Nursing and Midwifery
Baroness O'Neill of Bengarve Excerpts(4 years, 3 months ago)
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Baroness Blackwood of North Oxford
The noble Lord has made this point before and I have taken it back to the department before. He will know that we are providing additional financial support to nurses, including the maintenance grant of £5,000 in non-repayable funding, with specific targeted support of £3,000. However, I am very happy to take back his proposal once again, as we have an upcoming Budget.
Baroness O’Neill of Bengarve (CB)
My Lords, is the Minister aware that the Royal Statistical Society is celebrating the election of its first woman fellow, Florence Nightingale, and that nurses play a very considerable part in the collection and processing of data that matter for public health, and all our health?
Obesity
Baroness O'Neill of Bengarve Excerpts(7 years, 11 months ago)
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Lord Prior of Brampton
My noble friend makes a very good point. He is as confused about this as most of us are in this House. A very important part of the obesity strategy, when it is announced later in the summer, will be to address this very clearly. All the evidence from more than 600 separate studies reinforces the advice that is already out there from Public Health England, but it has been very muddied over the last five days.
Baroness O'Neill of Bengarve
Does the Minister agree that this is not a matter just of individual responsibility? Many meals are eaten in places where people have no choice. They are provided by public institutions, including hospitals, hospital canteens, schools, prisons and the armed services. Should not all those meals be designed not to further obesity?
Lord Prior of Brampton
My Lords, I was not saying that it was exclusively individual responsibility, but we have to recognise that individuals must take some degree of responsibility for their own actions. Of course the noble Baroness is absolutely right. That is why we and the last Government introduced free school meals in all infant schools. It is why the proceeds of the levy will be ploughed back into increased sport and PE facilities in schools and why we have the fruit and vegetable scheme for schools. Of course we take diet and food extremely seriously, and where we have direct control, as we do in schools, we take action.
Access to Palliative Care Bill [HL]
Baroness O'Neill of Bengarve Excerpts(8 years, 6 months ago)
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Baroness O'Neill of Bengarve (CB)
My Lords, this is a Bill on the right topic—on assisting the dying. That term has been used recently for a quite different Bill which was aimed at only a very narrow number of those who sought death and was about assisting their suicide. Here we have something that speaks to the many who die each year. So it is the right topic—and quite necessary.
It is also the right time, as the demography shows. We are going to have more deaths each year in the fairly near future. That may sound depressing but it arises out of a rather happy fact. Currently we have about half a million deaths in England each year, about 30,000 in Wales and about 55,000 in Scotland—so in round numbers, 550,000. The figure that has been referred to of 350,000 is the number of so-called expected deaths. But that figure of 550,000 will rise. Although we are all living longer, this increase in life expectancy is not a promise of immortality for any of us. The number of people who are likely to die is projected—it is only a projection but it is significant—to rise over the next 20 years to about 670,000 per annum in England, Scotland and Wales. That is a big increase on 550,000.
Every death will be sad in its own way but every death could be well or badly managed and it is clear that we know how to do it well in this country. The finding of the Economist Intelligence Unit is very reassuring in that respect. As my noble friend Lady Finlay of Llandaff said, the problem is the patchy availability, not the standard that we reach in many cases—not just exceptional cases. The quality of the best is excellent but it is availability at the time of need that is very bothering.
Unsurprisingly, availability at the point of need is less good for certain communities in the inner cities and for certain ethnic minorities, but I have personal experience of the fact that it is less good in many places that do not fall into those familiar categories. My brother died in leafy West Sussex. He was a well-organised person and when he knew he was dying, he contacted the local hospice and made arrangements to die there when the time came. When the time came and my sons and I could no longer look after him at home, I rang the hospice. They said, “Oh yes, we can take him in three weeks”. As he observed to me, “I shall be dead then”—as he was. We then turned to the GP, who was about to go on his Christmas holiday, and arranged admission to a care home. I cannot fault the standard of care given in that care home but the staff were not permitted to increase the dose of painkillers above what had been prescribed initially. It was Christmas weekend. He died on the day of the tsunami, in very great pain.
The continuation of that sort of event tells us that we are not doing it right at present and that it would not be complex to improve matters. Among the Bill’s many sensible provisions, those that focus on the unavailability of adequate pain relief at the point of need are particularly important. Pain comes in waves, as many people know. It does not wait for working hours, the end of bank holidays or for other events. He died with good care but appalling pain relief.
