Mesothelioma (Amendment) Bill [HL]

Lord Avebury Excerpts

Friday 20th November 2015 Lords Chamber

[Lord Avebury (LD)]

My Lords, I, too, begin by congratulating my friend, the noble Lord, Lord Alton, on his masterly presentation of the case for the Bill, and on the assiduity with which he has pursued compensation for mesothelioma sufferers over a great many years with determination and thoroughness. I know how many hours he has spent on this and how many more hours he is likely to spend on it in future, but if we get this Bill through, it will be a major advance in securing compensation for sufferers of this horrible disease.

I started work on mesothelioma 40 years ago with the late Nancy Tait, whose husband died an agonising death from mesothelioma. She formed the Society for the Prevention of Asbestosis and Industrial Diseases, which lobbied hard for tighter controls on asbestos, and she fought for the rights of victims to adequate compensation. We published a pamphlet entitled Asbestos Kills, but the use of the material continued here in the UK long after it was banned in other countries of the developed world. That explains why the UK was the country with the highest age-adjusted death rate from 1994 to 2008, with 17.8 deaths per million. The Health and Safety Executive expects the death rate to peak in 2018, after which it will slowly decline, but because there can be a delay of several decades between exposure to asbestos and the onset of mesothelioma, the disease may well be claiming hundreds of lives a year in the decade 2050-60. To put it another way, over the next 30 years, 30,000 deaths are expected from this horrible disease unless new and effective treatments are developed.

At the moment, there is no cure for mesothelioma, and funding for research is woefully inadequate and uncertain. There are said to be government grants of £1.2 million a year, and last January the insurance companies Aviva and Zurich announced one-off funding of another £1 million, but there is no continuity, no assurance that in the years to come there will be even the same level of funding as there is in 2015, with the obvious result that cancer researchers starting out on a career will look for projects in other areas. That may explain the paucity of really high-quality applications coming forward.

Cancer Research UK says it is looking to invest more in rarer cancers, and it would be useful if the Minister could say what has emerged so far from the strategy published in May last year. However, as the noble Lord, Lord Alton, reminded us, in 2014 a mere £860,000 was spent on mesothelioma research—a miserable amount compared, say, with the £9.9 million spent on skin cancer or the £5.5 million spent on melanoma, which are cancers with similar mortality.

The noble Lord, Lord Alton, has been tireless in his attempts to put this right over the years, and I warmly support his latest efforts in this Bill. In addition to the amounts active insurers are required to pay to fund the diffuse mesothelioma compensation scheme, he proposes, as he did in the summer of 2013, that the levy be increased by an amount not exceeding 1% of the compensation payments to fund mesothelioma research. This is supported by the British Lung Foundation, which points out that by improving outcomes and thereby reducing compensation payouts, insurers would stand to benefit from the research. The BLF tells me that the insurance industry is expecting to pay out more than £12 billion under the existing scheme over the years. A fraction of this enormous amount invested in high-quality research could revolutionise our understanding of mesothelioma and lead to significant improvements in the treatment and management of the condition.

Your Lordships may recall that when we last debated this matter in 2013 there was widespread support for the basic principle of insurer-funded research, and of course we are extremely grateful to the two companies that contributed voluntarily to start the process. However, as the noble Lord, Lord Alton, reminded us, there are another 148 insurers active in the employers’ liability market that would contribute if this Bill were passed. Zurich announced a few weeks ago that it was walking away from its £5.6 billion bid for UK insurer RSA. The amounts active insurers would be asked to pay under this Bill are insignificant in comparison with their assets, but they could transform the outlook for mesothelioma patients and their families.

Health: Obesity

Lord Avebury Excerpts

Thursday 26th February 2015 Lords Chamber

[Lord Faulkner of Worcester (Lab)]

My Lords, has the Minister had the chance to study this morning the reports of the research from the health campaign group Action on Sugar, which demonstrates that enormous quantities of sugar are found in so-called sports and energy drinks and that these are targeted at children in particular? One particular drink produced by a well known high street grocery—

[Lord Avebury (LD)]

Sainsbury’s.

[Lord Faulkner of Worcester]

Yes, Sainsbury’s. It contains up to 20 teaspoons of sugar in every can—far, far over the recommended limit.

