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  • Oct 29, 2019:
    • Health Service Safety Investigations Bill [HL] - Second Reading | Lords debates

      My Lords, I too thank the Minister for introducing this Bill.

      I have always believed that, if you want to know what is wrong in an organisation, the best thing you can do is ask the people who work there. They will also very often know what to do about it. If you want to manage change effectively, your first principle has to be to involve in its design those who are going to implement it. I am also, as a keen gardener, a fan of the old saying that the best fertiliser is the farmer's boot. In other words, there is no substitute for getting round the farm to see what is growing well and what is being eaten by caterpillars. The same goes for organisations. If managers do not get out of their offices to see how things are working on the ground, they will miss what is going wrong and lose out on valuable opportunities to hear from staff informally. Nowhere is that more important than in an organisation where people's lives depend on getting things right the first time.

      We therefore welcome the Government's objective of moving towards a learning culture, but in many good NHS organisations this is nothing new. There have been many successes when the principles I have just outlined have been put into operation and staff have embraced change, especially when it was their idea in the first place-or at least they believed it was. Sometimes small management and systems changes can make a big difference to patient safety: for example, the introduction of checklists in surgery has reduced mistakes considerably. These things are not the responsibility of any one member of staff but involve people working together. The Bill deals with thematic or systemic issues rather than individual cases so it has a rather different role from the existing systems for improvement and safety management, but I would like to know how its operation will link with and impact on those existing systems.

      Getting to the bottom of problems in the past has often been hindered by staff hesitating to report concerns because of worry about being victimised as a whistleblower -there have been some very bad cases of that-but also because of a lack of confidence that anything will be done. The safe space idea should help with this. However, I agree with the noble Lord, Lord Hunt of Kings Heath, that it has to be seen that the recommendations are put into place for that confidence to arrive.

      Currently, the duty of candour means that staff must express concerns when they believe there is an unsafe situation. However, the RCN tells us that half of those who do so are not convinced that any action has been taken. As the noble Lord, Lord Hunt, said, it will be a challenge to the new body to ensure that those who give evidence in the new safe space see that effective safety improvements are put in place as a result of their co-operation. It is also important that those who give evidence are not inadvertently put at risk by doing so. That means that the exemptions to disclosing information to other bodies must be narrow, clearly defined and well understood. I think my noble friend Lady Parminter will say something about the Parliamentary and Health Service Ombudsman, which feels that it should be treated the same as coroners. There must also be clearly understood definitions of what serious professional misconduct means.

      Therefore, to fulfil the ambitions for the HSSIB, investigations must look at the whole picture, not just at the individuals involved in any incident. They must consider whether the shift at the time of the incident contained an appropriate number of staff for safe working, with the correct skill mix, training and experience for the situation they find themselves in. For example, we know that there are currently 40,000 nursing vacancies, and half of nurses in a recent RCN poll reported that their last shift was understaffed. Brexit has and will make things worse.

      The investigations should also consider local and national policy and report on how they impacted the incident, and should be able to make recommendations to the Secretary of State about the need for structural changes indicated by the investigation. That is why it is so important that the organisation is independent. How do the Government plan to ensure that the recruitment of the board is really independent of government and includes lay members as well as medical professionals? Again, I agree with the noble Lord, Lord Hunt of Kings Heath, about the appointment of the chief investigator and the involvement of the Secretary of State.

      It is arguable that all patients, however funded, should be able to benefit from the work of the HSSIB. Are there plans to extend its remit, after a period, to all health services, including those provided by independent providers? Indeed, the BMA has already suggested that its remit should be extended to incidents that affect the safety of healthcare workers as well as patients. In Committee there will be discussions about the potential expansion of the remit. Can the Minister clarify the relationship with other bodies with responsibility for quality and safety in health and care such as the CQC and the various regulators? Also, there are already various pathways that staff can take to express concerns, so there needs to be clear guidance as to which path to take in each situation.

      Resources for up to 30 investigations per year are being provided. How has this number been arrived at? What if a serious qualifying incident happens just after the annual budget has run out? Will the HSSIB have to publish the number of incidents referred to it alongside the number conducted, to determine whether further resources are needed in the future?

      How will decisions on the criteria for investigations be made? The groups consulted should be as wide as possible, including patient groups as well as healthcare professionals and managers. The Secretary of State seems to have a slightly suspiciously large role in an organisation that is supposed to be independent.

      As I said, I welcome the safe space approach, but it is important that staff feel supported when they disclose what happened, especially if their view with hindsight is slightly different from what they might have said at the time. The primary objective of learning from mistakes will be achieved only through full disclosure to the investigators, and that will come only from confidence in the system.

