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  • Mar 27, 2017:
    • Gene Editing: Agriculture and Medicine - Question | Lords debates

      My Lords, given the potential of gene editing of non-reproductive cells for treating HIV, sickle cell, haemophilia and, as the noble Viscount said, cancer, what plans do the Government have to ensure continued research in this important and valuable area after Brexit?

  • Mar 23, 2017:
    • EU Membership: UK Science - Motion to Take Note | Lords debates

      My Lords, the tone of our debates at Question Time this morning was more subdued than usual for obvious reasons, but in this debate we have rightly returned to a considerably more forthright tone. We have heard words such as "idiocy", "derisory" and "carelessness", so if I continue in that forthright tone, I hope the Minister will accept it in the spirit of returning to business as usual as soon as possible.

      No scientist in her right mind would think of Brexit as being anything other than the worst challenge we could impose on UK science. Why would we want to lose access to major sources of funding, put at risk valuable international collaborations, deter top scientists from coming here and leave our biggest market for the outputs of science that make our lives better, healthier and longer? The committee's report does its best to be optimistic, but it expresses very clearly the serious downsides of the choice this hard Brexit Government have made. As someone who is particularly concerned about the effect of Brexit on our life sciences, UK patients' access to cutting-edge medicines and treatments, and the survival of our health and care services, I welcome the committee' report, which highlights many of the concerns I have felt ever since 24 June last year, and it proposes some solutions to mitigate the worst of them.

      One of the first effects I heard about, within a week of the referendum, concerned a research scientist I know who was in the early stages of a collaborative research funding application to the EU with scientists from elsewhere in Europe. He was asked to withdraw on the basis that his presence in the team would reduce the chances of the application being successful. So, while the committee states that there is a scarcity of hard evidence for this effect, it accepts that there is anecdotal evidence of discrimination in ways that may never be documented. I know that to be true.

      A great many of our research projects are funded by the EU. The UK has benefited more than any other member country from EU money for science, partly because we are very good at spending it well, so the Government's commitment to underwrite Horizon 2020 funding with new UK money is very welcome. However, what happens when Horizon 2020 comes to an end? It would be better if the Government tried to negotiate continued access for UK scientists to Horizon 2020, its successor and other EU funding, given that other countries outside the EU already have such access. The Prime Minister may not have the stomach to try to negotiate continued access to the single market, but surely our negotiators can have a try at this one, given its importance to our economy.

      Harmonised regulations are particularly important to the development of medicines and medical technologies. While I agree with the noble Viscount, Lord Ridley, on the issue of GM crops, I find myself more in agreement with the remarks of the noble Lord, Lord Hunt of Chesterton, about regulation. Regulation is not necessarily a burden, and if it was faulty we could have tried to improve it from within rather than walk away. We have the freedom to sell and the confidence to buy when our regulations are identical to those of our major customers. It is therefore not surprising that most of the submissions to the committee called for UK regulations in the scientific domain to remain harmonised with the EU.

      In the medical domain, UK scientists have played a major role in the European Medicines Agency, and we have here in London a great deal of the expertise in medicines licensing and regulation. Where will that expertise go after Brexit? Professor Dame Jocelyn Bell Burnell pointed out that if we wish to trade with Europe, we are going to have to abide by the European regulatory system. But of course, that system will not remain static; it will change over the years, so I ask the Minister, how are we going to keep up? If the Government decide to set up our own system it will be very expensive, as pointed out by Mr James Lawford Davies, a solicitor and partner at Hempsons, in his submission to the committee. The UK would have to set up its own infrastructure and administration, with no additional benefit to us. It looks to me like a classic example of shooting yourself in the foot. The Government tell us that it will be all right but I am afraid that, based on their record to date, I doubt it.

      Have the Government assessed the cost of setting up such a system, and if not, why not? The Government appear not to have heard of the phrase "plan B". Will the increased trade we are supposed to be expecting post Brexit be in excess of the costs of this system? The committee recommends that such an assessment be made and published prior to the introduction of what my noble friend Lady Ludford calls, "The not so great cut-and-paste Bill". Can the Minister assure us that that will happen so that we can assess the damage? Of course, the costs of an independent system are a fact, while the potential for increased global trade is speculation. No sensible business person exchanges facts for speculation, and neither do they take on unnecessary costs. That is why much of business is against Brexit, although as we know, big business is very flexible and resourceful and will survive.

