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  • Mar 14, 2019:
    • Food and Feed Imports (Amendment) (EU Exit) Regulations 2019 - Motion to Approve | Lords debates

      Given the importance of these issues-this is life-saving information-the Government have had two and a half years to do this and we are told that it has been a top priority. We know that, even if we leave the EU at the end of March or May, or whenever, there will be years of negotiations from that point. There is no certainty on exit day; we get certainty only at the end of this very long period of renegotiation of trade deals, relationships with institutions and so on. In the meantime, we are all concerned about the safety of our food. Telling us that we are working very hard and all want a close relationship is encouraging and helpful, but it is not what we need.

    • Food and Feed Imports (Amendment) (EU Exit) Regulations 2019 - Motion to Approve | Lords debates

      My Lords, I thank the Minister for her introduction. The general comments that I made about the first pair of SIs will apply to this second group, which concerns the relationship of the FSA and the FSS with the EFSA after Brexit. I agree with the noble Lord, Lord Dubs, on his point about the very short time that it is estimated businesses will require to familiarise themselves with and disseminate these regulations. I raised exactly the same point last week in the Moses Room on another group of SIs. I remain suspicious that this staggeringly small estimate was made to avoid the need for an impact assessment.

      I accept the Minister's statement that these SIs involve no policy change, but they alter who has the power to change them in the future and who will carry them out. For example, the food and feed imports regulations give quite a bit of power directly to the Secretary of State-in this case, Mr Gove, I think-amounting to the sort of power grab we have become used to in recent government proposals. Despite assurances from government that animal welfare and public health concerning food and feed controls will not be at the mercy of upcoming trade deals, it is possible to argue that the powers conferred on the Secretary of State could allow for that. Can the Minister assure us that this will not happen? If it does happen at a later stage, she should be assured that I will come back to haunt her.

      If the EFSA and FSA/FSS do not align, regulatory divergence will create difficulties for our importers and exporters, but nothing has yet been clarified. We might start with aligned regulations but the Government have always claimed that leaving the EU will allow us to be free as air to improve our regulations in the future. However, does the Minister accept that, if we do so, we will no longer be aligned, and that could cause problems for our food exporters, who may already be being hit by increased tariffs, and limit what importers can bring in? I would be very interested in her comments on that.

      I turn to the second SI-the official controls for feed, food and animal health and welfare regulations-which refers to the movement of animals and goods between countries in the single market and to what can enter the market. Again, I accept that this package of regulations does not amend general hygiene laws; it just amends the methods used to verify compliance with them. However, in that respect, is the Minister confident that we have enough staff in the right places to verify compliance, and how will it be done if the Irish border remains open, as we all hope it will?

    • Food and Feed (Chernobyl and Fukushima Restrictions) (Amendment) (EU Exit) Regulations 2019 - Motion to Approve | Lords debates

      I was not referring just to things that happen in the UK. We need rapid information about things that happen in the European Union that can so easily come over here.

    • Food and Feed (Chernobyl and Fukushima Restrictions) (Amendment) (EU Exit) Regulations 2019 - Motion to Approve | Lords debates

      My Lords, I thank the Minister for her introduction. Although these SIs are relatively non-contentious, I have some general and then some specific comments and questions. Of course, our main concern in all of this is the safety of consumers and of the food that we eat.

      One of the enduring reservations in the responses to the consultation, especially by the National Farmers' Union, was about the lack of clarity on the relationship that the Food Standards Agency and Food Standards Scotland will have with the European Food Safety Authority. A common approach is necessary to harmonise trade and maintain continuity, but the UK Government have given no convincing assurances yet as to how the EU and the UK will work together on this. The feasibility of a complementary EU-UK framework is doubtful, as third-country participation is possible only if the third country applies all EU-related legislation. It also relies on good will on both sides and, given how much we have messed the EU about recently, it could be forgiven for being somewhat less than co-operative.

      Neither has the UK framework yet been set up for harmonisation across our devolved authorities-although I understand that the FSA and FSS are working on proposals. This is deeply unhelpful for business as exit day draws closer. Can the Minister say what arrangements are in place now? The NFU has also noted the impact on the FSA and FSS workforces, and, although the chair of the FSA reassured the EU Environment and Energy Committee about its readiness, the chair of the committee, my noble friend Lord Teverson, warned that,

      "the UK Government has no idea whether we will have full access to EU risk assessments, or any access to their surveillance and information sharing mechanisms. This is deeply concerning".

