Covid-19: Resuscitation Orders

Baroness Watkins of Tavistock Excerpts

Wednesday 24th March 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the report is crystal clear that we accept that more training is needed. Front-line care support workers need to be given more support in their interactions, and we will be putting that in place.

[Baroness Watkins of Tavistock (CB)]

My Lords, I draw attention to my interests in the register, in particular the fact that I am a nurse involved with the Outcomes First Group, which supports people with learning disabilities. In order to increase the population’s awareness of care planning in relation to living and dying well, will the Government, in addition to training, consider incentivising healthcare workers to ensure that they have sufficient time to undertake proper assessment of individuals with cognitive impairment and learning difficulties as part of their routine care planning, which should be recorded and reviewed at least biannually?

[Lord Bethell (Con)]

The noble Baroness makes a very fair point; such care needs to be in the work plan particularly of those with learning difficulties, but of all those in care. We absolutely endorse the approach taken by the Resuscitation Council, which has extremely good guidance in this area.

NHS: Staff Numbers after Covid-19

Baroness Watkins of Tavistock Excerpts

Thursday 4th March 2021 Grand Committee

[Lord Clark of Windermere]

To ask Her Majesty’s Government what plans they have for the number of National Health Service staff after the COVID-19 pandemic.

[The Deputy Chairman of Committees (Baroness Watkins of Tavistock) (CB)]

The time limit for this debate is one hour.

[Lord Clark of Windermere (Lab) [V]]

My Lords, I count myself very fortunate to be introducing this Question. This is an invaluable parliamentary means whereby questions can be asked in a more discursive manner than usual and the Minister will listen and, we hope, provide answers. I shall make a couple of obvious general points.

The people of Britain love the NHS, as has been seen during the Covid-19 pandemic, but there were problems prior to the pandemic. I shall make three basic points to set the scene. The NHS is the fifth-largest employer in the world, yet we spend less on health as a percentage of our GDP than almost every other developed country in the world. To compound the situation domestically, there was a shortage of hospital beds prior to the pandemic. Indeed, we are bottom of the Euro league for intensive care beds, with 7.3 beds per 100,000 of population, compared with the best, Germany, with 33.8 beds—what a difference. Thus, prior to the previous cuts we were ill-prepared, and there have been too many cuts under the austerity measures of the early 21st century.

I am certain in my own mind that it was due only to the dedication, brilliance and sacrifice of NHS staff that we got through—and I mean all staff, from the top consultant to the most junior worker. And it has been at tremendous cost to many of them in stress, burnout and mental health challenges. We owe them a tremendous amount and I hope that, in his summing up, the Minister will confirm that this will be recognised when we have won the battle with Covid-19.

I will begin with nurses. Over the years, the Minister must have become tired of me pursuing him on the issue of nurses. I remain concerned. Currently, we are at least 40,000 nurses short. Over the next seven years we will face a shortfall of 108,000 nurses. I must ask the Minister very bluntly: will HMG drastically increase the training of fully qualified nurses? What discussions has he had to ensure the provision of the educational means to do so?

The Royal College of Nursing has conducted surveys and expressed deep concern about the exodus of qualified staff following the pandemic. I share that concern. Will the Minister push ahead and prepare plans to deliver what is necessary to persuade staff that they are valued, and to retain them in the NHS? According to the RCN survey, 35% of nurses are contemplating leaving the profession within the year. Will HMG also provide the NHS with the means to fund occupational health and psychological support, and, if necessary, breaks beyond annual leave?

Nurses are due a pay rise. They are currently worse off than they were a decade ago. Will HMG ensure that the upcoming pay settlement is really meaningful and commensurate with the ever-rising skills of nurses?

I turn now to GPs. If we are to meet the demands and expectations of the general public, we will have to increase the number of doctors, especially GPs. Does the Minister accept that we are still suffering in the training of doctors from the austerity years, over which his party presided? In spite of the modest increases of late to close the gap, does he accept that we face a shortfall of 7,000 GPs in the next two years? As a starter, we need to double the number of medical school places from 7,500 to 15,000 by the end of the decade.

I will move on from numbers to talk about processes. I am concerned about the reluctance of younger practitioners to enter general practice in many parts of the country, leaving it often to only elderly GPs to carry on as single practitioners, supplemented by agencies and bank locums. Do the Government really feel that that is satisfactory and sustainable?

I have a personal problem with this in Windermere at the surgery I am registered with. It operates from a fine purpose-built building but has been without a permanent GP for a number of years. It functions largely due to the skill, experience, training and commitment of nurse practitioners and other staff with specialist skills. Their work is supplemented by local doctors—if they can be persuaded to come. Five years ago, the practice was leased to a private company, OneMedical Group, 80 miles away in Leeds. Last autumn it took advantage of a break clause in its lease and surrendered it, and we are back to square one; it is far from a satisfactory situation.

The key issue is that younger GPs do not wish to buy into practices which might involve hundreds of thousands of pounds. I know a number of practices in Cumbria have had to undertake severe reorganisation and mergers simply to survive. In a letter to the Guardian on 1 March, a GP who has worked in the NHS for over 30 years made the same point, that younger GPs will not buy in to practices. I ask the Minister the most critical question that I am asking today: is this model, requiring such large financial commitments by individuals, suitable to the 21st century? Would the department do a preliminary examination of this problem?

