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  • Jan 12, 2021:
    • Amendment 15 | Medicines and Medical Devices Bill - Report (1st Day) | Lords debates

      My Lords, I am honoured to follow the noble Lord, Lord Field, and the noble Baroness, Lady Meacher. I too have put my name to Amendment 15.

      Before I specifically address the amendment of the noble Lord, Lord Field, I would like to acknowledge the Minister's reply to my Oral Question earlier today about the negative effect of Brexit on the legal supply of Bedrocan, and probably other cannabis medicines, to patients in the UK. He knows that this is a life-changing and life-saving medicine, so he will understand that patients and their families are very anxious. Can he assure me that they will be kept informed about progress on sorting this out? They and their clinicians were very worried by his suggestion that there needs to be compromise on both sides. There can be no question of compromise; it would be dangerous to try to substitute this medicine for a different formulation, extracted from a different strain of cannabis.

      In response to the DHSC's suggestion to pharmacists that one cannabis medicine can easily be replaced by another, I will quote from evidence that I have received from Evan Lewis, director of the Neurology Centre of Toronto. He is a clinician with extensive experience of medicinal cannabis for adults and children, and has said:

      "It is imperative that children who are benefiting from a particular medical cannabis product are not changed to another product. There is significant variation from one product to the next, and many unknowns as to how all the cannabinoids interact with each other to treat seizures".

      He goes on to say that swapping backwards and forwards between products can be extremely dangerous and is often ineffective. This misunderstanding nicely illustrates some of the problems we face in our campaign to make the benefits of cannabis medicines more widely available to UK patients on the NHS.

      On the wider issues in Amendment 15, the key issue is how evidence is obtained about the safety and efficacy of these medicines. I see the Government's fixation with random-controlled clinical trials as a real barrier to progress in the field of cannabis medicine. When scientists are trying to investigate any issue, they always use procedures that are appropriate to the material being investigated and to answering the question asked. When you have a very small patient cohort, such as the cohort of children with drug-resistant epilepsy, it is impossible to have a meaningful clinical trial. Besides, when giving a placebo to half the sample could be life-threatening, it could be unethical.

      As the noble Baroness, Lady Meacher, said, many drugs and medical devices are already used on an anecdotal basis. For example, as she said, 78 drugs are available and in use in the NHS that have no random control trial. The vagal nerve stimulator, which is successfully used to prevent seizures in some epileptic patients, also has no RCT in relation to it. There are many drugs used on children that have not been tested in clinical trials for use in children. Indeed, some of them were used on Alfie Dingley and the other children who now receive cannabis medicines before they fortunately discovered the benefits of the latter.

      These drugs are used off-label. This is a well-used way of prescribing in the NHS. Unfortunately, clinicians are being deterred from prescribing cannabis medicines in this way by very negative government messaging, and are even threatened with sacking by their health trust. They also need more information on these matters.

      It would be appropriate to set up a formal system of observation, recording and clinical evaluation of these products in use in the UK, alongside accepting the mass of evidence from other developed countries. Such observational studies are not the same as anecdote and would most certainly result in the acceptance of the safety and efficacy of these products for certain indications. Such evidence should then be included in medical education, particularly for neurologists and general practitioners, so that they can have the confidence to write free NHS prescriptions for patients who could benefit from cannabis medicines that have been used safely for years elsewhere.

      I hope the Minister is able to tell us in response what appropriate system the Government are prepared to put in place as an alternative to clinical trials, so that UK patients can have the benefits that patients in the Netherlands, Canada, the United States and many other countries have had for years.

    • Amendment 10 | Medicines and Medical Devices Bill - Report (1st Day) | Lords debates

      My Lords, I support this amendment. When we discussed this issue in Committee, I raised the matter of Section 57A of the Patents Act 1977 and the Minister pointed out that compensation needs to be awarded to a patent holder for any loss of profits as a result of the use of a Crown use licence and argued that this should be set against the potential savings that purchasing more affordable generic alternatives enabled by a Crown use licence could bring about. Tonight, I repeat that this has never been tested in court.

      The noble Baroness, Lady Sheehan, and the noble Lord, Lord Alton, mentioned Orkambi. The fact is that if the Government had issued a Crown licence and Vertex had decided to take the Government to court for compensation, the Government would probably have won the case, because they had a very strong case. Any reasonable person would have concluded that three years of failed negotiations showed that Vertex could not make the case that the NHS would definitely have bought the product from them had a Crown use licence not been issued. Had they taken the thing to court, the Government would probably have won the case, and the fact that they did not means that they really missed an opportunity to set a useful new precedent by fighting an interpretation that would render the entire Crown use provision next to useless.

