Medicines and Medical Devices Bill

Baroness Bennett of Manor Castle Excerpts

Committee stage & Committee: 2nd sitting (Hansard) & Committee: 2nd sitting (Hansard): House of Lords
Monday 26th October 2020 Grand Committee

I know my noble friend the Minister to be a compassionate person who resonates with those who suffer. He is aware of the support that my review has received on Second Reading, and again today, and I again thank noble Lords for that. However, I have received not only parliamentary support in both Houses but huge encouragement from a wide range of organisations and individuals, nationally and internationally. Indeed, Scotland has embraced this report and is already in the planning stages of implementing the recommendations relevant to it. Will my noble friend tell the Committee therefore what plans are being made in England to implement the report? The issue of safety cannot dally: it needs immediate action. As we know, he is not shy about putting forward his amendments. He has told us that he listens and understands how we can make this Bill better. I am sure that there is scope to incorporate what I seek through a government amendment to be discussed on Report. I look forward very much to his reply.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, it is a great pleasure to follow the noble Baroness, Lady Cumberlege, and her enormously powerful contribution. I wholeheartedly endorse her concerns about safety and share her worry that patient safety is still not being prioritised after so many years of disaster stories. One cannot but note the gender aspects of the failure of medicine over so many decades—not listening to patients, particularly female patients. Clearly we need to make this Bill better, with a focus on safety.

The report by the noble Baroness spoke to me very personally. My late mother suffered decades ago from endometriosis. She was not listened to or taken seriously and I have been distressed and angered by hearing, just this week, reports of how difficult endometriosis patients still find it to get taken seriously and obtain the treatment they need. The noble Baroness, Lady Cumberlege, has done a brilliant piece of work in highlighting these issues, with a focus on particularly abusive cases.

I have been following the story of vaginal mesh with a sinking heart for some years. It is such a familiar account of vulnerable, suffering individuals being trampled over, ignored and even derided by commercial interests. “First do no harm” is, indeed, a principle that a company —every company, not just those in healthcare—should be forced to consider as a key part of its approach.

However, at this point I will speak chiefly to Amendment 59, which is in my name. I apologise for not coming in to support earlier excellent amendments, or indeed others in this group. With our small Green group juggling crucial issues tangled up in the Government’s legislative pile-up, I just did not manage to get there. I thank the small number of Peers who are carrying a huge weight in this Committee. Amendment 4, tabled by the noble Baroness, Lady Thornton, was particularly important, but many amendments contain constitutional and legal principles that make it a particular regret that so many potential contributors—both last week and today—are in the main Chamber. However, as I plan to speak at some length to the group starting with Amendment 18, I will be brief here.

Amendment 59 seeks to ensure that the welfare of animals is considered when making regulations about veterinary medicines. I can see that some might think that health and welfare go together, but that is not always the case, particularly in the world of factory farming and considering the context in which noble Lords are seeking, on the Agriculture Bill and Trade Bill, to defend existing veterinary and farming standards against the introduction of truly dreadful health and welfare standards from elsewhere.

There has been a tendency to use drug treatments as an alternative to decent husbandry. Animals might be protected from disease arising from miserable, crowded, inadequate conditions, but their welfare is not being protected. Any intervention should improve their welfare, not block disease caused by misery.

Animals might also be given drugs. I am thinking here particularly of the use in the United States of antibiotics, as growth promoters, and of growth hormones, which leads to animals becoming overly large—sometimes too large to move themselves around, which can be a great source of misery. We might find drugs being sought or used as sedatives to keep animals in conditions in which they would otherwise be uncontrollable or dangerous. The answer is not to drug them but to ensure proper conditions. Health and welfare must go together. That needs to be in the Bill and I hope that the Government will consider including this amendment.

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Moved by

[Baroness Bennett of Manor Castle]

18: Clause 1, page 1, line 12, at end insert—
“(d) the environmental and social impact of such medicines, including their manufacturing.”Member’s explanatory statement
This amendment seeks to ensure that the environmental and social impact of medicines is considered in the making of regulations.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, I shall speak also to Amendments 25, 41, 80 and 91, which are also in my name.

My intentions in participating in this Committee and engaging on this Bill were originally modest. As a feminist and someone concerned about the impact of the profit motive on healthcare, I wanted to back up the work of the brilliant, ground-breaking and terribly important report prepared by the noble Baroness, Lady Cumberlege. However, when I looked at the Bill, I saw some gaping holes, which I have done my best to fill with assistance—which I wish explicitly to credit—from the British Society for Antimicrobial Chemotherapy; Dr Felicity Thomas, co-director of the WHO Collaborating Centre for Culture and Health at the University of Exeter; and, on the medical devices side, Team Consulting, which has provided me with a great deal of pro bono assistance. I am informed also by participants in the Westminster Health Forum event on sustainability in healthcare that I chaired recently.