      UK science depends not just on international collaborations but on attracting top-flight scientists and student scientists to the UK. Here, the committee expresses serious concerns in its report about the Government's approach to immigration. On the one hand, Jo Johnson MP stated,

      "We remain fully open to scientists and researchers from across the EU",

      while on the other hand, the Home Secretary, Amber Rudd, told the Conservative Party Conference that she would,

      "look again at whether our immigration system provides the right incentives for businesses to invest in British workers"-

      a not so veiled threat that is to be followed up by action. In two weeks' time the immigration skills charge-a charge of £1,000 per year for workers brought in from abroad on a tier 2 visa-will be implemented. There are exemptions for PhD chemists, physicists, social scientists, research and development managers and so on, but there are no exemptions for health and care employers bringing in essential doctors and nurses to fill the gaps in our health service. When we discussed the regulations two days ago, I demanded an exemption for the NHS and social care, and I repeat that demand today. The tax will cost front-line services £7.2 million per year and add to the black hole in funding, at a time of severe Brexit challenge to the health workforce. It is a very short-sighted thing to do. The committee pointed out that the Government are also being "less than helpful" in refusing to exclude international students from their immigration targets, rightly described as "idiocy" by the noble Earl, Lord Selborne. The financial viability of many of our universities depends on being able to attract international undergraduate and graduate students and staff, so no wonder they are concerned about the Government's intransigent attitude.

      There are other avoidable threats. When the Health Service Medical Supplies (Costs) Bill went through the House, we passed an amendment to ensure that when the Government use their new powers in the Bill, they have to take account of the need to promote a thriving life sciences sector and access for UK patients to new medicines. Considering the challenges outlined by the committee in the report we are debating today, I am surprised that the Government overturned the amendment in another place. I hope that noble Lords will stand their ground on this when the Bill comes back to your Lordships' House in a couple of weeks' time.

      I end by congratulating all members of the committee on their forensic examination of the threats of Brexit to British science, and I congratulate them on their valiant effort to be optimistic. I hope the Government will accept the committee's helpful recommendations.

    • Education: Nursery and Early Years - Question | Lords debates

      My Lords, the early years sector is very diverse in relation to types of governance. We have the state-funded sector, private settings, and not-for-profit and voluntary settings. Can the Minister ensure that the money to employ qualified early years teachers is easily available to all kinds of settings?

  • Mar 20, 2017:
  • Mar 14, 2017:
    • End of Life Care - Question for Short Debate | Lords debates

      My Lords, as the King's Fund report Understanding NHS Financial Pressures commented yesterday, terminally ill patients have very little political voice. Therefore, I am delighted that the noble Baroness, Lady Finlay, has spoken up for them this evening. Indeed, I am very grateful that I live in Wales and will probably die there.

      Over the last five years, we have seen several reviews of palliative and end-of-life care with multiple recommendations. Therefore, I hope that, at the end of this debate, the Minister will be able to provide us with an update on progress towards meeting those recommendations. For example, the Government's response to the review of choice made two commitments that are particularly relevant to the topic we are debating today-namely, to,

      "engage with clinical commissioning groups and Health and Wellbeing boards on improving end of life care provision through local strategic planning and commissioning";


      "to provide commissioners with data, tools and palliative care currencies to help identify palliative care needs in local areas and the best ways to commission services to meet those needs".

      I hate jargon, so I looked up what "palliative care currencies" means. I found that it refers to payment models for palliative care. As the Minister will know, the majority of community palliative care providers in England, which are largely in the voluntary sector, are currently commissioned by block contract, and a lot of hospices in particular have been working within the same cash envelope for many years. Indeed, yesterday's report from the King's Fund commented that one of the factors that make some services particularly vulnerable is that block contracts have not been adjusted to match rising demand, and that demand is continuing to rise.

