hidden but apparent and something that everyone who wants and needs it can rely on in the future.

Health and Care Bill

Lord Lexden Excerpts

Lords Hansard - Part 1 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, my amendment concerns patient data. I want to probe the meaning of new Clause 14Z61, proposed by Clause 20(2), which relates to the permitted disclosure of information by integrated care boards. It sets out, on page 27 of the Bill, a number of conditions under which disclosure can be made. They include when

“the information has previously been … disclosed to the public”

or

“the disclosure is made in accordance with any enactment or court order”.

That seems perfectly sensible. However, proposed new subsection (1)(f) contains a catch-all condition under which a disclosure can also be

“made for the purpose of facilitating the exercise of any of the integrated care board’s functions”.

That seems remarkably open-ended. My amendment seeks an assurance that this power excludes the personal data of patients.

We have already had one go at the issue of data and digital transformation, and I have told the House that I am right behind the efforts of the NHS and the Minister’s department to encourage the digital transformation of the NHS. The potential is clearly enormous. However, public confidence depends on the integrity of the system and having embedded in it a guarantee that every use of data will be consensual, safe and transparent.

The recent Laura Wade-Gery review, on which a number of noble Lords have commented, acknowledged some of those concerns. As she said:

“The field of data science is undergoing a revolution as new tools such as machine learning transform our ability to gain insights and improve outcomes. These advances, combined with the explosion of new data driven commercial business models, have caused citizens to be concerned about the privacy of their individual health data and the controls in place over its dissemination and use.”


There may be situations where a patient does not want a doctor—by the way, just for the Chief Whip’s reassurance, I have not spoken for 37 minutes as the clock says—to tell another doctor something about them, yet this can be ignored by those who want to copy records across a lifetime. Modern communications have created the capacity to copy medical records on a scale that can shatter medical confidentiality.

The experience of Care.data is surely a lesson for us. The decision to axe the scheme followed the publication of two reports that supported far greater transparency over what happens to the information, and opt-outs for patients who want their data seen only by those directly caring for them. A review by the late Dame Fiona Caldicott, and a second by the Care Quality Commission, recommended tougher measures to keep people’s medical information confidential. The Caldicott review said that there needs to be much more extensive dialogue with the public as to how their information can be used. As she said:

“Citizens have a right to know how their data is safeguarded. They should be included in conversations about the potential benefits that responsible use of their information can bring. They must be offered a clear choice about whether they want to allow their information to be part of this.”


This was brought home to me recently by NHS England’s announcement that it is to give trusts, as employers, access to the Covid and flu NHS vaccination records of their staff. I am fully behind the vaccination drive and sympathetic to the Government’s mandating of vaccines, but the announcement said:

“To assist Trusts with understanding the vaccination status of their workforce, we are providing a solution for Trusts to view the vaccination status of staff who are on the Electronic Staff Record … system. To do this, we are undertaking an exercise on Trusts’ behalf, to match ESR data, using NHS numbers, with vaccination data held in the National Immunisations Management System … which includes data drawn from all point of care vaccination systems. Following a successful import of ESR data into NIMS, a dashboard will be provided to each Trust detailing their workforce Covid and Flu vaccination uptake, drilled down to employee-level.”


Let me be clear: I support the vaccination drive, as I said, but am I the only one to worry about the access to confidential data that is being given? I recognise that we are talking here about electronic staff records as opposed to electronic patient records, but the principle of releasing patient data is the same.

I would like to hear some assurance from the Minister about the use of this clause and the open-ended nature of new Section 14Z61(1)(f), because, as I think we will shortly hear from the noble Baroness, Lady Brinton, such an open-ended disclosure provision in other legislation would be looked at with very great concern. Having said that, and having taken up 44 seconds, according to the Clock, I beg to move.

[The Deputy Chairman of Committees (Lord Lexden) (Con)]

My Lords, I have failed in my duty, and not for the first time. I should have stated before calling Amendment 145 that the noble Baronesses, Lady Brinton and Lady Harris of Richmond, will be taking part remotely. May I apologise, and invite the noble Baroness, Lady Brinton, to speak?