      We welcome the plan to put the new medical examiners on a statutory footing. It is important that bereaved families are helped to understand what happened and, if there is any doubt about the cause of death, that further investigations are put in place. Of course, we need the right sort of people for this with the right sort of training. It is essential that the service is properly resourced, particularly if it requires input from staff who are already stretched in their ability to provide good-quality and timely care to patients. Will the Minister say something about the staffing model for medical examiners? If they are to examine all deaths apart from those that go to coroners, there will be times of the year when they are very busy indeed, such as the winter months or in a heatwave. This is the same time when all clinicians are very busy, so if the MEs are clinicians employed elsewhere, doing shifts as medical examiners as well as their other job, they may need to be in two places at once at some times of year. How will the staffing model be designed to be resilient in that situation?

      In summary, one could hardly be against a plan to develop more of a learning culture in the NHS and enhance patient safety, but there are questions to be answered and reassurances to be given, and I hope that the Minister will be able to do that.

  • Oct 22, 2019:
    • Queen's Speech - Debate (6th Day) | Lords debates

      My Lords, I have recently had cause to be very grateful to the NHS and its dedicated staff. However, a service that leaves a vulnerable elderly patient in A&E waiting seven hours to see a doctor and, on two other occasions, waiting in A&E for a bed in a ward for 12 hours and overnight is a service that is either inadequately resourced or inadequately staffed, and probably both. Patients are well named in the health service of today.

      The health service relies on a thriving economy to provide its funding. This Government have played fast and loose with the prospects for our health service by their relentless pursuit of the hardest of hard exits from the European Union, within which our economy has thrived for more than 40 years. Brexit has already cost our economy £70 billion. It has also hit NHS staffing hard, with many well-trained and well-motivated staff either going home or not coming here at all.

      Why are so many A&E departments not reaching the target of seeing 95% of patients within four hours? It is not because the staff are not working hard. Clearly the reasons are complex, and demographics play a part. There are people who go to A&E who could have used other services. Here, I stress that all three visits I mentioned earlier were made after all other sources of help had been tried.

      However, two elements of the problem are outside A&E. One is delayed transfers of care, meaning that beds are occupied by patients who would be much better off at home with support or in social care. The second lies in primary care. Therefore, when I heard the Prime Minister's headline-grabbing claim that his Government will build 40 new hospitals, I looked at it very closely and found that it is really only six new hospitals and a bit of seed corn money for the rest. More importantly, I realise that this unelected Prime Minister has no idea what the problem really is if he thinks that the solution is six new hospitals.

      Patients who cannot get to see their GP will go where the lights are on, and that is A&E. It is very common for patients to have to wait three weeks to see their GP, and that is unacceptable. In many parts of the country, there are not enough GPs. In some places, this problem has been tackled by GP practices taking on other professionals to lighten the load on the doctor. This is an enlightened approach but it requires forward planning, funding and suitable premises. In the case of my local primary care services, that is not happening. There are no suitable premises for a modern all-service primary care facility, and that can make it hard to attract GPs. Therefore, to move to an efficient primary care service and reduce the pressure on A&E, we need funding and planning, but we are unlikely to get that from a Government intent on damaging our economy and promising not to increase taxes. Of course, the best course is to avoid damaging our economy and our health service by remaining in the EU.

      The other way to reduce pressure on our health services is to prevent ill health, and I absolutely agree with the gist of the speech of the noble Lord, Lord Young of Cookham. I welcome the focus on prevention in the NHS Five Year Forward View. However, I would like to mention a preventable cause of illness which the noble Lord, Lord Young, did not mention and which is linked to another of the Government's stated objectives-that is, action on climate change.

      Outside this building for the past two weeks, thousands of citizens have demanded urgent action on the climate change crisis. They did so while breathing air that has 50% more of the most dangerous small particulates than the WHO recommended maximum. In London, the average level of PM2.5 is 15 micrograms per cubic metre, while the WHO recommended limit is 10. Polluted air kills about 40,000 people a year. It causes respiratory and cardiovascular illness and affects the brain development of babies and young children. There is evidence that older people who breathe polluted air have a steeper reduction in cognition with advancing age compared with clean air breathers. Research from the University of Warwick shows a significant reduction in memory, equivalent to ageing 10 years, in those who breathe polluted air. Polluted air therefore attacks our thinking power as well as our health.

      Tackling climate change from the health perspective is also the right thing to do for the planet. It is bad for your health and tackling it is the healthy option, but the forthcoming Environment Bill needs to go further. It promises legally binding limits on air pollution but we have not been told what those will be. Actually, we already have them within the EU but have continually failed to reach them. What is required, as called for by the All-Party Parliamentary Group on Air Pollution, is much more than painting the number plates of electric cars green; it is a phased reduction in the legal limit for PM2.5 to 15 by 2020, 12 by 2025 and 10 by 2030. This would provide the incentive to government and local councils to reduce car use and speed up the introduction of non-polluting electric and hydrogen-powered vehicles, while bringing forward the phasing out of those powered by fossil fuels to 2030. We need radical action on charging and refill infrastructure. This would help the UK meet its climate change commitments, which it is otherwise unlikely to do.

