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  • Nov 6, 2018:
    • Government Vision on Prevention - Statement | Lords debates

      My Lords, at last we have a Secretary of State who has been listening to my speeches over the years, or perhaps, more realistically, he has come to the same conclusion all by himself that the NHS is unsustainable with the changing demographics and higher demand unless we do something to prevent the 40% of illnesses that are preventable. I am therefore delighted to welcome the Secretary of State's new focus on prevention.

      However, he said in his speech yesterday that it is difficult to divert money into prevention unless funding is rising, because otherwise you will be taking money from treatment. Well, funding is rising. The Minister spoke about diverting part of the extra £20 billion for the NHS into prevention, but that is only part of the answer. This a whole-government problem. People do not live in hospitals or GP surgeries. They live in cities with polluted air, often in overcrowded and damp homes, in areas with too many fast-food outlets and too few fruit and vegetable shops where the local sports centre or swimming pool has closed. They are stressed about paying the bills on low wages or benefits.

      Then there are lifestyle decisions. Often when people are in their own homes or the local pub, they smoke or send out for a high-fat and high-salt takeaway or drink too much alcohol. Many do not take enough exercise. They are subjected to large amounts of TV advertising for the wrong kind of food and drink, and far too many ads encourage them to gamble. None of this is good for their physical or mental health.

      My point is that the organisations that can help them with this are often not the NHS or wider national government, although both can do a lot. I am speaking about local authorities, whose overall funding, particularly for public health services, has been cut since July 2015 and is projected to carry on being cut. Does the Minister think that this is in line with the Secretary of State's vision? There is evidence that sexual health services, sports centres and weight management services have closed. Smoking, alcohol and drugs prevention and treatment services have been discontinued. Does the Minister not agree that some of the new funding should be diverted from the NHS into local authorities and ring-fenced to allow them to reinstate and widen these services? Of course, NHS professionals must be involved, but this should come under the public health responsibility of local authorities, where it correctly lies.

      Councils run as many of these good services as they can but they cannot afford as many as are needed to stall the national epidemic of obesity and other preventable health problems. According to a systematic review of the available evidence, published online in the Journal of Epidemiology and Community Health, every £1 spent on public health saves £14 on average, as referred to by the noble Baroness, Lady Thornton. In some cases, significantly more than that is saved. We should listen to such a meaty piece of research. Local directors of public health claim that they can spend money more efficiently than the NHS to prevent ill health. Why not fund them to do so?

      Turning to two other matters, I applaud the Secretary of State's initiatives for people with learning difficulties; I strongly wish them well. However, the Minister will understand from my background in cannabis-based medicines that I am still very concerned about the too-restrictive guidance that has been published on prescribing pharmaceutical-grade cannabis-based medicines. It seems that there is still a bureaucratic nightmare for patients who thought that the Government's recent relaxation of regulations meant that their troubles were over. I fear we do not have time now to go into this in detail, but I welcome the intention expressed in the Statement to get it right. What further reassurance can the Minister give me that clinicians will be given the information from patients and other countries to enable them to make sensible prescribing decisions-not just for Sativex and Epidiolex? Can he assure me that it will not have to be done as a last resort when a lot of licensed drugs with nasty side-effects have already been tried unsuccessfully?

  • Nov 5, 2018:
  • Nov 1, 2018:
    • Cannabis: Medicinal Uses - Question | Lords debates

      My Lords, while it is true that the faculty warns against the use of dried cannabis plant of unknown composition, it accepts that there may be benefits to pain management from pharmaceutical products. Fortunately, that is exactly what patients are demanding and what the Government have just legalised. However, the faculty is also demanding that, while we wait for clinical trials, a database-which is essential to better understand these medicines-should be set up. Will the Minister support the setting up of this database and ensure that it contains the massive amount of lived evidence and experience available from patients?

  • Oct 26, 2018:
    • Health and Social Care (National Data Guardian) Bill - Second Reading | Lords debates

      My Lords, I thank the noble Baroness, Lady Chisholm of Owlpen, for introducing this important little Bill. From these Benches, we support it. Patient data is precious to each and every patient, and it is vital to the success of treatment that it is shared appropriately with those who have care of the patient. As the noble Lord, Lord Patel, said, it is also precious to the NHS as a resource for research into new treatments and for monitoring the effectiveness of existing treatments. As such, it has a value, which raises the ethics of how it is used by the NHS and others. These two aspects of data make it highly desirable that we have a person, backed by an office and adequate resources, who can establish best practice and ensure it happens.