[Baroness Brinton (LD) [V]]

My Lords, this probing amendment from the noble Lord, Lord Hunt, is essential, because it protects confidential patient data from being given out by an ICB in contravention of the ethics rules of the General Medical Council and other regulatory bodies.

When the Police, Crime, Sentencing and Courts Bill arrived in your Lordships’ House in the autumn, it had clauses in it that gave the police, probation and prison services access to a patient’s confidential medical data as part of their role to reduce and prevent serious violence. As originally drafted, that Bill would have required GPs, CCGs and their staff to hand over that data. This was not just about those under suspicion; it could have been anybody involved in serious violence.

I had extreme concerns about this, and I tabled an amendment not dissimilar to Amendment 145. I was grateful for the support of the noble Lords, Lord Patel and Lord Ribeiro, the General Medical Council, the BMA and others in Committee on that Bill. We had meetings between Committee and Report with officials from the Department of Health and the Home Office, meaning that by the time we got to Report the Government had laid amendments to ensure that a patient’s personal data could not be demanded by the police, probation and prison services. It is now recognised that the medical regulators—the GMC, the Nursing and Midwifery Council and other bodies—actually have the responsibility and the excellent ethical standards by which their members are expected to judge what they should do if they are asked for personal data.

The amendment from the noble Lord, Lord Hunt, would address what data an ICB may disclose by adding a subsection to protect the Government in the same way as happened in the police Bill, so that the personal data of patients should not be disclosed. This is a vital amendment. The Government have already accepted in this Parliament that a patient’s personal data must not be accessible by those other than clinical and clerical staff dealing with it, who must abide by the confidentiality rules of their regulatory body or by their employment contract.

This is even more necessary, because the Bill says in new Section 14Z61(1)(g), on permitted disclosures of information, that

“the disclosure is made in connection with the investigation of a criminal offence”.

That is even broader than in the original police Bill. Patient confidentiality is a fundamental ethical duty. It is crucial to upholding the trust that lies at the heart of the doctor-patient relationship. The new section will give the ICB the right to override that.

New paragraph (e) is also more far-reaching than the investigation of any crime. It says that

“the disclosure is made to any person in circumstances where it is necessary or expedient for the person to have the information for the purpose of exercising functions of that person under any enactment”.

So it is not the doctor or the ICB that has the choice about disclosing that information; they must take the word of the person making that request. That is total free access for anyone who says that it is necessary or expedient for them to have that information. Where is the protection of a patient’s individual and confidential data?

It also removes the decision from GPs, despite GPs having very clear and effective guidance from the GMC on when, in exceptional circumstances, they can give out data. I will not quote the whole of the guidance, because we do not have time, but there are two vital points that a GP must consider: the patient must consent, whether implicitly or explicitly; and disclosure must be permitted or must have been approved under a statutory process that sets aside the common-law duty of confidentiality. The doctor also has a duty, even when they have made their decision, to use anonymised information if practicable, and they must be satisfied that the patient has ready access to information explaining how their personal information will be used. It goes on, but I will not quote the rest.

One might hope that Ministers assumed when drafting the clause that confidential patient data would never be included, other than for the treatment of the patient. However, paragraphs (e), (g), (h) and (f), as the noble Lord, Lord Hunt, outlined, put paid to that. If the argument is that the clause is needed because the ICB might have to share data with, for example, care providers or social workers carrying out assessments, that needs to be made clear, and it would be permissible. But, as drawn, it is far too brief.

The amendment from the noble Lord, Lord Hunt, at least protects the personal data of patients. It is very straightforward and provides the protection that every doctor, nurse and patient would expect. So I hope the Minister will say today that he is happy to accept the amendment. If he is not, please will he agree to a meeting with those who have spoken in this debate, and invite the GMC and the BMA? If progress is not made on this, I will lay an amendment on Report and am likely to press it to a Division.

[The Deputy Chairman of Committees (Lord Lexden) (Con)]

My Lords, the noble Baroness, Lady Harris of Richmond, is also taking part remotely and I invite her to speak.

[Baroness Harris of Richmond (LD) [V]]

My Lords, having spoken on just about every police Bill in this House for the past 23 years, I am afraid that I could not let this amendment pass without comment. I refer your Lordships to my policing interests in the register.