The problem is not that we do not know how to do it or that we cannot afford it—it would save money. It is a question of a will and a way, and this Bill points the way. I hope we can support it on to the statute book.
Medical Innovation Bill [HL]
Baroness O'Neill of Bengarve Excerpts(9 years, 6 months ago)
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Baroness O’Neill of Bengarve (CB)
My Lords, I am sorry to say that I am another non-medic. Indeed, I am a philosopher by trade and training but I would like to make three points. First, I was puzzled at Second Reading and again this morning by a certain divergence of vision among those of our medical colleagues with surgical experience and those who are not surgeons. It seems that, on the whole, those with surgical experience are quite happy with current legislation. They feel that they must innovate and that the non-standard anatomy, which I have learnt that we all enjoy, means that they cannot go in there with a rule book and just stick to it. I have not heard quite the same uniformity from our clinical colleagues who are non-surgeons. I hope that we could be a bit clearer about whether surgical procedures should be in here at all.
Secondly, the question of unintended consequences has already been raised by the noble Lord, Lord Giddens, and others. Some quite process-heavy amendments have been proposed which deserve rather more picking apart than they have already received. We do not wish to put in so much process that we successfully stifle the very innovation that it is the purpose of the Bill to achieve. I hope that we can come back to those amendments.
Finally, and with trepidation as I am standing right behind the noble Lord, Lord Pannick I say that, there is a bit of a difference between reasonableness and proportionality. They tend to come as twins. I am entirely in favour of reasonableness but proportionality suggests that you have at the back of your mind enough data to say what is proportionate and what is not. I fear that introducing requirements for proportionality may actually wreck the possibility of innovation in areas where part of the objective is to obtain the data, because they are not yet there. I would have thought that from a patient’s point of view it is reasonable to go for a treatment for which there are not yet complete data, and therefore no judgment of proportionality can be made, but which nevertheless is reasonable because the other options are dire.
Lord Mackay of Clashfern (Con)
My Lords, I had not intended to take much part this morning but, my name having been mentioned, I am stimulated to respond. The Bill is about innovation. Therefore, if a doctor is attacked for some failure in respect of innovation, the ordinary rules of defence that are presently available do not seem appropriate. Our colleagues who are excellent innovators have managed to avoid the necessity for litigation as a result of their innovations. However, if by any chance any of them were challenged, how would they go about their defence?
I make this basic point in answer to my colleague the noble Lord, Lord Pannick. He quoted what I said at Second Reading. It will not surprise your Lordships if I happen to hold still to what I said then. The point is that when there is an innovation, there is not much material on which to judge whether it is reasonable or proportionate. If there were in the existing practice, it would not be an innovation. The problem is therefore that the ordinary formulations of reasonable and proportionate with which lawyers are very familiar—I am enough of a lawyer to be familiar with them—are not really appropriate. I believe that the test which my noble friend Lord Saatchi’s Bill originally had, and which is preserved among all the innovations that have taken place since, is in Clause 1(4)(a):
“Nothing in this section … permits a doctor to administer treatment for the purposes of research or for any purpose other than the best interests of the patient”.
That is a simple test which the doctor must face at the time of innovation and, so far as I am concerned, elaboration with the familiar legal phrases that are very dear to lawyers is a mistake. I therefore adhere to what I said at Second Reading.
I should perhaps say that I am not entirely without experience in this area for when I was in practice in Scotland, which is now a long time ago, I did quite a lot of work in the Medical and Dental Defence Union of Scotland area. My very first appearance as a counsel in this House was in respect of a doctor’s negligence. My experience was over quite a long period; it may not have been very good but it was certainly extensive. I very much support the Bill and hope that we need not get around to voting on it today. There is plenty of scope for discussion about these matters and a good deal of substance in many of the amendments. We should discuss them further and, if necessary, have votes on Report.
Baroness Wheeler
My Lords, I am pleased that Amendment 28 has been grouped with the amendment of my noble friend Lord Winston and the noble Lord, Lord Pannick, as we have considerable sympathy with their attempts to define innovation. I understand that it is a probing amendment. We consider that the Bill would benefit from a clearer understanding of what we mean by innovation and indeed of some of the exclusions that would apply that were referenced in the earlier comments on Amendment 19. I am grateful to my noble friend Lord Giddens. His perspective on that was helpful. I look forward to the response on that.