      I agree with the noble Lord, Lord Knight of Weymouth, about the importance of knowing that we have proper and accurate data collection to enable us to exploit the enormous potential of artificial intelligence. When I left university more than 50 years ago, I worked at the Christie Hospital reading cervical smears. My job is now done much faster and probably more accurately by a computer, and there are many other opportunities to speed up diagnosis and make it more accurate. That is one of the many reasons why this Bill is needed.

      The measures that have been taken over the last few years, since the debacle of care.data, to protect patients' data and privacy have been very helpful, and I hope this latest step will go a long way to countering the lack of trust in some quarters which followed the data breaches of the past. Fundamentally, to have confidence in the system, patients should be able to know how data about them is used. That is necessary if the NDG is to be meaningful.

      Currently, many patients who want to see how data about them is used go to theysolditanyway.com. While it has a very negative title, it is not an official NHS site. The launch of the new NHS app would be a great opportunity for the NHS to make full and accurate information available to every patient. Patients understand how important it is that their data should be shared appropriately between health and care workers who are providing services to them. Indeed, it is highly desirable that all who have care of patients have relevant information on which to act. We have all heard of cases where this has not happened. I hope the Minister will be able to assure us that, with the safeguards that will be in place when this Bill becomes an Act, the quality, capacity and interoperability of IT provision in the NHS and care systems will be up to the job.

      However, patients are perhaps less aware of the value of anonymised data to researchers. Without access to it, medical research would be put back a long way. The first figures from the national data opt-out designed by the National Data Guardian are now available. They show that while hundreds of people made a consent choice each month using the online service, thousands of people did it at their GP. The latter option has now been taken away by Department of Health and Social Care. Is this the Government's idea of a successful digital service? Is it not vital to have an effective public information scheme so that patients understand the issues surrounding their consent, what is being done with their data and how to make their choice? The figures suggest that that has not been done so far, but it is early days.

      I hope that when the Bill becomes law the Government will be making an effort to explain to patients how their information is being protected and why they can now have confidence that when they allow their data to be used it will be done in an efficient and ethical manner in the interests of all patients now and in future.

      Turning to specifics, I think it is welcome that the NGD may not only issue statutory guidance but provide help and information to assist health and care organisations not just to comply but to achieve excellence in the way they handle patients' data and any constraints on their use of that data in generating income. Clause 4 provides that the Bill extends to England and Wales only. However, the Bill's Explanatory Notes state that Clause 1, which provides for the NDG to publish guidance and give advice, information and assistance, applies only in relation to the processing of health and adult social care data in England. Given that health is devolved in Wales, can the Minister please explain this for the record as it has been explained to me behind the scenes?

      I turn to the issue of cost. The Explanatory Notes state that the Bill may result in some,

      "implementation costs for the bodies and individuals required to have regard to the Data Guardian's published guidance, in that they will need to review and assess the relevance of the guidance".

      Given that NHS trusts, GPs, local authorities in respect of adult social care and so on are all under financial stress, what is being done to provide for these costs? It is not just a matter of assessing the relevance of the guidance, as the notes say; there may be a need to put in place new systems for ensuring that they are compliant with the guidance, and that also has a cost.

      In Committee in another place, Chris Bryant MP made the point that MPs often have confidential information about constituents' health given to them willingly by the patient when asking for help or making a complaint about their treatment, and that sometimes applies to Peers too. He asked whether the NDG would be able to advise MPs about the handling of this data even though they are not covered by the Bill. The answer from the Minister was not very helpful: she said she hoped health organisations would be open and helpful to their MPs about these issues. That is all very well, but it did not give Mr Bryant the assurance that he was seeking about help and guidance for Members, so can the Minister do so now?

      Having asked these various questions, I assure the Minister that we on these Benches are very supportive of this mainly uncontroversial Bill.

  • Oct 25, 2018:
    • Affordable Housing - Motion to Take Note | Lords debates

      My Lords, I will focus my comments on housing which is not just affordable to buy or rent but to live in. It is very tempting to think only of the capital cost of building new houses without considering the whole life cost of heating and maintaining it. By definition, people who need affordable housing are on low incomes and cannot afford the inevitable rising cost of energy. That is one reason for building and adapting houses that need little or no energy for space and water heating. The other reason is, of course, global warming and the need to hit our 2050 climate target well before 2050. Indeed, we should be aiming for energy positive, not just energy neutral, homes.