      The proposed office of environmental protection also falls short. We need an independent body capable of rigorous scrutiny, with powers to investigate and gain access to data and the ability to monitor and force compliance and take Ministers to court if they fail to address these issues. We need these things for our health's sake and our planet's sake. So will the Government support the Private Members' Bills introduced today by my noble friend Lord Tope and the noble Baroness, Lady Jones of Moulsecoomb? That would be a step in the right direction.

  • Oct 2, 2019:
    • Brexit: Medicines and Medical Devices - Question | Lords debates

      My Lords, in my local pharmacy there is a poster on the wall asking patients not to blame pharmacy staff for the current shortages of medicines and medical devices. While accepting that it is not the pharmacies' fault, can the Minister say whose fault it is?

  • Oct 1, 2019:
    • Influenza: People with Learning Disabilities - Question | Lords debates

      My Lords, is the Minister interested in the views of the pharmacist I consulted yesterday on this Question? He said that his difficulty was identifying the local people with learning difficulties, because unless they have a physical problem that keeps him and the local GP in contact with them, it is hard to get to know them and, therefore, to encourage them to have the flu vaccine. Does that not indicate the need for a major public information campaign in accessible terms to indicate the safety and efficacy of the flu vaccine and vaccines such as MMR?

  • Jul 19, 2019:
  • Jul 15, 2019:
    • Space Science and Technology - Question for Short Debate | Lords debates

      My Lords, I too thank the noble Lord, Lord Mawson, for securing this debate. When devising our industrial strategy, it makes sense to assess our opportunities and play to our strengths. In relation to both, the UK should be doing more: though only 3% of the world economy, we are 5% to 6% of the world space economy, so we are already doing well, although we need to do a whole lot better if we are to reach the Government's target of having 10% of the global space market by 2030. Apart from the trade and the very high-value jobs we can create from space exploitation, there are four good reasons why we need to be active in this field. Space programmes allow us to monitor and observe our world: this is vital for environmental protection and climate change mitigation. Communications rely on space programmes, as does navigation. Then there is the vital area of defence. We need to be independent in all these areas.

      We are already active in two of the major sectors of space exploitation: building satellites and receiving and interpreting data from them. The area where we are lacking is in independent launch facilities, although this aspect of space exploitation could be worth £3.8 billion to our economy by the end of the decade.

      The Sutherland space hub being developed by Highlands and Islands Enterprise is supported by £2.5 million from the UK Government as part of its £17.3 million funding, and other grants have been made available to companies developing a new rocket, launch operations and a new satellite. The location of this site makes sense, so that we can launch to the north-east, but it is in Scotland, a part of the UK where the people and the Government do not want to leave the European Union and where the SNP Government have threatened to attempt to break up the union if we Brexit. What happens to the Sutherland site then? I understand that there is another site in Cornwall where there are plans for a launch site, but the investment in Sutherland is already great. What discussions have taken place with the Scottish Government to protect that investment?

      Brexit threatens more than that. Half our current satellite manufacturing is exported to the EU. Tariffs would make us less competitive and a no-deal exit would be a disaster for companies such as those in the Glasgow and Surrey clusters, which build a lot of small satellites. One area in which we excel at the moment is removing space debris. There is a parallel here with the plastics that pollute our oceans. In our race for development, we have polluted the oceans with plastics that do not decompose and we have polluted space with bits of technology that are no longer used. A British satellite manufacturer has a clever netting system that can remove them. Surely this technology has enormous potential. Are the Government backing it?

  • Jul 9, 2019:
    • Restaurants: Calorie Labelling - Question | Lords debates

      My Lords, I was alarmed to read the Public Health England report about unacceptably high levels of sugar in baby foods, even some labelled as being healthy. What steps are the Government taking to ensure that such products give parents the information they need to make healthy choices for their children?

  • Jun 28, 2019:
  • Jun 18, 2019:
  • Jun 4, 2019:
    • Food and Feed Hygiene and Safety (Miscellaneous Amendments) (EU Exit) Regulations 2019 - Motion to Approve | Lords debates

      My Lords, I too thank the Minister for outlining all the technical details of this SI. Of course, this instrument has been withdrawn from the Order Paper twice before. Some of the changes made since we originally saw it are small but crucial. We are lucky that they have been spotted, but that raises concerns for the industry that there may be others. Now that the leaving date has changed, are the Government planning on conducting additional scrutiny on the other SIs that are being rushed through this House to make sure that they are up to scratch? How do the Government intend to convey these changes to the relevant individuals and companies on whom they will impact?

      I add my support to the question asked by the noble Baroness, Lady Thornton, about the capacity of the FSA. This is probably about the 16th time that we have asked the same question and we are still concerned about the capacity to replace all of the other measures.

      Some of these changes reflect very recent EU law that has come into force, as the Minister mentioned, so what do the Government intend to do about any new EU law that might come into force between now and 31 October or whenever we happen to leave? Will these SI and the ones that preceded them have to be further amended if there are other changes to EU law?