The context in which this Bill comes before us is an ageing demographic, the rise of chronic health conditions in our deeply unhealthy society, and the advent of “lifestyle” drugs, all of which have been key drivers in increasing use of pharmaceutical medicines and, although I do not have any statistics on it, I would also believe in medical devices. Prescriptions for just one type of statin used to reduce cholesterol rose from 12.8 million items to 18.2 million items over one year alone. One in six 18 to 64 year-olds was prescribed antidepressants at some point in 2017, rising to one in five of those aged 65 and over.

Critics of the pharmaceutical industry have highlighted how a “culture of optimism” generates new drugs, which increases the demand for such treatments while exaggerating their benefits and not counting their flow-on costs, including the environmental. Medicines and medical devices already have significant environmental impacts which, in the context that I have outlined above, are likely to grow rapidly. As we tackle many other causes of environmental damage, the proportionate impact of medicines and medical devices will grow unless we act.

The point that I am about to make is crucial. I note that the veterinary medicines section of the Bill states that

“the appropriate authority must have regard to … the safety of veterinary medicines in relation to animals, humans and the environment.”

I ask the Government why “the environment” appears only in the veterinary medicines section, when, as I will set out, human medicines and medical devices have significant environmental effects.

There are well-known concerns about veterinary medicines—I note in particular the impact of anthelmintics on insect life—but these issues are not contained to them. Why is there no parallel provision in the medicines and medical devices parts of the Bill? I ask the Government to consider parallel provisions from the veterinary part in the human medicine and medical devices part, which is what my amendments aim to achieve.

I am well aware that people will say that human health is different and has to be the top priority, and I agree with many of the issues about safety and health that we talked about in earlier groups of amendments. But this is not a case of saying that we have to weigh health benefits against environmental ones; it is not either/or. As Covid is reminding us, public health is very dependent on the state of the environment, whether that is in the rising danger of zoonoses; the spread of antimicrobial resistance; the well-documented impact of air pollution on health; or the as yet little understood but extraordinarily pervasive existence of microplastics in the air, soil and water in our lives. This is systems thinking—the sustainable development goals approach to which the Government are signed up.

If we look for an overarching way to think about this, the phrase “green pharmacy” recognises the potential for designing new drugs that are less harmful for the environment, whether in their composition, their impact when they escape into the environment or their packaging. It is clear to me that the expectation of this approach should be built into this legislation.

There are some examples of this happening. A project under the EU’s innovative medicines initiative aims to develop tools to screen environmental properties earlier in drug development. I hope to see that transferred into automatic practice in the UK through this legislation. In Sweden, Stockholm county council grades medicines on their environmental effects and doctors can choose to prescribe a less harmful drug where the option exists. If the Government want to be world-leading, that is the standard to be ahead of. The organisation Health Care Without Harm has elaborated 15 recommendations to the European Union for sustainable healthcare. I hope the Government are already well aware of those.

With the exception of Amendments 41 and 91, the amendments do not spell out in detail, in keeping with the Bill’s status as a framework Bill, what kind of provision should be made, although I suggest that they should be included in regulation. They set out the environment as a key issue in the development of medicines and medical devices, and their manufacture, distribution and use. I suggest that that is essential.

Amendments 18 and 25 both look at environmental impacts, with Amendment 25 explicitly about the disposal of unused medicines and the impact of medicines that otherwise reach the environment. That often, although not always, means talking about how medicines reach waterways and get into our drinking water. A 2014 report by UK Water Industry Research found that, in most of 160 sewage treatment works studied, several common drugs were present in the final effluent in concentrations high enough to potentially affect ecosystems. With current trends, the amount of pharmaceutical effluence leaching into waterways could increase by two-thirds before mid-century, according to a 2018 study by the Delft Institute for Water Education.

There are three ways in which drugs can enter into our waterways: by passing through the body, through being disposed of in waste, or during or after manufacturing. It is worth noting that, globally, over half of all medicines are prescribed, dispensed or sold inappropriately, and that half of all patients fail to take them as directed. Unused and waste medicines are also a problem, when they stay within the healthcare system. In the UK, the estimated cost of dealing with medicine waste in the NHS ranges from £100 million to £300 million a year. Research undertaken in Germany found that up to 16,000 tonnes of pharmaceuticals were disposed of annually from human medical care, with 60% to 80% of these drugs flushed down the toilet or placed in normal household waste.