      In 2010, Marie Curie's review of funding recommended that the NHS move to a per-patient funding model, defined by phase of illness, so that providers would be paid more for patients with more complex care needs. One of the major difficulties encountered was the fact that most voluntary sector providers have a mixture of NHS and charitable funding, so it was difficult to identify which aspects of care were NHS-funded and which were charitably funded. Therefore, moving every provider to per-patient funding has its problems. Can the Minister now confirm that NHS England will provide a number of different palliative care currencies so that commissioners can choose which method is right for their locality? If that is the case, how will value for money be audited and by whom?

      We have heard that palliative care in this country can be the best in the world. However, successive national care for the dying audits have found wide variations in the quality of care in different hospitals. I welcome the fact that end-of-life care is now a key area for assessment in the Care Quality Commission's inspections of hospitals, but can the Minister update us on the plans in place for those that perform badly to learn from the best?

      However, poor patient and family experiences are often due to poor commissioning, planning and co-ordination, as well as insufficient provision for family support, rather than poor delivery. Clinical commissioners have a vital role in co-ordination because it is increasingly rare that individuals' needs will be met by one service alone and they often need to be moved from one location to another as their needs change. Co-ordination is particularly crucial when terminally ill patients wish to die at home. Last year I spoke in your Lordships' House about a particularly distressing case that I know of where that all went wrong. Obviously it makes sense to get services right in the community rather than have the patient admitted to hospital when the family can no longer cope.

      Despite the numbers needing these services, according to Marie Curie, just over half of health and well-being boards in England made no mention of palliative care in their strategies, only a third had comprehensive plans, and 30% of STPs made no mention of end-of-life care at all. Given that NHS England says that it requires local leaders and professionals to ensure that a strategy for end-of-life care is in place, this is pretty disgraceful, and, having made that statement, it does not audit what is in place, so there is no accountability. Therefore, I ask the Minister how CCGs and health and well-being boards are being held to account for this state of affairs.

      Finally, I want to raise clinical training. A professor of palliative care who is a friend of mine told me recently that some medical graduates have no more than one day of training in end-of-life care. In other places, such as Royal Liverpool University Hospital, students spend three weeks in local hospices, which equips them much better. Although we need palliative care specialists, we also need generalists with enough knowledge of pain management and other issues linked to end-of-life care, including how to help the bereaved. I understand that Health Education England's end-of-life care core skills education and training framework-what a mouthful-is soon to be published. Can the Minister say how soon it will be implemented?

  • Feb 28, 2017:
    • Nursing and Midwifery (Amendment) Order 2017 - Motion to Approve | Lords debates

      My Lords, midwives have a very special role in the local medical and nursing team. They should be seen as an integral part of that team; their role should not necessarily end at the point of birth. I know from many cases that the personal relationship built up between a mother and her designated midwife during the antenatal period can be enormously valuable at a time when she is very vulnerable. The mother often has the confidence to confide in the midwife if she has any health or personal security worries. I am talking here about domestic abuse, which so often occurs when a woman is pregnant. It is important that this relationship is nurtured and nothing gets in the way of a midwife adding all the value of which she or he is capable. I would hope that in future there would be more integration between the midwife, the health visitor and the district nurse. There is a lot of potential for that.

      No debate about midwives and nurses is complete without talking about numbers. The noble Lord, Lord Hunt, mentioned rates of attrition. A couple of weeks ago, at Oral Questions, I asked the Minister how data are collected on the rate of attrition. It is not consistent. It makes it very difficult to know which areas of the country are good at keeping their midwives and nurses and which are not, so that we can see and spread best practice.

      We have an enormous number of nurses from EU countries and, indeed, from other parts of the world. Brexit is looming and there is uncertainty-which we debated in this House yesterday and on other occasions-over the status of people from other EU countries working here. At the same time, we have a Government who are trying to reduce their immigration rates to a maximum of 100,000 a year, which could affect midwives coming from countries outside the EU. This is a big concern and we must not ignore it when we are talking about regulation.

      I turn to the order before us and the amendment in the name of the noble Lord, Lord Hunt. We on these Benches are broadly supportive of the order, which will bring more flexibility into the regulation of nurses and midwives, in line with the way in which the GMC and other medical regulators are able to carry out their fitness-to-practise processes. It is right that the regulator should be able to deal more proportionately with cases where there is a finding of "no case to answer" and where the person concerned accepts that the practice in that case falls short of what should be expected. There is currently no power for examiners to consider alternative ways of resolving these cases. However, the Secondary Legislation Scrutiny Committee raised some questions about the new power to issue a warning. It accepted that this power is permissive but felt that, if examiners are to use the power to give a warning, and guidance is intended to direct users as to how terms should be interpreted, then the detail of the threshold for issuing a warning should either be in statutory guidance or in the order. What is the Government's response to the committee's suggestion?

