Drugs: Methadone

Lord Rennard Excerpts

Monday 28th October 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his question. He will know that the DHSC does not collect data on the costs of supply of methadone centrally, as he has asked this question. However, I reassure him that Public Health England carried out an evidence review in 2017 on the effectiveness of drug treatment across the UK, which found that our outcomes are as good as or better than those internationally, including on effectiveness and value for money. However, we recognise the challenge of drug deaths and drug treatment across the UK and the challenge to local authorities. There will be an effective review of drugs policy, which will include Carol Black’s review of drugs.

[Lord Rennard (LD)]

My Lords, what consideration has been given to extending the Swiss model of heroin-assisted treatment, with addicts attending clinics under supervision and injecting safely, given that there is clear evidence of the success of this model in improving the health of addicts and reducing both the number of overdoses and levels of crime?

[Baroness Blackwood of North Oxford]

Heroin-assisted treatment can be an effective way of treating individuals for whom other opioid substitutes have not been effective. It is open to local areas under the existing legal framework, but given that funding decisions on drug and alcohol treatment have been devolved, it is for them to decide whether to commission HAT services based on their assessment of local need.

Queen’s Speech

Lord Rennard Excerpts

Tuesday 22nd October 2019 Lords Chamber

[Lord Rennard (LD)]

My Lords, I am delighted to make the first contribution to this debate since the defeat of the Government’s programme Motion in the other place.

It is a long time since the last Queen’s Speech in June 2017, but now we have this one and another is due shortly. It is like waiting a long time for a bus and then seeing two of them come almost at once. However, this Speech is more manifesto than legislative programme. It promises that,

“Measures will be brought forward to support and strengthen the National Health Service”.


But those words may be just an election slogan, because the NHS long-term plan is under threat in several ways, and I will outline just three of them.

The first is the obvious lack of a specific funding plan to tackle the social care crisis. We were told in the gracious Speech that proposals will be brought forward to,

“reform adult social care in England”.

However, we were told in the 2017 Speech that:

“My ministers will work to improve social care and will bring forward proposals for consultation”.


Almost two and half years later, we are still waiting. Unless any new proposals are bold, and recognise what we need to pay for, then most, if not all, of the promised extra resources for the NHS will be taken up by looking after people in hospital who really should not be there. These people should be looked after in ways that they prefer, with greater independence and cost-effectiveness, at home or somewhere else outside hospital.

A second threat to the NHS plan is the Government’s lack of commitment to funding public health initiatives to address issues such as obesity, overconsumption of alcohol and tobacco smoking. The OECD estimates that obesity shortens lives by an average of 2.7 years and cuts GDP by 3.3%. It cites specifically the effectiveness of tackling the problem of obesity with measures such as the sugar tax, but this has been branded a “sin tax” by our Prime Minister.

So far, the Government are also failing to follow the successful lead of Scotland by introducing minimum unit pricing for alcohol. In fact, we are going in the opposite direction. Studies conducted using the University of Sheffield’s alcohol policy model suggest that cuts in alcohol duty over the last six years have resulted in not just the loss of £1.2 billion per year in revenue but over 60,000 additional hospital admissions. The additional costs to the NHS are estimated to be around £341 million.

Government funding is also being denied for cost-effective advertising campaigns which promote ways in which people are helped to quit tobacco. The amount spent on these campaigns in 2018-19 is less than half of that spent in 2015-16 and just 10% of the amount spent 10 years ago. Smoking remains the leading cause of preventable, premature death in the UK, killing around 100,000 people every year, which is around 300 people per day. The Government have committed to considering a “polluter pays” approach for the tobacco companies. Although there is no reference to this in the gracious Speech, I hope that they will now act on this principle to help deliver the additional national and local tobacco control activity needed to achieve their own target of a smoke-free England by 2030.