      The Minister mentioned that the system for minimum charging rates for hygiene controls of fishery products is somewhat out of date. Will the Government confirm whether they aim to change the pound-euro exchange rate from the 2008 level at which it is currently set? Although these charges, as we know, are rarely levied by local authorities, any change in the exchange rate, which could happen after Brexit, could have a big impact on the ability to pay of those against whom the charge is levied. We saw a big difference in the rate of the pound against the euro after the 2016 referendum, and the way in which we might, unfortunately, leave the EU, could have a similar serious effect on the exchange rate. What are the Government planning to do about those charges if there is such a big change in the exchange rate? Are they planning to bring it up to date from 10 or 11 years ago?

  • May 23, 2019:
    • Children: Gaming - Question | Lords debates

      My Lords, as the noble Lord, Lord Brooke, said, this is about gaming, not gambling. Although some games can indeed be beneficial, some of them have covert elements of gambling in them such as loop boxes. Will the Minister assure the House that the PSHE curriculum in schools will cover elements of gambling, including those hidden in otherwise innocuous activities such as gaming? How do parents find out which are beneficial and which are the harmful ones?

  • May 22, 2019:
    • Devolved Administrations: 20th Anniversary - Motion to Take Note | Lords debates

      My Lords, I am moved to preface my main remarks by strongly agreeing with the noble Lord, Lord Foulkes of Cumnock, in his belief that constitution matters. When the mess we are in at the moment is over and the dust has settled, we will need a UK constitutional commission. I believe that for many reasons. I do not have time to go into all of them but I will give you one: we are about to have a second Prime Minister imposed on us by 60 Conservative Members.

      However, I will turn to my main comments. I am not Welsh but I live in Wales with my Welsh husband, who is sitting next to me, and I visit Scotland frequently. I want to make some remarks about the way in which devolution has allowed the Welsh and Scottish Governments to take a different approach. I will use as my example how they have dealt with the lives and well-being of children.

      First, a word about Scotland. As with all Governments, the Scottish Government have to mind the pennies, but they found themselves with even wider inequalities than those in other parts of the UK. Therefore, in 2007, they commissioned some work about the cost-effectiveness of early interventions relating to children. Based on the analysis of cost, it became very clear that early intervention is not only cheaper but more effective than the cost of clearing up the mess later when everything has gone wrong.

      The result was the policy paper Early Years and Early Intervention, published in 2008. It opens with the following statement:

      "We have always known the earliest years of life are crucial to a child's development. However, it is increasingly evident that it is in the first years of life that inequalities in health, education and employment opportunities are passed from one generation to another. The early years framework signals local and national government's joint commitment to break this cycle through prevention and early intervention".

      The framework outlined in the paper marked a fundamental shift away from dealing with the symptoms of inequality-violence, poor physical and mental health, and low achievement and attainment at school-and aimed to focus on identifying and managing the risks that perpetuate inequality early in life by intervening early. Of course, the policy required resourcing, monitoring and follow-up, as well as partnerships and co-operation between local and national government and between different groups of professionals. Nobody expected it to happen overnight, but the principles underpinning the policy have been shown to be sound. The Scottish Government are rightly focusing on early action and tackling child poverty. I therefore congratulate them on taking the opportunity that devolution gave them to do things differently and show the way in this respect.

      In 2002, the Welsh Government were the first in the world to establish a national play policy. I found that very heartening because it demonstrated a new and different approach to children, which recognised that they are not just small adults but are different because of their developmental stage. They learn through play; it is important for their well-being and healthy growth. The policy also recognised that all children are different from each other. It emphasised the importance of allowing children to make choices, providing appropriate protection and safeguarding while offering an appropriate level of challenge. Implementation required safe places and facilities for play, time for children to play and training for play workers to supervise. To me, the policy was significant because it was based on the reality of what children are, how they learn, their rights and how provision for them is central to communities.

      That has led to other welcome child-centred policies. In 2011, the Welsh Government passed the Rights of Children and Young Persons (Wales) Measure, the purpose of which was to impose a duty on Welsh Ministers and the First Minister to have due regard to the rights and obligations in the United Nations Convention on the Rights of the Child and its optional protocols when making decisions of a strategic nature about how to exercise their functions. This incorporation of the UNCRC into the Welsh Government's obligations is something for which I have long campaigned in England. Unfortunately, my efforts to get successive UK Governments to agree to incorporate the UNCRC into UK law have fallen on deaf ears, despite many criticisms every five years by the UN committee that reviews compliance with the convention. However, I am not aware of the Welsh Government being inundated with complaints and court cases about Welsh children's rights not having been upheld, so the UK Government's fears appear groundless. This is just another example of where a devolved Government can be courageous and try something out on a smaller scale.