Amendment 28 is also a probing amendment and underlines that medical innovation and the adoption of new treatments require the whole NHS to make both research and innovation its business. The Secretary of State, the NHS regulators and all the key NHS bodies have a clear responsibility and the authority that they need; they need to use it. We have had many debates in this House that recognise the scale and pace of innovation taking place across the NHS and the frustrating barriers that prevent innovative treatments being adopted.
The noble Lord, Lord Saatchi, considers that doctors’ fear of medical litigation or disciplinary proceedings is a key factor that,
“reinforces a culture of fear and defensive medicine in the NHS”.
Whether medical litigation evidence supports that or not, we need to keep emphasising that it is just one of a number of barriers that have to be overcome. I know that the noble Lord recognises this as the context for his Bill. As Sir Robert Francis QC puts it:
“The real obstacles to responsible innovation are not to be found in the Bolam test but in the minefield of regulation and bureaucratic inertia which doctors presumably have to surmount, not to mention the reluctance to fund innovative treatment”.
The contribution of the noble Lord, Lord Blencathra, underlines that we are far too slow in this country to introduce new treatments.
The Health Research Authority is still yet to make a real impact on speeding up the painfully slow, complex and bureaucratic process of getting innovation in care and treatment adopted in the NHS. There is huge frustration across the NHS that existing pathways and mechanisms are not being fully used, such as the single portal of entry and single application procedures for clinical trials. NHS trusts’ slow implementation of the UK life sciences strategy, Innovation, Health and Wealth, and the very low level of awareness and action that they have taken on that strategy are continuing causes for concern.
Most important too is the role of Health Education England in ensuring that innovation and research are incorporated into the education and training of key medical and other health staff. The excellent vision report from the Association of Medical Research Charities, which my noble friend Lord Turnberg takes every opportunity to raise and endorse, showed the huge challenges we face in building support among doctors and patients for participating in research that leads to innovation.
As research and innovation go hand in hand, we were keen to include reference to research and innovation in our amendment, but I hear what has been said by the noble Lord, Lord Saatchi, and the Minister on this. I note that the Medical Defence Union, while now supporting the changes the noble Lord, Lord Saatchi, has made to the Bill, also makes the point about the importance of research being included because that is where most innovation takes place. It is concerned on this issue because it feels that many doctors are likely to be uncertain about whether the Bill would apply to innovation they are contemplating. This may hold up a proposed treatment or procedure while they check the position. In most cases, the Bill will not apply. Even where innovation arises out of a research project, doctors are likely to want to ensure that information gathered in treating the patient contributes to overall research in that area, and the MDU is concerned that the wording of the Bill may prevent that. I would be grateful for comments on this point from either the noble Lord, Lord Saatchi, or the Minister.
Our amendment seeks to place the Bill in the context of the duty of the Secretary of State and the key bodies of the NHS to support responsible innovation in medical treatment and makes it clear that that is the overall purpose of the Bill. I would welcome a response from the noble Lord, Lord Saatchi, on whether, despite his desire to keep the Bill short, he considers that a clear definition of the core concept of innovation, as the noble Lord, Lord Pannick, said, could be incorporated into the Bill as a reference to its overarching purpose. I would also appreciate the Minister’s comments on this.
Baroness O'Neill of Bengarve
My Lords, before the noble Earl responds, I would like to know whether other noble Lords think that this attempted definition of “innovation” does not perhaps inadvertently classify some entirely traditional medical treatments as innovations simply because they have been around for much longer than randomised clinical trials with equivalent clinical validation, and there will be no published evidence of their risks and benefits in peer-reviewed medical journals. I have in mind such homely treatments as prescribing the drinking of a lot of water, taking the waters or dietary advice. Many such things seem to be medical treatments but have probably not been documented in the journals.
Care Bill [HL]
Baroness O'Neill of Bengarve Excerpts(9 years, 11 months ago)
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The Earl of Erroll
I fully agree with the noble Lord. My challenge with it is how easy it will be to raise a human rights case if we find that the regulation does not comply with something on which we have legislated here and there is a conflict. I accept that it is theoretically possible. I would argue that maybe the way proposed by the noble Lord, Lord Owen, is another way of trying to make sure that we do not have to go to that step.