Alcohol: Impact on Accident and Emergency Services

Lord Avebury Excerpts

Wednesday 21st January 2015 Lords Chamber

[Earl Howe]

My Lords, we are keeping the developing evidence on a minimum unit price under review. It has only ever been part of our alcohol strategy—which, as I said, includes a range of actions. We acknowledge the need to give careful consideration to any possible unintended consequences of MUP, such as its potential to impact on the cost of living, the economic impact of the policy and, importantly, a possible increase in illicit alcohol sales that could ensue.

[Lord Avebury (LD)]

My Lords, is it necessary to refer to the alcohol industry for measures to alleviate the £21 billion-worth of harm that it causes? Should my noble friend not instead refer to the calculations by the University of Sheffield showing the amount by which alcohol harm can be reduced by increases in taxation?

[Earl Howe]

My Lords, we have taken a strong policy on taxation in recent years, particularly to reduce the availability of cheap, strong alcohol. Since the 2010 general election, duties on spirits have risen by more than 18%, which is well above RPI, and on wine by more than 21%, again well above RPI. We have also introduced a ban on the sale of below-cost alcohol, which should stop the worst cases of cheap and discounted alcohol sales.

Alcohol: Addiction

Lord Avebury Excerpts

Monday 12th January 2015 Lords Chamber

Asked by

[Lord Avebury]

To ask Her Majesty’s Government what are Public Health England’s plans for combatting alcohol addiction.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, Public Health England recognises that the harmful use of alcohol is a major health risk. The harm from alcohol is preventable; alcohol is one of seven key priorities that PHE is focusing on. It is implementing a programme to support national and local government, the NHS and partners to implement evidence-based policies and interventions. Included in this work is the reduction of alcohol addiction.

[Lord Avebury (LD)]

Considering that three years ago, there were 1.1 million alcohol addicts in England and that abuse of alcohol was costing the nation £21 billion—and probably much more than that today—how can the Minister reconcile the fact that we spend only one-tenth as much on treating alcohol addiction as we do on patients suffering from drug addiction? Why is it taking until 2016 to update the guidance on access to mutual aid fellowships such as Alcoholics Anonymous, when the ACMD has shown that there are effective ways of combatting the addiction?

[Earl Howe]

My Lords, my noble friend was kind enough to give me advance warning of those questions. I have to say to him that we do not recognise the figures he quotes; nor do we think that the comparison he makes is like for like. In 2007, an estimated 1.6 million people had some degree of alcohol dependence, including those with a slight dependence. Of those, some 250,000 were believed to be moderately or severely dependent. The specialist treatment centre system continues to work well for many people. Many of the trends in terms of treatment are positive. As regards supportive relationships, I fully agree with what he said; they are a vital element in helping individuals build their own recovery. In October 2013, Public Health England produced a strategic action plan for supporting the treatment sector to strengthen its links with mutual aid organisations to ensure that everyone in treatment can benefit from that support.

Alcohol-related Disease

Lord Avebury Excerpts

Wednesday 17th December 2014 Lords Chamber

[Earl Howe]

The noble Lord was kind enough to give me prior notice of that question just before we came in. I have taken advice on it, and the advice I have received is that there is no wholesale evidence of a shift of funding from drug treatment to alcohol treatment. There may be the odd example of that, but I can tell the noble Lord that Public Health England is monitoring this issue in local areas, to make sure that that shift does not take place in a disproportionate way in relation to the need in those areas.

[Lord Avebury (LD)]

My Lords, the BMA states that the misuse of alcohol is costing the UK £25 billion a year and imposing immense burdens on our overloaded health and criminal justice systems. Is not the answer to increase alcohol duty, starting with the alcohol duty escalator, which was withdrawn by the Chancellor, forfeiting £1 billion in revenue over the next five years, thereby also making it more difficult for us to meet our fiscal commitments? Increases in alcohol duties are the answer, as everybody who has studied the matter agrees.

[Earl Howe]

My Lords, we have acted on alcohol pricing. We have to look at this in the round and in relation to what is happening. Alcohol consumption per head has fallen in recent years. Reduced affordability of alcohol—influenced, I may say, by tax rises above the RPI each year to 2013—has certainly been one factor in that, we believe. We are committed to reducing alcohol-related harm. We have already banned alcohol sales below the level of duty plus VAT, meaning that it will no longer be legal to sell a can of ordinary lager for less than about 40p.