      Turning to the role of midwives in the governance of the NMC, it is important that the particular role of midwives is both recognised and catered for. However, if you are taking away the role of development support and supervision, and separating it from regulation, you do not necessarily need the existing structure of the midwifery committee. It is important and right that regulation and supervision are separated. I understand that there is to be a new midwifery panel which should be consulted and that supervision is to be replaced by new support and supervision structures in the four countries of the UK. There is also to be a new senior midwifery adviser. I take the point of the noble Lord, Lord Hunt, about status, which is important, particularly to the morale of the midwifery profession. Concerns have been raised that the new structures for support and supervision will not be ready in time for the changes at the end of March. I understand that, of the four nations, only Wales is ready to take over. What can the Minister tell us about the state of readiness of the other three nations?

      I recognise that the new structures that the Government are proposing present a challenge to the midwifery profession. This is right, in response to the reviews discussed earlier. There are concerns that the new structures within the NMC cannot, for example, put midwifery matters on the council's agenda. Can the Minister assure us that specific midwifery issues will be appropriately dealt with under the new structures?

      The effectiveness of the proposed new structures will take a while to be demonstrated, so it is right that we seek these reassurances at the outset. In the end, patient safety must be at the forefront and that depends on the quality of development, training and supervision of the midwives. It is a challenge for the profession, and it is only right that we give midwives the opportunity to demonstrate that they can rise to that challenge. However, it is right that the powers and structures of the regulator are up to date and able to cope with the workload in an appropriate manner at a time when, as the noble Lord, Lord Hunt, said, the demand is rising.

  • Feb 23, 2017:
    • Health Service Medical Supplies (Costs) Bill - Third Reading | Lords debates

      My Lords, we on these Benches are also happy to support the amendments. Like the noble Lord, Lord Lansley, I have no intention of detaining the House with long-winded thanks. However, I want to voice my recognition that the Minister, in his new role, has both understood and responded to the issues raised on the Opposition and Cross Benches about the shortcomings of the Bill, which had been through the House of Commons without anybody noticing or trying to amend its unintended consequences, rather like the Article 50 Bill that we debated in this House on Monday and Tuesday.

    • Terrorist Attack: Response - Question | Lords debates

      Does the Minister agree that confidence that they know what they are doing enables people to step forward in these situations, rather like the rugby player who recently stepped forward to give first aid to a member of the opposing team? Does she therefore agree that it is in response not just to terrorism but to the ordinary traumas of everyday life that we should all have a look at the citizensAID training?

  • Feb 22, 2017:
  • Feb 20, 2017:
    • European Union (Notification of Withdrawal) Bill - Second Reading (1st Day) | Lords debates

      My Lords, every day we start our deliberations by asking for wisdom and understanding. We pray that our counsels may result in,

      "the public wealth, peace and tranquillity of the Realm, and the uniting and knitting together of the hearts of all persons and estates within the same".

      Whether or not we are religious, these objectives should unite us all. Currently this country is very divided and very angry.

      When I came to the House of Lords, I knew that I did not represent a geographical constituency. I understood that I was here to represent all the people of the United Kingdom and to do what I judge the right thing according to my conscience. That is what I propose to do. Last time I looked, every Member of this House was equal. His or her opinion was equal and his or her conscience was equal. Last time I looked, it was customary to treat the opinions and consciences of other Members of the House with some civility and respect. I have to say that the speech before last did not do that and did not serve that Member's cause very well.

      Your Lordships' House has a duty to scrutinise legislation in detail and to ask the Government to think again when they are going in the wrong direction. There is precious little detail in the Bill but I judge that the Government have chosen to take the country in the wrong direction. There is no mandate for it. There is no majority to leave the single market. If we continue along this path, our people will be poorer and our country will be more isolated and less influential in the world. So I will be supporting amendments to protect the rights of citizens of other EU countries who live and work here, to protect our access to the single market and to allow the people of this country to have the last word, for the sake of our unity and democracy. That is what I believe democracy is.