I am aware that, in this context, there are often disproving statements of, “Patients are not disposing of the drugs properly”, but there is often very little information on drug packets or in information given to patients. I have heard anecdotal reports of people taking drugs back to their GP for appropriate disposal and being told, “Why are you doing that? Just throw it in the bin.”

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[Baroness Penn (Con)]

My Lords, the noble Baroness, Lady Bennett of Manor Castle, is a tireless champion of matters environmental and I am at one with her in wanting to consider sustainability in all that we do. However, I do not think these amendments are necessary and they are not strictly within the realms of regulating medicines and medical devices, which is what the Bill seeks to deal with.

Legislation is already on the statute book regarding the impact on the environment more broadly. In fact, I suggest that the Bill is part of a wider legislative canvas that delivers what the noble Baroness seeks reassurance on. Within that wider canvas is legislation on packaging waste, which is enforced by the Environment Agency in England. That imposes obligations on packaging producers to seek to reduce the amount of packaging produced, reduce the amount of waste going to landfill and increase the amount of packaging waste that is recycled. I will pick up her point on the production of medical devices being within this principle of producers being responsible for manufacturing waste and write to her on it.

Turning to elsewhere on the canvas, I say that there is also legislation on the statute book to address the environmental impact of producing and disposing of manufactured goods such as medical devices. This includes the Waste Electrical and Electronic Equipment Regulations 2013, which require the recycling of certain types of electrical equipment, including some types of medical devices. I hope that provides the noble Baroness with reassurance that these regulations are part of a wider whole.

The noble Baroness, and the noble Baroness, Lady Wheeler, also raised the importance of the appropriate use of reusable medical devices, which is essential to the provision of health services, with many medical devices being reusable in some form. I think we all agree that it is vital to ensure that decontamination of those devices is possible and, where it is, that it is efficient, effective and safe for patients to reuse. I assure the noble Baronesses that, under Clause 13, we would have the power to make provisions specifying that reusable medical devices must be designed and manufactured in such a way as to facilitate decontamination.

Amendment 25 deals with the important issue of medicines waste and medicine disposal, also touched on by the noble Baronesses, Lady Barker and Lady Wheeler. The environmental impacts of these are taken seriously, but dealt with by other legislation. For example, the Environmental Protection Act 1990 makes provision for the safe management of waste. The Act imposes a duty of care on any person who disposes of controlled waste to take all reasonable steps to ensure that it is not disposed of in a manner likely to cause pollution of the environment or harm to human health. Community pharmacies must comply with this legislation, and the NHS community pharmacy contractual framework makes specific provision for pharmacies in England to act as collection points for the public’s unwanted medicines. These returned medicines are then stored securely by pharmacies until they are collected for safe disposal.

I understand that the noble Baroness and others may also want to know what we are doing to reduce waste medicines in the first place. Medicines optimisation is a key workstream within NHS England’s medicines value programme; it aims to ensure that the right patients get the right choice of medicine at the right time. Through focusing on patients and their experiences, the goal is to help patients to improve their outcomes, take their medicines as intended, avoid taking unnecessary medicines, reduce wastage of medicines, and improve medicines safety.

The Secretary of State for Health and Social Care has asked Dr Keith Ridge, the chief pharmaceutical officer for England, to carry out a review of overprescribing in the NHS. Following a pause due to the Covid-19 pandemic, the review is due to report later this year. This work is looking at reducing inappropriate prescribing with a particular focus on the role of digital technologies, research, culture change and social prescribing, repeat prescribing, and transfer of care. The report will provide recommendations to reduce overprescribing, which will help to reduce medicines wastage.

Amendment 41, proposed by the noble Baroness, Lady Bennett, highlights the serious and growing global problem of antimicrobial resistance, or AMR. It has been placed on the National Risk Register of Civil Emergencies as a “longer term trend” likely to change the overall risk landscape for the UK over the coming decades. Already it is estimated to cause more than 700,000 deaths each year globally. That figure is predicted to rise to 10 million, alongside a cumulative cost of $100 trillion by 2050 if no action is taken. She will be aware that in January last year the Government set out the UK’s vision to contain and control AMR by 2040. This vision is supported by a five-year national action plan that includes comprehensive One Health action across the spectrum of human and animal health, agriculture, the environment and food.

While recognising the serious threat of AMR, I respectfully suggest that this amendment, specifically in the context of a clinical trial, is not necessary. Clinical trials of medicines, including those of antimicrobials or antibiotics, have strict requirements for reporting adverse events and for continuous monitoring of the benefits of the medicine under investigation versus the risks, as set out in the Medicines for Human Use (Clinical Trials) Regulations 2004 and associated good clinical practice guidance. Development of AMR during a clinical trial may manifest as an adverse event or as a lack of efficacy to the medicine being investigated. In either case, the investigators and trial sponsor have obligations to take action to protect the safety of the trial participant. This action might include taking an urgent safety measure, amending the trial protocol or terminating the trial early. These actions would require notification to the medicines regulator—the MHRA—and a research ethics committee. Development of AMR during a trial would also be expected to be transparent via the publication of the results of that trial.