Health: Pneumococcal Disease

Lord Avebury Excerpts

Monday 3rd November 2014 Lords Chamber

Asked by

[Lord Avebury]

To ask Her Majesty’s Government what assessment they have made of the progress of the Joint Committee on Vaccination and Immunisation in its review of the adult pneumococcal disease programme.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

The Joint Committee on Vaccination and Immunisation concluded a review of the adult pneumococcal vaccination programme in 2012. The committee will begin the next review in early 2015, taking into account the latest information on the epidemiology, cost effectiveness and impact of adult pneumococcal vaccination. It is anticipated that the review will take six months to complete, subject to the availability of the necessary evidence.

[Lord Avebury (LD)]

My Lords, the JCVI looked at the situation in its June meeting and said that it would like to see the results of recent trials on the effectiveness of PPV in adults, but the subject was not on the agenda for the October meeting. Why are those trials not in the public domain? Since it is likely that the vaccination would be effective against the 5,000 cases diagnosed in adults every year in England, with some savings to the National Health Service, what steps are being taken to accelerate the introduction of the PPV vaccine?

[Earl Howe]

My noble friend is right to highlight the burden of disease caused by pneumonia in particular in the elderly. As I said in my Answer, what happened at the October meeting of the JVCI was an agreement that a pneumococcal sub-committee should be formed to fully consider the latest evidence on adult pneumococcal vaccination, including the evolving epidemiology of pneumococcal disease in the UK following the introduction of the conjugate vaccine into the childhood vaccination programme. In addition, the review will consider the latest data on the use of the conjugate vaccine in adults. This was discussed at the October meeting, the minutes of which are due to be published next week.

NHS: Cancer Diagnosis and Treatment

Lord Avebury Excerpts

Monday 13th October 2014 Lords Chamber

[Earl Howe]

My Lords, I am aware that in some areas of the country access to GPs is proving problematic and a number of work streams are under way to address that. But we are confident in the light of the statistics that patients are not holding back in presenting to their GPs. As I said, referrals have gone up dramatically over the last few years and the NHS is treating a record number of patients.

[Lord Avebury (LD)]

My Lords, I declare an interest as a cancer patient. What arrangements are made for determining eligibility for treatment by the CyberKnife at the Royal Marsden and UCLH and does it involve any financial assessment of the likely cost to the NHS of the treatment of a particular patient?

[Earl Howe]

My Lords, my noble friend mentions a particular type of radiotherapy, the CyberKnife. At present there is only limited research evidence of the clinical and cost effectiveness of stereotactic ablative body radiotherapy—the full name. Therefore, it is available only for certain patients with lung cancer. Having said that, NHS England has agreed to make £6 million available over the next few years for new clinical trials which will involve trials on prostate cancer, lung cancer, pancreatic cancer and biliary tract cancers. It is important that we generate that clinical evidence before encouraging the NHS to apply this form of radiotherapy to those cancers.

Health: Meningitis B Vaccine

Lord Avebury Excerpts

Monday 24th February 2014 Lords Chamber

[Earl Howe]

I can give the noble Lord an assurance on the latter point. We will take a decision as rapidly as we can once we receive the JCVI advice. I appreciate that the JCVI’s interim position statement will have been disappointing to many people. I know the noble Lord recognises that it is important that decisions about the introduction of new vaccines into the national immunisation programme take account of evidence of their effectiveness, safety and cost-effectiveness compared to other healthcare interventions. We need to wait and see what the JCVI’s final advice is. I am aware that it is looking at the cost-effectiveness methodology that is used for vaccines of this type.

[Lord Avebury (LD)]

My Lords, do the options now being developed by Public Health England at the request of the Government include a population-based evaluation of the meningitis B vaccination, taking into account the discounted lifetime cost to the public sector of supporting children who are disabled by the disease? Will my noble friend also explain why the Department of Health assumed that the carriage effects achieved with meningitis C do not read across to this variant of the disease?