      As your Lordships will be aware, I speak for these Benches on health and social care. There are three main healthcare reasons why I believe the Bill should be amended. They boil down to: people, healthcare and Donald Trump. There are tens of thousands of EU citizens working in our health and care system and the Government are using their future, and the future of those they care for, as a pawn in a misguided game of cat and mouse with the other 27 countries. Without them, the staff shortages we are already experiencing will be a lot worse and patients will suffer. 1 am pleased there has been a cross-party outcry from your Lordships about this, so I hope all will vote for an end to that foolishness.

      Secondly, the businesses which provide the drugs, medical devices and treatments that British people need will be badly affected by a hard Brexit. That is why I support access to the single market rather than just waving a white flag and not even trying. The pharmaceutical products most of us depend on are developed by research by networks of scientists working together across Europe. These networks are already suffering and the massive EU funding from which they benefit is being put at risk. Clinical trials taking place here in the UK are at risk. UK patients get access to new and cutting-edge treatments because of them. The UK has played an enormous role in the regulation and licensing of medicines for the whole EU. Indeed, much of the expertise is here. It makes no sense to develop our own system. We could lose a lot of that expertise.

      Companies will always develop products for big markets where the profits are. Why would they want to develop a product to satisfy the regulations in a market of 68 million people when they could sell to a market of 400 million? Medicine distributors warn of cost increases, decreased access and even shortages. Harmonised regulation is not a burden. It gives us the freedom to sell and the confidence to buy. Why throw it away? Medcare products frequently cross borders in the course of their manufacture, packaging and labelling. Having tariffs imposed on them will increase their costs and decrease their competitiveness. So, for the sake of UK patients and their access to affordable and cutting-edge medicines and treatments, I will be supporting an amendment to give us continued access to the single market and the customs union.

      Then there is Donald Trump. Our NHS is probably our most valuable asset. Already a lot of American healthcare companies are sniffing around to see what they can pick up. We all heard what Trump said about trade deals putting America first-America first, not the UK first. So anyone who thinks a trade deal with the USA will not result in a lot of our health services being run by American companies must be completely mad.

      Finally, I will be supporting an amendment to ensure the approval of the British people for the deal put before them by the Government. All those who are most affected should have a say, including those who were denied one in the last referendum with its gerrymandered electorate, such as: citizens of other EU countries who live here; British citizens who have lived for many years in other EU countries; and 16 to 18 year-olds whose future study and work opportunities will be damaged by Brexit.

      We have a representative Parliament and we are not used to referenda. But perhaps, having ventured into that area, we should have taken a leaf out of the book of the Swiss. Here, our future wealth and well-being are being hijacked by an advisory referendum in which only 37% of a gerrymandered electorate voted for the change. That means that 63% did not. I believe I am here to speak for the 63%, along with all those groups that were not allowed to vote at all. So for those reasons, and, as other noble Lords have mentioned, because times have changed since 23 June, we need a referendum on the final proposals. You cannot start the process with some form of democracy and finish with a stitch-up. The long-term future of the UK and its population is at serious risk and this House must do its duty and ignore bullying threats about its own future.

    • Secondary Schools: Counselling Services - Question | Lords debates

      Will the Department for Education work with the Department of Health to carry out a joint cost-benefit analysis of having counsellors in schools compared to the cost of mental health services for children later in life?

  • Feb 9, 2017:
    • Immigration (Health Charge) (Amendment) Order 2017 - Motion to Approve | Lords debates

      My Lords, I welcome the noble Baroness to her new role. We welcome the exemptions and clarifications that she has just outlined. I should like to use this opportunity to express some concerns and ask some questions about the Government's policy of charging foreign nationals for the use of the NHS, and how this will work.

      It is right that those who are not entitled to the free use of our NHS should pay for their treatment-or it should be paid for by their insurance or their Government. Some hospitals have already introduced the policy successfully but, irrespective of its merits, the focus on collecting the equivalent of 0.5% of the NHS's annual spend reflects the Government's skewed priorities. It ultimately serves to mask the main challenge facing the health service-a lack of cash.