Thirdly, the greatest threat to the long-term sustainability of the NHS may be Brexit itself. The Government are clearly running away from producing an impact assessment of their Brexit deal. They know that our economy will be significantly smaller outside the EU than if we remained within it. Goldman Sachs estimates that the damage already done to the economy by Brexit over the last three years has been around £600 million per year. Brexit means less funding for the NHS and certainly not the additional £350 million per week that was promised. The economic facts contradict the claim painted on the side of that infamous red bus, which was probably the greatest lie of the decade. The NHS has serious staff shortages and Brexit is already causing some of the people we need to leave it.

It is astonishing that all this can be considered a price worth paying for changing our relationship with the EU from one in which we have a voice, a vote and a veto into one that means we will, like other neighbours of the EU, have to spend the rest of our lives negotiating with a much weaker hand than we have at present, accepting much of what we do not like in order to do business.

One reason for supporting Brexit is given by the tobacco lobbyists. They do not like the EU regulations to which we have agreed, which have successfully helped reduce tobacco consumption. Will the Minister confirm that, even if we are outside the EU, the Government will remain committed to maintaining exactly this kind of regulation and achieving the goals set out in their tobacco control policy?

Asthma

Lord Rennard Excerpts

Wednesday 3rd July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

As ever, the right reverend Prelate is insightful on this matter. Children going into school with identified respiratory illnesses should have care plans to assist the school in caring for them. Asthma UK has indicated that many children are slipping through the net and remaining on long-term oral steroids in primary care. This results in repeated trips to A&E with no referral to specialist centres. We are working with NHS Improvement and others to ensure that we support them with training in the use of medication and improving the use of smart inhalers, which can track the management of their care and reduce referrals to secondary care.

[Lord Rennard (LD)]

My Lords, I am grateful to the NHS for the fact that as a diabetic I do not pay prescription charges, but other people in England with long-term conditions have to pay such charges. In Scotland, Northern Ireland and Wales, all prescription charges have now been scrapped. Is this not somewhat anomalous? Is it not unfair that the 2.3 million adults with asthma have to pay these charges?

[Baroness Blackwood of North Oxford]

The noble Lord will already have heard me answer his question in reply to the opening Question. I have already met Asthma UK on this issue and discussed its concerns about the balance of prescription charges. We are not in a position at the moment to review prescription charges as a whole, but I will be working with that organisation to make sure that the system works as effectively as possible for asthma patients and that they get access to the exemptions that are in place.

Lung Health

Lord Rennard Excerpts

Monday 1st July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

My noble friend is right that poor air quality is one of the largest environmental risks to public health in the UK. That is exactly why we brought forward the air quality strategy, which has been identified by the WHO as an example for the rest of the world to follow. But he is right that it will not work if we do not also tackle variation across the country. That is exactly what we intend to do and why we will also look at air pollution as part of the Green Paper, which is due imminently.

[Lord Rennard (LD)]

My Lords, 6.1 million people in this country still smoke. The NHS long-term plan is good at encouraging further measures to reduce the prevalence of smoking. At the same time, 50% of local authorities have had to reduce funding for smoking-cessation services, even though smokers trying to quit are four times more likely to succeed if they can benefit from such services. Is it not essential to reverse cuts in funding to Public Health England and spend money cost effectively on further advertising campaigns to reduce the prevalence of smoking among adults in this country?

[Baroness Blackwood of North Oxford]

The noble Lord is right to praise the success that we have had in smoking cessation in this country. We now have the lowest rates of smoking that we have ever had, some of which is because of the work of local authorities and PHE. He is right to identify the need to target the variation and inequalities. We are targeting this through the prevention Green Paper and we identify the need for a sustainable funding settlement through the spending review allocation.

Atrial Fibrillation

Lord Rennard Excerpts

Tuesday 7th May 2019 Lords Chamber

[Lord Rennard (LD)]

My Lords, the noble Lord, Lord Black of Brentwood, is to be congratulated on securing this debate and on his personal tenacity in pursuing this issue through many other debates and questions and through the activities of the all-party parliamentary group. I have been pleased to take part in some of these, including the one to which he referred, in 2015, which focused on detection of AF. His Question today refers to the Menu of Preventative Interventions published by Public Health England in 2016. This communicated an ambition to increase optimal management of people with atrial fibrillation from 74% to 89% over the five years to 2021.