Briefly, there are some commercial issues with this. One of the changes is that the National Health Service may end up giving away data that are all good for research purposes but which would be very useful for pharmaceutical development and stuff like that. Companies will make a lot of money from information that they get from the data, but I would like to see the NHS benefit. I do not have a problem with it selling the correct data if it is properly controlled for the right research purposes. There will also be some businesses and companies that will make a business out of analysing such data and selling the analysis back to the NHS. It would be useful because the NHS does not have the time or the skill to do that work, but the NHS should benefit from the work and effectively charge for the data that it sells.
There are two reasons why I like the amendment of the noble Lord, Lord Owen. On the Minister’s interpretation of statistics, if we take the more general wording, “the promotion of health”, and it is possible for the food industry to use it to bolster some of their stuff, we have to look at some of the underlying assumptions of the statistics, which can be dangerous things. We need to see how that is done. Even if we go for the newer wording in Amendment 40C, there could be problems in this area. I do not think that anybody is capable of regulating themselves. We always have our own internal biases towards our own objectives and can be regulated only by someone who is looking at it from another point of view, from outside.
We have had the Caldicott guardians for a while. The system works as they are looking after the public interest. They give the public confidence that things are not being misused in their names. Therefore, why are we throwing away a few years of experience of something that works? It is not tampering with the wording of the Bill or playing around with a mish-mash of words; it is merely re-establishing something that already exists. It is a sensible balance. If you cannot check yourself, checks outside the organisation have to exist. Therefore, I suggest that we support the amendment.
Baroness O’Neill of Bengarve (CB)
My Lords, I hope that the Minister will comment on a fact mentioned by the noble Earl, Lord Erroll: namely, that on its imminent coming into force the European data protection regulation will indeed supersede our Data Protection Act, which implements the current European directive. I am sure that the debate in Brussels has been conducted with the highest aims for the protection of privacy but I also believe that it is based on considerable illusions. It aims to introduce reliance on specific and explicit consent for each and every reuse of lawfully held data. This is an illusory standard. In the commercial world it works as we can tick and click as giving consent to terms and conditions, but it does not provide an adequate model for the world of medical research. I fear that when this draft regulation comes through, which it is very likely to do, we will not have secured better standards for the protection of patient privacy in research, and nor will we have secured the future of medical research.
This seems to me to be a very poor moment at which to have to make decisions on protecting the privacy of patient data, because the ground rules are about to change. They will of course be compatible with an interpretation of the European Convention, but they will change a great deal. I declare an interest as chair of the ethics, regulation and public involvement committee of the Medical Research Council, and as chair of the Equality and Human Rights Commission.
Mental and Physical Health: Parity of Esteem
Baroness O'Neill of Bengarve Excerpts(10 years, 6 months ago)
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Baroness O'Neill of Bengarve (CB)
My Lords, I think that we are all very grateful to the noble Lord, Lord Layard, for securing this debate. It is a theme of such enormous dimensions that it is almost tempting to avoid how centrally serious it is. He has concentrated on this area for many years, and I am sure that many of us have learnt from his work. I declare an interest as chair of the Equality and Human Rights Commission, which has among its responsibilities helping to reduce—of course, one hopes, to eliminate—unlawful discrimination on the basis of disability, including unlawful discrimination on the basis of mental health disability.
Speaking in June this year, the Minister with responsibility for care services, Norman Lamb, commented on the Royal College of Psychiatrists’ report, to which reference has been repeatedly been made, Whole-Person Care: From Rhetoric to Reality (Achieving Parity Between Mental and Physical Health). He said:
“What do we mean by parity of esteem? … I think the report—in its definition and vision for parity—has it right. It’s about equality in how we think about mental health and physical health care—it’s about how they’re valued. We need to ‘close the gap’ with physical health services—whether that’s a gap in access, in quality, in research, or even in the aspirations we have for people”.
As the Minister made very clear, this is an extremely large agenda ranging from the commissioning of services and the integration of services to interventions to reduce premature mortality among those suffering from mental health conditions. It is also an agenda that stretches far beyond the NHS. Indeed, it is an agenda to which anybody and everybody, particularly employers, communities and schools, can make a large contribution.