      I shall add just a few words about the Covid-19 pandemic. Many countries, such as Germany, Hungary, Canada and Australia, have made alterations to their patent laws to make issuing a compulsory licence easier, in the interests of public health. That is because, in those countries, it is accepted as a valuable tool that can help overcome pricing and manufacturing barriers to accessing crucial vaccines, medicines and diagnostics which could help save millions of lives. Will the UK Government follow this example, set a precedent, next time the opportunity presents itself, and make the necessary changes to our law to make it easier, not more complex, to use our legal right of issuing a Crown use licence to protect public health?

    • Cannabis Oil - Question | Lords debates

      My Lords, I thank the Minister for that very encouraging response. He will know that time is of the essence because these medicines prevent children having severe fits, some of which are life-threatening. Can he go back to his department and educate some of his officials? Unfortunately, a lot of the families are very upset at being told that they can safely be switched to an alternative formulation. That is both ignorant and dangerous. All the expert clinicians who know about these issues say that that cannot be done safely. Even if it could, eventually putting these children back on to the original formulation sometimes does not work. Will he make sure that his officials listen to the clinicians who are expert in prescribing and in following the progress of people on these formulations?

    • Cannabis Oil - Question | Lords debates

      To ask Her Majesty's Government what steps they are taking to ensure that cannabis oil continues to be legally available to patients when prescribed by their physician.

  • Jan 7, 2021:
    • Covid-19: Restrictions - Question | Lords debates

      My Lords, a weak link in the measures to suppress the virus has been the small percentage of people not self-isolating when they should. This is often because they cannot afford to do so. Dozens of times my Lib Dem colleagues and I have asked the Government to provide adequate financial support for self-isolators. So I ask the Minister again: in order to suppress the virus, will the Government pay the wages of poor people who need to self-isolate?

  • Jan 5, 2021:
    • Obesity - Question | Lords debates

      I thank the Minister for his reply, but he will know that we have had several obesity strategies before. What steps are the Government taking to ensure that this latest strategy is implemented in full without delay? Can he provide an update on the timelines for implementation? One of the main concerns of our witnesses was that the full range of services should be provided everywhere in the country, with easier access at any stage of the pathway. Will the Government take this on board?

    • Obesity - Question | Lords debates

      To ask Her Majesty's Government what assessment they made of the report by the All-Party Parliamentary Group on Obesity The Future of Obesity Services, published on 25 November 2020.

  • Dec 30, 2020:
    • Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 2) Regulations 2020 - Motion to Approve | Lords debates

      My Lords, the last time that we discussed restrictions, I asked the Minister whether volunteers would be used for non-medical tasks to improve the speed of testing and tracing. The Minister dismissed the idea. Now they are asking for volunteers to marshal patients in vaccination centres. Will he now recognise the important role of these public- spirited people and tell us what resources will be given to St John Ambulance to organise them?

      The Government spoiled Christmas for head teachers by insisting, on the last day of term, that schools should open on time next week and that all children and staff should be given the rapid test. Yet virtually no time, money or person power has been provided to enable them to do this. While I believe that keeping schools open safely should be a priority, what are the Government doing to support heads and teachers? Will there be enough testing kits provided for schools to use? Will staff be given priority for vaccination to give them the confidence to return to work? Will volunteers be recruited to help with the testing to allow teachers to teach?

      Children's education is vitally important, but many of them have lost weeks of classroom time intermittently, not because of lockdowns but because of serial Covid outbreaks in the school and the need to go home for two weeks-over and over again. If the imminent announcement by the Secretary of State for Health and Social Care does not introduce strict measures to stop the virus in its tracks and if the Government do not implement an efficient vaccination rollout, this stop-start education will continue. The effect on our children's education is not just whether or not we open schools but whether or not we win the battle against the virus. Does he agree?

  • Dec 16, 2020:
    • Energy White Paper - Statement | Lords debates

      My Lords, will the Government focus on green hydrogen production for heavy transport and industrial use, and phase out other types of hydrogen production as soon as possible? Our gas infrastructure for homes is currently unsuitable for pure hydrogen. What is the cost of upgrading it and how does that cost compare with installing heat pump networks, which are safer, deliverable now, cheaper and require less generating capacity than other available options?