The pandemic has changed so much, and we were found wanting. The years of austerity caused serious damage to our NHS. Only because of the beliefs of our NHS staff are we getting through it. One thing is clear: there is increased demand on our health service. There will have to be much change, including permanently increasing spending. The Government will have to recognise that what may have worked in the past may not do so in future. Models which have been sacrosanct may need to be examined and, if necessary, changed. All this is essential, with a radical White Paper bringing health and social care together. I ask the Minister: are the Government up to it?

--- Later in debate ---

[Baroness Greengross (CB) [V]]

My Lords, the All-Party Group on Adult Social Care—[Inaudible.]

[The Deputy Chairman of Committees (Baroness Watkins of Tavistock) (CB)]

We are having difficulty hearing the noble Baroness. We will come back to her after the next speaker, the noble Lord, Lord Willis of Knaresborough.

[Lord Willis of Knaresborough (LD) [V]]

My Lords, I will make a very brief reference to a group of NHS staff who have gone largely unnoticed during this pandemic and the debate but have been trailblazers and lifesavers in equal measure. I refer to the newest recruits in the registered healthcare workforce, nursing associates. The nursing associate register commenced two years ago, and today there are 4,036 registrants with a further 7,000 who commenced training at the height of the pandemic. Many plan to train on as registered nurses. These remarkable people, most of whom were dedicated care assistants, have risen to the greatest nursing challenge ever seen, saving patients and, indeed, the NHS. What steps are the Government taking to recognise the contribution of nursing associates and to redouble the investment in the recruitment and training of future cohorts?

[The Deputy Chairman of Committees (Baroness Watkins of Tavistock) (CB)]

I will move to the next speaker, the noble Baroness, Lady Altmann. We hope by the end of her speech to have resolved Baroness Greengross’s communication issue.

[Baroness Altmann (Con)]

My Lords, I am pleased to see that the numbers applying for nursing have been increasing. I know that the Government have started on their task of recruiting 50,000 more nurses by the end of this Parliament. What progress has there been towards that target? More crucially, what is the plan for improving retention rates in the NHS, as well as recruitment? Is there any further plan for improving recruitment and retention in the social care sector, which has not been mentioned so far?

I know that there is also a potentially significant issue with GP shortages being caused by early retirement, which has been encouraged by pension rules. Is there a plan to look into that issue as well?

[The Deputy Chairman of Committees (Baroness Watkins of Tavistock) (CB)]

I call the noble Lord, Lord Green of Deddington.

[Lord Green of Deddington (CB) [V]]

My Lords, as the noble Lord, Lord Clark, outlined, we have for years failed to train the medical staff we need. To take doctors, for example, the numbers are astonishing: over one-third of our doctors—35%—obtained their qualifications overseas, yet in both France and Germany the figure is below 10%. Meanwhile, some 8,000 British applicants are being turned away every year.

The figures for nursing are even worse. Until 2016, more than 30,000 UK applicants were turned away every year, while tens of thousands of nurses were recruited from abroad, often from countries that need them far more than we do.

Finally, the Covid crisis is an opportunity for a major reform of medical training. I certainly hope the Government will take it. The NHS’s standing has never been higher and the number of volunteers has never been greater. We need some firm action. Our young people deserve these opportunities. I look forward to the Minister’s response.

[The Deputy Chairman of Committees (Baroness Watkins of Tavistock) (CB)]

I now call the noble Baroness, Lady Greengross.

[Baroness Greengross (CB) [V]]

My Lords, I am co-chair of the All-Party Group on Adult Social Care. Our recent report found that the government target of recruiting 20,000 additional social care workers was not enough—[Inaudible.]

[The Deputy Chairman of Committees (Baroness Watkins of Tavistock) (CB)]

I am sorry; I think the difficulty is that the noble Baroness is not close enough to her microphone. When she was tested, it was fine. If we cannot hear her again, perhaps she could write and the Minister will pick up the issues she would like to raise? I will give the noble Baroness one more try right now.

I am sorry; our connection is just too poor for us to hear the noble Baroness. If she could send an email in, the Minister will pick up the issues when he sums up. I thank her very much for her patience.

I call the noble Lord, Lord Winston. No, the noble Lord has withdrawn. I call the noble Lord, Lord Balfe. No, he has withdrawn too. I call the noble Baroness, Lady Bennett of Manor Castle.

Future of Health and Care

Baroness Watkins of Tavistock Excerpts

Tuesday 23rd February 2021 Lords Chamber

[Baroness Watkins of Tavistock (CB) [V]]

My Lords, I declare my interests as outlined in the register and broadly welcome this paper. I particularly applaud the removal of the need for competitive tendering and the introduction of the discharge to assess model, which I and many other professionals have long advocated. However, could the Minister explain why such extensive powers are planned for the Secretary of State prior to the reforms of social care coming before Parliament? Why can they not come concurrently? He has partly just explained that, but it would be much better if we waited and did the two things together. Section 5.153 of the White Paper is designed to widen the scope of Section 60 of the Health Act 1999 to provide further powers enabling the Secretary of State to

“make a large number of changes to the professional regulatory landscape through secondary legislation.”

