Ultra-processed Food
Lord Deben Excerpts(6 months, 1 week ago)
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Lord Markham (Con)
Obviously, I am always happy to look at all the research because this is a vital area. This is the fifth time we have discussed it in the last three and a half months, so I apologise for any repetition. We are ever vigilant on this area but, as the contributors to yesterday’s debate showed, the research is mixed. The key things to get behind are the bad features of ultra-processed foods that are high in sugar, salt and saturated fat.
Lord Deben (Con)
My Lords, I will ask a very simple question. Was it not true that, before we had the link between smoking and lung cancer, we did have evidence of an epidemiological connection? The problem here is that we have no direct link, but it does seem that there is a connection that we do not yet know is causal. Will the department be very careful not to ignore that evidence simply because it is very inconvenient for scientists if their whole history of understanding nutrition is undermined by it?
Lord Markham (Con)
Absolutely—we have to be understanding of the latest research in cause and effect. The evidence I have been shown so far is that it is about the features within those ultra-processed foods—are they high in fat, sugar or salt? Those are the things that are causing the harm. If we find links to the processing itself, we will act on that.
NHS Industrial Action: Government Preparations
Lord Deben Excerpts(1 year, 4 months ago)
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Lord Markham (Con)
My understanding, based on the long time that this has been in place, is that this is an annual review. April is now quite close; for that April review, it can take into account all the factors, including what happened to inflation during the year. I expect it will take all that into account, quite rightly, in what it comes up with for that next pay review. It is a long-established principle that it is there to do this. I trust it to get the right answer in time for April.
Lord Deben (Con)
Will my noble friend be very careful to stick by the case being put forward? We know that those arguing it want to hide behind some discussion of the mechanisms in order not to say what they really think about the pay rises. The Government have a responsibility to stick by the system. If we lose that, it will be the Minister who makes decisions always, which is what we have tried to avoid since the 1980s.
Lord Markham (Con)
I agree. Clearly, there are difficult choices; if we changed the position, we would have to take money away from other parts of the system, such as the elective care fund and other front-line services, which we clearly do not want to do. It is absolutely right that we let the experts guide us in this, as all Governments have done for more than 30 years.
Brexit: Medicine Supply and NHS Staffing
Lord Deben Excerpts(4 years, 8 months ago)
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Lord Deben (Con)
My Lords, the Government have claimed that they have done a detailed account of what would happen if we were to leave the European Union, as far as the health service is concerned. Why have they not published that detailed account, why do we not know any of those details and why is the whole country being kept in the dark on all these issues? The Minister has the facts. Can we please have them now, so that we know what we are debating about?
Baroness Blackwood of North Oxford
I do not believe that the noble Lord is presenting an accurate picture of the case. We have been very clear with the public, and a lot of information has been published on the MHRA website, on GOV.UK, on nhs.uk and in a number of other places, regarding the information about the analysis of the impact of no deal on patients and on the NHS. We have been very clear about the risks that we think there may be to the supply of medicines due to temporary disruption at the border and the mitigating measures that we have taken to ensure that the supply will continue uninterrupted to patients and to the healthcare system. If the noble Lord wishes to have more information, I am sure that he would be very happy to write to me, and I will place a copy of my reply in the Library.
Food Additives, Flavourings, Enzymes and Extraction Solvents (Amendment etc.) (EU Exit) Regulations 2019
Lord Deben Excerpts(5 years ago)
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Lord Deben (Con)
My Lords, are we not very lucky that they managed to put off the date as long as this, otherwise this SI would not have come before us? I just wonder how many SIs are hidden behind this one that would not have been passed in time. It seems pretty remarkable that we are talking today—after the date that the Prime Minister promised that on any basis whatever we were going to leave—and are dealing with this very important matter. It just draws attention to the absolute barminess of the whole process. To be doing this after what we did earlier in the week seems remarkable.
I do not envy my noble friend who has to defend this. When she says there are no changes, there is, of course, a fundamental change in that every small business in Britain that is exporting to the rest of Europe has to get itself passed by both the British and the rest of Europe. Although my noble friend rightly said that she did not believe this will stop people importing things, it could easily stop people exporting things. Indeed, the whole Brexit operation is designed to shoot the exporter in the foot and to enable the importer to have unrestricted access.
My first question is whether my noble friend can conceive of any circumstance in which the British would have different rules from the rest of the European Union on, for example, cocktail cherries. I hope the House has seen that there is a specific reference to cocktail cherries in this SI. I do not know why cocktail cherries should have this applied to them; it would be difficult to eat enough of them to be severely damaged in any way other than what always happens if you eat too much fruit. The issue is this: can we imagine circumstances in which we had a different regime from the rest of Europe?