As the noble Lord said, AF is the root cause of one in five strokes, and people with the condition are five to six times more likely to suffer a stroke than those with a regular heartbeat. Aside from the human cost and many indirect costs, strokes directly cost the NHS more than £2.2 billion each year, but the risk of an AF-related stroke can be substantially reduced by providing effective anticoagulation therapy to prevent the formation of clots. Too often, however, AF remains underdiagnosed and undertreated. In 2014, NICE estimated that around 250,000 people in the UK have undiagnosed atrial fibrillation, and the King’s Fund says that a huge proportion of those who have been diagnosed with AF are not receiving the correct anticoagulation medicine to prevent stroke.

Better diagnosis and treatment could prevent around 7,000 strokes, prevent more than 2,000 people suffering severe disability and prevent 2,000 premature deaths each year. With an ageing population, AF prevalence is likely to grow, so why are we not identifying the condition and treating it as effectively as we might? Much of the problem is that there are significant gaps and inequalities in our health system, as shown by the rates of AF detection and access to therapies and treatment for stroke. Cardiovascular disease is one of the conditions most strongly associated with health inequalities, and if you live in England’s most deprived areas you are almost four times more likely to die prematurely than someone in the least deprived. Cardiovascular disease is also more common where a person is male, older, has a severe mental illness or is south Asian or African-Caribbean in ethnicity.

Action to address health inequalities, as proposed in the recent NHS Long Term Plan, is of course very welcome. The plan states:

“Early detection and treatment of CVD can help patients live longer, healthier lives. Too many people are still living with undetected, high-risk conditions such as high blood pressure, raised cholesterol, and atrial fibrillation”.


A new return on investment tool confirms that savings can be made from better identification and management of patients. This suggests that more than 14,000 heart attacks and strokes could be prevented each year through earlier identification, diagnosis and effective management of AF. However, we are not doing what we could because suboptimal treatment of AF is widespread, particularly through the prescribing of aspirin monotherapy.

The National Institute for Health and Care Excellence recommends that people with AF who are at risk of stroke should be offered either warfarin or a non-vitamin K oral anticoagulant, known as a NOAC. NICE also makes explicit that people with AF should not be prescribed aspirin on its own for preventing stroke, as the bleeding risks outweigh the clinical benefits. This is reiterated in the NICE AF quality standard, QS93:

“Adults with atrial fibrillation are not prescribed aspirin as monotherapy for stroke prevention”.


But some healthcare professionals still believe that aspirin is an effective alternative to other NICE-recommended therapies. This practice puts a significant number of patients at unnecessary increased risk of stroke. The most recent national audit for stroke reveals the extent of suboptimal treatment with aspirin monotherapy and the impact on patient outcomes. In 2017-18, approximately 2,400, or 14%, of AF-related stroke patients were being prescribed aspirin on its own when they were admitted to hospital. This issue can be addressed with better education for healthcare professionals, particularly in primary care, to prevent aspirin on its own being prescribed when new cases of AF are diagnosed. Just as importantly, local GP practices and the new primary care networks can take proactive steps to ensure that existing AF patients are appropriately anticoagulated by identifying and reviewing those currently prescribed aspirin alone for AF-stroke prevention, as a priority.

At a population health level, addressing inappropriate treatment in individuals whose clinical risk factors are suboptimally managed provides the opportunity for every health economy to improve AF-stroke prevention at scale in a short timeframe. This can be achieved by undertaking a systematic audit of primary care data to identify AF patients being treated with aspirin monotherapy, and offering them more effective long-term treatment with a NICE-approved anticoagulant therapy such as warfarin or a NOAC. The new NHS Long Term Plan included a commitment to support the creation of CVDprevent, a new national cardiovascular disease prevention audit, to support healthcare professionals in primary care to improve the identification and management of patients with high-risk CVD conditions, including AF. It is critical that this system incorporates metrics to systematically identify patients with AF currently treated with aspirin monotherapy.

