Medicines and Medical Devices Bill

Lord Crisp Excerpts

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

Many of us complain about the hardships resulting from the lockdowns associated with Covid. The African Union’s Dr Ngozi Okonjo-Iweala told our Select Committee that fears across developing nations were not about lockdowns, but about being locked out—locked out because of monopolies, vested interests and self-interest. Compared with countries that have been capitalising and profiteering on the back of Covid-19, the United Kingdom has values and a reputation of which we are justifiably proud. The amendment in the name of the noble Baroness, Lady Sheehan, gives us an opportunity to demonstrate that that reputation is well deserved.

[Lord Crisp (CB) [V]]

My Lords, I support Amendment 19, which would have been important at any time, but is, of course, as we have already heard, particularly important at the moment. I will speak briefly, and I can do so thanks to the eloquent contributions by the noble Baroness, Lady Sheehan, in moving the amendment and by my noble friend Lord Alton.

There are points of principle here, and practical points. I start with the points of principle. First, the UK signed up to the International Covenant on Economic, Social and Cultural Rights in 1976, which guarantees access to medicines as part of the right to the highest attainable standard of health. This should be integral to all our medicines regulation.

Secondly, as we have heard, the World Trade Organization’s TRIPS Agreement explicitly included public health standards, giving countries the right to grant compulsory licences and to determine where there is a national emergency, and the freedom to establish a regime of exhaustion of intellectual property rights—in other words, taking control of access to medicines on behalf of their populations. Both these principles are underpinned by the basic responsibility that Governments have for maintaining, protecting and improving the health of their people, but also by the wider points that my noble friend Lord Alton just talked about on our interconnectedness and responsibilities to our fellow citizens of the world, in our own self-interest as well as from other motivations.

However, as the noble Lord and the noble Baroness said, in addition to principles there are very practical issues that should guide our thinking on this. The first is that there is good precedent. The UK and other Governments have used, and/or threatened to use, these rights on several occasions over the years with good effect for the benefit of their people. They are useful and viable measures, and should be at the front of our minds at this time, because—here the point is being made again—the response to Covid is bringing with it a frankly unprecedented number of new treatments and vaccines in a relatively short period of time. It is vital that these are made available as quickly, widely and cheaply as possible, not just in the UK.

I echo the questions from the noble Baroness, Lady Sheehan. I will be interested to hear the Minister’s response about our participation as a country in the global sharing and the global effort.

It was good to hear my noble friend Lord Alton’s description of the situation in Africa and of the imperative need for us to bear that in mind in our policy-making here in the UK, while also bearing in mind the great reputation that we have had over several years for doing so. On Friday, I got in touch with the World Health Organization in Africa. Some of the figures that the person I spoke to talked about, regarding the impact of the pandemic on wider health issues, were formidable indeed. I was told that we have lost the gains of 25 years in the past 25 weeks—an extremely depressing statement.

Just as depressing, as both noble Lords mentioned, is the fact that we are already seeing signs of the way in which some pharmaceutical companies will approach this extraordinary period of new vaccines and treatments in what is happening with remdesivir, with shortages and treatment rationing here in the UK, let alone anywhere else.

This amendment is absolutely right in asserting that the UK should reaffirm its position and its rights to protect the health of its population. We should adopt it. The future will be difficult, as will the negotiations on this issue, but no one should be in any doubt about the UK’s firm position. We should support not just the UK’s position for the population of the UK directly but a global effort to deal with these important matters.

[Baroness Walmsley (LD) [V]]

My Lords, the Government take an enormous number of powers to make regulations in the Bill.

In the light of the paucity of parliamentary powers to check these, particularly prior to them coming into effect—as demonstrated by the recent Covid-19 regulations —the only way in which Parliament can influence these regulations before they are even drafted is by inserting into the Bill those things to which Ministers must have regard. That is why my noble friend Lady Sheehan seeks via Amendment 19 to insert two important elements into the Bill after the priorities of safety, availability and so-called attractiveness. I support her amendment and look forward to the Minister’s answers to her questions.