I seek assurance that there will be ample opportunity to debate this latter issue during the passage of the Bill.

[Lord Bethell (Con)]

I am extremely grateful to the noble Baroness, Lady Watkins, for her generous remarks on competitive tendering and discharge to assess. These are examples of where we have listened to stakeholders and those in the NHS who have called for changes. In terms of the powers given to the Secretary of State and the link with social care, it is worth remembering that this Bill is a stepping stone towards other changes. Changes to social care funding can take place largely without any legislative change; they can be introduced by secondary legislation. Changes to the funding model in social care are a matter for a very large engagement process that will include other parties, as the Prime Minister has outlined, and will include very considerable engagement with stakeholders.

In the meantime, we are seeking to correct an overreach in the seclusion and mandation of the NHS to give the Secretary of State the kinds of powers that are reasonable in a parliamentary democracy in the governance of such a large and important national institution. Those powers are to be used with restraint and a degree of circumscription, but they rebalance the political geography of the NHS to give it full accountability. As such, they give the kind of authority the Secretary of State needs to institute the kinds of social care reforms I know the noble Baroness, Lady Watkins, is interested in.

Covid-19 Update

Baroness Watkins of Tavistock Excerpts

Thursday 4th February 2021 Lords Chamber

[The Deputy Speaker (Lord Russell of Liverpool) (CB)]

Since the noble Baroness, Lady Jolly, has withdrawn her name, I call the noble Baroness, Lady Watkins of Tavistock.

[Baroness Watkins of Tavistock (CB) [V]]

My Lords, I ask the Minister about British citizens working overseas. I declare an interest in that my son is in this category. We have done such a fantastic job here on the vaccines to date, but there are many British citizens working abroad in a volunteer, business or diplomatic role. They recognise the need for quarantine and the need for vaccinations to enable them to work between their UK base and their overseas commitments. How best can the Government include those UK citizens in our vaccination programme—clearly, not giving them priority but to ensure that we protect their health, as well as that of people living in Britain at the moment?

[Lord Bethell (Con)]

My Lords, the Government take very seriously their commitments and obligations to those British citizens who live overseas. It is a matter of considerable concern that they be included in the vaccination deployment. However, there are certain practical challenges with this, so we invite those who want the vaccination to return to British shores so that they can be part of the vaccination process, and to ensure that they are registered with their GPs so that they are included in the list. The Prime Minister has made it very clear that we are putting border measures in place that will ensure that we are protected against mutations and variants. Once again, therefore, I invite all those living overseas who want the vaccination to ensure that they have thought-through arrangements in place to return to this country to get their vaccinations.

Medicines and Medical Devices Bill

Baroness Watkins of Tavistock Excerpts

Report stage & Report stage (Hansard): House of Lords & Report: 1st sitting & Report: 1st sitting: House of Lords
Tuesday 12th January 2021 Lords Chamber

[Baroness Masham of Ilton (CB) [V]]

My Lords, I agree with the noble Lord, Lord Lansley. It is very good news that there is to be a patient safety commissioner. I congratulate everyone who has worked so hard to create this amendment, especially the noble Baroness, Lady Cumberlege. It is so good that the Government have listened. Patient safety is vital, especially now when the NHS is under so much stress and demand. Over the years, some tragic incidents could have been avoided if patients had been listened to and there had not been cover-ups.

The noble Baroness feels that the words

“so far as reasonably practicable”

should be removed. She may feel that they would weaken the amendment; is this the case? This is important, because patients need clear information about how they are to communicate with the patient commissioner, so that they trust the system.

[Baroness Watkins of Tavistock (CB) [V]]

My Lords, I am delighted to follow my noble friend Lady Masham of Ilton. I reiterate my support given in Grand Committee for the appointment of a patient safety commissioner, and I thank both the Minister and the noble Baroness, Lady Cumberlege, for the work they have done together to get to this point.

To reflect on the speed since the report of the noble Baroness, Lady Cumberlege, I remind noble Lords of the report, in the early 1970s, called Sans Everything, about the terrible atrocities and lack of safety in some in-patient mental health services. It took nearly a decade for that to be taken seriously, so we warmly welcome the speed with which we are dealing with this situation now.

I am delighted that Amendment 54, which will be moved by the noble Lord, Lord Bethell, on behalf of the Government, will identify the principles relating to core duties, involvement of patients and amendment to primary legislation, together with regulations for appointment and operation of the office for the commissioner. I too have concerns about paragraph 3(3) of the proposed new Schedule A1, concerning the statement:

“A relevant person must, so far as reasonably practicable, comply with a request by the Commissioner”.


This means that a reluctant organisation—we need to remember that some very small organisations deliver healthcare on behalf of the NHS—or individual is potentially provided with an excuse not to co-operate with the commissioner on a reasonable request. I ask the Minister: could the words

“so far as reasonably practicable”

be removed?