What we are proceeding to do today is decide that the UK will test and check everything and do it again—or perhaps not. Perhaps what we are really going to do is say, “We accept everything that the rest of Europe says but we’re not going to have any part in it at all”. Is this not the fundamental issue about the whole Brexit concept—that the only way Brexit would work would be on the basis that we did everything that we do today but we did not have a say in it? I know this is very unfair on my noble friend but it seems important to me that we do not let any of these SIs go past without reminding your Lordships and the public of the fundamental lunacy of this whole policy.
That brings me to the cost and resources. The FSA has been starved of resources; the cuts have been significant. Yet the public are increasingly interested in food safety, and there is a good reason for that. We have lived through a whole lifetime in which food has fallen in price but we are now in a world in which food will be rising in price, by the very nature of the emerging middle classes throughout the world and the fact that resources right across the board are less and less available. In these circumstances, because there is more money to be made by fraud, we are likely to have more of it. The FSA is going to have a great deal more to do even without this additional work being placed upon its shoulders.
It is important for my noble friend to reassure the House that the full costs, both to local authorities and to the FSA, will in fact be provided by the Government. This is another example of the mathematics of Brexit never having been properly explained, because none of this came into the arguments about how much we were going to save by leaving the EU. We still need to have that fundamental reassurance. It is not unreasonable to ask the Minister to give us examples of when our independent FSA is going to make different decisions from the rest of Europe and, if so, how that would deal with the import/export problem to which I have adverted.
No doubt we will have to pass this—and are we not lucky that we have an opportunity to do so?—but, frankly, it is yet another example of the sheer waste of time that we are all involved in due to this Alice in Wonderland position in which we seriously think that a nation 22 miles off the coast of the rest of Europe is actually going to have a different safety arrangement for food products that are, and have to be, freely traded within the EU.
Baroness Blackwood of North Oxford
I thank noble Lords for this fascinating debate. I want to be the first to wish the noble Baroness, Lady Walmsley, a happy birthday, and I thank the noble Lord, Lord Deben, for disclosing to the House his passion for cocktail cherries.
Our approach to EU exit when it comes to the FSA is underpinned by three principles. The FSA has been working hard to ensure that UK food remains safe and is what it says it is; that the high standard of food and feed safety and consumer protection we enjoy in this country is maintained when the UK leaves the EU; and that from day one a robust and effective regulatory regime will be in place, meaning that business can continue as normal.
As has been debated, this instrument was subject to parliamentary scrutiny through the affirmative procedure and requires affirmative approval. It needed redrafting and I would like to go into some detail on that, given that the issue was raised by the noble Baroness, Lady Wheeler. Some drafting errors were identified. I have been advised that they were minor. They mainly related to drafting style, rather than content. That is why the instrument was withdrawn. The errors have been rectified and the amended draft was brought back today. They related to an error in Regulation 16(b), where an obligation to inform the authority—the FSA or the FSS—of the receipt of an application for a product to be included in the list of products authorised for smoke flavourings was not included. That has been addressed. The FSA felt that the changes were minor, including a correction to remove a quotation mark at the end of a definition, which had been overlooked.
It was also said that the draft required elucidation relating to the requirement for definitions of appropriate authority and the authority prescribed for certain regulations. The FSA felt that this was not necessary as definitions are inserted by other draft EU exit regulations, but this has been actioned to make sure that it is absolutely as it should be. A final comment was about the failure to comply with proper legislative practice. This related to whether some text should be presented as a footnote instead. Again, the FSA considered that this was not required when originally drafting the instrument, as it replicated how the text was presented in the European Union (Withdrawal) Act 2018. However, the comment was taken on board and the amendment has now been made. I hope that clarifies what the amendments were.
I turn to the questions raised by the noble Baronesses, Lady Walmsley and Lady Wheeler, about the FSA’s preparedness and about funding, which was also raised by my noble friend Lord Deben. Extra funding—£14 million last year and £16 million this year—has been allocated to the FSA to help it prepare for the additional requirements it will have to take on board. This has enabled it to put in place some additional risk assessment tools and risk management experts and to replace some EFSA procedures on which it previously relied. It is important to understand that the FSA has always had a robust risk assessment system in place and has always undertaken evidence-based risk management decisions for the future of food and feed safety issues. It has now built into its capacity the ability to provide robust risk assessment and management advice post exit, using the additional funding provided. That is why we have been able to provide reassurance as these SIs have gone forward, and this has been taken into account as we have prepared for negotiations going into the implementation period, whether in a deal or no-deal scenario.
Obviously, we are considering what kind of relationship we will have with EFSA and what the situation will be regarding the RASFF. At this point, no decision has been made about our future relationship with EFSA, because it will be subject to forthcoming UK-EU negotiations. However, departments have undertaken an analysis to understand the impact that withdrawal from the EU will have on our relationship with EFSA and the EU agencies. This is why the FSA has ensured it has robust risk assessments in place, no matter what the scenario may be. However, it is our preference to have a close relationship with EFSA and access to the RASFF. That is the ideal scenario, which we will be working towards.