      Energy used in homes accounts for about 20% of UK greenhouse gas emissions, and three-quarters of that comes from heating and hot water. Eighty percent of the homes people will inhabit in 2050 have already been built, meaning that it is not possible to rely on new builds alone to meet legal energy-saving targets set in the Climate Change Act 2008.

      The Institution of Engineering and Technology has published a new report that highlights how the UK cannot build its way to a low-carbon future without retrofitting old, cold homes to meet 2050 climate targets. Deep retrofitting is a whole-house approach to upgrading energy efficiency in one step, as opposed to a series of incremental improvements. This includes: adding solar panels and local microgeneration, insulation and ventilation, and sustainable heating systems. It has identified the barriers to the development of a national programme of deep retrofit. They include: lack of customer demand; no effective policy driver for change, high costs per home, as there is not yet a supply chain that can deliver deep retrofits cost effectively, in volume, and at speed; and a lack of initial financing.

      The report calls for both national and local government to take the lead in encouraging and supporting the necessary changes, which include: consistent policy objectives and a national programme for deep retrofit and climate resilience, with an initial focus on social housing; reducing costs and building supply-chain capacity by developing pilot programmes; engaging with home owners to discuss the benefits of deep retrofit; and creating larger projects that are attractive to investors, by aggregating smaller projects into bigger blocks and introducing more flexible ways for local authorities to borrow and invest in such programmes.

      Affordable housing should be regarded as essential infrastructure: good-quality shelter is as important as food, mobility, healthcare and community. We simply cannot compete in a global sense if our housing infrastructure is inadequate and poor quality, but at present we fail on both counts.

      I will finish with three other, often disregarded issues. The first is progressive, integrated design and delivery models. A House of Lords report recently dealt with offsite and modern methods of construction. We have a tremendous opportunity in the UK to embrace a genuine culture shift away from construction as we know it, towards progressive, integrated methods, employing design for manufacture and delivery. This could be a game-changer, and move us from what is now an unattractive, backward-gazing sector, to one which attracts the brightest and the best, and moves forward in an exciting way.

      The second is making the most of the UK's renewable resources, particularly timber. We have untapped potential, with the development of UK-derived innovative timber products, which could safely replace plastics, steel and concrete, which are often imported. Not enough focus is being put into supporting R&D in this area.

      The third issue is the large, interconnected network of low-carbon and circular-economy industries, such as domestic-scale, micro-renewable technologies, which could emerge across urban and rural UK regions. This is particularly relevant to Wales, highland and south-west Scotland, but many other regions could contribute. I would be grateful for the Minister's comments on these three opportunities.

  • Oct 17, 2018:
    • General Practitioners - Question | Lords debates

      My Lords, I was rather surprised to learn that the Government were trying to recruit more doctors from Australia, the very country to which a great many of our newly qualified doctors go for better pay and conditions. What are the Government doing to try to recoup the taxpayers' money spent on their training? It is surprising that they go to developed countries such as Australia, and that we get no benefit from the cost of their training.

  • Sep 10, 2018:
    • Child Sexual Abuse: Safeguarding Failures - Question | Lords debates

      My Lords, is the Minister aware that the committee had evidence that one of the schools consulted its legal adviser as to whether it was legally obliged to report the abuse that it knew about. Having learned that it was not so obliged, it decided to cover it up. How much more evidence do the Government require of the need for mandatory reporting of child abuse in regulated activity? Of course, that does not include social workers, because social work is not a regulated activity. Will the Government now follow the evidence and respond with legislation?

    • Child Sexual Abuse: Safeguarding Failures - Question | Lords debates

      To ask Her Majesty's Government how they plan to respond to the report of the Independent Inquiry into Child Sexual Abuse regarding safeguarding failures at Downside and Ampleforth schools, published in August 2018.

  • Sep 6, 2018:
    • NHS: Healthcare Data - Motion to Take Note | Lords debates

      My Lords, I thank the noble Lord, Lord Freyberg, for introducing this important debate and congratulate him on his masterful tour d'horizon in his speech. I support his demand for a national strategy on this issue-we must not be left behind. I also very much enjoyed the maiden speech by the noble Lord, Lord Bethell; as I sat here, I found myself musing on whether he would follow in the temperance footsteps of his grandfather or the non-temperance footsteps of his father. I look forward to hearing a lot more from him.