  • Dec 3, 2020:
    • Coronavirus Vaccine - Statement | Lords debates

      My Lords, the rollout will require many people, in addition to those giving the injection. Are there any plans to use the thousands of NHS volunteers who signed up during the first lockdown to act as marshals, drivers, identity checkers, or whatever else is required? In planning the appropriate use of the military, have the Government recognised the concerns of certain community leaders that their presence at testing sites would not reassure members of their communities who are hesitant about taking the vaccine because they do not trust authority?

  • Dec 2, 2020:
    • Children: Online Grooming - Question | Lords debates

      My Lords, following up on the Minister's reply to the noble Lord, Lord Harris of Haringey, she may be aware that industry compliance in taking down child abuse images fell by 89% in the first month of lockdown. What tools are the Government using, or threatening to use, to ensure that social media companies such as Facebook design and deliver platforms and services that put child protection front and centre?

  • Nov 30, 2020:
    • Covid-19 Update - Statement | Lords debates

      My Lords, at the beginning of the first lockdown in Wales, we were forbidden from going out of our borough or travelling more than five miles for exercise. It worked. Now some Government Back-Benchers are demanding more granularity in the tier areas, with restrictions being eased in boroughs with lower case numbers. If this is to be done, it must be-as the Minister just mentioned-without risking the virus spreading from adjacent high-incidence areas, as it did before. If the Government are inclined to give in to this pressure, will they at least consider imposing travel restrictions in high-incidence areas?

  • Nov 16, 2020:
    • European Qualifications (Health and Social Care Professions) (EFTA States) (Amendment etc.) (EU Exit) Regulations 2020 - Motion to Approve | Lords debates

      My Lords, my understanding is that these regulations are a tidying-up exercise to continue to recognise existing Swiss and other EFTA health professionals with qualifications after the end of transition this year. This does not address plans for future pathways of recognition. However, I would like to focus on professionals of whom we need more to clear the backlog of treatments-that is, dentists, who are a bit different from other health professionals. Can the Minister confirm that, irrespective of any new agreement made with the European Union, the General Dental Council will be able to continue to recognise the qualifications of all graduates of dental schools within the EEA, without the need for candidates to sit the overseas registration exam?

      Can the Minister also tell me what steps have been taken by the General Dental Council to resume overseas registration examinations for non-EEA overseas dentists, which have been halted due to Covid, and ensure a continuing pathway for recruitment of EEA and non-EEA dentists? In light of the backlog of 15 million treatments, surely we need all the dentists we can get.

      As the Minister will know, the NHS dental service does not have a registration system like the medical services do. Each course of treatment is a separate contract. Even with the same dentist, there is no obligation for either party to continue the relationship after a course of treatment ends, except to sort out any issues relating to a recent course of treatment. The patient is free to go to another dentist, and the dentist is free to decline further NHS courses of treatment.

      The result of the lack of any registration system is that after a course of treatment ends, nobody has any obligation to find another NHS dentist for any patient. This gives NHS patients no security whatever about continuity of treatment, either preventive or responsive. Given that this situation has been made worse by Covid-19, and given the shortage of NHS dentistry in some areas, does the Minister's department have any plans to ensure we have enough dentists going forward after the end of the transition phase of exit from the EU?

    • UN Convention on the Rights of the Child - Question | Lords debates

      Last week, the Scottish Government put an end to the legal defence of justifiable assault, which could be used by those committing violence against children. Will the UK Government follow suit and put an end to the equivalent defence of reasonable chastisement, which is against the convention and confusing to parents, and which discriminates against some children?

  • Nov 10, 2020:
    • Covid-19: Dental Services - Question | Lords debates

      My Lords, I thank the Minister for that reply, but 60% of dentists can now see only a quarter of their usual number of patients, particularly because of the measures needed for carrying out aerosol-generating procedures. There is a backlog of 15 million treatments, and many dentists are in danger of going out of business. They cannot afford ventilation equipment, which would enable them to see more patients in a day. Will the Government provide funding for this, so that the backlog of patients can be cleared?

    • Covid-19: Dental Services - Question | Lords debates

      To ask Her Majesty's Government what measures they are taking to ensure the continued provision of dental services during the COVID-19 pandemic.