Clarity over roles and responsibilities will be key to maximising patient safety, as will the independence of such a commissioner. It may well be that, as we work forward, we can be clear about the level of independence to ensure that, as they revise the principles of better patient safety, they consider not only patients in hospitals and mainstream community care but patients further afield, particularly in areas provided by the independent and charitable sector.

Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020

Baroness Watkins of Tavistock Excerpts

Thursday 7th January 2021 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I am pleased to contribute to this debate and I hope that it will result in further clarification of the Government’s approach to managing the pandemic over the next two months. There is much concern about the plethora of statutory instruments that have been passed with the aim of containing the virus, and about what appear to be sudden, unexpected changes in geographical tier allocation and guidance restricting the way in which people lead their lives. Are decisions made entirely on the R rate locally, or is it this and other issues, including the estimated risk factors in a local population and the availability of hospital beds for treatment? Research shows that if you want people to comply, you need a straightforward message. Greater transparency about the reasons for changing allocations would, I believe, result in greater adherence to the restrictions.

Nearly every UK citizen wants to do their best to reduce the spread of the virus, but many fail to understand why, for example, they were encouraged to send their children to school on Monday but are now asked to keep them home, seemingly until half term. Can the Minister explain when there will be a review of the current restrictions and whether there will be further attempts to work with the devolved Administrations to get a more joined-up approach across the four countries?

I congratulate the Government on rapidly altering the training requirements for retired healthcare workers wanting to return to assist in vaccination, and I am pleased to report from a Microsoft Teams meeting with the CNO, Ruth May, and Mark Radford from the HEE this morning that there are sufficient permanent and recent volunteers to administer the vaccines for the foreseeable future. However, there remains a need for extra staff to work in clinical areas. Can the Minister confirm that that is the case and tell us what further interventions will be taken to increase the health and social care workforce this year, including intakes in September?

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

Baroness Watkins of Tavistock Excerpts

Wednesday 30th December 2020 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I am by nature a libertarian, believing that individuals should, by and large, be responsible for their own behaviour. However, I fully support these regulations, and think that they do not go far enough given the current R rate and the Covid-19 challenges.

Nursing staff, of whom I am one, as your Lordships know, play an indispensable role in delivering health and social care services, and have gone far and beyond during this crisis. The challenges presented by Covid-19 have been exacerbated by existing and severe staffing shortages in our healthcare sector. We are now seeing the highest numbers of recorded cases of Covid-19 in the UK, with some trusts and areas reporting that they are at breaking point. With the added pressure of winter and unprecedented demand on the service, there are not enough healthcare staff to care for people across the system. These pressures not only exacerbate workforce issues but put patient safety at risk.

Having spoken to Dame Donna Kinnair, the chief executive of the Royal College of Nursing, and having considered other briefings, including from the NHS Confederation, I believe that we need to introduce tomorrow night, as an emergency, some kind of curfew, so that people do not go out in pairs, meet others in pairs, or get alcohol from those off-licences that can open, in order to protect the few beds that we have available in the health service at the moment and ensure that we do not make things worse in the next 24 hours.

Covid-19 Update

Baroness Watkins of Tavistock Excerpts

Tuesday 15th December 2020 Lords Chamber

[Lord Bethell (Con) [V]]

My Lords, the restrictions in England have never been based on a two-week circuit breaker. It was not a policy that the DHSC supported.

[The Deputy Speaker (Baroness Watkins of Tavistock) (CB)]

The noble Baroness, Lady Blower, has withdrawn, so I call the noble and gallant Lord, Lord Craig of Radley.

[Lord Craig of Radley (CB) [V]]

My Lords, the Statement refers to a new variant of the virus. Is this the only variant, or are others being found overseas? Porton Down is working to discover whether the current vaccines will remain effective. When does it hope to report? I declare an interest: I was vaccinated in the Fakenham medical centre in Norfolk this morning—a very efficient and reassuring experience—which had 365 planned for today.

--- Later in debate ---

[Lord Bethell (Con) [V]]

My Lords, the noble Baroness is entirely right: the whole purpose of the isolation payments and the idea behind them is the recognition that people who are being asked to self-isolate, particularly if they come from a low-income household, to which the isolation payment is targeted, need financial support to fulfil their civic obligations. That is why we put the scheme in place. It is true that it has been tremendously successful in some areas. We continue to review whether that fund needs to be topped up.

[The Deputy Speaker (Baroness Watkins of Tavistock) (CB)]

The noble Lord, Lord Rooker, and the noble Baroness, Lady Fox of Buckley, have withdrawn, so I call the noble Lord, Lord Singh of Wimbledon.

[Lord Singh of Wimbledon (CB) [V]]

My Lords, the Statement rightly emphasises the need for swift and decisive action to control the deadly virus, which is increasingly affecting schoolchildren. Yet, when a few schools in London planned to close a few days before the end of term but to continue with internet classes, they were threatened with legal action. Does the Minister agree that, while children’s education is important, their health and that of their parents and grandparents should also be considered before rushing to legal threats?