      As we have heard, the NHS has the most enormous amount of valuable data that could be used for improving patient care in a large number of ways; to me, that is the most important objective. First, data can help healthcare providers to measure their performance against baseline standards and against best practice in other similar providers. It can alert us to problems with patient safety and emerging quality problems. Digging into the detail of data can often reveal where providers are failing and suggest solutions-I shall give an example of that later. Data can assist regulators and inspectors to reach their conclusions. It can inform clinical decisions, through what it reveals about efficacy and outcomes, and can influence commissioning decisions through what it reveals about cost-effectiveness and the effects of strategies on public health. It can be used to assist research and to plan and assess clinical trials, and can help agencies to plan and reconfigure services.

      The noble Lord, Lord Kakkar, mentioned the importance of the quality of data. He told us about the massive amount of it, which made me wonder how accessible that data is to researchers-if it is not easily searchable, it will be like looking for a needle in a haystack, in the same way as the doctor, mentioned by the noble Lord, Lord Bethell, looks through his pile of paper files.

      We have heard about many issues of concern. First there is patient consent and privacy, about which the noble Lord, Lord Hunt, was so eloquent. We have heard about the need to prevent exploitation and discrimination from the right reverend Prelate the Bishop of Southwark. We have heard concerns about how data is made available to commercial companies, how value can be realised and about the ownership of private data by a few large corporations. The noble Lord, Lord Mitchell, asked us to maximise that value and he is absolutely right, but there need to be enormous safeguards. I very much agree with him that the NHS, too, needs experts. If it does not, the experts in the big data companies will, as he put it, "crawl all over us".

      A transparent public dialogue is needed about how data is currently used, the opportunities for the future and how risks can be managed. It is vital to balance the benefits of sharing data, which are enormous, with concerns about security and confidentiality, but these concerns should not be a barrier to progress. Many noble Lords have mentioned the crucial need to rebuild patient trust following the care.data problems and recent massive leaks-most recently, this was mentioned by the noble Lord, Lord Macpherson.

      According to the Royal College of Physicians, patient-level data containing patient characteristics, as well as information about treatments, pathways and outcomes, are the most valuable. Indeed, such data can also reveal inequalities in access to care and the quality of care provided to different groups; it can also help to make comparisons of outcomes from different providers fairer, when we know something about the case mix they face. How fit the patient is at the point of diagnosis and how advanced the disease is at that point are important factors when comparing the outcomes achieved by different clinicians and healthcare settings. But such data should be anonymised or pseudonymised wherever possible to avoid identification of individual patients.

      One can also get a lot more out of data if information about the patient can be linked to healthcare activity and outcome information; this requires different systems to talk to one another, which is particularly important in end-of-life care. But this is where the NHS currently falls down. However, I was pleased to learn from a recent briefing by the NHS Confederation, which represents private healthcare providers, that steps are being taken to integrate their datasets with those of the NHS; this will mean patients and the NHS can get a full set of information in one record. On a point made by the noble Baroness, Lady Rock, I was told recently by Simon Stevens that the NHS is no longer the world's biggest purchaser of fax machines; he was rather indignant when I mentioned that.

      There are many examples of where data can be used successfully to improve patient services. Some studies have also been able to motivate settings to improve their track record when linked to payment incentives-a sort of payment by results. This was done as a result of the National Hip Fracture Database. A number of notable national reviews have had tremendous effects on outcomes-such as the National Review of Asthma Deaths, which shockingly found that that a quarter of deaths resulted from inadequate care-which can then be addressed. The Sentinel Stroke National Audit Programme included patient input to help improve services resulting in the establishment of the very successful hyper-acute stroke units in London and Manchester, a model now being copied across the country.

      One issue that concerns me is the amount of data available to the patient and how it could help patients to manage their own healthcare. We cannot expect patients to engage with doctors in taking steps to manage their own condition if we do not give them feedback about whether changes they make in their lifestyles result in better health. For example, I would like to know the exact readings for the good and bad types of cholesterol in my own blood tests, so that I can see whether my lifestyle changes are helping. When I asked the question, I was told, "It's fine-keep on with the medication". That is no help to me when I am trying hard to get to a position where I do not need the medication at all. I agree with the frustrations of the noble Baroness, Lady Neville-Rolfe, on this matter. Like her, I think we should be able to see our own medical records; we should be able to trust the patient with them.