There are a number of questions to consider. How close are we to having regular systematic audits in every GP practice? The guidance on risk assessment and stroke prevention for atrial fibrillation, known as the GRASP-AF tool, can help to identify people at risk who are not anticoagulated or who are suboptimally anticoagulated. How far is this tool being used to help GPs assess the risk of AF-related stroke and provide for effective management of AF in patients? Can the Minister tell us what new measures are being taken to ensure that new and existing patients with AF are not prescribed aspirin monotherapy for preventing stroke, in line with NICE clinical guidelines? In addition, can we know the timelines for implementing the CVDprevent primary care audit programme?

We look forward to hearing what steps are being taken to enable local NHS services to identify AF patients who are being suboptimally managed, and then supporting them to obtain the right treatment. We would like to know how local NHS clinical commissioning groups and providers are using the national audit for stroke to improve atrial fibrillation management. For example, what training is being made available to medical personnel and health staff, including pharmacists, to encourage pulse checks in routine check-ups, and in non-clinical settings, to detect AF?

Finally, I draw attention to how researchers at the University of Birmingham have developed two apps that help patients and clinicians manage atrial fibrillation more effectively. Funding for this research came in part from Horizon 2020, the EU framework programme for research and innovation. Will this kind of funding be guaranteed in future?

Tobacco Harm Reduction

Lord Rennard Excerpts

Tuesday 2nd April 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Lord, who has expertise in this area, for his intervention. He is absolutely right that we need to target a reduction in lung cancer rates. Cancer Research UK states that smoking tobacco is the biggest cause of lung cancer in the UK, with seven out of 10 lung cancers caused by smoking. The NHS Long Term Plan has a very heavy emphasis on prevention, including smoking cessation services. One of the first interventions from that plan to be rolled out is the innovative targeted lung health check, which will provide an easy-access gateway to lung health and smoking cessation services. I hope that he is reassured by that answer.

[Lord Rennard (LD)]

My Lords, Sweden has banned the advertising of tobacco products, introduced clean indoor air laws and increased the price of cigarettes. Together with the properly regulated promotion of e-cigarettes, have not these measures been shown across the world to be the best methods of tobacco control? Is there not a real danger with products such as snus that tobacco companies want to promote their dual use, pushing potentially dangerous tobacco products in clean air environments and continuing to push traditional tobacco smoking products elsewhere?

Tobacco Products and Nicotine Inhaling Products (Amendment etc.) (EU Exit) Regulations 2018

Lord Rennard Excerpts

Tuesday 4th December 2018 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to the noble Lord for this opportunity to discuss e-cigarettes. It is also a great opportunity to press the Minister on the Government’s Brexit situation. I do not think that we have heard him on this matter before. It is interesting to reflect on the confidence set out in the Explanatory Memorandum that,

“as a responsible government, we will continue to proportionately prepare for all scenarios”.

That is just as well because I do not share the Minister’s confidence that the future is at all clear or, indeed, that all scenarios have been planned.

I am sure the regulations are sensible but the Explanatory Memorandum takes us back to our debate when they originally came through your Lordships’ House, during which a number of us expressed concerns that the directive on which they were based takes too draconian a view on e-cigarettes. I happen to think that e-cigarettes are one of the most successful public health measures to help reduce smoking that we have ever seen. It is a great pity that some elements of the public health community that I know well and love have such a downer on e-cigarettes that they have encouraged a disproportionate approach to their regulation. In Grand Committee, the argument was put that e-cigarettes should be regulated in a completely different way from tobacco-based products. I remain convinced of that.

Of course, we must be very careful about the potential impact on young people. I know there are those who think that attractive advertisements and the way e-cigarettes are marketed can sometimes lead young people to take up smoking. The evidence for that is very dubious. We know that e-cigarettes are attractive to people over whose heads most public health campaigns completely fly. Although I fervently hope that we do not exit the EU next March, if we do and if the Government bring forward at some point new regulations on tobacco products in general, I hope they will take note of our debates and look at e-cigarettes in a completely different way.