--- Later in debate ---

[Lord Bethell (Con) [V]]

I completely accept the point made by the noble Baroness. It is incredibly frustrating that the exact communities which have often seen some of the highest mortality rates are also those which are sceptical about the vaccine. This is one of our biggest challenges; it has been for months and will continue to be so. I pay tribute to colleagues at the Department of Health and the Cabinet Office who have done a huge amount in working with specialist media—radio, magazines and online forums—to target exactly these communities. They have used advertising and direct engagement with the presenters to put the message across, often in local languages, and this has proved increasingly effective.

[The Deputy Speaker (Baroness Watkins of Tavistock) (CB)]

My Lords, all speakers have been called.

Health Protection (Coronavirus, Restrictions) (All Tiers) (England) Regulations 2020

Baroness Watkins of Tavistock Excerpts

Tuesday 1st December 2020 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I appreciate that the issue of reducing the spread of the Covid-19 virus is essential for the health of our population. However, while I broadly support the regulations before us today, I am extremely concerned that people in England are finding difficulty in understanding the correlation between the R rate in their local community and the tier in which those communities are being placed. Can the Minister explain why London should be in tier 2 when some parts of the north and the Midlands that have been placed in tier 3 seem to have similar R rates per 100,000 people in the population? We have been told that in many situations this is because of the pressure on hospitals. Is it the case, therefore, that there are sufficient empty ITU and vacant hospital beds to allow for an increase in the R rate that may occur associated with the social mixing allowed under tier 2 regulations in London compared to hospital bed availability in other parts of the country?

It is reported in the media that Ministers believe the adoption of the new tier system will enable a re-evaluation of tier allocation, depending, presumably, on the R rate, in as little as a fortnight. Members of the public might be in tier 3 from tomorrow, might move to tier 2 restrictions rapidly and might then enter the national relaxation in restrictions over the Christmas holidays. This concept suggests that if people adhere to the rules in tier 3, a rapid move to tier 2 is likely. Can the Minister confirm that, in the event of the R rate increasing in tier 2 areas over the next fortnight, these communities will be moved into tier 3 level restrictions prior to moving to the rules that are associated with the Christmas period?

We are told that these tiers are necessary to protect the NHS. In fact, the NHS is not just acute hospitals. Rather, the NHS involves public health, primary care and the long-term support of people with chronic health problems, in their own homes and in residential care settings, where there is inevitably close liaison with social care. Will the Minister inform the House what estimates have been made of the pressures on community mental health and learning disability services as a result of the pandemic, and what further interventions are being planned to support community-based services in tier 3 areas? Unless we intervene to tackle the effects of the pandemic on the most vulnerable in our society who do not require hospitalisation, we are in danger of doing more harm to the health of the population than we realise. The BBC “News at Ten” last night focused on the isolation and poverty that has been exacerbated as a result of the pandemic. It was a harsh reminder to anybody who watched it of the wider effect of the virus.

Finally, I remain concerned that, as the amendment to this Motion tabled by the noble Baroness, Lady Neville-Rolfe, states, “the restrictions being introduced” are not sufficiently

“informed by a wide and detailed analysis”

of other factors. The UK continues to reduce inbound travel restrictions from a range of countries using a methodology endorsed by the four CNOs in the UK. It states:

“As UK infection rates rise, the relative risk to public health from imported cases decreases”.


The latest changes were agreed at the sixth statutory review on 16 November when incidence was high in the UK. As the Minister has said, UK rates are now already reducing. How long will it be before we review again the travel restrictions? I ask this question because the methodology also states that:

“The rationale for this is that the impact of travel restrictions is expected to be greatest when UK infection rates are relatively low.”


Therefore, if we succeed in reducing the rates before Christmas, is the Department of Health and Social Care confident that the transmission of Covid-19 within the UK from people arriving in this country with asymptomatic disease is highly unlikely?

As a healthcare worker myself, I remain concerned that we have to face high levels of restrictions on social interaction to contain the disease and protect healthcare workers. The public do not wish to comply with our community’s restrictions only to have their own investment in disease reduction wasted as a result of people travelling from other parts of the world and unwittingly increasing infection rates in the UK again over the Christmas period.

Medicines and Medical Devices Bill

Baroness Watkins of Tavistock Excerpts

Committee stage & Committee: 5th sitting (Hansard) & Committee: 5th sitting (Hansard): House of Lords
Wednesday 11th November 2020 Grand Committee

[The Deputy Chairman of Committees (Baroness Watkins of Tavistock) (CB)]

We now come to the group consisting of Amendment 94A. I remind noble Lords that anyone wishing to speak after the Minister should email the clerk during the debate.

Amendment 94A

Moved by

--- Later in debate ---

[Baroness Walmsley (LD) [V]]

My Lords, I heartily support the noble Lord, Lord Field, and the noble Baroness, Lady Meacher. I thank the noble Lord for his important evidence, and congratulate the noble Baroness on her many years of energetic campaigning on this matter. Noble Lords may know that I too have campaigned long and hard for medicinal cannabis projects, that have been proved to be safe and effective, to be prescribed on the NHS for UK patients. When the Home Office changed the status of medicinal cannabis two years ago, many of us thought that, given the mass of evidence that there are many such safe and effective products in widespread use abroad, such medicines would become available free to UK patients. That has turned out not to be so. Although some expert clinicians are prescribing them for appropriate patients—including the noble Lord, Lord Field—in a private capacity at high cost, very few patients have received their medicine free on the NHS. Why is this? It seems that it is because NICE has not approved them because there have not been any random controlled double-blind trials. Therefore, several health trusts are forbidding consultants who want to prescribe these medicines to do so, on pain of losing their jobs.