Parity of esteem is not just a matter of ensuring that different conditions are treated with the expertise appropriate to them, although that is, of course, central. It is not just a matter of concern within the health and care systems that the people who suffer these conditions are treated with dignity and respect. It extends far beyond medical treatment and care, and many non-medical approaches are also of great importance.
First, I shall give a brief reminder of how stark and bitter the absence of parity of esteem and all that goes with it can be for those who suffer mental health conditions and for their friends and family. I have been permitted by a colleague to quote from an account from a family with two sons who are both young adults. One is in an advanced stage of muscular dystrophy and the other is diagnosed as chronically mentally ill. The family said:
“The son who is physically disabled has many special needs. He gets emotional support everywhere he turns. His handicap is visible and obvious and the community, family and friends open their hearts to him and go out of their way to make his life better. My other son, on the other hand, is misunderstood and shunned by all. He is also terribly disabled … but his disability is not visible.”
At least, it is not visible in the same way. The extended family,
“all think that he’s lazy, stupid, weird and naughty. They suggest that somehow we have made some terrible mistake in his upbringing. When they call on the phone they ask how his brother is and talk to his brother but they never inquire about him. He upsets them. They … wish that he’d go away”.
That is poignant and sad, and shows how stark the absence of parity of esteem and all that goes with it can be for those who suffer mental health conditions. That probably is an extreme case, all the more poignant for being in one family, but it reminds us of a lot.
Of course, these conditions and their diagnoses are complex and highly varied. Many conditions have both mental and physical aspects. For example—I know that this also is a very large area of need—difficulties with communication are not easily classified as mental or physical, and there are many other conditions that combine both sorts of symptom. We have to agree that there are physical conditions—for example, disfigurement —where sufferers may encounter reactions from others that are as harsh as those sometimes faced by people with mental health conditions.
We also have to remember that there are many conditions which people do not want to disclose. We have very little idea how many of those we live among may be coping on a daily basis with physical and mental conditions that are invisible to us, that they manage more or less adequately and that they try to keep to themselves, be it diabetes or depression, digestive problems or severe phobias. Nor do we have much idea how much physical or mental pain, or both, others are often managing, whether day-in, day-out or episodically. Much of the burden of disease is invisible to others, and much of it is not solely mental or solely physical.
We also must not forget the cases where the conditions are all too visible. One of the difficulties is that the person who has the condition becomes invisible because people focus on the wrong thing. One only has to witness the many terrible stories of the condescension to which wheelchair users are subject, as though the use of a wheelchair somehow rendered one incapable of speaking.
For all those reasons, I believe that, while changes in the way in which we organise health and social care are essential for securing parity of esteem for persons with different sorts of health conditions, much also depends on the social and economic arrangements that we have, and in making sure that they recognise and include those with varying health conditions.
I shall make just a few illustrative comments on the way in which wider employment and community arrangements can make a difference. Let me start with something that perhaps is mainly a concern of schools; namely, speech and language difficulties. It has long been recognised that this is a major area in which complex interventions and social support matter greatly. The Bercow report, A Review of Services for Children and Young People (0-19) with Speech, Language and Communication Needs, was published a few years ago but its findings bear repetition. It states:
“Approximately 7% of five year olds entering school in England—nearly 40,000 children in 2007—have significant difficulties with speech and/or language. These children are likely to need specialist and/or targeted intervention at key points in their development. Approximately 1% of five year olds … more than 5,500 children in 2007—have … severe and complex”,
difficulties in this area.
“They may not understand much of what is said to them … may have very little spoken language”,
and are at risk of other mental health conditions.
Specialist intervention is, of course, what is important for such children and young people but again it is not all that is needed. For those with communication difficulties, the reaction of others can be one of the worst hurdles. The parents of such children,
“expressed concern that their children’s ability to communicate, to speak and to understand was taken for granted”.
They said that,
“their children often looked like any ‘normal’ child and yet behaved differently”.
One parent commented:
“They don’t think quickly and they can’t express themselves quickly, but they look as if they can manage. All my children stare at people because they are looking for cues, and that causes fights”.
Here we can see very clearly that a great deal of what matters for partly invisible conditions is inclusion; that is, including the child with communication difficulties in activities, in school, in play, in the community and, later, in the workplace.