      Of course, it has not ended there because, to comply with the convention, the Welsh Government needed to scrutinise their other laws and ensure that they were compliant. As the noble Baroness, Lady Gale, mentioned earlier, that led to the introduction into the Senedd of the Children (Abolition of Defence of Reasonable Punishment) (Wales) Bill in March this year. The Bill's purpose is to abolish the common-law defence of reasonable punishment so that it is no longer available in Wales to parents, or those acting in loco parentis, as a defence for assault or battery against a child. The Bill supports children's rights by prohibiting the use of physical punishment through removal of this defence. As I heard it described on Welsh television, Wales cannot ban smacking by parents, which is legal in the UK, but it can take away the defence on which parents could depend if they were to physically assault their children. The intended effect of the Bill, together with an awareness-raising campaign and support for parents, is to bring about a further reduction in the use and tolerance of the physical punishment of children in Wales.

      Again, I tried unsuccessfully in this very Chamber, under the Labour Government, to ban the use of physical assault by parents against their children. I was foiled in this attempt by the continued existence of this discriminatory defence, which is unhelpful to parents and undermines the rights of their children. I therefore heartily congratulate the Welsh Government on what they are doing. As it currently exists, the defence allows a parent to smack a child as long as they do not leave a mark. This discriminates against children with dark skin and does nothing to guide a parent as to what sort of force can legally be used. Who knows whether a sharp slap will leave a mark or not? Of course, the safest thing is not to smack at all but to use more positive parenting methods of discipline. Clearly, the Welsh Government have come to the conclusion that the only thing smacking teaches children is that violence can make people do what you want. I wish the Bill well as it passes through the Senedd and is implemented across Wales. It will send a powerful signal.

      Wales also appointed the first Children's Commissioner, sadly as a result of some terrible cases of child abuse at children's homes in Wales. Of course, all the devolved Administrations now have a Children's Commissioner, with varying powers, but the most recent is the Children's Commissioner for Jersey, who was also created as a result of some appalling child abuse cases on the island. However, something very interesting happened in the creation of this latest devolved Children's Commissioner. Her powers were put together as a result of consultation with, among others, the other four commissioners; as a result, her powers are more comprehensive than those of any of them. One unique power of the new commissioner is the power to instruct deliverers of services to follow her advice on what is best for the welfare of the children in their care. None of the other commissioners has that power. They can report and write letters and demand a response but they cannot insist that best practice is followed. I very much welcome this new power for this new devolved officer. When will the operation of this power be reviewed? Will the Government consider strengthening the powers of the other commissioners in the same way if they prove useful in protecting children?

      My remarks have not been party political so far but I hope that I will be forgiven for saying a few complimentary words about Kirsty Williams, the Liberal Democrat Education Minister in Wales. Kirsty has been a pioneering Minister. She introduced a new system of student funding for full and part-time students in which all can obtain a loan to pay tuition fees and receive a combination of grants and loans for living expenses up to the level of the minimum wage. Kirsty introduced the new scheme with the support of the National Union of Students. It knows that living costs are a great worry for students and can get in the way of effective learning. All students in Wales get a minimum of £1,000 per year living grant no matter what their parents' income may be. This recognises the fact that students are independent people. Kirsty has also introduced a radical new school curriculum.

      On this 20th anniversary of devolution I should like to use children's policy in Wales and Scotland as a good example of the benefits of devolution, and I look forward to the day when the UK Government follow some of the very good examples shown by the devolved Administrations.

  • May 8, 2019:
    • NHS: Shortage of GPs and Nurses - Private Notice Question | Lords debates

      My Lords, the Nuffield Trust has noted that there are fewer GPs per head in poorer areas than in wealthier areas. Health inequalities in this country are being made worse by some of the political decisions of this Government. Can the Minister say what steps the Government are taking to ensure that everyone has equal access to a GP, whatever their income and wherever they live?

  • May 2, 2019:
    • Antimicrobial Resistance - Motion to Take Note | Lords debates

      My Lords, I too thank the noble Lord, Lord Lansley, for giving us the opportunity to talk about antimicrobial resistance, because, as we have heard, it is one of the world's most difficult and dangerous health challenges. It could put back the clock and make many of the treatments which we take for granted, such as the surgery undergone by the noble Lord, Lord Crathorne, far too risky in future.

      It is not often that you read a book by an eminent doctor whose findings not only scare you but had obviously scared them too. However, that is what I found when I recently read the book about AMR by the Chief Medical Officer, Professor Dame Sally Davies. Near the beginning of the book she says that the findings of the group of experts she brought together were simple: first, we are losing the battle against infectious diseases; secondly, bacteria are fighting back and becoming resistant to modern medicine; and, thirdly, in short, the drugs no longer work. She admitted to feeling rattled about that, and so am I. Therefore, I congratulate the Government on the latest iteration of their comprehensive plan to tackle AMR, and welcome the fact that the plan outlines actions to control AMR both within and beyond our borders. I also welcome the fact that the plan for the next five years has brought the four nations of the UK together, unlike the previous version.