      I also look forward to the day when, living in Wales, I will be able to make appointments and ask for repeat prescriptions online, as my relatives in Scotland already can and my relatives in England will be able to next year. That, however, will require a major step forward in technology, which I do not see on the horizon.

      This morning I came across a perfect example of how data can help to improve services. I hosted a round table at which we heard about research into the issues relating to local authorities missing targets for chlamydia screening. Chlamydia is an increasingly common sexually transmitted disease, which can cause major health problems including infertility. There have been several changes, and indeed reductions, in the funding for this screening. Initially the money went to local authorities, which are responsible for public health, as a dedicated grant, and then it became integrated with other funding. Finally, the funding has now dried up altogether and the National Chlamydia Screening Programme simply monitors how well targets are being met and supports local authorities. Unsurprisingly, the targets are not being met, following a year-on-year decline. In 2017, only 20% of commissioning councils achieved the Public Health England target of 2,300 annual diagnoses.

      The research that I heard about this morning was qualitative. It sought to collect data on various aspects of the difficulties that councils face with a view to proposing how things can be improved. It turns out that, although funding is a significant issue, public awareness is one of the greatest barriers that councils need help with. They would like more national resources to help them develop local marketing programmes to let people know about the dangers of chlamydia and about the screening and services available to them locally. They also need technical help with targeting the most at-risk groups. I thought it was a good example of where digging deep into the data can help to improve services. I am pleased to know that Public Health England is soon to publish a review on this and all other sexual health matters.

      So my questions for the Minister are as follows. What progress is being made on integrating patient data from all health and care settings and making the records available to patients? What measures are being taken to give patients trust and confidence in their data being properly handled? How will applications for outside use of NHS data be handled and against what criteria? Finally, is funding being passed to the Welsh Government to enable patients in Wales to benefit from the technological advances that are already available in Scotland and are soon to be available in England?

  • Jul 18, 2018:
    • Medical Equipment: EU Law | Department of Health and Social Care | Written Answers

      To ask Her Majesty's Government whether they plan to maintain equivalence with the EU Regulation on Medical Devices 2017/745 during the planned transition period from March 2019 to March 2021.

    • NHS: Warehouses | Department of Health and Social Care | Written Answers

      To ask Her Majesty's Government what assessment they have made of warehousing requirements for NHS suppliers if frictionless trade with the EU is not maintained following Brexit.

    • NHS: Warehouses | Department of Health and Social Care | Written Answers

      To ask Her Majesty's Government what assessment they have made of NHS warehousing requirements if frictionless trade with the EU is not maintained following Brexit.

    • Obesity - Question for Short Debate | Lords debates

      My Lords, I thank the noble Lord, Lord McColl, for bringing us back to this important subject, and I welcome the noble Baroness, Lady Boycott, to your Lordships' House.

      Travelling on the Tube yesterday in the middle of the afternoon, I sat opposite a gentleman who took up two seats. His stomach was protruding out of his shirt. He looked very uncomfortable, and he was eating a pasty. I thought, "Sir, this is not good for your health". It took me back to an occasion soon after I entered your Lordships' House when I sat down at the long table in the Home Room with a plate of salad. A former very personable Member of the House sat next to me, looked at both our plates and started to laugh. She said, "Oh look! The slim lady is eating salad and the fat lady is eating sausage and chips". I was too polite to say, "Well, yes, don't you think there's a connection?" Of course, the noble Lord, Lord McColl, is right. What matters most is what we eat and drink.

      Many clinicians now feel that it would help to regard obesity as a disease. We would then be less judgmental and recognise that many people suffering from it have been conditioned since childhood to respond to sugary or carbohydrate-rich foods, with those foods then becoming a need. The gentleman on the train is probably one of them. They need help and services, not judgment, and those must include mental health services. For some, one of the services needed is bariatric surgery, with a multidisciplinary team to help them return to a healthy body weight. I talked recently to an eminent paediatric bariatric surgeon. He told me that the service he provides is not widely available and yet it can save the lives of his patients and reduce the eventual costs to the NHS. Therefore, I ask the Minister what plans are in place to make this service available wherever it is needed. Of course, it is a last resort for very serious cases, and I want to emphasise that the surgeon I spoke to spends a great deal of time working with public health services to prevent people becoming obese in the first place. Prevention, I believe, is the key.