As my noble friend Lady Brinton has just said, the Police, Crime, Sentencing and Courts Bill, which has just gone through this House, had provisions that gave the police and other criminal justice bodies investigating possible serious violence, or plans to produce serious violence, the power to demand the confidential medical data of individuals. As drafted, unspecified police officers —that means any police officer, not just a senior ranking officer—could make requests to a GP’s surgery or a CCG, or their staff, to hand over the data.

What I found chilling was that the police would not be required to explain to the patient’s GP why they wanted the information, or whether the patient concerned was a potential criminal or possible victim—or even someone associated with the investigation, for example a possible witness or family member. After discussions with Peers, the General Medical Council, Ministers and the British Medical Association, the Government made their own amendments, making it clear that the police would not have this universal access to patient data. Instead, they would have to use the current, traditional method of approaching a patient’s GP directly and asking for the data, with the decision being made by the GP under the GMC code of ethics, as my noble friend Lady Brinton explained.

New Section 14Z61 gives the new integrated commissioning boards a duty to hand over personal medical data to a wide range of bodies that request them. However, I will focus on paragraphs (g) and (h), which are about police requests for data when they are undertaking criminal investigations. It is even more extraordinary that a health Bill is proposing to give the police even wider powers than in the recent police Bill. At least that Bill originally limited access to cases of serious violence. I will quote my noble friend from 25 October 2021, in debate on the Police, Crime, Sentencing and Courts Bill:

“It is quite extraordinary that this Bill proposes that any Home Secretary can, at will, demand that doctors and other healthcare professionals breach patient confidentiality, over and above their responsibilities of confidentiality to their patients and their commitments to their regulatory body.”—[Official Report, 25/10/21; col. 551.]

Health and Care Bill

Lord Lexden Excerpts

Lords Hansard _ Part 1 & Report stage
Wednesday 16th March 2022 Lords Chamber

[The Deputy Speaker (Lord Lexden) (Con)]

My Lords, I have been informed that the noble Baroness, Lady Campbell of Surbiton, would like to participate in this debate remotely. I invite her to contribute.

[Noble Lords]

She is here.

[The Deputy Speaker (Lord Lexden) (Con)]

Not remotely but present, which is very good indeed.

[Baroness Campbell of Surbiton (CB)]

My Lords, I am so thankful to be here tonight. It is a rare appearance but an important one and I am glad to be here in your Lordships’ House to oppose Amendment 170, which repeats the amendment that the noble Lord, Lord Forsyth, tabled in Committee. I apologise to the noble Lord for missing the first sentence of his contribution—I always enjoy his contributions and I am sorry to have missed the very first part.

This is a complex and highly contentious ethical issue. Opening the door to what is effectively assisted suicide would be a monumental change in the criminal law with potentially lethal consequences. If we get it wrong, it will result in some vulnerable people needlessly taking their own life.

The current Bill on assisted dying needs to be examined with the utmost care on the basis of highly informed opinion, robust evidence and a deep understanding of why hundreds of disabled people fear it. I do not think that we understand this cohort. I wish we did but we do not. We have seen a range of legislative developments in recent years in the UK and abroad, all of which demand detailed analysis.

Using this Bill to force the Government’s hand and the pace of deliberation on a matter specifically covered by an existing Bill is, I believe, as others do, a blatant manipulation of the parliamentary process. It sets a dangerous precedent and should be resisted. This is the wrong Bill, the wrong time and the wrong way in which to debate one of the most fundamental issues that we face as a society. I beg—yes, beg—noble Lords to reject the amendment.

Health and Care Bill

Lord Lexden Excerpts

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

[Baroness Chakrabarti (Lab)]

My Lords, the aim of Amendment 174 is to learn from mistakes made during this pandemic and ensure that, in the event of a public health emergency of international concern, our Government share and support others to share critical knowledge, data, research and intellectual property relating to vaccines, tests, treatments and their associated materials. By sharing this information and intellectual property we can scale up and, crucially, diversify the manufacturing of pandemic tools to ensure equitable access around the world, expediting our ability to end the emergency for all by winning the race against new variants.