      One principle of the plan is reducing the need for using antimicrobials to limit the opportunity for microorganisms to evolve resistance to them. I will mention three ways of reducing the need for these medicines: immunising the population against the diseases that might require such treatment; tackling the spread of infection; strengthening the natural immunity of patients and supporting their general health so that they can fight off infections themselves.

      Vaccines are of course the most effective preventive health tool in human history, and have been able to eradicate entire diseases such as smallpox. As the noble Baroness, Lady Greengross, mentioned, expanding the use of existing vaccines would have a major impact. For example, universal coverage of children by the pneumococcal vaccine would avert 11.4 million days of antibiotic use in children under five each year. However, we also need new vaccines, but no new class of vaccines has been discovered in decades.

      The noble Lord, Lord Lansley, was absolutely right to focus on money. There are major financial barriers in the way of developing new antimicrobials. It is now five years since the Health and Social Care Committee in another place urged,

      "tangible and rapid progress in this area within six months".

      However, as the House has heard, in the last few years, since discussions have been ongoing between the industry and the Government about the deterrent effect of the current funding model, three multinational pharmaceutical companies have left the market. Significant government investment is also needed in novel vaccine research, to tackle an increasingly urgent global problem.

      Although the UK cannot rescue the situation alone, the unique nature of the NHS gives us the opportunity to demonstrate a new funding model that could work for both of these groups of pharmaceuticals and set an example to other countries. I was therefore pleased to see that the Government and the industry have agreed a new funding model for antimicrobial development and supply that will provide more stable income to the companies, while providing the NHS with novel antimicrobials which can be held in reserve by doctors for use when older, cheaper medicines no longer work because resistance to them has been developed. I understand that the new model will delink the payments made to companies from the volumes of antibiotics sold, basing the payment instead on a NICE-led assessment of the value of the medicines and supporting good stewardship.

      When will the Minister be able to report on the timeline for the full implementation of this pilot scheme and how will the Government assess whether it has been a success? Will the new model also be used to fund the development of new vaccines, many of which are badly needed in countries that cannot afford to develop them themselves but which are often the source of infection outbreaks in this country?

      Infections are spread around the population by many means, via water, food, air droplets and poor sanitation, and we are fortunate in this country on most of those issues. However, what should be most easily prevented are those infections acquired in healthcare settings. This is particularly dangerous because patients are at their most vulnerable and may have compromised immune systems. Healthcare-acquired infections are among the most serious modern public health problems worldwide and many are caused by antibiotic-resistant bacteria, so effective HAI management is vital to slowing the AMR crisis. It is therefore critical that the NHS puts in place system-wide processes, such as screening and surveillance programmes, and the highest possible level of hospital hygiene and sterile practice that can help tackle HAIs and reduce their incidence. The Government must also maintain their focus on HAIs to ensure that infection rates, which have been falling, do not start to rise again. Unfortunately, they have now plateaued.

      Across the NHS, there is regional variation in hospital-acquired infection rates. According to freedom of information data, almost two-thirds of hospitals do not offer point-of-care testing, a tool that could help provide real-time information on patients for a range of infections. Only eight out of 50 trusts routinely carry out point-of-care testing for infections such as flu, and less than 10% of trusts test for a full range of infections, such as MRSA and others. Some trusts consistently appear among the best, and some consistently among the worst, for reported cases. Of course, one has to ask whether these trusts have better or worse reporting mechanisms, or whether they have more or fewer cases to deal with. But whatever the answer, can the Government assure me that the focus is still on getting these figures down? Personally, I would be very reluctant to go into a hospital with a poor record on this.

      Optimising use-for which read "reducing unnecessary prescribing"-requires both public and medical education. Patients need to know that it is sometimes for their own benefit when their doctor tells them they do not need antibiotics but advises them instead to go home, rest and take plenty of fluids, and not to go to work or school and spread it around. On a system-wide basis we need to be able to report on the percentage of prescriptions supported by either a diagnostic test or a decision support tool. There is a target for this in the plan. Will the Minister say whether there are online learning packages and easily available diagnostic tools, so that GPs can be supported to make the optimum decisions about prescribing?

      We should not ignore the potential of strengthening patients' own ability to fight off infection without the use of antimicrobials. Malnutrition can reduce the body's own defences, and it is a disgraceful fact that there is malnutrition among the poorer sections of the UK population today, particularly among children and older people. I have even heard of malnutrition among long-term hospital patients because of the poor quantity and/or quality of hospital food, or the fact that no attempt is made to ensure that the patient eats it. This factor cannot be ignored when considering how we can reduce the spread of disease. Will the Minister say what action is being taken to tackle malnutrition?