      I was interested in two items on the news this morning which chimed exactly with what I wanted to say today. First, there was new guidance from Public Health England's Scientific Advisory Committee on Nutrition about the number of calories that should be consumed by young babies. It was reported that many are consuming far too many calories and this is laying the foundation for obesity later in life. We were reminded that exclusive breast-feeding, at least for the first six months of life, lays the best foundation for health, not just because of the many antibodies and good micro-organisms passed on from mother to child but also because breast milk is perfectly balanced nutritionally and has just the right number of calories for healthy growth. Therefore, I call Public Health England in aid when I ask the Minister what is being done to encourage more mothers to breast-feed-we have a bad track record in this country-and to ensure that they can do so comfortably wherever they need to do it.

      The second news item was about the Football Association saying that many days of play are prevented because of the state of the pitches. This is because of years of underfunding of local authorities, which cannot afford the necessary upkeep. As my noble friend Lord Addington told us, what we eat may be a major part of the obesity problem but keeping active is also vital. Incidentally, it is also important for mental health. A senior tutor at an Oxbridge college told me recently that, of all the students coming forward for counselling for mental health problems, not one took part in regular sport. She found that very significant and I am sure she is right.

      However, my main concern is with young children. We have had the statistics from the Royal College of Paediatrics and Child Health, and I join its demand that there should be a 9 pm watershed ban on advertising on TV foods that are high in sugar, salt and fat. I am pleased that chapter 2 of the childhood obesity plan promises a consultation on this. I am quite sure that the evidence will show that the majority of TV watched by children is not children's programmes, which already have a ban, but family viewing between 6 pm and 9 pm. If your Lordships are looking for evidence that advertising these foods influences people's choices, they have only to look at how much the food companies spend on it. The noble Baroness, Lady Boycott, reminded us of that. They would not do that if it did not work. People are influenced by messages that tell them how delicious these foods are and how happy they will be if they eat them, so I hope the Minister will assure me that when the Government get this evidence in the consultation, they will act decisively.

  • Jul 12, 2018:
    • Sure Start - Question | Lords debates

      Following up on the previous question, is the Minister aware that yesterday, the All-Party Parliamentary Group for Children published a report showing that many local authorities are unable to afford the early intervention programmes that have just been mentioned and are so effective? The result is that a lot of children in some parts of the country are not getting the services that they would with the same level of need in another part of the country. Many children and families in that situation are going into a downward spiral and getting to the point where they need much more invasive intervention-even taking the child into care. It is cheaper and more effective to intervene early, so will the Minister have a look at the 12 recommendations of that report? They have the evidence, and the Government ought to act on it.

  • Jul 9, 2018:
    • Aortic Aneurysm | Department of Health and Social Care | Written Answers

      To ask Her Majesty's Government what assessment they have made of the availability to UK patients of fenestrated endografts, developed in the UK, manufactured in Scotland and used around the world, if the current draft NICE guidelines on Abdominal Aortic Aneurysm are implemented.

    • Aortic Aneurysm | Department of Health and Social Care | Written Answers

      To ask Her Majesty's Government whether they have conducted an impact assessment of the draft NICE Guidelines on Abdominal Aortic Aneurysm, including the impact (1) on patients over 65 years old who may be medically unsuitable for open surgical repair, and (2) of removing certain treatment options when clinical professionals have indicated that patients require such treatment.

  • Jul 5, 2018:
    • NHS: Equitable Access - Question | Lords debates

      My Lords, as a member of the Parliament choir I am a bit tempted to start singing, but I will resist. Given the remarkable success of the various vaccination programmes during the 70-year history of the NHS, will the Minister say when preventive measures for two modern-day diseases will be made equitably and nationally available? I refer to pre-exposure prophylaxis for HIV, which has already been shown by the trials to be remarkably effective, and vaccination against human papillomavirus, which should be made available for teenage boys as well as teenage girls to ensure full protection.

  • Jun 21, 2018:
    • Cannabis-based Medicines - Question | Lords debates

      My Lords, I thank the Minister for showing that he quite clearly understands the distinction between recreational and medicinal use. Is he also aware that Epidiolex, which is medicine produced by GW Pharmaceuticals for epilepsy sufferers and which will soon be approved, will not help children like Alfie Dingley who have uncontrolled epilepsy seizures? I understand that the cannabinoid CBDV is very important to such sufferers, and there is none of it in Epidiolex. Will the Minister ensure that the review takes account of the special needs of the 200,000 patients with uncontrollable seizures? Will the panel be able to hear from patients as well as studying research?