      We rely heavily on and contribute heavily to the European Rapid Alert System for Food and Feed. It helps to save lives. The public portal allows consumers to look for warnings about allergens in imported foods that are not labelled as containing them on the packaging. Will we lose access to that portal when we leave and will we be immediately setting up our own-not some time during the implementation period but right away? This is a serious issue.

      I have a few specific comments about the two SIs. On the first one about prohibiting food imports from areas affected by the Chernobyl and Fukushima nuclear accidents, currently there is a moratorium on imports. The Chernobyl restrictions are due to be reviewed in 2020 and the Fukushima restrictions in 2019. The SI will enshrine these dates in UK law and does not amend them. I accept that and we support these measures. However, once the UK is no longer a member of the EU or Euratom, the FSA, the FSS and local authorities will have the responsibility of checking that standards are being maintained. This is likely to lead to regulatory divergence. In addition, given how cash strapped local authorities are, how confident is the Minister that they will have enough trained staff to do this? Some local authorities no longer have a full-time food and feed officer.

      On the SI that regulates the amount of radioactive contamination in food, we learn that when it is "scientifically justified", the Government can amend the permitted levels of radioactive substances through statutory instruments, following an alert from the FSA about any nuclear incidents that may affect food. The Secretary of State then decides what steps to take. Why is this additional power for the Secretary of State necessary when the head of the FSA has said that those powers will be conferred on the FSA anyway at a later, unspecified date? But why not straightaway? Why do we have to give it to the Secretary of State?

  • Mar 11, 2019:
    • Brexit: Food Labelling and Food Safety - Question | Lords debates

      My Lords, the consumer portal of the rapid alert system is particularly useful for consumers who are concerned about food safety and allergies. For example, in the last few weeks it has contained warnings about E.coli in cheese, norovirus in oysters and chocolate bars with peanuts in them that had no warning about peanuts on the wrapper. All those items came from the EU, so what advice will the Minister give to consumers about where they should go in future for this life-saving information? Are we to have our own portal and how quickly will it be set up?

  • Mar 7, 2019:
    • Brexit: Import of Radioisotopes - Private Notice Question | Lords debates

      My Lords, it is not this House that needs reassurance but doctors and consultants, who are feeling the need to reduce their treatment lists next month because they simply do not trust the Prime Minister to avoid a no-deal Brexit. The reason for that is because she adamantly refuses to take it off the table, despite the fact that, as a negotiating tool, it is about as much use as a chocolate fireguard. The other side knows that she cannot use it; when will she take off the blinkers?

  • Mar 4, 2019:
    • Cannabis: Medicinal Use - Question | Lords debates

      My Lords, when the Chief Medical Officer recommended that cannabis medicines be rescheduled, she produced a report showing that the most rigorous regulatory authorities in the world-those in the US, Australia and Ireland, as well as the World Health Organization-had strong evidence of the benefits of cannabis-based medicines for people with epilepsy. In light of that, it is completely unacceptable that only four licences have been granted. Why are UK patients being deprived of these safe and effective medicines which have fewer side-effects than some licensed pharmaceuticals, such as sodium valproate?

  • Feb 28, 2019:
    • Safety of Medicines and Medical Devices - Motion to Take Note | Lords debates

      My Lords, I also congratulate the noble Lord, Lord O'Shaughnessy, on achieving this debate and on his passionate opening speech. There can be no greater issue in relation to medicines and medical devices, apart from whether they work, than whether they are safe. I hope that the House will not be bored by the fact I agree with him, as I agree with the noble Lord, Lord Hunt. I will focus on similar issues but I also want to talk about the role of community pharmacies in ensuring the safe and cost-effective use of medicines and medical devices.

      As we know, sodium valproate is a medicine prescribed for certain kinds of epilepsy and bipolar disease, and we know about the dreadful rates of birth defects in the babies of women taking these medicines during pregnancy. Despite the fact that clinicians were advised to prescribe valproate only to patients who had effective contraception and for whom no other medicine worked, and guidance was given about patient information and consent, questions arise about whether that is happening. In October 2016, a group of epilepsy charities surveyed nearly 3,000 women and reported that 20% of those who were taking sodium valproate were not aware of the risks in pregnancy. The survey was repeated a year later, when it was found that 18% of women taking the drug still did not know the risks, and 28% of women said that they had not been informed of the risks in pregnancy despite the availability of the MHRA toolkit produced in February 2016. More than two-thirds of women taking sodium valproate said that they have not received the toolkit. Philip Lee, the chief executive of Epilepsy Action, is calling for a mandatory discussion of the risks with a health professional for all women with epilepsy on valproate so that they can make informed choices before they conceive. Does the Minister agree with that?