      The principle that those not eligible for free NHS care should pay up front for non-urgent treatment is sound. However, there must be clear safeguards in place to prevent profiling of people who have surnames that sound "not British", and to protect vulnerable people such as the homeless who cannot prove their right to treatment by providing the correct documents. We must also guard against any temptation to extend this policy to urgent treatment. How do the Government plan to ensure that this does not happen?

      Health tourism should be properly addressed, but it is not particularly significant in terms of the overall funding of the NHS. The recent government announcement cannot mask the refusal to address the serious failures of care which are now routine across the NHS as a result of impossible financial pressures. Only this week we have heard about increases in waiting times for operations, and in unexplained deaths among those with mental health problems. One hospital trust in Kent has halted all non-urgent operations until the end of the financial year. The Government need to tackle important problems such as staff shortages and retention and a lack of social care. Recent statements reflect a warped sense of priorities. I hope that my right honourable friend Norman Lamb MP's cross-party meeting with the Prime Minister last week will lead to a genuine consensual process to deliver a long-term settlement for the NHS and social care.

      Ultimately, the NHS must not lose the humanity and compassion that are the hallmarks of an institution of which this country is rightly proud. Doctors do not see their jobs as being border guards or revenue collectors. Can the Minister assure us that clinical staff will never be expected to collect money? This would completely change the relationship between doctor and patient. Can she also assure us that hospital administrators will get funding for extra help, and if they do, will the policy be cost-effective? Talking of capacity, I heard a Minister on the radio recently whom I felt was actually encouraging people to come from abroad to use our NHS-as long as they paid for it. As waiting lists and queues in A&E and for GP appointments get longer, I would have thought the last thing we should be doing is encouraging more customers from abroad. Can the Minister say whether hospitals are charging a full cost-recovery amount-or more, or less? Does the hospital keep the money, or does it go straight to the Treasury like the rebate on drugs?

    • Hospital Beds: Availability - Question | Lords debates

      My Lords, integration is of course very important, but has the Minister ever met anybody in the health service who does not believe that you will never fix the pressures in the health service until you put more money into social care? That means helping areas with low-value properties, not just those with high-value properties, such as in leafy Surrey.

  • Feb 7, 2017:
    • Health Service Medical Supplies (Costs) Bill - Report | Lords debates

      My Lords, I am grateful to the Minister for what he has just said and for the conversations that we had about this group of amendments at Richmond House. As noble Lords will see, I have added my name to the government amendments in this group, because they achieve exactly what I was hoping to achieve when I tabled amendments in Committee. I am grateful to the noble Baroness, Lady Finlay of Llandaff, for supporting me in that intention. Unfortunately, when I withdraw my amendments in favour of the Government's amendments, my message to the noble Baroness, Lady Finlay, did not get through, so she has unfortunately failed to withdraw her name. That is why she has asked me that, when the amendments in her name come to be put in order, I should make it clear on her behalf that they are not moved, which will achieve our joint intention. I know that the committee is also grateful to the Minister for hearing our concerns and taking action.

    • Health Service Medical Supplies (Costs) Bill - Report | Lords debates

      My Lords, before the noble Lord sits down, is he able to respond to the issue about biosimilars, which I raised in an earlier debate and which the noble Lord, Lord Hunt, has just raised?

    • Health Service Medical Supplies (Costs) Bill - Report | Lords debates

      My Lords, as I mentioned in the debate on Amendment 3, I support this amendment because it gives the Secretary of State a bit more flexibility to take account of the specific circumstances of a company with very high fixed costs, in the interest of making sure that we have security of supply and patient access to the particular products that it produces. I do not think it undermines any of the objectives of the Bill in any way, and because of that, I hope that we will hear something encouraging from the Minister.

    • Health Service Medical Supplies (Costs) Bill - Report | Lords debates

      My Lords, in supporting the amendment, I reiterate my support for the general purpose of the Bill, which is to ensure good value for the NHS. However, there is a danger that it could result in reduced access for UK patients to new drugs and treatments if badly handled by the Government in future. As usual, the devil is in the detail-and, in particular, how the Government use the powers given to them in the Bill. That is why I support the imposition of a duty to ensure the continued growth of the life sciences sector and to protect access for patients to new medicines and treatments.