Proposed new paragraph (d) would ensure that the Government have regard to the International Covenant on Economic, Social and Cultural Rights of 1996, which the UK ratified 10 years later. This affirms a citizen’s basic human right to access medicines without discrimination, which means that they must be both affordable and available. We have committed ourselves to that.

Proposed new paragraph (e) reaffirms the international protections conferred by the WTO’s TRIPS Agreement. It recognises that these intellectual property rights protections have been misused and abused by big pharma; that resulted in the WTO’s Doha declaration of 2001, which reaffirmed public health safeguards for citizens of all nations. The details are in the amendment.

The amendment is absolutely crucial as the world awaits new tests, treatments and vaccines for Covid-19, as other noble Lords have mentioned. In particular, the pandemic demonstrates the importance of paragraph (e)(ii): the right to determine what constitutes a national emergency. The Government have used that.

However, the track record of big pharma does not bode well for equitable distribution of medicines, and this demonstrates the importance of the right to issue a Crown use licence. Drugs to treat cancers, HIV/AIDS, hepatitis C, cystic fibrosis and toxoplasmosis have all been withheld from citizens while Governments were held to ransom during negotiations with pharmaceutical companies. The NHS has had to ration necessary drugs because of price gouging. The threat of using a Crown use licence, and the actual issuing of one, has been helpful in such negotiations, and several countries have used the powers to great effect.

The issue of compensation, however, needs to be clarified. This section of the law has not been tested in court. Will the Minister commit the Government, therefore, to review Section 57A of the Patents Act to ensure that it does not block the use of the crown use licence provision? Countries such as Australia, Canada and Germany have revised their patents laws for this purpose, and other countries have taken action. Will the UK Government do the same? This power could be needed to ensure access to Covid vaccines and treatments, so time is of the essence. Will the Government act now and not just stick to business as usual?

Social Care Workers

Lord Crisp Excerpts

Wednesday 7th October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I echo the tribute paid by my noble friend to those working in social care during the pandemic. Naturally we have a huge amount of concern about those in social care during the pandemic. However, it is amazing how much hard and committed work those who work in social care have put into the arrangements and how effective many of those arrangements have been. The numbers that she cites are really impressive. I cannot make the commitments that she asks of me right now, because the deal for social care workers has not been written, but I completely acknowledge the suggestions that she makes; those are very much on the wish list and the agenda for any social care reform when it happens.

[Lord Crisp (CB) [V]]

My Lords, is the Minister familiar with the work of the Tribe Project? It was set up by a successful digital entrepreneur and is now being used by six local authorities to predict the needs for care, match people with carers, and, very importantly in this context, support professional carers in setting up independently as microenterprises. This reduces overheads and therefore both improves care income and reduces costs. Does he agree that this approach could be very useful in helping with this crisis, and will he explore it further?

[Lord Bethell (Con)]

My Lords, I am extremely grateful for the noble Lord’s recommendation. The project that he describes is incredibly interesting. I am not aware of it today, but I will definitely seek it out and try to find out more. I emphasise the broader point that the noble Lord is making: fresh thinking, digital innovation and the work of entrepreneurs to try to create new ways of working—to pool, for instance, the efforts of teams of people and to use platforms like the one that he describes—can make a massive difference in the area of social care. We are very supportive of digital entrepreneurs bringing fresh thinking to this important area of work.

Covid-19: R Rate and Lockdown Measures

Lord Crisp Excerpts

Tuesday 9th June 2020 Lords Chamber

[Lord Bethell [V]]

The work is being undertaken at the moment. Rather than focusing on local lockdowns, we are focusing on local action plans with a wide variety of measures, perhaps including behavioural changes as well as clinical and diagnostic interventions. It is only by working across the piece that local actors, such as local authorities, directors of public health and local infection directors, can implement the right array of measures. That holistic approach is the one we are pursuing.