The noble Baroness and my noble friend Lord Deben raised the consultation with industry. It is important to point out that this was a thorough six-week consultation, undertaken by the FSA, which took place in September and October last year. Late responses were also taken into account. There was significant support for the approach the FSA has now taken with the SIs. That is why we are confident that the industry and stakeholders will be able to take on board the approach taken in this and other SIs, which have been fully debated in the House. That approach has also involved the devolved Administrations, and the FSA will continue to have close working relationships with the Administrations in Scotland, Wales and Northern Ireland as we go forward. That is why we are confident that, in practice, it will be possible to make arrangements and operate a framework for food and feed safety regulations across the UK, whatever exit scenario we have.
The noble Baroness, Lady Walmsley, asked about contingency arrangements should there be changes in regulation within the EU. If noble Lords support these regulations they will be on course to come into force this week. But if there is a short delay to food law they will not be fully operable, amendments to authorised products could not be made and urgent action might be required on unsafe food. The Food Safety Act and already corrected retained EU law would then continue to provide food safety protection for consumers, and enforcement action could be taken against the placing of unsafe food on the market. I hope that reassures the noble Baroness on that point.
I thank noble Lords for their consideration of these regulations, and I hope I have answered their questions. As I said, the Government’s priority is to ensure that the high standards of food safety and consumer protection we enjoy in this country are maintained when the UK leaves the European Union. This instrument performs an important part of our preparations for a functioning statute book on exit. Food additives, flavourings, enzymes and extraction solvents are important parts of substances referred to as “food improvement agents”. We must ensure we have the correct protections in place to protect public health after exit. This instrument makes no change to public policy—pace my noble friend Lord Deben—and I hope noble Lords will therefore accept it as it stands.
European Qualifications (Health and Social Care Professions) (Amendment etc.) (EU Exit) Regulations 2018
Lord Deben Excerpts(5 years, 1 month ago)
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Viscount Bridgeman (Con)
My Lords, I apologise for my discourtesy in not being present at the beginning of this debate. A number of years ago, with the very great help of our noble friend Lord Howe, we secured the requirement from the Commission that healthcare professionals coming to this country from the European Union be subject to language tests before registration, and not the other way round, as in the previous arrangement. Can the Minister confirm that this valuable requirement will be kept in place under the new regulations?
Lord Deben (Con)
My Lords, I trust that the House heard with great pleasure the Minister’s comments on how major an advantage this whole arrangement in the European Union has been to us. We should not be discussing any of these SIs without reminding people that our membership of the European Union has been a huge advantage to us, and that what we are doing at the moment is picking apart something which is to our advantage, for reasons which are increasingly difficult to understand. We should not allow any of this to go past without constantly reminding the Government that they are leading this country into a position in which it will be poorer and less advantaged than when they came to power. A historic responsibility will lie on their shoulders, and we should remind them of that constantly.
My concern in this whole debate is that we are being asked to discuss this SI under a double falsehood. The first is the argument that we need it because we might crash out of the European Union, but that we need not be too worried because we will not crash out. The second difficulty is that, if we do not crash out of the European Union, we are legislating for a series of things which will be there in the course of further negotiations. Even if what is referred to at the moment as the Prime Minister’s “deal” were to be accepted—and it is manifestly not satisfactory—it is not a deal at all. It is an agreement to go on discussing to get a deal. During that period of time, what we are discussing here will be there in the background. There have been a number of occasions on which Opposition spokesmen have rightly pointed out that the trouble with these things is that if they are in the background while we are negotiating, they have a real effect. We have to take this very seriously.
Nor should we pass over the problem we are presenting ourselves with. We are saying that, to get the best advantage out of this ludicrous foot-shooting activity, we are going to make sure that every European Union national can come to this country to do what we want them to do without there being any difficulty. Of course, we cannot do any of the things that have made that particularly valuable in addition; we are not going to share the information both ways, which is what the European Union enabled us to do. Rather like the noble Baroness, Lady Thornton, I have a real concern that the IMI system will not continue. The idea that you can happily forget about it because it happens to be convenient, and do the things you can do because they happen to be convenient, seems to me an abnegation of responsibility which I find extremely difficult to accept.
The noble Baroness, Lady Jolly, rightly referred to the additional matter of the electronic alert system. We will not be alerted to the very professionals we most want to know about, because we will have decided that, because Britain is so ultimately different from everywhere else, we will not have this association. I know it is not the fault of the Minister, who is having to defend the ridiculous situation in which we find ourselves, but it is for this House to remind people all the time of what this really means.
Then we go on to the fact that these regulations are in conformity with the withdrawal Act, which says that we are not going to use it to create any new legislation, but merely take into national legislation things that would not be in it if we left the European Union without any agreement. The trouble is that this is not actually possible, because we have to have regulators making decisions. They are now going to make decisions under a new regime—in that sense it is a new regime—and I very much want to hear the response to the noble Baroness, Lady Thornton, on how we make sure the regulators make, roughly speaking, the same decisions across the whole range, and how we make sure that those regulators do not make decisions that extend or change the position we are in now. The latter would be contrary to the undertakings given by the Government.