The Health Protection (Notification) Regulations 2010 places a legal duty on the operator of a diagnostic laboratory to notify Public Health England of the identification of specified causative agents in a human sample within seven days. On 1 October, those regulations were updated to require diagnostic laboratories to report the results of any antimicrobial susceptibility test results and any resistance mechanism identified in respect of a sample. I hope that provides reassurance of the Government’s focus, not just to maintain high levels of surveillance of rates of AMR but to successfully contain and control its spread for future years. Given the existing provisions and ongoing work in the department, I hope I have reassured the noble Baroness that additional powers in this regard are unnecessary and she now feels able to withdraw her amendment.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, I thank the noble Baroness, Lady Barker, for adding to the outline that I provided on the importance of the greenhouse gas emissions of the NHS and bringing in the issue of the use of water, which is becoming an increasingly rare resource in the UK. I thank her for providing her personal account of the frustrations of individuals who want not to waste NHS resources, based on her own experience.

I thank the noble Baroness, Lady Wheeler, for focusing on plastic waste. I shall restrain myself from commenting on the broader points of this issue, but thank her for highlighting the particular importance of illegal exports of medical waste and the big issues around Covid-19 and the waste unavoidably being generated at this point, as she said.

Coming to the Minister’s response, at the start there was a suggestion that this was a provision to go somewhere else—that all these issues could be in the Environment Bill or packaging regulations, et cetera. I do not accept that. If we take a systems-thinking sustainable development goals approach, then we have to make sure that all these issues are in every piece of legislation. Everything has to be considered as a whole. Rather than saying “We’ll deal with it somewhere else”, given the issues of legislation being delayed—we do not know when the legislation that we have not yet seen will arrive—it needs to be built into every element of our thinking on this fragile, much-abused planet.

Coming to some specifics, the Minister commented on current arrangements for recycling of devices. I note that there was a disturbing report out this morning through the waste industry about the number of fires occurring in waste management facilities as a result of the inappropriate disposal of batteries. I do not know how many of those involved medical devices, but I would think it highly likely that, in some cases, they would be. There is clearly a real problem with our current disposal systems. The Minister referred to Clause 13 dealing with the contamination issues. I will take that back to my technical advisers. I was pleased with her comments about the efforts on medicines optimisation. If we think about this in the context of a waste period more broadly, we know that “reduce” is always the best option.

I am also pleased with the overall tenor of this debate and the focus that we have seen on antimicrobial resistance. If we think back—gosh, it is two Prime Ministers back now—David Cameron gave a major speech on antimicrobial resistance and we have seen growing awareness of this issue. I am pleased that this debate has been an opportunity to highlight it and focus on the need for more action. For the moment, I beg leave to withdraw my amendment, but I reserve the possibility of further consultation, and potentially bringing it and my other amendments back in this or a different form.

Amendment 18 withdrawn.

Covid-19: South Yorkshire

Baroness Bennett of Manor Castle Excerpts

Thursday 22nd October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am glad to reassure the noble Lord that Manchester businesses will be getting a payment to cover the backlog, as he described.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, my city, Sheffield, and the South Yorkshire region have been mentioned a great deal today. My specific question, of which I have given prior notice, comes from the Green councillors there but is, sadly, of interest to an increasing number of areas of the country. When can the funding for tier 3 areas be expected to arrive? Will it be in regular tranches or a lump sum? When can it be expected to reach businesses? Are conditions attached to the money and its continuation?

[Lord Bethell (Con)]

My Lords, grants will be available from 1 November, will be administered by local authorities and will remain in place until April 2021, with a review point in January. The funding will apply only to England and, if applied across the country, would provide over £250 million of support each month.

Health Protection (Coronavirus, Restrictions) (No. 2) (England) (Amendment) (No. 5) Regulations 2020

Baroness Bennett of Manor Castle Excerpts

Tuesday 20th October 2020 Lords Chamber

[Baroness Bennett of Manor Castle (GP) [V]]

I congratulate the noble Baroness, Lady Fox, on her maiden speech.

We are back to debating SIs implemented three weeks or more ago, some measures of which have already been superseded. In two minutes, I could bemoan the huge democratic deficit behind government by decree, and note that in reducing the UK’s credit rating last week, Moody’s said that

“the quality of the UK’s legislative and executive institutions has diminished in recent years”.