A final example is one that employers can foster. I believe that the example of really energetic ways to develop flexible working can make a great difference to many people. The British Telecom report, Flexible Working: Can Your Company Compete Without It?, states:
“At BT, flexible working is business as usual. Already seven out of 10 people work flexibly and nearly 10% are home-based. It has saved the company millions in terms of increased productivity and cut costs. It has also motivated our people and released more potential … we are attempting nothing less than the complete transformation of the way in which the company runs, the way we communicate, and the way we work together”.
For BT, that saves costs and improves productivity. I think that we must all acknowledge that it is in an advantageous position because telecommunications allows for distant working more easily, but remote working, even if harder in other areas, can have many benefits—above all, the benefit of the possibility of including many people who either could not travel to work or could not work as many hours as some others. It has great benefits for carers, including the benefit of a working life of self-respect and money they have earned.
There are many other examples of businesses making creative and effective use of specific disabilities, including mental health disabilities. There are companies that have found ways to use the distinctive capacities of some people with high functioning autism spectrum disorders to carry out tasks that require focused accuracy and have given them preferential employment in these areas. For example, the Danish company—I may mispronounce it—Specialisterne, is almost entirely staffed by people with autism spectrum disorders. They specialise in the high precision task of quality checking software. Apparently, those of us who do not have those disorders would be less good at it.
The benefits of inclusion matter greatly for those with mental conditions as well as those with physical conditions. We should make efforts to secure as much inclusion in schools, at work and in community life for those with disabilities of all sorts as we possibly can.
Nanotechnologies and Food: Science and Technology Committee Report
Baroness O'Neill of Bengarve Excerpts(13 years, 9 months ago)
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Baroness O'Neill of Bengarve
My Lords, I, too, was privileged to serve on the Sub-Committee on Nanotechnologies and Food. Not being a scientist, I found it challenging. Being chaired by the noble Lord, Lord Krebs, it was also fun. With the excellent support that we received both from the Clerks and our specialist adviser, Professor Stephen Holgate, I think that I ended up understanding a certain amount about nanotechnology. What I think I understand very clearly is why this is an important topic, and one where the new Government will have reason to take action on various fronts.
The debate takes place at a moment that may be either awkward or advantageous—I am not sure which—but it is at the very least unplanned. The Select Committee’s report on nanotechnology and food addressed a world in which the Food Standards Agency was the UK’s lead body with responsibility for food standards and safety. The Government’s response to the Select Committee’s report is the response of the previous Government, who showed considerable confidence in the Food Standards Agency, which they asked to co-ordinate that response.
It is far from clear that this confidence is shared by the coalition Government. Over recent days there have been numerous reports that the Government plan to abolish or dismember the Food Standards Agency. Headlines have ranged from the Mirror’s rather trenchant:
“Food Standards Agency watchdog is chewed up by ConDems”,
to the Atlantic’s more political—indeed, conspiratorial —revelation:
“How the Food Lobby Killed Britain’s FDA”.
That is of course not a misprint, and it is inaccurate to think that the Food Standards Agency corresponds exactly to the Food and Drug Administration in the US.
Perhaps inevitably, some commentators have begun to wonder whether the Government are unsure which FSA they want to reform and which they want to abolish. We are tonight concerned only with the Food Standards Agency. The Government have indicated that they have not yet reached a decision on what might be done. The Minister confirmed that this afternoon in responding to a Question from the noble Lord, Lord Krebs. However, there is a widespread sense that the Food Standards Agency may be in some danger. The main question—which I hope the noble Earl can answer—is: how far do the Government plan to stand by a response that is not of their making? Which commitments do the new Government seek to shed and which do they seek to strengthen? The coalition Government should welcome many of the committee’s recommendations and endorse much of the previous Government’s response. This was, after all, a report about cutting-edge research, emerging technologies and their application in a domain of daily concern to everyone. It is not an area from which any Government would wish to bow out.
The questions that are raised by the introduction of new technologies—in particular very novel technologies that are not well understood—into food processing link basic and applied scientific research, knowledge transfer, innovation in manufacturing, the fate of a very large part of the British economy and the daily consumption of food by each one of us. The human and economic consequences of getting matters wrong could be large, ranging from failure to adopt food technologies that may be useful for human health, to failure to co-ordinate work on the scientific basis of nanotechnologies, to failure to build on the achievements of UK scientists, to a considerable loss of competitive advantage by the UK food processing industry, not to mention the possibility of failure to adjust regulation to focus accurately on the risk assessment that will be needed.