      On 30 November 2016, in answer to a question from my right honourable friend Norman Lamb MP in another place, the Minister in her former incarnation said:

      "In order to monitor the effectiveness of the valproate toolkit, the MHRA has sought feedback from all stakeholders and will continue to work with the Royal Colleges, professional bodies, patient groups and relevant charities to increase awareness of the toolkit among general practitioners, pharmacists and patients. The MHRA's current priority is working to ensure that women taking valproate are fully aware of the risks in pregnancy".

      Can the Minister now say what percentage of women taking valproate are receiving the MHRA materials? That is absolutely crucial to their informed decision. In addition, what lessons have been learned about how effectively to cascade down information and materials produced centrally? If they are produced centrally, however good they are, they are no use at all unless they get to the patients.

      I turn from one medicine with considerable risks that have not been sufficiently taken into account to others for epilepsy where the risks are very low, as has been proved in other countries, yet their accessibility for patients with epilepsy in this country is not very good. I am talking about cannabis-based medicines, which, despite the change in their regulatory position last year, are still not getting to adults and children with epilepsy and other conditions which could benefit from them. Can the Minister update us on that?

      The other issue mentioned by the noble Lord, Lord Hunt, is the use of vaginal mesh for pelvic organ prolapse. He is absolutely right: the NHS was very slow to listen to patients with complications after surgery and options were not available to them. Eventually, the Mesh Oversight Group was set up, which consisted of relevant professionals but, crucially, also included patients. One of its recommendations was addressing the knowledge of GPs, because it is to GPs that women go first. They go to GPs when they first realise that they may have a prolapse but, after the surgery, they go back to the GP when they feel that they have complications. The problem is that GPs do not necessarily realise what the cause might be.

      As the noble Lord, Lord Hunt, mentioned, this report has particular focus on women who have developed complications. It is very important that they have access to specialist centres with multidisciplinary teams able to advise them and treat complications. I support the call of the noble Lord, Lord O'Shaughnessy, for those to become specialised commissioned hospital services. The Royal College of Surgeons, in its rather late briefing for this debate, also called for clinical trials and traceability by barcoding for all medical devices for implantation. That is important across a wide range. Can the Minister update us on the progress of those recommendations and tell us what lessons have been learned about patient involvement in policy-making? Finally, can the Minister or the noble Baroness, Lady Cumberlege, tell us about the progress of the Cumberlege review?

      Given the shortage of time that GPs have to spend with their patients, community pharmacies have a big role to play in ensuring safe and cost-effective use of medicines. The New Medicine Service provides support to patients who have been newly prescribed medicines for long-term conditions. It is intended to improve medicines adherence and is focused on a small range of conditions. It has been assessed on its effectiveness and come out very well, but pharmacists are now suggesting that the service should be extended into other medical conditions where there is significantly poor adherence to the medicines regime. Is that proven intervention to be extended to other medical conditions?

  • Feb 25, 2019:
    • Mental Health: Eating Disorders - Question | Lords debates

      My Lords, in some areas, referrals for treatment are at a later stage of the illness than otherwise because some CCGs have increased the threshold for criteria to be satisfied before a referral can be made. This will result in increased cost and, very often, decreased effectiveness. Have the Government done any assessment of this situation and the impact it could have on patients?

  • Feb 20, 2019:
    • Human Fertilisation and Embryology: Frozen Eggs Storage - Question | Lords debates

      My Lords, the Minister has just claimed that the current law has public support. Can she say how recently that was explored and what the result was? Also, does the time limit have any effect on a woman's decision whether and when to have their eggs harvested, and when to use them? Has any research been done on that and if not, why not?

  • Feb 19, 2019:
    • Honda in Swindon - Statement | Lords debates

      It is a fact.

    • Honda in Swindon - Statement | Lords debates

      My Lords, I noticed that the Minister did not answer the point made by the noble Baroness, Lady Altmann, about the Government's options in relation to no deal. A few minutes earlier she fell into the trap, which many Ministers fall into, of stating something that is not correct: that the only alternative to no deal is a deal. That is not correct. We have the opportunity to unilaterally withdraw Article 50, to request an extension or to put the matter to the people of this country again. Why do the Government keep saying something that is incorrect? They put 29 March 2019 into the legislation and they can remove it but stubbornly refuse to do so.

  • Feb 7, 2019:
    • Brexit: Counterfeit Medicines - Question | Lords debates

      I thank the Minister for her reply and welcome her to Oral Questions. Under the falsified medicines directive, UK patients can have the confidence that their medicine is a genuine product and has not been tampered with, but if we have a hard Brexit we will have only seven weeks either to recreate the barcode system at great cost, which is impossible in the time, or agree a fee to remain part of the system. Has the UK had any preliminary negotiations about such an agreement? If so, is there an estimate of what it would cost to be part of the system as a third country? Is this not yet another cost of Brexit that the people were not told about in 2016?