[Lord Rennard (LD)]

My Lords, there are those—I am certainly not among them—who welcomed the idea of Brexit because they did not like the restrictions on the promotion of tobacco that we agreed across the EU. Contrary to the biased and selfish claims made on behalf of the tobacco industry, these regulations have been successful in reducing significantly the prevalence of tobacco smoking and its related diseases. We should never forget that tobacco products shorten the lives of half the people who smoke.

The tobacco lobbyists will be disappointed with the regulations because they show that they have lost the argument and there is now cross-party consensus on tackling tobacco-related problems. As the Minister said, even if we have the disastrous no-deal Brexit that some of those people want, the regulations will allow for a set of pictures, as currently used in Australia, to continue to appear on cigarette packs in the UK to warn smokers of the terrible damage done to their health by smoking.

As the Minister said, the regulations have the support of the excellent Action on Smoking and Health, of which I am a former director. Of course, they have my support too, but I would like to remind the Minister that the Tobacco and Related Products Regulations 2016 require the Secretary of State to review those regulations and publish a report before 20 May 2021. Some of the important points made by the noble Lord, Lord Hunt of Kings Heath, should be examined when that report is made. Some of us also feel passionately that e-cigarettes can and must be promoted effectively as an alternative to smoking tobacco, but in such a way as not to encourage people who have never smoked tobacco to take up an addiction to nicotine. I would like the Minister to confirm as well as he can that there will be no going back on our successful tobacco regulation policies, which are doing so much to improve the health and life expectancy of so many people. We should do nothing that reverses the excellent progress being made on this issue.

[Baroness Thornton (Lab)]

My Lords, I apologise to the House for being a minute or so late. I am afraid that business moved too quickly and the lift too slowly.

As the Minister said, the current regulations for tobacco and related products are designed to promote and protect the public’s health. Speaking as a veteran of tobacco regulation from the previous Labour Government and the Minister responsible for the point of sale retail advertising regulations that put tobacco products out of sight in our shops and supermarkets, all those actions were rigorously and energetically opposed by the noble Lord’s party and the Minister’s predecessor but one. I welcome the Government having definitely seen the light on this; it is wonderful. I am pleased to learn that the Government’s priority is to maintain the same high standards after the UK leaves the European Union, if that is indeed what happens.

The noble Lord and I are discussing regulations that will be necessary if there is no deal. I suspect they are the first of many. We have a whole load of embryonic and blood things to discuss next week. I wonder whether that is really a productive use of his time or mine.

On what these regulations do, in the event of no deal we will be obliged to introduce legislation to ensure that the policies and systems in place to regulate tobacco products and e-cigarettes will continue to function effectively and maintain continuity with current arrangements. The website and the Explanatory Notes use the words “where possible”, so I suppose my first question to the Minister is to explain the words “where possible” and where the current arrangements might not be possible.

If the UK leaves the European Union in March 2019 with no agreement in place, that will mean, as the noble Lord said, that the tobacco products directive and the tobacco advertising directive will no longer directly apply to the UK—which is ironic, as we were the pioneers in these matters all those years ago. UK domestic law that implements these directives, such as the Tobacco and Related Products Regulations 2016, would remain in force.

My understanding is that these regulations’ purposes are threefold: to introduce a new domestic system to allow producers to notify e-cigarettes in accordance with existing rules; to introduce a new domestic system to allow producers to notify tobacco products in accordance with existing rules; and to introduce new picture warnings for tobacco products, already mentioned by noble Lords, based on the picture library owned by the Australian Government. The noble Lord and I have both learned that the pictures in use at the moment come from a library based in Brussels. We will no longer have access to it.

I thank ASH for its views and vigilance on these important matters, and for its participation in the consultation process. I agree with it that the system set out for notification of e-cigarettes and novel tobacco products in the consultation document is pragmatic and practical, and would minimise the additional work involved in the notification process if there were to be a no-deal Brexit. Products notified to the UK prior to the UK leaving the European Union would not require re-notification and data will be accepted in the same format as currently submitted. Those arrangements seem satisfactory.