I could point to the chaos and suffering, or to the report on the impact on Generation X of the lockdown measures—a further perspective on the health versus economy debate that we hear is raging in the Cabinet. I could debate the 10 pm closing time, which is of great, indeed existential, concern to many businesses. There is a lack information, clarity and data—as the amendment in the name of the noble Baroness, Lady Jolly, sets out—and a lack of signs that the impacts will be measured, as the noble Lord, Lord Scriven, said.

However, let us cut to the crucial issue. Expert advice tells us that this, and many measures in subsequent regulations, will not be enough. We will have to go further. The virus is outpacing the Government in Westminster again. So I want to take a minute on the big picture, looking around from northern England. Look east: Wales knows what is happening and it has a plan; further east, so too does the Republic of Ireland. Look north: Scotland is producing a strategic plan that will be discussed with party leaders next week and then in Holyrood. Yet we are now debating regulations covering the north-west. Like many noble Lords, I am sure, I have been glued to social media and have just heard by tweet that the extremely heated Greater Manchester talks have concluded with black smoke emerging from the chimney.

In the debate preceding this one, the Minister, the noble Lord, Lord True, said in a different context that we need a steadying hand. That should clearly also apply to the approach to the SARS-CoV-2 virus in England. So my question to the Minister is simple: who is going to provide the steadying hand in England?

Covid-19

Baroness Bennett of Manor Castle Excerpts

Tuesday 20th October 2020 Lords Chamber

[Lord Bethell (Con)]

I reassure the noble Baroness that 24 hours is our objective, and it is clear that a 24-hour target is right. Having swift turnaround is conducive to effectiveness, and that is what we are trying to do. There has been a very large increase in demand in the last 11 weeks, which has put pressure on our operations and pushed back some of our turnaround times. We are working extremely hard to address that; new capacity is coming on-stream all the time, and we are hopeful that that can be turned around very quickly.

The noble Baroness is entirely right to raise her point on clarity, which is very similar to those raised by others, including the right reverend Prelate. There is a really important balance that we have to get right here because to have communal buy-in to our measures, we need to somehow mobilise leaders that people trust, from their faith community, their local community or other leadership groups that they subscribe to.

However, to give people a role in the decision-making about what measures are to take place in one area or another, there will be an uneven application of regulations—what happens in one place will not be the same in another. We have made a commitment to a partnership between national and local government, and we are trying to manage that complex partnership at the moment. As noble Lords know from the discussions in the other place and our conversations with Manchester, this is an extremely bumpy affair and it does not always work out well.

However, we are committed to doing this precisely for the reasons the noble Baroness described: to have buy-in, we need to mobilise all the country and all the people who are respected by those who adhere to the rules. That is why we take the approach we do. It means that gyms will be open in Lancashire but not in Merseyside. It is argued that this is a complexity that the British public can handle. It also takes us into very public conversations about funding, the allocation of resources and the establishment of new testing facilities. We believe it is worth the administrative and political effort to try to do that. There are also delays to the implementation of some of the restrictions. The British public will form their own judgment on their politicians and whether that is worth their while. These are the prices and friction costs to the local/national partnership that we are committed to, which has been advocated on the Benches of this Chamber for many months.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, the noble Lord, Lord Lansley, referred to the risk of mixing indoors. From the housing department, the noble Lord, Lord Greenhalgh, today kindly answered a Written Question from me about ventilation standards in building regulations in the light of Covid-19. It referred to the most recent SAGE paper on aerosol transmission, dated 22 July. The science on aerosol transmission has moved on a great deal since then. The noble Lord indicated that a new paper is being prepared by the SAGE Environmental and Modelling group. I note that German schools, for example, have strict conditions about opening windows regularly, even in the coldest conditions. Is the Minister confident that the current strength of advice on levels of ventilation, particularly to businesses where people are mixing, either retail premises, offices, or gyms, as we have been discussing, and to schools, is adequate?

[Lord Bethell (Con)]

The noble Baroness is right to raise questions about the way in which the disease is transmitted. We have put a huge amount of effort into studying it. I pay tribute to the epidemiologists who have crafted sophisticated models and have sought to test them in practical ways in order to establish, for good, the really important questions of how one person’s conversation, breathing and spoken word might transmit the disease to another person either through the air or on surfaces. Understanding that is absolutely essential in order for us to put in place the right kinds of Covid safety measures. However, at this stage it is an imprecise science. For instance, there is some evidence that transmission from hygiene and surfaces can play a very important role, perhaps meaning that we have to invest more thought and commitment in cleaning measures. The guidelines we have for workplace and school testing reflect the very best provable standards according to scientific evidence. We continue to invest in these important epidemiological insights, and I welcome very much the contribution of the scientists on SAGE and all those who continue to try to gain a better understanding of this issue.