    • Brexit: Counterfeit Medicines - Question | Lords debates

      To ask Her Majesty's Government what plans they have to protect patients from counterfeit medicines after the United Kingdom has left the European Union.

  • Feb 5, 2019:
    • NHS: Workforce Implementation Plan - Question | Lords debates

      My Lords, is the Minister aware that the planned rollout of the new, more sensitive screening test for bowel cancer has been delayed because of a shortage of appropriate staff to undertake the follow-ups? That is life-saving work. What is the Government's plan to correct the situation?

  • Jan 31, 2019:
    • NHS Long Term Plan - Motion to Take Note | Lords debates

      My Lords, I too congratulate the noble Lord, Lord Hunt, on his speech. I will focus on obesity and my colleagues will focus on other areas.

      Chapter 3 of the plan proposes improvements in cancer, cardiovascular disease, stroke, diabetes, respiratory disease and mental health. But the disease of obesity is often the root cause of these and is one of the top-five risk factors for premature death. Obesity services are mentioned in chapter 2, but the problem is that there is no recognition that obesity is a disease, the prevention and treatment of which is vital to avoiding a wide range of other diseases. Bringing professionals of many disciplines together to work on this in primary care settings is essential to success. This is not all down to the NHS. Local authorities have a big role to play, along with CCGs. However, because of their progressive underfunding, many have had to withdraw services. From 2016 to 2017, the percentage of CCGs reported as commissioning tier 3 services went down from over 68% to 57%.

      I was pleased to read that the NHS will provide more access to weight management services in primary care for people with a diagnosis of type 2 diabetes or hypertension with a BMI of 30-plus. But do you have to wait until you get sick to access these services? I was also pleased that the NHS has noticed the remarkable success of the GP Dr Unwin, who got hundreds of his type 2 diabetic patients into remission through low-calorie and low-carbohydrate diets, and is now going to run a pilot scheme of its own. However, professionals working in the field are clear that obesity is not just a lifestyle choice which can easily be reversed by exercising more or eating less-it is much more complex than that. Will the NHS follow the proven cost-effective model of the Fakenham weight management service, which uses a multi-disciplinary team to give personalised tier 3 services to suitable patients? They provide specialist nurses, dieticians, exercise professionals, consultant endocrinologists, psychotherapies and pharmacotherapy, and can refer some for bariatric surgery, which is also very cost-effective.

      Recognition of this disease would remove the stigma and mental illness experienced by sufferers, and focus attention on treatment and research. The mechanism of obesity disease is not yet fully understood, but genetics play a part. It appears that the brains of sufferers respond differently to hormones generated in parts of the gut which tell the brain that the person is full and does not want any more to eat. So far, a few drugs have been developed to mimic this normal response, and these have been helpful to many patients. Patients who have undergone bariatric surgery show this phenomenon dramatically. Their diabetes disappears overnight and they lose weight rapidly but do not feel hungry.

      Whatever the cause, will the Government make the commissioning of tier 3 weight management services mandatory, because then all CCGs would have to provide them? This could save a lot of misery, and save the NHS millions.

  • Jan 30, 2019:
    • National Health Service: Missed Appointments - Question | Lords debates

      My Lords, this morning I had an appointment at a hospital in Wales, for which I had two reminders on my mobile phone, yet because I live in Wales I do not have access to the NHS app to make appointments with my GP. First, as the app develops, would it not make sense to add reminder functionality to it to remind people of their GP appointments? Secondly, what discussions have taken place with the Government of Wales to allow patients in Wales the same advantage from digital health management as patients in England?

  • Jan 24, 2019:
    • Climate Change - Motion to Take Note | Lords debates

      My Lords, yesterday I received a letter from four children called Bamba, Louie, Oscar and Jakson, from year 6 at the Rofft Primary School in Marford, near my home. They are learning about climate change and are concerned that polar bears are losing their habitat. They have questions for the Government which I will come to later. To help me reply to the children, I turned to scientists at one of our leading Welsh universities, Bangor. They told me about the increasing rate of decline of the sea ice in the Barents Sea, and the feedback loop which will mean that within a decade the limit of the Arctic habitat may have moved a great deal further north. As mentioned by the noble Baroness, Lady Brown, there is little we can do to stop it-it is going to carry on. This indicates the danger of the 1 degree of warming we already have, already affecting our climate in the UK. Last year's "beast from the east" may very well have been caused by it, so polar bears are not the only ones affected by loss of sea ice-we are too.