However, the word that I very much worried about when the Minister used it was “flexibility”. She said that no longer being in the European Union would give us a flexibility on the establishment of professional qualifications which we did not have up until now. I do not think that flexibility can possibly be accepted within this SI, because that genuinely changes the position from what it was before. It may be that it is convenient for the Government to talk about flexibility as an advantage. I find it pretty difficult to see what that advantage would be. What would be the point of being flexible in changing our arrangements in such a way that they were out of line with the arrangements of our neighbours, when we rely upon those neighbours for such a high proportion of our professionals? It seems to me that flexibility is one of those convenient words used by the Government and those who believe in Brexit to suggest that there are some advantages hidden here which we have not yet got hold of. I do not think that there are, or that it would be legal for us to use flexibility under this SI, because it is specifically not supposed to introduce into our legislation anything that we have not had up to now.
I am afraid I will move on to something that I constantly say; that there is no impact assessment here. Why is there not? This is the real reason I say to the Minister that this is unacceptable. The reason there is no impact assessment is that the Government want us to believe that there is no impact. It is very inconvenient for the Government to say that the impact is that we will no longer have the advantages we had before leaving the European Union. They ought to be listing those advantages and explaining what the impact on us will be. But they are not doing that, because that would make more and more people aware of the lunacy of the measures we are now taking, and the ridiculous position in which Brexit places us.
But then there is another question. If you do not have an impact assessment, you also do not appear to have any idea about how much it will cost. I am afraid that I am a Conservative, and I am always interested in costs—I like to know how much it costs. I know that that is a disadvantage in the whole Brexit discussion, because the one thing we never get is the cost. It is amazing, is it not? We have a Conservative Government who never talk about the costs of Brexit, which is an absolutely ludicrous position for us to be in. Let us ask ourselves—I repeat the words of the noble Baroness, Lady Thornton—“What burden? What resources? What cost?”
One of my difficulties is that I have had the misfortune to have had to sit through a large number of these SIs, and every time you ask about the cost, the Minister concerned explains—charmingly, and with considerable aplomb—that the costs are negligible.
Lord Deben
I have got it right this time. That is what they say. In every individual case, negligibility may well be the truth, but what is negligible in one case, when added up with a lot of other “negligible” costs, ends up being rather expensive. I am amazed at the number of things you can do with negligible cost. We are filled with these SIs—with all the things that we can do for nothing. I ran businesses, and I have to say that I do not know anything you can do in business which does not cost you something. I would love the Government to explain to me how they are managing to move whole areas of control and regulation over to British regulators without any cost. I would be able to apply that to my businesses and it would be extremely valuable, because all I know is that the moment you change or move anything, it costs money.
I want to know not only how much it costs but whether we have the resources for it. It is also said that we have these organisations that are perfectly capable of doing all this, as if this is an easy thing to do, when in fact it is not only difficult, but if we get it wrong, we are endangering people’s lives. Clearly, we have not worked out what the cost of doing this is; I just do not understand whether we have the human resources and the trained resources to do it. After all, we have shown so far that we cannot run the National Health Service without large numbers of people coming in from outside. I would like to understand whether we can regulate all this without some additional resources, and if so, we ought to know exactly what resources we will need and how much they will cost.
I am sorry that I have to say this to the Minister with such vigour, but it needs to be said; otherwise, this House looks pretty damn stupid. We look as if we are sitting around, having a gentle argument about what is the programme for catastrophe. This is what we are talking about: how a nation decides how to put itself into a very much less favourable position than it is in at the moment. Sometimes people say, “Ah, but Britain will manage—look what it did during the war!” But we did not ask for the war; we did not say that we wanted it. It happened, and we said that we had to fight it. Here we are asking for it, and are seriously sitting around planning for it. We are asked to do that with a degree of politeness and charm, and courtesy and care, when we ought to be very angry indeed that any Government should even suggest that we need SIs like this.
Lord Warner (CB)
My Lords, it is a positive delight to follow the noble Lord, Lord Deben, as I have done on a number of occasions in the past few months in debates on other SIs which have been considered in Grand Committee. The one thing I would say about the noble Lord is that he has been masterly in the consistent way in which he has expressed himself. I do not altogether share his high assessment of previous Conservative Governments on costings, but we will let that one pass.
Brexit: Food Standards Regulations
Lord Deben Excerpts(5 years, 8 months ago)
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Lord O'Shaughnessy
I can tell the noble Lord that we will be maintaining the same standards of safety and protection. We will be seeking not just continuity but equivalence. We may want to go further in other areas. Of course, this will be for discussion with the House. The ongoing role of the Food Standards Agency will be as it is now, to make sure that public health and consumers’ interests continue in relation to food. There is no need to issue a ministerial direction or anything else to ensure this because it is its legally given role and one it will continue to fulfil.