Health Protection (Coronavirus, Local COVID-19 Alert Level) (Very High) (England) Regulations 2020

Baroness Bennett of Manor Castle Excerpts

Wednesday 14th October 2020 Lords Chamber

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, I welcome the maiden speech of the noble Lord, Lord Moylan, delivered under difficult, compressed circumstances.

As with the other SIs with regional impact, I have consulted with Green Party councillors in Liverpool, currently the only place where “very high” is applied, and heard from them, unsurprisingly, about the huge personal strain that they see so many individuals suffering, and the great worry for businesses and staff, as the noble Lord, Lord Storey, testified. Before we get to the technical debate, we need to rest our thoughts with their suffering and acknowledge the need for sufficient support to help them to keep going. Understandably, Liverpool feels unfairly singled out, and has a basis for this conclusion, as the noble Baroness, Lady Smith of Newnham, explained. Of course, this is something that Liverpool has experienced before, as we learned in retrospect that there was a current in the Thatcher Government that wanted the city in managed decline, as the noble Lord, Lord Rennard, noted.

This is part of a national plan and package, and it needs to be acknowledged that, although this SI has reached us more quickly than previous ones, it is already being overtaken by events. The last position from the Prime Minister that I have seen—and I do not know whether this flailing Government have already been overtaken by events—is that there is an 80% chance of an English lockdown soon. We need to reflect on that. While we are seeing general and scientific support for that position, it is also crucial to highlight the need for measures to make sure that the lockdown works and that we get somewhere close to catching up with Covid-19. That means fully funded local track, trace, isolate and support, with money freely supplied, without blackmail, from the Government to local authorities, plus proper financial support for all individuals who need it and consistent, evidence-based, sober communication with the public. Please let us have no more promises of moonshots, which turn out to be pie in the sky. In the meantime, I express the Green group’s support for the amendment in the name of the noble Baroness, Lady Thornton. I am making it a public versus private argument.

Health Protection (Coronavirus, Restrictions) (North East of England) Regulations 2020

Baroness Bennett of Manor Castle Excerpts

Monday 12th October 2020 Lords Chamber

[Baroness Bennett of Manor Castle (GP) [V]]

I declare my interest as a vice-president of the Local Government Association. We are talking today specifically about what will soon be historic rules applied to the north-east of England from Westminster. My remarks are informed by observations of Green Party councillors from the region, and I thank them for providing them and hope that they may not be too late to inform the forthcoming changes, or at least their implementation.

There are many ways in which to approach these regulations, including the approach that I took last week in asking whether we were learning appropriately from global best practice—a question that needs to be applied to everything that the Government do and one that they invite with frequent claims to be “world-beating”. Reflecting the Green slogan, “Think global, act local”, today I outline some of the issues reported to me from the north-east, seeking to add information to that provided by other noble Lords rather than repeat their points, although I agree with much of what has been said.

One issue is what might be called the “edge effect”. Communities just outside the areas of restriction are concerned about people from inside restricted zones coming to use businesses and socialising in ways forbidden in their home area, potentially bringing the virus with them. Secondly, whether they are inside or outside a restricted area may not be known to significant numbers of residents. Local government areas and coverage have changed significantly over the years. For example, Darlington was part of County Durham until 24 years ago, and many residents still write “County Durham” on their address. Darlington was not covered by these regulations, and people may be experiencing unnecessary isolation and deprivation as a result. Conversely, in other places, people may be breaking the law without any ill intention.

The answer to the second problem is clearly the best possible communication and information and a broader reflection on the need to involve communities more in local governance, to ensure that local government has the resources and powers it needs to be relevant to people’s lives, which would also encourage residents to vote in local government elections, further building their knowledge. That should include control over anti-Covid measures, as called for by the noble Lords, Lord Hunt of Kings Heath and Lord Greaves.

My second point refers to what might be called “concentration effects”. My local observers were reflecting on schools and colleges, but it is true in many aspects of life today that people have been concentrated into a few small areas. Where once pupils from a wide area used to go to local colleges, now they all go to one place. That has obvious risks both in spreading coronavirus and for anxiety and concern. The communities which see a large influx of people are concerned about the risk they might represent to them. This is, in terms of resilience, a risk for future pandemics where infections have greater impacts on younger age groups.

As a final point on detailed local concern, the local voluntary aid groups that were so effective in the early stages of the pandemic have less capacity now. Funding is needed to fill the gaps.