      The noble Earl, Lord Caithness, may not, but 97% of scientists agree that greenhouse gas emissions are the cause of our warming climate. The Paris accord and government policy were based on estimates of how quickly we need to reduce emissions to avoid the dangerous 1.5 degree rise. However, a recent article in Nature magazine quoted evidence that current predictions may be too conservative and we could get to dangerous levels as early as 2025. The Government's target of 2050 may sound a very long way off-though it is not for the children of the Rofft school-but 2025 is a great deal nearer.

      Far away from the polar bears' habitat, but also related to warming oceans, Dr Gareth Williams of the School of Ocean Sciences at Bangor drew my attention to the effect of the more severe climate change estimates on coral reef regeneration. His conclusion is that in some areas it is much more severe than previously predicted. The warming effect that would result, even if all the Paris Agreement pledges are realised, would not allow corals sufficient time to regenerate between bleaching events.

      Why should we in the UK care about coral reefs? The answers are: biodiversity; new medicines; fishing to feed millions; that the loss of low-lying islands means the relocation of people; and that the UK has several overseas territories with coral reefs. Is the UK prepared for increased frequency and intensity of coral bleaching events? What if we start to lose some of our overseas territories due to the erosion of coral reefs? Many of these places support human populations and some house military bases that we share with allies. Will the Government respond to the latest research and revise their emission targets to halt the speed at which ocean warming events are occurring? I agree with the noble Lord, Lord Rees, that the Paris Agreement is not enough-it will be too little too late.

      Moving from sea to land, every sector must reduce its impact on climate change. Agriculture accounts for 9% of UK greenhouse gas emissions. Another paper from Professor Chadwick of Bangor showed that greenhouse gas emissions from global agriculture are increasing at around 1% per year, yet substantial cuts in emissions could be achieved. His group assesses the mitigation potential of land sparing: increasing agricultural yields, thereby reducing the area of farmland needed and at the same time actively restoring natural habitats on the land spared. Restored habitats such as broad-leaved woodlands, wetlands and peatlands can sequester massive amounts of carbon and offset emissions from agriculture. The study showed that planting mixed broad-leaf woodland is much better at sequestering carbon than monocultures of fast-growing conifers, as well as promoting biodiversity. As has been said, it also contributes to cooling, prevents soil erosion and flooding, and slows down the release of fertilisers into waterways. Combining this approach with strategies to reduce food waste and meat consumption could help the UK achieve its climate objectives.

      Higher yield potential could mean 30% to 40% of current farmland being used for carbon storage, with numerous biodiversity and social benefits. The researchers concluded that if this "spare land" was used to increase UK tree cover from 12% to 30% by the middle of this century and to restore 700,000 hectares of wet peatland, the farming sector could deliver its contribution to the legal target of cutting carbon emissions by 80% from 1990 levels.

      The most promise was shown by improved crop plants that are more efficient at capturing nutrients from the soil, using water and photosynthesising. This requires investment in non-medical life science research, which had only a minor role in the Government's industrial strategy, so I agree with the noble Lord, Lord Selborne, about the potential improvements that we could make through agriculture. Will the Minister say what work is being done in this area? Might our revised agriculture environmental support strategy, aimed at payments for delivering ecosystem services, result in displacing food production overseas unless we improve our own yields at the same time? There is a danger that, unless we increase yields, we could reduce our own emissions at the expense of those of other countries where there might be worse environmental and animal welfare standards.

      Is Defra looking at land sparing? What government support is being given to efforts to plant more trees? As for the children, they ask what the Government are doing to get companies to reduce their emissions since only 10% of companies have a strategy for doing so. They are going to write to some local companies to ask them. They also want the Government to encourage more use of renewable energy. I think those are very sensible questions and I hope the Minister can answer them.

    • Brexit: Insulin Supplies - Question | Lords debates

      My Lords, there is already evidence that some insulin is going on restricted supply, which means that a pharmacist, once she has used up her allowance, will have to spend valuable time going direct to the manufacturer to prove that she has the prescription. Pharmacists tell me that this is a nightmare and takes up a lot of time that they could otherwise spend advising patients. What advice will the Minister give to pharmacists in this situation?

  • Jan 15, 2019:
    • Breast Cancer: Women Over 73 - Question | Lords debates

      My Lords, has the department carried out any research-and if not, will it do so-into the number of women, like me, who were diagnosed with breast cancer on the final routine mammogram for which they were called? If the number is substantial, surely that indicates that the age range for the routine screening service should be extended, particularly in the light of the fact that we are all getting older.