      I share the concerns of the noble Lord, Lord Warner, about the effect of Brexit, which I mentioned in my Second Reading speech. In the light of the hard Brexit on which the Prime Minister is intent-without a mandate-there are many hazards to this industry, on which we depend for a major contribution to our economy, and to the future of medicine in the UK, so it is vital that the Government have that in mind when operating the Bill when it becomes an Act.

      I have in mind as an example the new biosimilar medicines that the noble Lord, Lord Carter, pointed out in his report have the potential to save NHS a vast amount of money while providing the same or even better treatment. He said that one new biosimilar drug alone can save the NHS £60 million a year. These biologic drugs currently account for six out of the top 10 medicines by spend in the UK, and I gather that five out of the top seven biologics will come out of patent by 2020-so there will be enormous potential for the development of generic biosimilars for many diseases. These drugs cost about 100 times more to research and develop than other generic drugs, but the current pricing system does not take that into account. They are different and, because of their enormous cost-saving potential and the competitive environment in which they will be marketed, which could bring down the cost even further, I think that they need special consideration from the Government.

      Amendment 7, tabled by the noble Lord, Lord Lansley, which I support, could achieve this if the Government were inclined to use it, but I think we need to go further and put at the heart of the Bill a duty on the Government to protect future cutting-edge medicines when they first come into the market. Unless that is done, UK patients could become the last in the developed world to get these medicines. We want to be first, not last.

      A healthy, competitive market will deliver tremendous cost savings to the NHS in the long term, but this requires sufficient-not excessive but sufficient-financial returns to compensate for the high cost of R&D. Otherwise, we will not have enough companies prepared to compete over a long period. This will prevent the NHS benefiting from the potential savings offered by these medicines. For those reasons, I support the amendment.

    • Health Service Medical Supplies (Costs) Bill - Report | Lords debates

      My Lords, the noble Baroness, Lady Finlay, is so grateful to the Minister that she asked two of us to convey her thanks for the time he has given to addressing her concerns. She is very happy with these amendments.

    • Nursing and Midwifery: Student Applications - Question | Lords debates

      My Lords, filling the places is one matter, but the level of attrition is another, and that is dreadful. Apparently, one in four student nurses leaves during their training, and in the first two years after qualification two out of five leave the profession. Part of the problem is that the data are not consistently collected. If they were, we would be able to know which settings are very poor at keeping their young nurses. Will the Government do something about collecting those data in a consistent way so that something can be done about the level of attrition?

  • Feb 3, 2017:
    • Regulation of Health and Social Care Professions Etc. Bill [HL] - Second Reading | Lords debates

      My Lords, I am grateful to the noble Lord, Lord Hunt of Kings Heath, for producing this Private Member's Bill and echo his praise for all the health professionals who look after us in this country. For the most part, they are highly trained, highly skilled, and extremely hard-working and conscientious. Indeed, so are the regulators, which do their very best, under some difficult circumstances, to fulfil their purpose of ensuring fitness to practise-right through a person's career-and the safety of patients.

      I support the noble Lord's efforts to persuade the Government to get on with modernising the regulation of health and care professionals. There have been extreme delays, and the expression used by the noble Lord, Lord Turnberg-glacial-is very apt. Ministers commissioned the Law Commissions of the UK to review the mass of legislation, which has been put in place piecemeal over the years, that underpins the nine health and care regulators. The resulting UK report was published in April 2014, and the four Governments' responses were published nine months later. In December 2015, a Health Minister confirmed that the Government intended to consult on how these matters would be taken forward. However, 13 months later, this still has not happened, and I am not surprised that the noble Lord and all the regulators are getting more than a little impatient. Will the Minister tell us exactly when the consultation will be launched? How long will it last? How soon will Ministers respond and when do the Government intend to legislate? Can we expect pre-legislative scrutiny, which would be most appropriate for this kind of legislation? I thought the Home Office was slow in implementing promised consultations, but this one takes the biscuit.

      Noble Lords will no doubt, like me, have received a number of briefings-most of them, I am afraid to say, only 24 hours ago-about this attempt to put a bomb behind the Department of Health. I hope its imminent move to Victoria Street to make way for the Commons will not delay matters further. Noble Lords may also, like me, have been lobbied over probably the past two or three years about the shortcomings of the current legislation and the need to improve it. However, here we are and I hope the Minister will give the matter some priority because it is very important for the safety of patients.