  • Nov 9, 2020:
    • Carbon Emissions - Question | Lords debates

      My Lords, by 2030, home heating emissions must fall by a quarter to be on track for zero carbon by 2050. Yet only 2% of boilers are being replaced by the cleanest, most efficient method: ground source heat pumps powered by renewable electricity such as wind. Will the Government ensure that their funding strategy and skills strategy together ensure that more heat pumps are installed in homes, because the Green Homes grant will not help with ground source heat pumps?

  • Nov 4, 2020:
    • Amendment to the Motion | Health Protection (Coronavirus) (Restrictions) (England) (No. 4) Regulations 2020 - Motion to Approve | Lords debates

      My Lords, I support the need for the lockdown and will not be supporting any of the amendments to the Motion that express regret. However, I regret the fact that the Government did not accept the advice of their scientific advisers and take the decision to do this sooner; if they had, the NHS might not have needed to move to the highest level of risk in its emergency preparedness framework this morning.

      I agree with my noble friend Lord Scriven that the Government must use the lockdown to get test, trace and isolate right. There is no point in boasting about the capacity of 500,000 tests per day; people do not trust that figure because we know that it does not mean 500,000 people tested, so it undermines trust and affects compliance. Although the processing time of the tests has improved, it is still not good enough. Tests have been returned several days late or are sent back to the wrong care home, so they are of no use.

      Isolating rates may be as low as 10% and the ability of police and local officials to enforce quarantine is low. We need to use the carrot rather than the stick and make more support available for those isolating. I heard an MP the other day say, "Just pay their wages". After all, it is for only two weeks, but it would have a massive effect on people's willingness to isolate, and that matters for getting the R rate right down. If we do not reduce the R rate well below one, it will cost the economy a lot more because the lockdown will have to be extended. Will the Government consider this?

      The Government are now trialling the new mass testing system in Liverpool, and I wish it well. However, from residents' comments I have heard, they do not seem to have the messaging right. People are questioning why they need to take a test if they feel well. That, of course, is the point-testing potentially asymptomatic people-but, clearly, the message has not got through. What does the Minister propose is done about that?

      Now that the rapid test is available, could it please be given to relatives of care home residents so they can safely visit their loved ones whom they have not seen for many months? Finally, there are children with very rare diseases who need special treatments which schools cannot cope with and who therefore cannot go to school, and their parents are getting to the end of their tether. The prospect of another four weeks of lockdown fills them with dread. They also need more clarity about who should shield. Will the Minister look into this because these families have been left behind?

  • Oct 22, 2020:
    • Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) Regulations 2020 - Motion to Approve | Lords debates

      My Lords, I agree with the noble Lord, Lord Rooker, about the difficulty posed by the complexity of these regulations, and with the noble Lord, Lord Hunt. Poorer people, without a smartphone that supports the NHS app, are more likely to be fined if they fail to isolate than those who have the app. This is because, without the app, the only way that they can be asked to self-isolate is by test and trace or a council official. If those with the app who learn that they have had a contact are not subsequently contacted by test and trace and asked to self-isolate, nobody will be able to enforce the penalty if they do not.

      Given the poor record of NHS Test and Trace in contacting those who have tested positive and their contacts, that would leave an awful lot of people not self-isolating and not liable for a penalty if they do not. I am concerned that these penalties may deter people from taking a test. Also, a person who tests positive may be quite reluctant to disclose any contact who they predict is not likely to be able to self-isolate, in case they expose them to the possibility of a big fine.

      Like the noble Lord, Lord Hunt, I am also concerned about the disclosure that the police will be given the details of people who have been asked to self-isolate. The BMA and the Chief Medical Officer have expressed concerns that this could also deter people from getting a test, and this would apply in particular to those who feel that they cannot afford not to go to work. Why is it necessary to involve the police? This is a disclosure of health information and an invasion of privacy. If the police are informed, what guidance and training are they given about how to approach the person concerned? Will they initially explain why self-isolation is important and direct them to support before using the big hammer of a fine?

  • Oct 15, 2020:
    • Covid-19: Access to Vaccine - Question | Lords debates

      My Lords, it is reported that the UK has bought six experimental vaccines, stockpiling 340 million doses, awaiting the results of clinical trials. While this is probably a wise strategy, can the Minister say how much the Government have paid for these? This is enough to vaccinate our population five times over; will any surplus licensed stock be distributed to poorer countries?