Lord Deben (Con)
Is the Department for International Trade aware of these facts? It appears to be thinking of agreements—were we to leave the European Community—in which we would have to accept the much lower food standards of countries like the United States.
Lord O'Shaughnessy
There are no suggestions that there should be lower food standards. Obviously, after we leave the European Union, the Food Standards Agency will carry out any risk assessments. There are no proposals to change these rules; we will continue with them. Of course, there would be a proper scientific and evidence-based assessment if there were such suggestions.
National Health Service (Pharmaceutical and Local Pharmaceutical Services) (Amendment) Regulations 2017
Lord Deben Excerpts(6 years, 6 months ago)
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Baroness Seccombe (Con)
My Lords, I am fortunate to live in a lively Warwickshire village. There are two doctors with their own pharmacies, but every time I want something as simple as paracetamol I have to get the car out and drive eight miles to the nearest pharmacy. Last week, I was thrilled to see that the closed HSBC bank had a sign above it saying “pharmacy”.
I understand that in an NHS with increasing demands for funds it is not sensible to have pharmacies—each of which costs the NHS, on average, £220,000 a year—in abundance every few yards in urban areas. However, in rural areas it can be more than difficult to buy those essentials we rely on, especially if you do not have a car and there is an infrequent bus service. I congratulate the Government on being selective in supporting pharmacies that make life easier for country people while encouraging those small businesses to expand their basic service. In another village, I recently saw a sign in the window saying, “Opening hours: 6am to 9pm Monday to Saturday, and 9am to 5pm on Sunday”. What a service.
Last Saturday, I went inside the empty pharmacy and met Steve, the new pharmacist who is planning to open next week. He is enthusiastic to get going. So to him and all independent pharmacists who are free to flourish and to respond to the needs of the community, I say good luck, as they provide a really worthwhile service to the community. I am sure noble Lords will understand why I am not able to support this Motion.
Lord Deben (Con)
My Lords, I declare an interest as chairman of the Climate Change Committee. I intervene only because one of the largest uses of vehicles is for health reasons. I hope my noble friend will not mind if I say that the Department of Health has perhaps not shown itself to be quite as central to the solution of our problems with climate change as other departments have. I hope this is going to change, and I am intending to bang on his door quite a lot until it does because this is a central issue.
This debate has shown that it is a useful one to have. I am not sure I want to enter into the party politics of it but there are quite good arguments about how many extra community pharmacies there have been, and there is certainly no doubt that the Government have shown themselves to understand this. No doubt there are other arguments, but the issue for me is proximity and propinquity. I am thinking not just about rural areas, although I live in a rural area and I understand the point very strongly; for many people in urban areas who do not have access to motor cars and where bus services are exiguous, the fact that they can walk to a pharmacy or ask others to do so if they themselves are unable to, is an important part of the kind of service that we need. It is disappointing that in the various collections of data we have not spent a bit more time looking at how many journeys are made and how many hours’ worth of diesel are used by people in accessing the health service. We know exactly how many journeys by lorry carry food—it is about 42% of all the lorry journeys in Britain—so we know a lot about these things, but I am not sure we know enough about what happens in the health service. When we are making these judgments, we have to make them in a holistic way.
So I do not apologise for the fact that on this, as on many other issues, I shall try to dramatise the fact that we should not be making decisions without asking ourselves, “What is the issue here in trying to meet the requirements which are now statutory?”. By 2050 we have by law to cut our emissions by 80%. We have to meet by law the fourth and fifth carbon budgets, and we have just issued the clean growth plan which is designed to deliver that end. There is nothing in any of that on the contribution of the NHS. It is time we asked the NHS to recognise that part of its role is to ensure that people’s access is as convenient as possible, not just for their convenience or because it saves money for other bits of the NHS, but because we as a community have to look at our statutory requirements to meet our climate change targets.
I hope that my noble friend will accept this as a preliminary thrust on the subject of the health service’s contribution to what we need to do. Indeed, in doing it, it is of course a circular system. Many of the problems the NHS has to deal with result from the subsidiary effects of pollution. It is not a matter not just of changing our climate but of the pollution at a much lower level physically but very high-level in terms of air pollution, and the damage that that does to health. I do not think this is something the health service can avoid and I hope my noble friend will take it into account.
Lord Shipley (LD)
My Lords, I should like to ask the Minister to clarify four issues. First, does he agree that community pharmacies are for many people the most accessible healthcare location, particularly where there are no GP surgeries locally; that community pharmacies in those situations can take pressure off GPs, and that in fact overall community pharmacies can take pressure off accident and emergency? Both GPs and A&E are experiencing rising demand.
Secondly, I am not clear whether the Government have responded to the Murray review and whether they plan to be clear what they think about that review, which was published in December last year. What policies do they have for community pharmacies as a consequence of that review?