      Another aspect of boosting natural immunity-mentioned, I think, by the noble Baroness, Lady Masham -is the role of microbiome; that is the 39 trillion microorganisms that occupy our bodies. Of course, some can be harmful, but the majority contribute to health. There is some evidence that a healthy, varied gut microbiota can have a beneficial effect on our immune system. Specific bacteria in the gut have been associated with immune development, and we know that germ-free mice have less well developed immune cells. Altered populations of bacteria are associated with a host of diseases, from allergy, asthma, autoimmunity and neurodegenerative diseases to obesity. However, we probably still do not fully understand which specific bacteria are important for health. A better understanding of the community of bacteria that affect our health is needed. This is a promising area of research, so will the Minister tell the House whether the Government are investing in research into the contribution the microbiome can make, particularly to immunity against infectious diseases?

  • Apr 25, 2019:
    • NHS Mandate - Statement | Lords debates

      My Lords, I am very sorry that the Minister has been forced to give such an innocuous Answer on such a very important issue. We are awaiting not only the mandate but the workforce plan, and we have long awaited the social care Green Paper. Is the department still busy recruiting around the world to replace positions that are being vacated by staff from the EU-who are either going home or not coming here in the first place-or is there some other reason? I would have been much more reassured if the Answer had told us that the department is discussing with other departments across government the social determinants of health and how addressing those will help make the NHS much more sustainable in the near future. Can the Minister rescue this innocuous Answer by assuring the House that those discussions are taking place?

  • Apr 24, 2019:
    • Residential Construction and Housing Supply - Motion to Take Note | Lords debates

      My Lords, I shall focus on the word "sustainable" in the wording of the Motion, because I want to talk about two linked crises: the crisis of the housing shortage and the crisis of climate change.

      The BEIS Select Committee looked into this on 12 March this year, taking evidence from representatives from Barratt, Persimmon and Melius Homes. The builders were asked what percentage of the houses they are building this year comply with the latest energy efficiency regulations. Barratt's answer was 53%. The representative was asked, "Why only 53%?" He explained that the point at which you buy the land and get planning permission fixes the building regulations to which you must abide in perpetuity, so there are people still building to 2006 regulations.

      It strikes me that that is a particular problem, given the phenomenon called land banking. It seems that if you buy some land, get planning permission and do some innocuous preparations, you can fix the regulations with which you have to comply, so you can bank your energy regulations as well as your land. That sounds like a good deal for the builders but a poor one for home buyers and the planet in an era when the standards of energy-efficiency regulations are rising. Surely this should change.

      Public perception is that new properties will be substantially more energy efficient than older properties, in which case, the Select Committee asked, why did the Committee on Climate Change feel the need to point out that if builders actually built to the specification to which they should be building, consumers could save up to £260 per year on their energy bills? Are house buyers being misled into believing that their properties are more efficient than they are? The witnesses accepted that there is a performance gap between the energy performance certificate rating and the actual performance in use; this is something that the committee had dug into earlier. The witnesses made the point that homes that were designed to a B standard often turned out to be a C or D standard as built. It was put to the builders that this was mis-selling, similar to where someone buys a three-bedroomed house and it turns out to have only two bedrooms: they are being swindled. But, apparently, few buyers go back to the builder and complain that their energy bills are higher than expected. It seems that it is very difficult to make the comparison because of the complexity of the energy market. Do the Government plan to make it any easier for house buyers to check that they are getting what they paid for when they buy a new house?

      Tools do exist for testing the thermal performance of the house at the point of sale. Indeed, I saw it done in my own house; I can say from my experience that I built a passive house and my heating bills are exactly within the range quoted by the architect and small builder. What is more, they checked this out again a year later to make sure the house was still performing-it is. The committee's witnesses said they would be happy to be measured on this basis, so why do the regulations not insist that, instead of being based on a theoretical design, the EPC is issued on actual performance?

      The Committee on Climate Change has stated that we need to decarbonise our homes by 2050. The builders were asked what percentage of the homes they built last year would need to be retrofitted to meet this ambition. The answer from Barratt and Persimmon was, "all of them", since none was built to zero-carbon standards. But the small builder Melius Homes builds all its houses to this standard and still makes a profit.

      Given that it could cost five times as much to retrofit a house to a zero-carbon standard than to build to that standard in the first place, we have one chance to get zero-carbon homes cheaply. The builders claimed that they are capable of building zero-carbon homes if that is what the Government want. However, the zero-carbon homes standard was scrapped. Can the Minister say why the Government are not reinstating it? The industry says it can do it, the planet needs it, so let us get on with it.

      Cost is often raised as an issue. The committee asked about the extra cost of building to passive house standard and the reply was £10,000 to £12,000 per house. However, the climate change committee estimated £4,800 per home. It was agreed by the witnesses that this was probably ambitious but that, if it was at scale, perhaps it could be done. The committee then established that, at £10,000 per home extra, the total cost of building all Persimmon's homes to zero-carbon standards would be £65 million per year, which happens to be only 10% of the amount paid to its senior leadership team last year. In other words, Persimmon could have built all the homes it built last year to zero-carbon standards for about 10% of what it paid the bosses. What will the Government do to ensure that scale builders put a little extra insulation into houses and a little less into the remuneration packages of their senior executives?