[Lord Crisp (CB) [V]]

My Lords, many academics are warning of the likelihood of a second wave of the virus, and there is some evidence that it is already happening in other countries. I appreciate that the Government seek to avoid that, but what is their assessment of the likelihood of a second wave, what lessons have they learned from their first experience of lockdown, and what planning are they doing for a second wave nationally and regionally?

[Lord Bethell [V]]

The fear of a second wave is profound. We have seen what happened in Singapore and we remain vigilant. However, enormous progress is being made against the epidemic, as the noble Lord will have seen from recent figures. We have put in huge infrastructure to protect ourselves in the winter, which is the moment of greatest anxiety. That includes Europe’s biggest testing programme, stockpiling medicines, upgrading NHS capacity, the recruitment of returning staff to the NHS and—as I mentioned to the noble Baroness, Lady Brinton—the implementation of a local action plan regime which will give teeth to our measures on a local basis.

Nursing and Midwifery

Lord Crisp Excerpts

Thursday 30th January 2020 Lords Chamber

Asked by

[Lord Crisp]

To ask Her Majesty’s Government what plans they have to celebrate Florence Nightingale’s bicentenary and the World Health Organization’s Year of the Nurse and the Midwife in 2020.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the Government are working with the Chief Nursing Officer for England on plans to celebrate the bicentenary of Florence Nightingale and those in the nursing professions. Plans includes supporting the Nursing Now campaign across the NHS in England. The Chief Nursing Officer is also working in partnership with the Florence Nightingale Foundation to plan many activities, culminating in an international conference organised by the foundation and the Burdett Trust for Nursing in October 2020.

[Lord Crisp (CB)]

My Lords, I thank the Minister for that reply. This year is a chance to celebrate the legacy of great nurses and midwives of the past such as Florence Nightingale, notably, but also great figures such as Mary Seacole and others in this country and elsewhere. It is also a chance to celebrate today’s nurses and midwives, and thank them for what they do. In passing, I am delighted to be wearing a piece of the new nursing tartan, designed by Scottish nurses and commissioned just last month. However, this is also an opportunity to look again at nursing and midwifery, recognising how far the professions have developed in recent years and that they perform a very wide range of roles, all with customary care and compassion.

Nurses are true health professionals in their own right, no longer handmaidens to doctors—if they ever were—and have the potential in the future to do even more. With that in mind, I ask the Minister two questions. First, what plans do the Government have for investing in training and increasing the numbers of advanced nurse practitioners? Secondly, what plans do they have for reversing the decline in community nurses, school nurses and health visitors in this country, who will play such a vital role as services move more towards the community?

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his important question. I am envious of his tartan and I definitely identify with his praise for nurses, who work long hours and serve the most vulnerable at the moments of their greatest need. To answer his specific questions, as part of the NHS people plan, we are committed to supporting career development for nurses, which includes supporting a diverse range of careers. An example would be the advanced practitioners within multi-professional teams. This is an important point that the noble Lord raises. We are also developing a plan for district and community nurses to work with healthcare providers, practitioners and higher education institutions. The plan will set out how we will grow the community nursing workforce, which includes mental health and learning disability nurses, and it is expected to be published later this year.

National Health Service Infrastructure

Lord Crisp Excerpts

Thursday 9th January 2020 Lords Chamber

[Lord Crisp (CB)]

My Lords, given that the NHS is seeking to shift to being a more community and primary care-based organisation, can the Minister say more about what investment is going into community and primary care in capital terms?

[Baroness Blackwood of North Oxford]

We have been looking at providing additional funding and support to councils to meet the rising demands and to continue to stabilise the social care system. We announced access to an additional £1.5 billion of funding for adults and social care, and we will be considering this further in the spending review.