Less than 10% of people in low-income countries have been double vaccinated. Lower-income countries are not prioritised. The status quo pharmaceutical model of supplying to the highest bidder means that low-income countries have to rely on the good will of high-income countries and companies to provide donations. Evidently, this has not proven effective in achieving global equitable access. Many low and middle-income countries therefore want to manufacture their own vaccines, tests and treatments so that they can have greater oversight of supply volumes, timelines for dispensing products and prices now and for the future. However, pharmaceutical companies have widely refused to share their technology openly. In addition, the United Kingdom, the EU and Switzerland have continuously blocked South Africa and India in their proposal to temporarily waive certain provisions of the Trade-Related Aspects of Intellectual Property Rights Agreement—the TRIPS agreement—on all Covid-19 tools, vaccines, tests and treatments.

Amendment 174 seeks to remedy this. It calls for the Secretary of State to support or initiate a temporary global waiver of the TRIPS agreement within three months of a pandemic being declared at the WHO. This three-month period is there to give pharmaceutical companies the opportunity and the push to make plans for how they will voluntarily openly license their products and engage in transferring their know-how to companies with established manufacturing capacity. This time period is in step with the recommendations of the Independent Panel for Pandemic Preparedness and Response.

The pharmaceutical industry is an immensely powerful machine, and we need to work with it. But as history has taught us, through the HIV crisis, pricing for cancer treatments, and now with Covid-19, it does not always do the right thing. As we speak the WHO’s mRNA hub in South Africa based at a biotech company called Afrigen has managed to reverse engineer Moderna’s vaccine. As Moderna made a pledge not to enforce patents during the pandemic, Afrigen are doing well in its development. The project has been significantly slowed down by Moderna and BioNTech’s refusal to share their knowledge with the hub. This is just one example. There are over 100 potential mRNA producers across Africa, Asia and Latin America who could be producing vaccines now, if only they had access to the know-how and data, and were not restricted by the fear of patent infringement.

Amendment 174 is about encouraging the industry to do the right thing and the Government to take action to protect global health and live up to the slogan “global Britain”. It is not just political rhetoric but epidemiological fact that none of us are safe until we are all safe. If viruses are left unchecked, they will mutate and this pandemic is far from over; cases have risen hugely in South Korea, China and here in the UK of late. Talk of Covid-19 becoming endemic does not that mean it has disappeared. Malaria is endemic in many parts of the world, but it continues to kill hundreds of thousands of people every year.

This amendment will also initiate a great deal of cost saving for the NHS during pandemics. We are paying the highest recorded price for the Pfizer vaccine at £22 per shot. This amendment reaffirms our commitment to using in these emergency situations compulsory licences, one of the public safeguards in the TRIPS agreement to enable the domestic manufacturing of generic and biosimilar products, which would mean that any company within the UK with manufacturing potential could be making these vital medical tools.

Just today we heard that a draft copy of the waiver has been leaked, although it has been significantly watered down and reduced in scope. None the less it shows there is a global consensus that intellectual property monopolies are a barrier to accessing Covid-19 vaccines, tests and treatments. We need the Government to use this moment finally to do the right thing and support a waiver on all intellectual property covering vaccines, tests and treatments that can be utilised by all countries in the negotiations to come.

I also urge Her Majesty’s Government to use their influence as a faithful customer of Pfizer and Moderna to push them to share their technology with the WHO’s mRNA hubs and revoke the patents they filed on Covid-19 technologies. This amendment is about improving access to affordable life-saving health technologies for our NHS and worldwide during public emergencies. We can bolster pandemic preparedness and expedite our response to Covid-19 and future pandemics. I beg to move.

[The Deputy Speaker (Lord Lexden) (Con)]

I invite the noble Baroness, Lady Brinton, who is taking part remotely, to speak now.

[Baroness Brinton (LD) [V]]

My Lords, I have signed Amendment 174 in the name of the noble Baroness, Lady Chakrabarti. I thank her for introducing it and for making it clear that this aims for global pandemic preparedness. The World Health Organization set a target to vaccinate 40% of the world by the end of 2021. However, 92 countries missed this target due to a lack of access. Despite the funding from high-income countries to the WHO-run COVAX and Gavi schemes, low-income countries have remained at the back of the queue as high-income countries have been able to jump in ahead, using their money to get second and third doses for their own population.