[Earl Howe]

I can tell my noble friend that the JCVI has been considering both those issues: first, the possible need for a population-based evaluation of the MenB vaccine to address uncertainties in its effectiveness; and, secondly, what the possible effect of the MenB vaccine on the carriage of meningitis B bacteria might be. I say again that we need to wait for the JCVI’s final statement of advice to get clarity on either of those issues.

Mesothelioma: Research Funding

Lord Avebury Excerpts

Thursday 16th January 2014 Grand Committee

[Lord Avebury (LD)]

My Lords, the noble Lord, Lord Alton, has reminded us of the assertion by the noble Earl, Lord Howe, that progress on mesothelioma research was being held up not by the lack of available funding but by the absence of high-quality research applications. That has been refuted by a number of experts, notably Professor John Edwards, one of the foremost experts on this disease, who says that he and his colleagues have,

“identified that we could spend about £10 million instantly”.

Will the Government now acknowledge that there would be high-quality applications if researchers knew that a definite source of funding was available?

In 2012, £1.2 million was spent on mesothelioma research by the National Cancer Research Institute’s partners, so the loss of the net £880,000 available from the insurers represents a fall in total expenditure of no less than 43%. The British Lung Foundation says that the new community of researchers that it supported had,

“the potential to make real breakthroughs … of the kind we’ve seen in other types of cancer in recent years”,

but this is now under threat as the money has run out. As the noble Lord, Lord Alton, said, if a cure were found for this horrible disease, the enormous future costs of treatment, benefits and litigation arising from mesothelioma would be saved, benefiting not only the patients and their families but also the NHS, the DWP and the insurers. For this, we need ongoing work such as the research by the Sanger Institute, with two American groups, to identify the role that genes play in this disease. This could be the first stage in finding a cure, through chimeric antigen receptor cell engineering, a process in which T-cells are taken from the patient and genetically modified so that they link on to receptor proteins on the cancer cells and destroy them. This has already been used successfully to treat patients with acute lymphocytic leukaemia at the Children’s Hospital of Philadelphia, which says that this is,

“another important milestone in demonstrating the potential of this treatment for patients who truly have no other therapeutic options”.

So there is a glimmer of hope for mesothelioma sufferers here, if only the research funding were available.

We understand that a new agreement would be needed for the industry to extend the funding that some companies have provided over the past three years, or better still to increase it in line with the fall of the value of money. If the Government then provided matched funding, as the Minister in another place indicated was being discussed between the DWP, the DH and the ABI, we could be looking at £2.4 million a year between 2014 and 2017. The Minister said the ABI had “gone to the industry” and would come back to him and the noble Earl, Lord Howe, with its answer and that that process continues. However, the ABI tells me that Ministers said plainly that they were not prepared to look at co-funding between the Government and the industry.

If joint funding could be agreed in principle, there would be an overwhelming case for all employers’ liability insurers to come forward with half the money. The total over the coming three years would match the amount spent in a single year on cancers with similar death rates, such as myeloma and melanoma.

As it is, we leave this debate without any solid assurance on the future of the research spend on a disease which is extremely painful and always fatal. We, too, have not been able to respond to the urgent need for research to deal with the consequences of previous Governments’ failure to act on the known risks of asbestos use, but this Government have not heard the last of the matter.

Mesothelioma

Lord Avebury Excerpts

Thursday 5th December 2013 Lords Chamber

[Earl Howe]

My Lords, we have committed to doing four things, the first of which will be to set up a partnership to bring together patients, carers and clinicians to identify what the priorities in research are. Secondly, the NIHR will highlight to the research community that it wants to encourage research applications in this area. The NIHR Research Design Service will be able to help prospective applicants develop competitive research proposals, and we will convene a meeting of leading researchers to discuss and develop new proposals for studies. I think that those four measures together will deliver what the noble Lord seeks.

[Lord Avebury (LD)]

My Lords, does my noble friend acknowledge that the £3 million has run out and that there is a danger that the talented clinicians who have been working on mesothelioma as a result of that fund will move on to other subjects? However, the Association of British Insurers has told me that it would be prepared to consider a new scheme funded jointly by all employer’s liability insurers and the Government, so I wonder if the Government will approach the ABI to see if that scheme could be taken a little further.

[Earl Howe]

I am very grateful to my noble friend and that is certainly something I can undertake to do, perhaps in conjunction with the British Lung Foundation.