To conclude with an overview, there was an understanding back in March that the virus, however much we should have been preparing for an epidemic in general, had arrived suddenly, with very limited information and understanding about it. There was good will and an understanding that mistakes would be made through lack of information and time to plan. That does not apply now. From the north-east and around the country, we are hearing clear understanding—which reflects what the scientists are telling us—that restoring any kind of secure, certain life requires a highly effective test, track, isolate and support system, and that local systems, not a distant privatised call centre, are the key to making that happen. We are finally seeing some moves in that direction.

However, we need much more of an understanding that, for the north-east and every other region, it is local people who know and understand their community who need the resources to make plans and decisions and to implement the measures needed to keep coronavirus under control. In understanding that many of these communities are already blighted by poverty and inequality, there is a moral responsibility to understand that levelling up means spreading out the concentration of money, resources and particularly power in London and the south-east and not continuing to stand in the way, as Westminster has for decades, of people taking back control in their communities.

Covid-19 Update

Baroness Bennett of Manor Castle Excerpts

Tuesday 6th October 2020 Lords Chamber

[The Deputy Speaker (Baroness Pitkeathley) (Lab)]

The noble Lord, Lord Robathan, has scratched, so I call the noble Baroness, Lady Bennett of Manor Castle.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, questions in your Lordships’ House on this Statement have understandably focused on Covid-19, but the Statement as delivered in the other place is a broad-ranging survey. It starts by talking about treatments for Covid and then shifts to approvals for new cancer treatments; it looks at the expansion of urgent and emergency care; and those mysterious 40 new hospitals appear yet again, as the noble Baroness, Lady Barker, alluded to. In that context, I ask the Minister whether this Statement is sufficiently balanced. If this is a survey, where is the public health element?

Covid has exposed, even more than we recognised before, a deeply unhealthy society with terrible diets, inadequate opportunities for exercise, poverty, stress, and a mental health epidemic. We know from Victorian and early 20th-century times that it is public health measures that really make the difference. In facing up to tackling Covid, surely that is the direction in which we need to be looking. For example, new research today showing the impact of air pollution includes some very stirring suggestions that childhood exposure has an impact on the rates of dementia and Alzheimer’s. My questions to the Minister are these. Are the Government paying enough attention to public health? Is their strategy sufficiently balanced? Are they funding and doing enough on the broad measures that will create the healthier society that is so clearly desperately needed in the time of Covid or at any other time?

[Lord Bethell (Con)]

In her analysis of the Statement, the noble Baroness is, as ever, inspiring and optimistic. I am extremely grateful for her remarks. The Building Back Better programme will put a vision for public health at the centre of our efforts. We will build on this awful epidemic to ensure that our public health outcomes improve.

Covid-19: Adult Social Care Complaints

Baroness Bennett of Manor Castle Excerpts

Monday 5th October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, the nature of any future inquiry has not yet been defined. However, all parties will be taking learnings from Covid and bringing forward their lessons-learned experience. As the major regulator, the CQC will play a leading role in bringing together the data and information from the front line but, as the complainant of last resort, the ombudsman will also play an important role in that process by bringing insight from patients and those who have made complaints.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, as the noble Lord, Lord Loomba, indicated, in the context of Covid many families and patients will be looking to stay at home and receive private care there, for longer than they might have. The Minister referred to the “Because we all care” publicity campaign about the ombudsman and its services. However, the annual review of adult social care complaints called for mandatory signposting. Will the Government be introducing mandatory arrangements and rules to be followed by all private providers to ensure that the services of the ombudsman are signposted to people who may need them—not just a publicity campaign but clear direction and information being provided to everyone who might need it?

[Lord Bethell (Con)]

My Lords, I recognise that the ombudsman’s recent report on adult social care did call for a statutory requirement for signposting. We have worked substantially with the sector to improve signposting of the ombudsman and other routes of complaint. The commitment by CQC and Healthwatch to the “Because we all care” campaign is an important and effective measure to fill the gap and raise awareness of the complaints procedure. It is right to wait until we see the results of that campaign. We acknowledge the possibility of mandatory signposting but would like to see a voluntary and more effective marketing campaign work if it possibly can.

Coronavirus Act 2020: Temporary Provisions

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Monday 28th September 2020 Lords Chamber

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, I declare my interest as a vice-president of the Local Government Association. I express my enjoyment of our two maiden speeches thus far and look forward to the third.

I am glad that the Minister acknowledged that we cannot say when the crisis will be over. That makes a refreshing change from the World War One-style boosterism of “over by Christmas”; we know what a disastrous impact that approach had a century ago, and I fear it has done great damage today.