For the purpose of providing an alternative to the current picture warnings in the event that the UK leaves the EU with no deal, since we would no longer have access to the rather revolting and graphic pictures in the SI—I have not seen any other legislation with pictures in it, but this instrument has them; I suggest that if noble Lords have not read the statutory instrument they should at least open it and look at the pictures it contains—the Minister has said we will switch to the ones used in Australia, which I gather are even more horrible. However, I remind the Government that, in the longer term, the Tobacco and Related Product Regulations 2016 require the Secretary of State to review the regulations and publish a report before 20 May 2021. This review needs to examine the objectives intended to be achieved by the regulatory provision made by these regulations, and to assess how far they have been met and whether they remain appropriate. That will allow a review of quite a fast-moving area in terms of product development to take place. Does the Minister agree that is the case?

For the purpose of providing an alternative to the current picture warnings in the event that the UK leaves the EU with no deal, switching to the pictures from Australia is a short-term quick fix for this emergency. However, current best practice in Australia and the UK is to rotate, regularly review and update those health warnings. Therefore, it is essential that in the longer term the Government review the warnings—they are currently being evaluated by the Australian Government—and find ways to increase the number to allow for rotation, as is currently the case. When can we expect that review to take place?

I do not need to add to my noble friend Lord Hunt’s remarks about the importance of vaping and its role in reducing smoking. These statutory instruments serve their purpose.

Health: Diabetes

Lord Rennard Excerpts

Wednesday 31st October 2018 Lords Chamber

[Lord Rennard (LD)]

My Lords, I refer to my interests in the register. I congratulate the noble and learned Lord, Lord Morris of Aberavon, on securing this debate and on his personal tenacity in pursuing the important issue of helping people with type 1 diabetes to secure access to new technologies that might help them to manage their condition better. My own interest in diabetes is long term and personal. My father was one of the first people to benefit from the development of insulin in the 1920s; he developed diabetes probably as a result of the shock he experienced having a leg amputated following injuries to it during the First World War. Because of insulin he was able to live quite a long life for someone born in 1889. I was born in 1960, when he was 71. His survival for so long was testament to the effectiveness of insulin in saving lives and helping people to live with a condition that, until then, had been known to have fatal effects for thousands of years.

I was diagnosed with type 2 diabetes at the relatively young age of 34, almost 25 years ago. My lifestyle, related to my work in politics, was extremely poor for a long period. By the time that I was 45, I was on insulin as well as tablets. In my late 40s, I was warned that even the maximum levels of every form of medication available would not sustain me into my 50s unless I changed that lifestyle fundamentally.

However, changes to lifestyle are not so relevant to people with type 1 diabetes, and not always achievable for those of us with type 2 diabetes. The consequences of poor diabetic control are the same for people with either type 1 or type 2 diabetes. My own poor diabetic control some years ago is probably responsible for the fact that both my feet now suffer from a condition called foot drop. This means that I need to wear ankle foot orthoses, known as AFOs, and, like all other diabetics, I have to take great care of my feet.

I have been fortunate to receive great support from the diabetic team at St Thomas’ Hospital. I was there yesterday and was pleased to be told that my long-term control, as measured by my HbA1c blood glucose level, remains very good at present. It has been helped by changes in lifestyle, including those that have resulted from a GP referral for some physical fitness training—which I certainly needed—the acquisition of my Fitbit monitor and recognition that I needed to eat more healthily and consume fewer products filled with sugar, which for many people is a very addictive ingredient.

I know from friends with type 1 diabetes how much harder it is for them to maintain good control, whatever they do. They have to test their blood with finger-prick tests eight or more times per day and can observe their blood sugar levels increasing rapidly or falling dramatically, sometimes without any apparent explanation. The emergency services all too often have to pick up someone who has collapsed, with many people thinking that they are perhaps drunk when in fact they are suffering from a “hypo”. I experience hypos rarely, but type 1 diabetics are much more vulnerable to them.