      I was struck by the level of agreement among the organisations that have briefed me about the problems with the current rules, although they disagreed about whether this Bill's attempt to simply get the Law Commissions' proposals implemented is the right thing to do. Clearly, it is much better than no change, but the problem is that time has passed since that work was done and things do not stand still in health and care. The situation has moved on very quickly. However, there is a consensus about the sort of improvements that need to be made.

      One of the common themes is the lack of flexibility in the current legislation. This is preventing regulators responding to the vastly increased workloads by streamlining enquiries. For example, the GMC tells us that when the Medical Act was passed in 1983, it had about 350 complaints per year. As we heard from the noble Lord, Lord Turnberg, we now have about 9,000, and the reasons for that are probably pretty obvious. The GMC closes thousands of cases every year without further action and yet it is obliged to consider all of them. Apparently, very many of them do not reach the thresholds set by Parliament, whereby a doctor has to be considered such a risk to patients that it should take action to restrict his or her ability to practise. A recent development is the local responsible officer who, according to the GMC, would be a much more appropriate person to deal with many more minor concerns. So the GMC would like the power to decide when a full investigation is appropriate and when it could be handled more appropriately by the RO. This would reduce the number of unnecessary investigations, reduce the stress on doctors-my goodness, we need to do that-and cut costs so that more resources can be diverted to where there is a need for serious action.

      Another item on the GMC's wish list is to be allowed not to have a public hearing in situations where the doctor accepts what has happened and is willing to accept the sanction. Finally, it would like a more nuanced suite of regulatory sanctions in relation to education and training concerns rather than just the nuclear options it has at the moment. All this seems to me to be sensible, and I am not sure why it is taking the Government so long to do anything about it.

      The Royal College of Surgeons has raised an issue that emanates from the changes to the qualifications of members of surgical teams. A number of new roles in the extended surgical teams are not yet regulated, including physician assistants and surgical care practitioners. The college gives an example of the problem with this, in that physician associates cannot prescribe or order X-rays and CT scans. Statutory regulation of these roles to allow suitably qualified people to carry them out would free up surgeons to do other vital work, while at the same time reassuring the public. It is also anxious to see Sir Bruce Keogh's recommendations on cosmetic surgery implemented, and the GMC supports this. It raised other matters such as ability to use medical titles and the testing of language skills, which we may be able to do in future.

      The Optical Confederation highlights the rapid advances that have been made in eye care interventions by the use of digital technology-the noble Lord, Lord Hunt, mentioned one of them in a debate a few months ago. In addition, our ageing population has of course added greatly to the demand for eye care. The confederation supports the proposals of the Law Commission on the whole, but warns that the inevitable disruption and organisational change could interfere with its current work on transferring a lot of services from hospital into primary care or the community. That of course is what we are encouraging all hospitals to do. I think its conclusion is that this may not be the right time to change regulation. It did not mention the effect of the turmoil of Brexit, but I read that between the lines. What a pity this was not all done two years ago.

      The NMC was the organisation most outspoken in its view that the draft legislation proposed by the Law Commissions is no longer the best way forward because of the passage of time. Its view is that its own founding legislation is too complex and prescriptive, and contains an unnecessary amount of overprescriptive detail, preventing it from adapting and modernising. It would like to be able to follow the more cost-effective approaches adopted by some other professional regulators, within its rules, but is prevented from doing so by its own particular rules. Clearly, there have been some minor but welcome changes to its regulation-we have heard about those that have gone through Parliament-but these make the whole package very bitty, and more is in the pipeline and will, as we have heard, come before your Lordships' House very soon. But the NMC emphasises the need for further consultation before implementing the 2014 proposals because of the effect of the inordinate passage of time. Even the Health Secretary has asked the NMC to regulate the new nursing associate role. It is willing to do so but cannot do it without changes to the legislation.

      It all boils down to a need for rapid consultation and rapid response from the Government. We on these Benches will happily work with the Government to ensure that the legislation that is so badly needed is properly and speedily scrutinised. Can the Minister tell me when we will get that opportunity?