Thirdly, we have heard about rural areas. I agree entirely with what has been said, but I shall talk in addition about deprived urban neighbourhoods where few people have cars. Has the department done an impact assessment on deprived communities’ access to health and care services, because I think it is material to this debate, particularly in the context of my fourth question? Do the Government accept that many pharmacies have cash flow problems? Many do, and I understand that it will be much worse from next month. What exactly is the Government’s grand plan? I cannot see one at the moment.
Mental Health Services: Children and Adolescents
Lord Deben Excerpts(6 years, 9 months ago)
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Lord O'Shaughnessy
I accept the point that the noble Baroness makes. Unfortunately, we are starting from a low base, over many years, in mental health provision, and that is what we are trying to rectify. She will know that the Prime Minister is deeply committed to this agenda. Let me point to a couple of issues. First, there is the introduction of the first waiting time standards—and indeed there are positive early data on meeting those stretching standards—as well as an increase in the number of beds available for those suffering from the most severe episodes of mental illness.
Lord Deben (Con)
My Lords, this is an area which has been not only underfunded but not cared about for a long time, and we have got to get it right. Someone has to stand up for these people because in their own home circumstances they do not have the kinds of opportunities and support that many others do. Will the Minister commit himself personally to make this worth fighting for? This issue is perhaps in the front-line of human rights in Britain.
Lord O'Shaughnessy
I completely agree with my noble friend and I commit myself personally to this issue. He may know that I have opened up primary free schools which focus on improving mental health and well-being, so I feel this personally. He mentioned children coming from chaotic homes, which is true in some instances. However, it is not always true. Mental illness can strike anyone, and all families and schools need to be prepared for it. Another commitment in the manifesto, about which there will be more detail in the Green Paper, is the introduction of a single point of contact in schools so that there is a champion, if you like, for any child who needs to access mental health services that go beyond the school gate.
Human Fertilisation and Embryology (Mitochondrial Donation) Regulations 2015
Lord Deben Excerpts(9 years, 2 months ago)
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Lord Deben
To leave out from “that” to the end and insert “this House declines to approve the draft Human Fertilisation and Embryology (Mitochondrial Donation) Regulations 2015 laid before the House on 17 December 2014 and calls on Her Majesty’s Government not to lay new draft regulations until a joint committee of both Houses has been established and has reported on (1) the safety of the procedures permitted by the draft regulations, (2) the compliance of the draft regulations with European Union and domestic law, and (3) the key definitions used in the draft regulations”
Lord Deben (Con)
My Lords, first, I have to say that I am in favour of mitochondrial donation. I am not opposed to it in principle. I tabled this amendment because otherwise it would have passed through this House—in the Moses Room—without the kind of concern that we now have. The numbers present show it to have been right to discuss this matter very carefully. It is right because we are dealing with something of incredible importance to the families concerned: the fathers and mothers who can produce children but cannot, because those children will, almost certainly, carry this terrible disease. They deserve all the care that we have expended on them. The fact that some suggest that there are not that many of them is nothing: if there were but one we should be as concerned about this as we are.
I yield to no one in my determination to try to do what is right in this area and I do so for a personal reason, which is that I am thankful every day that my wife and I produced four children who in that sense—though perhaps in no other—are perfect. Those of us in this situation have a particular need to be concerned. We should be concerned with the parents; we should be concerned with the wider community; and we should be concerned with the children who would be born in these circumstances. My concern is that the Government have approached this in a way that is very unhappy. Because there are so many of us who would find the movement of a spindle from a non-diseased egg to a diseased egg something that we could accept, there was a basis for a commonality of understanding and support. That was there. All we needed, therefore, was to be assured that the procedure was safe and legal.
My noble friend—and he is a noble friend; he was one of my Ministers, and we worked closely together—has carefully covered his view of the law. I think that the law is very often an ass. I am certainly not one who would demand that lawyers should decide what we should want. I say sorry to the noble Lord, Lord Pannick, who looks unhappy at that comment. However, I believe that we should obey the law and it is quite clear that there is considerable disagreement—I put it simply like that—about whether this action is legal under European law. Although my noble friend gave the best account that he could, it is worth saying that many others take a different view. What is more, the two law officers, the Attorney-General and the Lord Chancellor, voted against these regulations. The Attorney-General has said clearly that he did so on legal grounds, so it cannot be said that those of us who suggest that the legal arguments are at least uncertain have an entirely unreasonable position.
Many who are present will have been sitting through the last part of the previous debate on ticketing. I had taken a particular view on that but felt that the House had heard enough of me without intervening on that occasion. But it may be within the memory of the House that the Government fought very hard not to take action on ticketing until they were absolutely sure about the legality, under European law, of what was being proposed and that there was a proper investigation of it. I had expected my noble friend to say that he had been to outside experts and to the European Union itself to be assured that he was not going to find himself in court were this passed. He has not done so. The only legal advice that has been presented to this House is the internal advice of the Department of Health. I do not find that satisfactory.