European Qualifications (Health and Social Care Professions) (Amendment etc.) (EU Exit) Regulations 2018

Lord Crisp Excerpts

Thursday 7th March 2019 Lords Chamber

[Lord Crisp (CB)]

My Lords, some concerns about nursing were raised in the committee by my noble friend Lady Watkins. She cannot be in her place today, but I understand that those concerns largely related to the points the noble Baroness, Lady Jolly, just made about Spanish and Irish nurses who will be disadvantaged by these regulations. The Spanish nurses will be disadvantaged for the reasons just mentioned—their time in the UK will not count towards their qualifications in Spain—and the Irish nurses because, for the first time, they will have to pay a fee for registration. Could the Minister assure us that steps are being taken to do something about those two points? Both of them affect groups of nurses from different countries, but they profoundly affect us. We should remember this in the context of the fact that 33,000 EU nurses are registered in the UK.

I will also make a wider point. Health staffing is one of the most vulnerable of all the Brexit issues—particularly if no deal is put in place. I note in the regulations that there will be a review within two years. However, I suspect a whole range of unforeseen issues will arise in the short term. Could the Minister let us know what arrangements will be in place to monitor those, and what liaison she and colleagues will have with employees, employers and staff organisations to monitor and deal with the issues that arise within that period?

Health Inequality: Autism and Learning Disabilities

Lord Crisp Excerpts

Thursday 10th May 2018 Grand Committee

[Lord Crisp (CB)]

My Lords, I too congratulate the noble Lord on securing this debate, on what he said and on the very powerful points that he made, as well as his final call for equality and whether it is too much to ask. This is a really important set of issues, not just for the people we are talking about but for the NHS as a whole, as it seeks to move towards a much more personalised approach to care—and what could need a personalised approach more than the sort of issues that we are talking about here?

As everyone here has, I have received very good evidence from the different charities involved in this field, which make an enormous number of very powerful points. Of the various questions that they ask, I select three to ask the Minister. The first has already been mentioned by the noble Lord, Lord Touhig. Will the Minister confirm that an autism care pathway will be established in the way the noble Lord talked about? Secondly, will the review of the Mental Health Act that is under way look at how it works in particular for people with autism? Thirdly, I am struck by how many other health issues people with autism and learning disabilities have. I was struck by the evidence that we received—I suspect that we all received it—from SeeAbility that there are GP health checks for people with learning disability and special dental care but nothing at all for access to specialised eye care, with which an awful lot of people in this area have problems.

I conclude by speaking briefly about a personal example about the importance of the personal focus here. I have a close relative, aged 56, who has Down’s syndrome, who lives with his 94 year-old father. I have three observations to make. First, as he ages, there is less and less evidence and research about what will happen to him as he moves on into his 60s and 70s, simply because people have not lived that long so far. There is a real need here for the continuation of the research and making sure that it is of a high quality. The second point is the obvious one that quite a lot of people are living with ageing parents in this way. It is important that there is support for them.

The third point comes from a recent occasion when my relative ended up having an operation on his knee and it is about the health service staff’s understanding of the condition and how to talk to people with these conditions. I was struck that my relative would tend to agree with you if you asked a question and would try to work out what you wanted him to say. If you asked, “Is the pain worse on this side?”, he would reply, “Yes”, but if you then asked, “Or is the pain worse on this side?”, he would say “Yes”. You need to understand how to work through those sorts of issues. I was struck that the GP found this difficult, but the orthopaedic surgeon did it brilliantly. There is a real personal aspect here and it is important to have people in the health service who understand how to do that.

I finish by congratulating the Government, because I understand from a recent press release that they have established a new “golden hello” for nurses coming in at postgraduate level who are working with people with learning disabilities, and for mental health and district nurses. This is a very positive step forward.

NHS Winter Crisis

Lord Crisp Excerpts

Monday 8th January 2018 Lords Chamber

[Lord O’Shaughnessy]

I thank my noble friend. He is right to point out that there is variation across the country. He mentions Luton and Dunstable University Hospital. It has been a pioneer of how to make sure that people coming into A&E are properly dealt with. Indeed, the £100 million that was invested in A&E services to support better triaging was based on the Luton and Dunstable model. Obviously, we need to make sure that those high standards are replicated across the country.