      Finally, I would like to ask for some clarification about the powers of local authorities to grant planning permission only if the houses are built to zero-carbon standards. The Government have said that,

      "local authorities are not restricted in their ability to require energy efficiency standards above Building Regulations".

      But some councillors are still confused and have been consulting the Passivhaus Trust on the matter. They point out that the planning system involves a number of considerations, including the three legs of sustainability: economic, environmental and social. They want to know whether they need to declare a local climate emergency in order to be allowed to give greater weight to the environmental leg in determining planning applications. They are of course very averse to judicial review. Can the Minister clarify this please?

  • Apr 9, 2019:
    • Food Additives, Flavourings, Enzymes and Extraction Solvents (Amendment etc.) (EU Exit) Regulations 2019 - Motion to Approve | Lords debates

      My Lords, I too thank the Minister for repeating the information that has been debated already in another place. I share most of the concerns of the noble Baroness, Lady Wheeler, particularly those about the resourcing and training of the FSA and local authorities. In fact, I expressed those concerns in debates on every single SI in this group which were responded to either by the Minister or by the noble Baroness, Lady Manzoor, so I will not repeat them. However, I still have concerns about the fact that an organisation that has been so minimally resourced until now will take on such enormous responsibilities in the future.

      We are now three days away from the current exit day from the European Union. Friday happens to be a day that I share with the noble Lord, Lord Robertson, as my birthday and I very much hope to have the best possible birthday present when we do not leave the European Union on Friday and the worst possible one if we do. However, the proximity to Friday is particularly relevant to this SI because of the delay in putting it before the House. It occurs to me that there will be a lag between possible exit on Friday and the coming into force of this instrument. What effect will that have?

      On the re-evaluation process-the ongoing rolling procedure-there appears to be another time lag, because I understand that we are going to keep up with the European process until 2020 before we then take it over ourselves. What measures will be in place in the intervening time for the emergency appraisal of any new additive or for considering any new technological information that comes to light? What if something is banned in the EU in the intervening time? We certainly do not want weaker regulations. Can the Minister say anything about that?

      If there is an extension to the date of exit, as we all hope, will the Minister say how the Government intend to keep businesses informed regarding if, when and how they should prepare for a no-deal scenario? Stakeholders have asked whether the Government will commit to a close working relationship with the EFSA based on the exchange of information and expertise, contributions to scientific networks and cross-European collaboration. When do the Government intend to make a decision on the UK's involvement in these important intelligence-gathering tools, including the rapid alert system for food and feed, the European food fraud network and the EFSA's emerging risks exchange network? We have asked questions about this before. We have had some reassurance, but I do not think firm decisions have yet been made, I suppose because they are subject to ongoing negotiations.

      Several important questions were not asked or considered during the consultation. What do the Government intend to do regarding, for instance, legislation surrounding export health certificates and the reference laboratories? Can the Government give more details on the timely and consistent involvement of the devolved nations in the enactment of this SI? We do not want to have divergence among the home nations in relation to these instruments, even for a short time.

    • Access to Medicinal Cannabis - Statement | Lords debates

      My Lords, I thank the Minister for the action she is taking. I have some specific questions about what she said. Can she confirm that the second opinion she mentioned will come from a doctor with an appropriate understanding of the safety and effectiveness of these drugs, and that it will be available to all patients in the same situation? Secondly, she mentioned the British Paediatric Neurology Association's interim clinical guidance, which was made very much as a snap judgment straight after the rescheduling last November; in effect, it just said, "No, no, no". Can the Minister encourage the BPNA to consider further the massive amount of evidence from abroad and produce more considered guidance? Thirdly, she mentioned the 80 prescriptions for CBD medicines, but that does not strike me as making much progress, because you can get CBD legally on the internet; the only advantage of such prescriptions is getting the drug for free. The issue concerns medicines containing THC, which are the ones that patients desperately need. Finally, the Minister will probably find that trusts are stopping doctors who would like to prescribe these medicines from doing so. Getting the NICE guidance a lot sooner than next autumn would probably encourage trusts to allow their employees to do so. Can she encourage NICE to hurry up, please?

  • Apr 1, 2019:
    • Vaccine Hesitancy - Question | Lords debates

      My Lords, any distrust of experts sends out a terrible message to all those young people who spend years of study and thousands of pounds becoming experts. Does not our education system fail unless it produces a population who can properly interrogate scientific evidence?

  • Mar 21, 2019:
    • Yoga - Question | Lords debates

      My Lords, there appear to be particular benefits of yoga for older people in improving balance and muscle tone, NICE estimates that falls cost the NHS more than £2.3 billion a year, and we know that older people often become lonely, so the mental health and social benefits of going to classes also apply. Given those facts, will the Government encourage yoga for older people?