  • Jun 19, 2018:
    • Bee Population - Question for Short Debate | Lords debates

      My Lords, I congratulate the noble Baroness, Lady Bloomfield, on the debate, and I particularly enjoyed her stories about bees. I point out to her that lime pollen makes bees drunk, so they die happy, and that once a swarm is out of sight of the person whose hive it came from, if you can collect it, it is yours, and you can decide where to put it. I have benefited from that, because my gardener I found one in someone else's garden and brought it to me; they did not want it anyway. I too am a beekeeper, and I keep Welsh Black bees, not Buckfast bees. They came and squatted in an empty hive. I am very pleased with them because they are very strong.

      It has been lovely to hear stories from fellow beekeepers. The noble Lord, Lord Stevenson of Balmacara, should get a new bee suit. If he is being stung so often, it obviously has holes in it. The noble Viscount, Lord Falkland, was right about hay fever-the noble Lord, Lord Marland, mentioned it as well-but the honey must be raw and not overfiltered or heat-treated, so that you get the pollen from your local garden. It certainly works for me as well. By the way, I am very jealous of the noble Lord, Lord Marland, and his electric honey extractor. I am afraid that I have the manual kind. When it is time to harvest my honey, I have to call on the strong right arm of my husband, my noble friend Lord Thomas of Gresford. I think that he will be wondering whether I am going to raid the family coffers and buy an electric extractor. His strong right arm would certainly be grateful.

      As a beekeeper, I am well aware of the need to conserve all our important pollinators as well as our honey bees and wild bees, many species of which are endangered. The mouth parts of different insect species are adapted to reach the nectar in different-shaped flowers, so we need the whole range of insects to pollinate our crops. I am afraid that wind will not cut it because of the shape of the flowers.

      I must congratulate the noble Viscount, Lord Ridley, on his species-rich wildflower meadow and the noble Lord, Lord Robathan, on his cowslips, because they are important. I want to mention the many groups of volunteer gardeners such as my daughter and her colleagues in Altrincham in Bloom, who, with permission, have sown species-rich beds of wildflowers and other flowering plants in public places in the town. These have provided not only beauty for residents but a corridor of forage for a wide variety of bees and other pollinators. Such voluntary activity is to be encouraged and not discouraged, as happens when council workmen strim down the lot. I hope that most local authorities will encourage and co-operate with this sort of voluntary group who give so much of their time in the interests of our pollinators. It is also important that verges of major roads and motorways are left to flower and not strimmed to within an inch of their lives at the earliest opportunity. Does the Department for Transport have a policy on this?

      Gardeners can play their part. As a keen gardener myself, I have a wide variety of plants in my garden. In fact, it has often been commented that I have less of a garden and more of a plant collection, but a wide variety of plants is important because of the need for a wide variety of pollinators.

      Of course, beekeepers make a big contribution to pollination by protecting honey bees. Beekeeping is an excellent hobby, combining biology, physiology, history, horticulture and pharmacy. However, it is a big commitment and there is a great deal to learn. I have made some terrible mistakes in the past, from which I hope I have learned. It makes sense for new beekeepers to join local beekeeping associations and make use of the courses they offer and the advice so freely given. I am very grateful to my own bee mentors, Lloyd Roberts and Dell Hannaby. Does Defra provide supportive funding for these groups that are so valuable, particularly to new beekeepers?

      Bee inspectors provided by the National Bee Unit are important, too, because they check the health of bees and help prevent the spread of disease. They also give good advice, as I can testify. It is sad to see that Defra, which runs the NBU at arm's length, is not replacing bee inspectors. I heard recently from a bee inspector in Wiltshire that when he retires at the end of this year Wiltshire may not have an inspector. This is very dangerous for the health of bees in the county-we have heard all about the various diseases that are rampant. Can the Minister tell me whether this situation is happening in other areas of the country and what, if anything, is being done to replace these valuable officers?