I will give one further example of an area where that planning has taken place. We know that there has been pressure on ambulance services and that there has been a variability of performance there. There is now a national ambulance control centre which is keeping real-time data and looking at how to manage that performance so that we can get a proper national grip on this picture.

[Lord Crisp (CB)]

My Lords, does the Minister acknowledge that 59,000 people a day going into A&E is an indicator that there simply is not enough support in the community? Can he give us any indication of how many people he thinks could have been prevented from going into A&E and causing these sorts of problems in hospitals if there were more support in the community, which would mean, for example, that people with infections were caught early and would not need to be admitted? Does he also note that a recent survey showed that one-fifth of the people in adult mental health hospitals were there simply because there was no provision for them in the community? That does not mean just social services; it means housing.

[Lord O’Shaughnessy]

I thank the noble Lord for that point. He will have experienced a few of these difficult winters when he was running the NHS. It is difficult to say what number or proportion of those 58,000 or 59,000 people could have been treated in the community. We do know that the 111 service has been successful this year, with nearly 40% of calls involving a clinical opinion keeping people out of A&E, as has primary care. It is difficult to estimate, but we know that a number of people have been kept away. Of course, there is a growing and ageing population, and that is the underlying driver of demand. On mental health, the noble Lord is quite right. We have not done enough in mental health over many years, and that is one of the reasons that it has been a priority for the Prime Minister, with a big increase in the number of mental health staff in the years ahead.

Healthcare: Spending

Lord Crisp Excerpts

Tuesday 4th April 2017 Lords Chamber

[Lord O'Shaughnessy]

My noble friend is quite right to point out that there are different funding systems in different countries. We, of course, have a taxpayer-funded system that is free at the point of use, which this Government are fully committed to. There are different ways of funding healthcare. However, it is worth reflecting on polling carried out by Ipsos MORI which showed that 69% of the public said they get good healthcare in the UK, contrasted to just 57% in France and 59% in Germany. That is a huge testament to the work that everyone in the NHS does.

[Lord Crisp (CB)]

My Lords, does the Minister accept that there is a real problem here? On prevention and the work that NHS England is trying to do to change the system, does he further accept that there is a need for transitional funding, not least for running services in parallel? Additional funding is needed to make the changes that need to happen.

[Lord O'Shaughnessy]

The noble Lord is quite right and he speaks with great authority on this issue. The sustainability and transformation plans are providing the changes that we are looking for. That is precisely why additional capital funding was announced in the Budget: to provide and seed that kind of change so that we can run in parallel services that we need to reduce and upscale those that we need to increase, particularly community care.

Adult Social Care: Funding

Lord Crisp Excerpts

Thursday 16th March 2017 Lords Chamber

[Lord O'Shaughnessy]

I thank my noble friend for bringing that to the House’s attention—some might describe it as a hospital pass, if noble Lords will excuse the pun. The Government remain committed to implementing Dilnot from April 2020. My noble friend is quite right that this is not a blank sheet of paper. There have been some really important reforms over the last seven years, including the better care fund and the Care Act. In the Budget, we have more funding for the short-term sustainability of the social care system, as well as a commitment to the Green Paper.

[Lord Crisp (CB)]

My Lords, I would like to ask a question about children’s social care, where I notice there is also a problem. For example, in the last year local authority support for palliative care services for children was cut by two-thirds, and it now provides only 1% of the expenditure on children’s social care. First, does the Minister acknowledge that there is a problem here as well and, secondly, what are the Government going to do about it?

[Lord O'Shaughnessy]

The issue of children’s palliative care came up in the debate the other evening on palliative care. A review is taking place with the charitable sector of the distribution of funding, particularly for children’s hospices, over the next year. In terms of children’s social care—this may come as a surprise to some noble Lords; it certainly did to me—the fastest-growing part of the adult social care budget is for adults with learning disabilities. Of course, that often comes in at the point at which people leave the children’s social care system and the school system and move into the adult social care sector, so there is an important point about continuity from one to the other.