There are children with intractable epilepsy in this country whose lives have been saved by the medicines, for which their parents have had to fundraise. The lives of some of those children have been put at risk because the coronavirus has prevented that fundraising, and they suffered serious preventable fits. Many of these children have been treated with approved pharmaceutical medicines that have never been approved for use with children and have serious side effects. That is why we need a proper regulatory framework based on the full cadre of available evidence, which this amendment proposes. It will not be difficult to establish the safety of these medicines, as required by subsection 3(a). If those making the regulations are allowed to take into account the health records of people who have already been taking these medicines, and also the vast amount of evidence from other developed countries which the noble Baroness, Lady Meacher, has listed, that will subsection 3(c). Subsection 3(b) requires that availability be considered when making the regulations. These medicines are readily available. Indeed, a lot of them are being made in this country and exported because they cannot be sold here. How mad is that? Nor are they expensive as medicines go, and the NHS can bulk buy at a discount anyway.

In order to satisfy those who do not trust evidence from other countries—although why is beyond me—we also need to collect data from UK patients who are managing to get cannabis medicines in order to provide the information required by NICE, but there is no system in place to do that. Will the Minister say why the NHS Commissioning through Evaluation system is not being used? It is a well-established and approved system that collects patient data and clinician observation on the use of novel medicines and treatments. It strikes me that, given that cannabis medicine’s illegal status made it impossible to collect much UK data before 2018, it would be an ideal candidate for this trusted method of evaluation. Finally, I would welcome the Minister’s response to this suggestion.

[The Deputy Chairman of Committees (Baroness Watkins of Tavistock) (CB)]

I call the noble Lord, Lord Norton of Louth. Lord Norton? We will move to call the noble Lord, Lord Patel, and come back to the noble Lord, Lord Norton if we have time. I call the noble Lord, Lord Patel.

[Lord Patel (CB) [V]]

My Lords, I will need to speak only very briefly because the noble Lord, Lord Field of Birkenhead, and the noble Baronesses, Lady Meacher and Lady Walmsley, have covered the ground extensively, fully and informatively. It is a privilege to be involved in an amendment moved by my noble friend Lord Field of Birkenhead. We have been friends, discussing such issues for very many years, although he was in a different House, so it is a pleasure to see him and support his amendment.

My noble friend Lord Field spoke from personal experience, and my noble friend Lady Meacher spoke extensively about the information available. In 1998, the Science and Technology Committee of the House of Lords recommended that there should be a programme to assess the medicinal use of cannabis and that ways should be found to use it. NICE has recommended one or two areas where it can be used, as has already been said. Very few NHS prescriptions have been given out, but more than 1 million people use cannabis preparations bought privately at huge cost. They use them because they find benefit from them. The report suggests that the people who benefit from it mostly suffer from chronic pain. Despite that, reports have been published where people with Alzheimer’s, cancer, chronic pain, Crohn’s disease and multiple sclerosis, to name but a few, found benefits from it. More than 20,000 publications on PubMed, not of clinical trials, but of people’s experience and data collected from patients, show that they have found it to be beneficial.

When recommending and assessing medicinal products using cannabis, NICE suggested that research should be carried out in six or seven areas. I do not know what research has been carried out. The problem with such a recommendation is that it does not recommend who should do the research. So I ask the question: who should be doing this research to explore the benefits that patients find in medicinal cannabis?

Private clinics prescribe more and more cannabis on a daily basis, and more and more clinics are opening in cities in England where cannabis is available. My noble friend Lady Meacher and the noble Baroness, Lady Walmsley, alluded to two important issues. One is that a way needs to be found to collect information on patients’ experiences and data to show why so many patients go to private clinics to get cannabis products and what benefits they derive from them.

I look forward to the Minister’s response, but I hope she may agree, as it would not require legislation or an amendment to the Bill, that the NIHR or the Department of Health and Social Care through the NIHR should establish a forum of specialists, including patients, to find a way forward to collect information on a more formal basis. I hope the Minister will respond positively to that. It has been a pleasure to take part in this debate.

[Baroness Jolly (LD) [V]]

My Lords, the amendment signed by my noble friend Lady Walmsley and others would require the Secretary of State to make regulations concerning medicinal cannabis and associated devices. The noble Lord, Lord Field of Birkenhead, made his case clearly and strongly. I have a family member who used cannabis as a painkiller towards the end of their life when pharmaceuticals failed. Given the huge relief it can bring to patients with conditions such as epilepsy, it is vital that barriers to access are removed. We have heard that since the law was changed in November 2018, only a very small number of prescriptions have been written for medical cannabis.