Lord Willis of Knaresborough (LD)
I am grateful to my noble friend for giving way. Does he accept that the Wellcome Trust has published and given to all Members a legal position which has all the authority of its own lawyers and which backs up the position of the Minister?
Lord Deben
The Wellcome Trust has certainly done that but I was referring at that moment to the ministry and the Minister. However, the Wellcome Trust has not gone to experts in European law; it went to an expert that it chose. I am perfectly happy about that but it is only one of a series of opinions, which are contrary one to another.
I started with this point because of my concern about the families. It seems that it would not be a good beginning for this change if, immediately afterwards, the large number of Members of the European Parliament —from the right to the far left—who have said that they would see this as so clearly contrary to European law seek to refer it to the courts. That would not start this off very well. The real question is why the Government have not taken the steps which would enable us all to accept that this was legal. I do not understand why they have not done that, so my first questions to my noble friend are: why was that not done and why, even after we asked for it, did the ministry not go out and see that it had exterior and clear European advice, so that we would know where we were?
That is of course only the first part of it; the second is a question of safety. I have said that if we talked about transferring the spindle from one egg to another, I would not have any ethical objection. Indeed, it would be the opposite; I would want to support it. I ought to say that, because one noble Lord, who I know is going to speak later on, at an earlier meeting said, “Well, he only says all those things because he’s a Roman Catholic”. I think I will face that. Those Members of your Lordships’ House who took part in the proceedings on the Marriage (Same Sex Couples) Bill will remember that I spent a good deal of time supporting the Government’s position on that.
The Deputy Speaker (Lord Geddes)
I assume the noble Lord would like to move his amendment.
Lord Patel
My Lords, I am sorry for rushing in, but the noble Lord, Lord Deben, excited me so much with the comments he made that I have to answer some of his points, particularly on safety. I hope that noble Lords will have patience, because I need to go through each of the points he has made on safety, as I have no doubt that they will come back again in subsequent debate.
It is important that I put down some ground work. What are we talking about? We are talking about a mitochondrial DNA disease that commonly affects multiple different organs. Symptoms include severe muscle weakness, diabetes, heart problems, cardiac failure and sudden cardiac death, as well as central nervous system problems, which include dementia, epilepsy, stroke and such other horrible conditions. It results in death, which can occur early in childhood or after a prolonged period of incapacity and pain that can last for years.
It is important to have some facts about mitochondrial DNA genetics and inheritance. Mitochondrial DNA is strictly inherited maternally, via the egg. The mitochondrial DNA copy number and the number of mitochondria vary between cell types, with more than 200,000 in the egg and early embryo down to perhaps as few as 10 to 20 in many cells of the two to three-week old embryo, and hundreds to thousands in most cell types in adults, where the number tends to correlate with energy demand. Cells can have a mixture of two or more types of mitochondrial DNA sequence, a condition referred to as heteroplasmy, in contrast to homoplasmy, where each copy has the same sequence. More than 300 distinct mutations of mitochondrial DNA have been found in patients with mitochondrial disease. Although some mutations are far more common than others, if an individual is heteroplasmic, with a mixture of mutant and normal mitochondrial DNA, the proportion of the former determines whether they show symptoms of mitochondrial disease. Some women at risk of transmitting mitochondrial disease to their children are heteroplasmic and may have levels considerably below the disease threshold, but their eggs can have very high levels of mutant mitochondrial DNA or even be homoplasmic. This can be explained by the so-called bottleneck, which I will not go into in detail, but, during the development of the egg, only a certain number of mitochondria go into fertilisation, and that causes a bottleneck that sometimes results in only the mutant mitochondria getting through.
It is estimated that at least one in 200 children in the UK is born with some faulty mitochondrial DNA—so quite a lot of them may well have some faulty mitochondrial DNA. It is estimated that one in 6,500 babies goes on to develop serious mitochondrial disorders. The severity varies from mild to extremely debilitating and may result in early childhood death. Almost 2,500 women of child-bearing age in the UK are at risk of transmitting mitochondrial disease to their children. Estimates based on this figure suggest that between 100 and 150 births a year in the UK risk passing on mitochondrial disease to the child. If today we were discussing cancer or dementia, and how we could modify those diseases with some form of genetic or mitochondrial manipulation so that people would not get it, everybody would be in favour of it; but as mitochondrial disease affects 100 to 150 people a year, we do not take it so seriously—or so it seems.
I will now go on to what the noble Lord, Lord Deben, said about the two techniques that we are likely to be discussing—the maternal spindle transfer, which the noble Lord prefers, and pronuclear transfer—and I will say why I believe it is necessary that currently the HFEA, as a regulator, is allowed to decide which method might be appropriate for a given patient in a given centre. We do not know which technique is the more efficient and safer, despite what some others may believe. In fact, they may not be equally efficacious in every woman.