The problems associated with both types of diabetes have grown rapidly in prevalence and are likely to do so even more in future. Diabetes UK said on Monday that some 500 people with diabetes die prematurely each week. I regularly read distressing accounts of how more than 6,000 foot amputations per year result from diabetic-related conditions, many of which are preventable. If not managed effectively, poor diabetic control results in loss of sight, kidney disease and a much greater prevalence of strokes and heart disease.

The most recent NHS National Diabetes Audit report on complications and mortality shows that men and women between the ages of 35 and 64 living with type 1 diabetes are three to four times more likely to die prematurely than those without the condition. Men and women in the same age range who have type 2 diabetes are up to twice as likely to die prematurely.

What can be done? Control is of course the key, and I have no doubt that wider use of FreeStyle Libre, a flash glucose monitoring system, is assisting a number of people, particularly those with type 1 diabetes, to improve their control. I have looked at the Medtech innovation briefing from NICE and the devices appear immediately cost effective compared with, let us say, the costs of 10 finger-prick tests per day. The evidence of benefit to long-term blood sugar control is not yet so clear, but I know from my own experience that behaviour is changed in a positive direction when you are regularly alerted to your blood sugar levels. This is, in my view, much more likely to be the case with such a flash monitoring device than with the more traditional blood glucose meter.

There was very strong evidence in the report suggesting that users of a flash glucose monitoring device suffered far fewer hypos, experiences that can be very unpleasant and quite dangerous. The fact that such devices can now potentially be prescribed as a result of their inclusion in Part IX of the England and Wales drug tariff a year ago is very welcome but, as the noble and learned Lord, Lord Morris of Aberavon, said, there is still far too much variation between CCGs in their provision, and the guidelines from NICE are very restrictive. In the recent Question that he referred to, he suggested that around 30% of CCGs are not yet considering prescribing these devices.

I know that the aim of reducing variation in the management and care of people with diabetes by 2020 is included in the NHS England mandate, but can the Minister tell us a little more this evening about exactly how this will be achieved? There are implementation plans to facilitate the wider provision of flash glucose monitoring systems; how are these progressing? We all know that we need to rely on NICE conducting some sort of cost/benefit analysis for any such product, but is the Minister satisfied that its processes for analysing the costs and benefits of new technologies aimed at improving diabetic control are sufficiently long term? Does he accept that any such analysis for public policy should factor in all the long-term costs to the NHS and the welfare system of poor diabetic control, as well as the wider benefits to the economy and to society of helping people to achieve good control?

Flash glucose monitoring, real-time continuous glucose monitoring and insulin pumps may all provide technological solutions to help people with type 1 diabetes live healthier and happier lives for very much longer. There is, for example, a much greater provision of insulin pumps in the United States than in this country, and this is not simply because the US has a greater love of technology than we do. Overall, the US healthcare system is known to be massively inefficient and ineffective compared to our own NHS but, with an insurance-based model, you know that the insurance companies evaluate the long-term costs to their businesses of dealing with the complications that arise from poor diabetic control. These insurance companies appear to have decided, on sound business grounds, that much greater provision of insulin pumps saves them money in the long run, to say nothing of the wider benefits to patients and everyone else.

I look forward to the Minister’s comments on these issues and what he has to say about how technological innovation may help some of the problems associated with diabetes.

Hepatitis C

Lord Rennard Excerpts

Monday 9th July 2018 Lords Chamber

[Lord O'Shaughnessy]

I would need to write to the noble Baroness specifically about minority women. I do know that there are specific programmes taking place in towns and cities across the country to support minority groups where there is a high prevalence, and I mentioned the south Asian group, which has increased screening and diagnosis. It has reduced mortality, which has been affected. Clearly, that is something we need to do more of.

[Lord Rennard (LD)]

My Lords, does the Minister accept that NHS England may in the past have been too restrictive in its use of the relevant drugs? How might improved procurement policies result in greater use of those drugs, including more innovative products, as well as providing better value for the NHS in reducing the prevalence of hepatitis C?

The Long-term Sustainability of the NHS and Adult Social Care

Lord Rennard Excerpts

Thursday 26th April 2018 Lords Chamber

[Lord Rennard (LD)]

My Lords, I draw the attention of the House to my entry in the Register of Lords’ Interests.