The noble Baroness, Lady Meacher, my noble friend Lady Walmsley and the noble Lord, Lord Patel, have for many years supported the use of medical cannabis for a small number of conditions. Very few patients have received their medicine on the NHS because NICE has yet to approve the use of cannabis in any context. Evidence is available, so why are the Government fighting shy of using cannabis or its derivatives, thus forcing individuals to become criminals by having to go abroad to countries where cannabis is legally available, but at a huge cost, and then smuggle it home? It does not make sense. We support the amendment.

[The Deputy Chairman of Committees (Baroness Watkins of Tavistock) (CB)]

We do not seem to be able to contact the noble Lord, Lord Norton of Louth, so I call the noble Baroness, Lady Thornton.

[Baroness Thornton (Lab)]

I thank my noble friend Lord Field—he may not technically be my noble friend, but he is really—for bringing this issue to the Committee at this stage. He probably knows that he is not the only parliamentarian who has been driven to cannabis products for similar reasons, but my lips are sealed about who the others might be.

The noble Baroness, Lady Meacher, is absolutely correct. She and I have form. I have been supporting her from the Front Bench on this issue for quite a long time. While the debate was going on, I looked to see what Hansard had to say about this. The last time, I think, that we discussed this was in March 2019. At that time, the framework and law had been changed the previous November, so that is two years ago. At that point four people had managed to get cannabis products prescribed. When the noble Baroness put the question to the House, it was answered by the Minister’s predecessor. Will the Minister say how many more people there are now? I think it is probably not that many more, and I see this amendment as a scream of frustration about this issue. There is justifiable frustration that we have not managed to regulate this product in a way that makes it accessible to people who need it most. It also exacerbates the inequalities in our health system because, as the noble Lord, Lord Field, said, he can afford to buy it, but there are thousands of people who need it and cannot afford to buy it. I support this amendment, but I am really much more interested to see what on earth the Government are going to do to make progress with this.

[The Deputy Chairman of Committees (Baroness Watkins of Tavistock) (CB)]

I am now able to call the noble Lord, Lord Norton of Louth.

[Lord Norton of Louth (Con) [V]]

My Lords, I am delighted to have the opportunity to contribute to the debate and I apologise for not being able to contribute in my allocated slot.

I was very keen to add my name to the amendment to support the noble Lord, Lord Field of Birkenhead. I do not want to repeat the points that have already been made, but I draw attention to the fact that a few years ago I initiated a debate in the House on drugs policy. My point was to argue the case not for a change in policy but that policy must be—or should be—evidence-based. At the time, the Minister who replied said that opinion on this is divided. Someone afterwards pointed out that only the Minister disagreed with me because everyone else who spoke in the debate supported the case I was making that the Government were resisting going on the basis of evidence. For whatever reason, they were sticking their heels in.

As we have heard, the evidence really supports the case for change. The APPG for Drug Policy Reform showed the case and that there is evidence for the value of medicinal cannabis in relieving pain. There is a very strong argument on the basis of evidence and a moral case as well, given the sheer number of people who are forced, at great expense and possibly some danger, to find alternative ways of getting hold of cannabis for medicinal purposes, so I very much support what has been said by preceding speakers, including the noble Lord, Lord Field. I think the amendment is a step in the right direction in what it seeks to achieve. It is targeted and proportionate. It is designed to help to expand access to safe and regulated medicinal cannabis products in the United Kingdom. There were other points I was going to make in support, but I do not want to repeat points that we have already heard. I just wanted my name to be on the record as supporting the very powerful cases that have been made for the amendment.

[Baroness Penn (Con)]

My Lords, Amendment 94A in the name of the noble Lord, Lord Field of Birkenhead, deals with a topic of great difficulty. As the noble Lord has personally testified, patients and families deal courageously with challenging conditions, and I know that the issue of medicinal cannabis is one that has had much debate.

As other noble Lords have pointed out, it is almost two years to the day that the Government changed the law to allow the supply of medicinal cannabis under misuse of drugs legislation. These regulations provide that medicinal products containing cannabis can be prescribed or supplied when certain conditions are met. These conditions are that the relevant cannabis product is a special medicinal product, an investigational medicinal product for use in a clinical trial or a medicinal product with a marketing authorisation.

I do not have specific figures for the noble Baroness, Lady Thornton, on the number of people who may have accessed cannabis drugs since then. I understand that the collection of data on certain private prescriptions was suspended because of Covid-19, but we can go away and look for the latest data and, when it becomes available, update the House. I believe I heard the noble Lord, Lord Field, say that there may have been 204 prescriptions. While I cannot endorse that figure, and noble Lords may feel it is low, it is considerably higher than the figure that the noble Baroness quoted for one year after the approval of medicinal cannabis. Therefore, if it is correct, progress is being made in the right direction.

Noble Lords are right that cannabis remains a controlled drug. I appreciate that the noble Baroness, Lady Meacher, already expressed views on this in our discussions with the MHRA on whether it ought to be a controlled drug at all. The noble Lord, Lord Field, also made that point. However, the changes to its restrictions are set out in the Misuse of Drugs Act 1971, the Misuse of Drugs Regulations 2001, for England, Scotland and Wales, and the Misuse of Drugs Regulations (Northern Ireland) 2002. Those regulations are not within the scope of the Bill.