Frankly, we need a better system for future pandemics. We need to understand that openly licensing newly developed Covid-19 technologies, waiving intellectual property rights and sharing the manufacturing know-how would allow more companies to begin producing life-saving vaccines, drugs and tests across the world. However, pharma companies have widely refused to share their technology openly. We also need to source other key critical control products, such as testing equipment, PPE and masks. Relying on too few suppliers in too few countries caused immense problems for the first six months of the pandemic, and again as subsequent waves hit those countries. In addition, the UK, the EU and Switzerland continue to block South Africa’s and India’s proposal to temporarily waive certain provisions of the Agreement on Trade-Related Aspects of Intellectual Property Rights—TRIPS—on Covid-19 tools.

Despite regular pandemic exercises in this country, and despite previous experience with vaccines for other diseases not being shared with low-income countries, we have not learned the lessons. This amendment sets out what a Secretary of State should do within three months of the WHO declaring a public health emergency. I really hope that Ministers are prepared to help make progress on this issue. If not, and if the noble Baroness, Lady Chakrabarti, calls for a Division, we will support her from these Benches.

[The Deputy Speaker (Lord Lexden) (Con)]

I now invite the noble Lord, Lord Campbell-Savours, who is taking part remotely, to speak.

[Lord Campbell-Savours (Lab) [V]]

My Lords, this is an important amendment. To me, it is the most important in the Bill. It concerns preservation of life in conditions of general pandemics. If you leave worldwide vaccine manufacturing programmes to the free market, you will never fully deliver. Profit will always trump the public good, unless the state intervenes in some regulatory form or another. This is basically why I am a Labour person.

With that in mind, it is clear that the more we are told that the current arrangements for licensing and manufacturing are necessary for reasons of quality control, the more I am convinced that this is not the only consideration in mind. There are other considerations—primarily the need to maximise profit. There is nothing wrong with profit if the justification is reasonable. It drives initiative and entrepreneurship. However, when there are wider issues involved, as in the case of a global pandemic which threatens the well-being of nations and the international economy, there must be a consideration of the wider public good and benefit. I am not convinced that, apart from the case of the AstraZeneca project, public benefit has been the driver.

In Committee, I set out in some detail a case wider than this amendment for worldwide licensing arrangements based on the original amendment of my noble friend Lady Chakrabarti. I remain confused by the Government’s position, which seems ever reliant on research and limited production at home, with volume production overseas. I would have thought that there are lessons to be learned about supply volatility from the case of oil from Russia. Equally, with both China and India leading the world in vaccine supply—at the same time as both countries remain reluctant to support us over certain areas of dispute and crisis in foreign policy—alarm bells should be ringing. I remain of the view that we in the United Kingdom should lead the world in this area of research, development, manufacturing, licensing and supply.

We are moving into an era of further pandemics as research-spawned accidental releases inevitably will reoccur, or perhaps they will not even be accidental in origin. There are huge foreign policy benefits to be gained arising out of being the world’s primary producer and licensee of these vaccines. When you help people, they remain indebted. That is the approach China is taking in many areas of its foreign policy.

I will give an example. The French Government funded my higher education in France 60 years ago. To this day, I remain indebted to France, with a lifetime feeling of obligation. This is often the case for foreign students. I believe that if we had been suppliers and licensees to the world over the recent period, in particular Africa and the third world, the payback would have been immeasurable, with huge implications for foreign policy.

I will exaggerate to make my case: suppose we had been supplier and licensee to China. Can noble Lords imagine what influence such beneficence would have had on Chinese public opinion and, perhaps ultimately, on Chinese foreign policy? A friend in need is a friend indeed—we should never forget that.

I appeal to the Government, even at this late stage in the current pandemic, to think long term, and create the vaccine supply, manufacturing and licensing programme that my noble friend Lady Chakrabarti is advocating. Her amendment seeks at least a temporary, time-agreed waiver. It is a start. I am using her amendment to argue a wider case, a new vision. Her excellent amendment puts in place a building block on which a longer-term strategy should be constructed. We should lead by helping others to help themselves. The rewards are inestimable.