Some years ago, when I was advising my noble friend Lord Ashdown on what to say during elections, I asked him to avoid using the phrase “rationing” when it came to talking about the NHS because the phrase is perceived very negatively. But in reality, trying to meet ever-growing demands with resources that are not growing proportionately will always mean having to ration those resources in some way.

The noble Lord, Lord Patel, and his committee are to be congratulated on their report. It does much to address the issue of NHS sustainability—much more than the Government seem willing to admit is necessary, at least publicly. The problem results from both significant demographic changes and a reluctance in the past to ask people to pay higher levels of taxation to fund the consequences of people living far longer, needing pensions for far longer, and needing much more healthcare intervention, particularly to deal with long-term conditions.

Forty years ago, a man who had worked and paid taxes for 50 years retired at 65 and lived, on average, for just two years in retirement. The cost of his pension and his healthcare was therefore not very great. Today, a man is expected to live for 20 years in retirement. His state pension, therefore, has to be paid for 10 times as long as was the case 40 years ago. Women may live for longer, but both women and men on average will now expect to have 12 years of good health in retirement but eight years when more active health and care intervention will be required, some of it very expensive.

We have had great economic growth over the last 40 years, and this has financed far greater levels of taxpayer support for the NHS than might ever have been expected during most of the last 70 years. Even so, the increasing level of taxpayer funding for the NHS is not keeping pace with the growing demands on it, or with the demands for social care. So we need people to pay more for their health and social care, and to recognise that the most efficient way of doing so is via general taxation to pay for a national health service and to integrate this properly with social care.

The noble Lord, Lord Layard, referred a few moments ago to a MORI opinion poll. I draw the House’s attention to the recent British Social Attitudes survey, which showed that most voters now back tax rises to fund the NHS if it needs more money—and, as the noble Lord, Lord Prior, indicated, it most certainly does. Options for paying more taxes found support in that survey from 61% of people. It showed that the alternatives—for example, charging for non-medical costs such as hospital food, or paying £10 to visit a GP—received just 21% support. The latter approaches are, I think, quite unacceptable.

The highest level of support in the survey was for people to pay more through a separate tax that would go directly to the NHS. A 1p increase in the basic rate of income tax, for example, would produce an additional £6 billion per year. However, it seems to me that a much more radical restructuring of the income tax and national insurance system is required to fund what is needed. I wish the Select Committee report had been less equivocal about hypothecating taxes for the NHS, because I believe that that is the only way forward by which people will agree to pay more taxation.

However, in my view the report was right to say that the long-term sustainability of the NHS requires more than an increase in taxpayer funding. For example, we need to do much more to reduce the demands on the NHS caused by factors such as the escalating rates of obesity and diabetes, and problems with alcohol misuse, and we still need to reduce further the prevalence of smoking tobacco.

In trying to tackle all these issues, we have to overcome the powerful lobbying interests of the food and drinks industry, as we have largely done with the tobacco industry’s activities in this country. We need also to promote healthier lifestyles. At this point, I should declare my interest in having benefited from a GP referral programme that successfully encouraged me to take more physical exercise. The result of that may not be immediately self-evident—but your Lordships should have seen me 10 or 20 years ago.

We also need to make much more effective use of technology to improve the functioning of the NHS, which has been far too slow in replacing paper and fax-based correspondence with electronic communication. Much greater use must also be made of assistive technology, whether funded publicly or privately or through the increased use of personal health budgets. Providing specialist equipment to children that reduces the likelihood of surgery in later life, adapting people’s homes, whether with grab rails, stairlifts or specially adapted kitchens, and ensuring that people have the most appropriate assistive technology to enable them to live their life to the fullest and most independent degree possible should become a much greater priority in the decades ahead.

That is all absolutely essential if we are to curb successfully the escalating demands on the NHS and, at the same time, enable more people with disabilities or long-term conditions to enjoy more gainful employment and contribute positively to society and to the economy.