      One of the biggest hazards for bee colonies is the use of certain pesticides. The Government's code of practice, which is due to be updated shortly-perhaps the Minister can tell us when-states that certain pesticides which may harm bees will be labelled as "harmful" or "high risk". The person responsible for a spray operation is obliged to tell local beekeepers, or the British Beekeepers Association's local spray liaison officer, 48 hours before the use of an insecticide at certain times of the year, giving beekeepers time to take the necessary precautions. The SLOs act as go-betweens, informing beekeepers when the farmer is going to spray.

      However, this process has not always been effective, so a new initiative, which has already been mentioned by two noble Lords, has been set up by responsible farmers and growers. It is called BeeConnected and aims to help reduce pollinator exposure to insecticides by alerting beekeepers electronically before spraying. As my noble friend Lady Miller mentioned, BeeConnected has been developed in conjunction with the BBKA to replace the need for SLOs and instead inform beekeepers directly. It is a simple process whereby the person responsible for the spraying registers on the website and identifies the fields using Google Maps. The system automatically informs local beekeepers when someone intends to spray a particular field. Beekeepers who have plotted the location of their hives on the system will then receive a notification ahead of a spray event. This is as an excellent initiative, and I intend to go on the website and register my hives.

      Such initiatives are important in the light of the risk to bees if we exit the EU and are no longer bound by the ban on neonics and other substances, unless the Government take similar action. Can the Minister assure us that the Government will continue to protect our pollinators if, unfortunately, we leave the EU?

      Finally, the noble Viscount, Lord Ridley, made a point about how crop-pollinating insects are thriving. If we grow more crops to feed the world's growing population, it occurs to me that we are providing more food for their pollinators, so I am not surprised that they are thriving. I wonder whether the noble Viscount agrees. I look forward to the Minister's response.

    • Drugs Licensing - Statement | Lords debates

      My Lords, I, too, welcome the Statement and thank the Minister for making it. I thank her also for her efforts in this cause and those of her noble friend Lord O'Shaughnessy, who is in his place. I welcome the fact that Professor Sally Davies will now review the mountain of evidence for the medicinal and therapeutic benefit of cannabis-based medicines. She will undoubtedly find that the fact that there are no legally recognised benefits is quite wrong and must change. By what means will Professor Davies hear evidence from the many patients who already know about the benefits? Their doctors know the benefits, too. If she does not already, I am quite sure that Professor Davies will soon know them as well.

      I also welcome the fact that the Government will reschedule cannabis when Professor Davies demonstrates those benefits. It should never have been scheduled as a drug without any medical benefits in the first place. Can the Minister estimate how long this process will take, as thousands of patients await the outcome in pain and discomfort?

      While we wait for this to be done, it is very welcome that the Government have set up an expert panel to advise Ministers on any applications to prescribe cannabis medicines. It is outrageous that the Dingley family's heroic doctors should have been put through the wringer by the inappropriate processes which the Home Office has imposed on them during the past four months.

      I cannot say how delighted I am that Alfie Dingley and Billy Caldwell will get their medicines at last. However, it should not have taken four months since the Prime Minister promised Alfie's mother, Hannah Deacon, when she visited No. 10 with me and a group of Peers and MPs, that her son would get a licence for his cannabis medicines on compassionate grounds and speedily. During that four-month period Home Office officials were trying, mistakenly, to operate a system for licensing which was not intended for such cases but was intended for normal clinical trials. It became clear very quickly that the system they were trying to use was not fit for purpose, yet they persisted. I would like to be assured that a system that is fit for purpose will be put in place. Will the Minister give me that assurance? It should not have taken a child, Billy Caldwell, being put in a life-threatening situation for the Government to take this action but I am delighted that they now have.

      During the campaign I have been convinced of the Minister's good faith in this matter but, frankly, although she is always welcome in her place, it should be a Health Minister standing there at the Dispatch Box. I am delighted to see the noble Lord, Lord O'Shaughnessy, in his place listening to this debate. Drug licensing is a health matter, not a Home Office matter and clearly the Secretary of State for Health and Social Care agrees with that, so how will the Department of Health and Social Care be involved in the new arrangements outlined in the Statement and those that will inevitably follow?

      Yesterday the Prime Minister said a system is already in place for the medicinal use of cannabis and that government policy would be driven by "what clinicians are saying". The system has failed thousands of patients, but it is good news that the Government are now trying to put that right, and I thank the Minister for that. Can she say whether expert evidence from countries such as the Netherlands, where cannabis medicines have been safely used for some time, will be heard during the review?