It is useful to think back to the mood in your Lordships’ House, Parliament, London and indeed the country six months ago as we passed this Bill. The message on the cover of The Hitchhiker’s Guide to the Galaxy, “Don’t panic”, almost seemed to be projected on the walls of the Chamber in large friendly letters. The noble Baroness, Lady Chakrabarti, referred to the heavy heart that many of us felt at the swingeing provisions of the Act. Six months later, the serious human rights damage and the unnecessary attacks on peaceful protest are clear, as reflected by my noble friend Lady Jones of Moulsecoomb.

We have learned a great deal about the virus that we did not know in March, but the mood of determination to pull together, applaud our NHS and shop for vulnerable neighbours and indeed the promise from the Chancellor to do “whatever it takes” have dissolved, and the Government must take significant responsibility for that. Sadly, “whatever it takes” was a promise that fell apart quickly: local government, huge numbers of self-employed people and those caught in the new starter furlough quickly found that it was not for them. Despite the obvious risks and the still-high levels of the virus around the nations, the message to “stay home” pivoted straight to “get out, mingle and spend money”. It is worth reflecting that it is just one month since Eat Out to Help Out ended.

Let us look forward to the next six months, and three elements that might be in this Act. The first is elections—not a general election, as my noble friend was referring to, although I am far from convinced that stability has suddenly broken out after three elections in five years; we have all heard the rumours. I am talking about the other scheduled, already-delayed elections, elections that are much closer to people’s homes and to decisions that affect people’s lives on a day-to-day basis. The sections of the Act allowing for the delay in elections are still in force. The Government need to publish a plan for elections to go ahead safely in 2021. The election provisions in the Act should be repealed on that basis. Referring to those elections, the Minister said that they hope for normal service to be resumed next May. I say, “Don’t hope. Plan.”

Secondly, on the economy, what is the Government’s long-term plan? Where is the understanding that we will never return to business as usual and that nor should we want to, given the human misery, poverty and environmental destruction that underpinned it? Where is the thinking about how this is a chance to support small independent businesses up down found the land and flourishing newly peopled communities? What were once commuter centres empty most of the time are now humming, with chances for outdoor cafes, catering vans, print and home-office services and computer support, with something like a 15-minute commute—a social and community environmental ideal—to level up by spreading economic activity to every community in the land?

Thirdly, on education, this morning I was reading an email from a desperate home-schooled A-level student left high and dry. Where is the plan to stop SATs and find alternative methods of assessment for GCSEs, A-levels, BTECs and other qualifications next year?

We should be seeing significant elements of the Act repealed now, replaced by a plan and a way forward. I hesitate to interfere with the words of the late, great Douglas Adams but they need amending for this current time. We could project on the walls of No. 10 in large friendly letters, “Stop panicking and plan”.

Health Protection (Coronavirus, Restrictions on Gatherings) (North of England) Regulations 2020

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Friday 25th September 2020 Lords Chamber

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, I declare my interest as a vice-president of the Local Government Association.

The Minister, in introducing these six statutory instruments, said that they had “Done so much good”. I certainly would not deny the level of effort from the public right through to Westminster, but what is inescapable is a sense of a Government flailing around, laying down statutory instruments, changing them shortly afterwards and acting as though Westminster knows what is best—from Leicester to Lakeside and Newcastle to Newquay. In the meantime, the virus keeps advancing.

I note that what I am about to say reflects the thoughts of Pendle council, as shared with us by the noble Lord, Lord Greaves, and that it also reflects what the noble Lord, Lord Beith, said about clearly dividing laws and guidance. We need a set of alert levels, with enforceable laws that operate for businesses and groups, and a practical guide for action for the police and officials—to act on, for example, an illegal rave or a pub failing to collect contact-tracing evidence. That should be combined with guidance for the public.

As we said in this House on Wednesday, the rule of six means that many households could legally mix in one day, which would obviously be unwise. This is not useful guidance for action, let alone a practical rule. People are making up their own rules, sometimes for want of clarity and useful rebuttal from the Government based on the infodemic that the noble Baroness, Lady Bull, outlined.

Deciding on local alert levels and communicating them should be in the hands of local government, as should contact tracing and support for self-isolation, with appropriate resourcing from the centre. General, practical guidance to all on how and why to minimise risk can be distributed both nationally and locally, while acknowledging the practical difficulties in childcare, for example, as noted by the noble Baroness, Lady Bowles. Will the Government now consider—after stepping back, drawing breath and taking time to think, as the noble Lord, Lord Dobbs, said—a COBRA meeting to help them divide laws from guidance, stop focusing simply on testing numbers and look at testing effectiveness, and give back control to local authorities, which understand the demography and geography of how to control the virus in their area?