What is within scope is when those medicinal products are regulated as a human medicine. The noble Lord is asking for regulations to provide for a specific licensing regime for medicinal cannabis. However, I stress that medicinal cannabis products already have a route to market. They fall within the scope of the Human Medicines Regulations 2012 and the Medicines for Human Use (Clinical Trials) Regulations 2004. It is entirely appropriate that they are subject to the same standards and requirements of evidence as any other medicine. The MHRA’s licensing process takes into account evidence of clinical efficacy. This includes consideration of all evidence supplied by the manufacturer. The regulators also inspect the factory where the medicine is to be made to make sure that supplies will be of a uniformly and consistently high standard. Companies can and do submit evidence of use from other countries, so there is no need to set an explicit requirement to consider efficacy internationally. If a company wishes to make a product available, it can within this regime.

Medicinal devices that administer medicinal products, including medicinal products containing cannabis, would also need to comply with the relevant provisions of the Medical Devices Regulations 2002. But a medicinal product in the UK must be safe. We have talked throughout the Committee about the critical importance of safety and the need to uphold standards. There is a paucity of evidence to support the quality, safety and efficacy of these products, meaning that very few hold marketing authorisations. To address this, the industry needs to further the evidence base and support the use of their products. Government is supporting this with a programme of two randomised control trials commissioned by the National Institute for Health Research. I hope that reassures the noble Lord, Lord Patel, as the National Institute for Health Research is engaged in assessing the evidence in this matter. These trials will be critical in ensuring that evidence for cannabis-based medicinal products can be developed to plan future NHS commissioning decisions for the many patients who may benefit from these innovative medicines.

Just to pick up on the question of how many drugs may already hold licensing, I can say that there are three such licensed products, including Sativex for MS and Epidyolex for rare epilepsies. These drugs are proof that cannabis-based products can meet the high standards of quality, safety and efficacy that we rightly expect in the UK. I say to the noble Baroness, Lady Jolly, that the drugs that have been licensed by the MHRA also have NICE approval for use in the NHS in certain appropriate conditions. As we heard in our meeting with the MHRA on Monday, it is able and willing to provide advice to researchers and companies that wish to conduct clinical trials and go through the licensing process for their products.

Cannabis-based products for medicinal use can also be supplied as unlicensed “special” medicines, as noble Lords have noted. A special medicinal product is a product that is manufactured or assembled according to the specifications of a specialist medical practitioner to meet the needs of a specific patient, in accordance with the stringent “specials” regime provided for in the Human Medicines Regulations 2012. Those unlicensed products have not been assessed by the National Institute for Health and Care Excellence for clinical or cost effectiveness. These are the foundations of NHS decisions about routine funding for medicines.

I appreciate that families with ill children, or patients themselves, would dearly love to have greater products available to them for more purposes, but this is not about creating new licensing routes. It is about companies coming forward and undertaking clinical trials and tests and it is about having the appropriate level of assessment and understanding of the impact. We are taking steps to improve the body of evidence available. When marketing authorisations are sought, they will be dealt with by the regulator, as they would for any other medicine. That may not be as quickly as some would like, but it is necessary to protect patients. On that basis, I hope that the noble Lord, Lord Field, is content to withdraw his amendment.

[The Deputy Chairman of Committees (Baroness Watkins of Tavistock) (CB)]

I have received requests from three noble Lords to speak: the noble Baronesses, Lady Finlay, Lady Walmsley and Lady Thornton. I call the noble Baroness, Lady Finlay.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, I am most grateful to be able to come in at the end of this important short debate. I particularly commend the noble Lord, Lord Field of Birkenhead, for his outstanding and long history as a parliamentarian and, yet again, for his clarity and ethical approach to every subject that he addresses.

I am glad that the Minister has referred to the two studies from the NIHR and simply support the idea that we need to wait for those, although I draw attention to the fact that, in 2018, there was a Cochrane database review, which looked at the 16 double-blind randomised control trials that it could find. It found some support, but it was not terribly strong. One of the difficulties here is that pain is a symptom that occurs in an enormous range of disorders, but the fundamental cause of the pain will be very different in different people. To get a matched population where you can compare one with another is extremely difficult. I hope that the change that NICE is looking to in the evidence that it seeks, where it will also look at evidence in practice, will support the evidence coming through from large patient cohorts who can then be put into broader groups.

The other point about pain is that, as people get multiple pathologies, they often take several other medications as well, which can interfere with the ability to assess them. They are also often elderly. The evidence certainly needs to be accrued. I would say as a clinician that one worry was always whether there would be a leak of cannabis on to the streets. However, in practice, I think that the leakage has gone other way so that it comes from the streets into people’s homes. Clinicians have had to look at this with Nelson’s eye because they do not want to support clinical activity. In a study that I did, while we did not ask patients to tell us specifically where they were getting some things from, when we put together all the different types of alternative therapies being used by a group of people who were cancer patients, the numbers were huge. This supports many of the comments that have already been made. I am glad that the Government are looking at it and I expect that it will not be too long before we find that the ability to get the medication that is needed is made easier. I worry that it may be too late for some patients, but we are getting there.