I am no friend of excessive regulation, and like many who have run a small institution, I know its costs all too well. However, there are cases in which laissez-faire and market solutions will not work. Public health is a public good, often not achievable by the interplay of market forces and consumer choice alone. The long-running battle between the FSA and the food industry over labelling illustrates—if it illustrates nothing else—that there are those in the food industry who prefer to communicate, or at least pretend to communicate, in ways that demonstrably are not understood by many consumers and indeed may not be comprehensible to many consumers. Mere labelling will not be enough to secure public acceptance of food products containing nanoparticles, despite the fact that nanoparticles are found in many naturally occurring products, including traditional foods—and the sub-committee was told that ricotta cheese contains many of them. We need a more thoughtful approach.
I have mentioned some examples of matters that bear on success or failure in the use of nanotechnologies, in particular in the food industry, where, it seems to me, only Government and regulatory action can hope to be effective either in protecting consumers or in supporting the British food industry. First, there is the matter of securing agreement, including international agreement, on definitions. The noble Lord, Lords Krebs, has already mentioned this topic with his great expertise. There are those who seek to define nanoparticles simply in terms of their dimensions. Nanoparticles, they propose, should be defined as particles of which at least one dimension falls below an intrinsically arbitrary threshold of 100 nanometres. However, the reason why some nanoparticles are of interest to the food industry, as they are to other industries, is not simply that they are very small, intriguing as that may be, but that some, though not all, particles at nanoscale have functionally distinctive properties, so may offer nutritional or commercial advantages, though may also require additional risk assessment. Will the Government ensure that the regulatory definition of nanomaterials that must be built into the formulation of any requirements for additional risk assessment is functional and not merely metric? Will they work towards trying to ensure that EU regulation also settles on a functional and not a merely metric definition?
Secondly, there is the matter of ensuring that communication by companies to consumers is adequate. There has been a great deal of emphasis on communication by labelling. But I think that we all know that communication is genuine only where it is actually understood by the relevant audiences—in this case consumers. Transparency by itself is never enough. It is not enough because the fact that information is made available does not ensure that it will be noted, understood or taken into account by relevant audiences. Excessive reliance on consumer choice—when that choice is supposedly informed only by incomprehensible data delivered in the smallest print, on colourful packaging designed to emphasise other, more glorious matters—is not genuine communication. Only government can ensure that food marketing achieves genuine rather than pretended communication with consumers.
There are a number of important audiences for genuine communication in this area. There is the matter of ensuring that communication between companies about research at a precompetitive stage supports, rather than suppresses, the understanding of important information. There is the matter of ensuring that communication by food companies with the wider public is adequate. Possibly the most worrying finding of the sub-committee, alluded to by both previous speakers, is that food companies appear to be secretive about the research that they are conducting. They do not, as far as we could discover, have in place modes of exchanging information on precompetitive matters, and they do not foster public engagement.
The sub-committee was well aware that this secrecy may reflect awareness of the problems created just over a decade ago by a non-UK company when it trumpeted the advantages of its products incorporating the then new technology of genetic modification into plant varieties without adequate communication with, and in particular without listening to, the public. We all know the disaster that resulted for UK and EU plant-breeding companies. We all know that we now live in a bubble in which we pretend that the foods we eat contain nothing that is genetically modified—except of course by traditional methods such as evolution and selective breeding of animals and plants—although non-EU countries have adopted many of the genetically modified crop varieties without harm and to their advantage. But the way to avert another disaster for another British industry is not to be economical with communication about research on products that incorporate engineered particles at the nano scale. What will government do to seek better communication among companies and between companies and the wider public, with a view to fostering an effective and mature discussion of the real issues that need to be addressed if engineered particles at the nano scale are to be incorporated into our food?
Queen's Speech
Baroness O'Neill of Bengarve Excerpts(13 years, 11 months ago)
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Baroness O'Neill of Bengarve
My Lords, your Lordships' House is extremely fortunate in the two Ministers who have arrived on the government Front Bench. We all know that the noble Earl, Lord Howe, has for many years followed health matters with scrupulous and impressive attention to detail. No one could be better qualified, and it is marvellous to have him in his post. It was also a great pleasure to hear the maiden speech by the noble Lord, Lord Hill, from the Front Bench this morning. I think that we can look forward to serious engagement on a wide range of extremely difficult topics.
I will make one undertaking at the beginning of this speech; I will not plead for the protection of a particular area of expenditure. I have my favourites and my interests, and I have a long university career behind me, but I am not going to plead for those. I looked at what would be at the head of the queue, and it is of course the Academies Bill, so I decided that I would focus on the issues that legislation in that area will raise. We expect to hear, and a first reading of the Bill suggests that we will hear, quite a lot about governance. I strongly support better governance and more independence for schools, with the caveat that we must all realise that more independence means that some will do a less than ideal job. We cannot expect greater independence to have uniformly good effects, but it will have better effects, and that is its justification.
The topic on which I want to say something today is not directly about governance but about the concepts of accountability and assessment that are ancillary to governance. Rather too often, systems of accountability undermine the independence that governance supposedly secures for institutions, and systems of assessment can undermine our educational aims for pupils. Of course accountability and assessment are both needed, but we need intelligent accountability and intelligent assessment, and in these matters more is not always better. That is why I have a suggestion for noble Lords on the Front Bench as to where savings might be made.
I will give two examples of defective accountability. When at breakfast I mentioned the theme on which I would speak today, my son, who is a governor of a very poorly performing primary school in Tower Hamlets, remarked that the governors of that school are accountable for 98 school policies that run to 100 or so pages of A4. He commented that if they did nothing but review those 98 policies every two years, as they were required to do, they would do absolutely nothing else. That is a reasonable example of a defective form of accountability. Requirements of this sort seemingly delegate but actually confer a quite illusory independence that obstructs other activities. The test in taking forward academies is that we do not undermine their independence and the education that they might offer by imposing forms of accountability that obstruct them.
My second, and unfortunately far from local, example is the system of assessment by which pupils, teachers and schools now find themselves held to account. Pupils and schools are judged on the scores achieved in SATs, at GCSE, at AS and at A-level. These are used not solely for educational purposes, which might be their proper use, but to construct league tables with very heavy implications for the futures both of pupils and of schools. This form of assessment becomes a rigid and educationally distorting form of accountability.
We hear that academy status is to be available to the best schools. Behind that phrase “the best schools” lurks of course a system of accountability and in this case perhaps a system of accountability that is in part based on pupil performance and league tables. But if merit is to be judged by pupil attainment, schools will continue to be hyper-incentivised to push limited forms of educational attainment. Gaining academy status will not lead to real independence for schools.
I remember talking to the head of an independent school which was very close to the top of the league tables when AS-levels had been introduced a few years before. I asked her whether it had had benefits for pupils. In her judgment, it had not. It had reduced the educational attainment possible in the lower sixth by cutting into teaching time and requiring a relentless focus on less demanding—indeed, quite often terminally boring—examined content. More generally, the system incentivises schools to push those subjects where A grades are more easily obtained.
I rather naively commented that, given the position of her school, she could refrain from entering pupils for AS-level. Her reply has stayed with me. She said, “With parents like mine, I can’t. They want every point that is available”. Systems of assessment can undermine the independence even of independent schools. If they are used for ranking schools in the future, the independence which the coalition Government seek will be undermined because all schools will be driving their pupils across the same hurdles. Even if those hurdles are not very high, there are a lot of them. More passes is always regarded as better. Another generation will be subjected to Stakhanovite quantities of exams, rather than being given plenty of teaching and an interesting and thoughtful education in which skills are assessed by exams and by examiners who are permitted to use their judgment and are trusted.
For too long the assessment tail has been wagging the education dog. I hope that the Government can be bold enough to see that serious judgments of quality cannot be based on test scores. If schools are to have greater independence, they must be free to teach more and to examine less, to emphasise skills, including skills in academic subjects, more. I greatly welcome the comments of the noble Lord, Lord Baker, who is not in his place, about technology colleges for 14 to 19 year-olds, but we need to free schools to concentrate on skills in academic subjects, not merely on the imparting, memorising and regurgitation of information—you may say factoids. We need better skills in languages, maths, science and writing. At A-level, pupils deserve to be offered an exam system in which reading beyond the syllabus is valued and celebrated, and not penalised as it has been by the examination system. There is a long way to go and I wish the Government well.