Pronuclear transfer has been used successfully in animals for more than 30 years with no evidence of adverse effects. On the other hand, maternal spindle transfer is a newer technique, which is likely to result in less carryover of mitochondria but has a higher risk of chromosomal abnormalities. That is an important point: pronuclear transfer may have more carryover of mitochondria but maternal spindle transfer has a higher risk of chromosomal abnormality. Maternal spindle transfers are very sensitive to manipulation. The embryo is less sensitive in its early stage to such manipulation.
Furthermore, both techniques have been found to be variable for avoiding mitochondrial disease. Which technique will be used for each individual patient will be a decision for the patient, based on their informed consent, their clinicians, the evidence from research and the safety aspects. In my view, it would be inappropriate for Parliament to make a scientific judgment as to which technique should be able to be used. One thing is certain: the scientists and the clinicians will go with whichever method is the safest and most efficacious. If it turns out, through research that is currently going on, that we can make maternal spindle transfer safer and less likely to lead to chromosomal abnormalities, that is the method that the scientists and the clinicians will choose. Research is going on to make that process safer. There are many ways of doing this. I am not being flippant when I say that one of the methods that has been tried is to use a small amount of caffeine to make the maternal spindle transfer more stable. Eventually, we will get that research right and whatever method is safest will be used. However, it would be wrong to opt now for one method which is not as successful as others.
Issues have been raised about the health and safety risks of some of the techniques. I agree with the noble Lord, Lord Deben, that it is never possible to be certain that new medical procedures will be 100% safe or effective. That applies to the whole of medicine—drugs, devices or surgery. Risks have been assessed in detail. As the Minister said, there have been three separate reviews of the scientific evidence on the technique’s safety by a specially convened independent panel of experts. It would be wrong to suggest that these experts might be biased when none of them has any financial interest in mitochondrial research or treatment, or that they might not have understood the issues and that we in this Parliament are more likely to understand the science which underpins this research, which has led to the point where it is now possible to use this technique to help women to have normal babies.
Decisions on safety and efficacy should be taken by the statutory regulatory authority created to do this—the HFEA. Risks must be balanced. Evidence suggests that any risks of mitochondrial donation are proportionately less than the significant risk that children will continue to be born who will develop severe mitochondrial disease if these techniques are not used. Ultimately, it will be up to affected families to judge the balance of these risks. They are the ones who will take the risks.
I would like to explore some of the health risks that the noble Lord, Lord Deben, mentioned, although he did not mention that of the potential effects of the donated mitochondrial DNA on the rest of the cell. I turn first to traits attributed to mitochondrial DNA. On variations in the 37 well studied genes, a whole mitochondrial genome has been sequenced for all these genes and they have all been found to have one function in expressing the protein that produces energy. No other trait has been identified from the sequencing of the whole mitochondrial genome. Therefore, the variations have been well studied. Although this is still contentious among mitochondrial experts, theoretically—I admit—it is possible that a child born after mitochondrial donation might have a slightly different energy metabolism compared with his or her female ancestors. However, none of this has resulted in devastating mitochondrial disease.
Evidence has also been cited that a mismatch between the DNA in the donor’s mitochondria and the mother’s nuclear DNA might have a negative impact, namely sterility and impaired growth—the noble Lord mentioned sterility—in the resulting child, as well as slow metabolism. This issue was considered in great detail by the HFEA scientific panel. In normal human populations the mixing of nuclear DNA during sexual reproduction means that there can be a complete exchange of nuclear and mitochondrial DNA type over a few generations—I calculate it to be about six generations. Given that I married an English lady, the mitochondria of my children have changed dramatically. My ancestors’ mitochondria are no longer in my children—they have English mitochondria. However, I am glad to say that they have produced terrific children. Evidence of mismatch between nucleus and mitochondrial genomes has come mostly from research where new combinations have been made experimentally across animal species that have been separated for many hundreds of thousands of years or longer—for example, rats and mice. Within species, such as in some experiments involving mice or fruit flies, evidence of mismatch is seen only when particular sub-strains of a species have been reproductively isolated from each other and each inbred. The one species, the human race, is the most outbred species there is. Some of us are examples of that.
Lord Deben
My Lords, if ever anyone questions the value of this House, this evening proves it. It has been a really valuable debate and I hope that all noble Lords who have taken part in it and those who have listened will recognise that we have all learnt and valued what we have heard, even from those who have spoken from a different point of view.
There was a phrase used during the debate that particularly annoyed me—an attack on playing God. I do not believe that that is a proper way to discuss these issues, not least because it is of the nature of the Christian understanding of creation that we share with God in His creative power. It is the great gift of the Almighty to us. Therefore, the idea that we should not do any of these things because for some reason or other they are reserved to God seems to me to be fundamentally theologically unsound as well as philosophic nonsense. I hope no one has suggested that those who take the view that I take do so from some arcane understanding of the Almighty.
Nor do I think anyone will now suggest that we were trying to push this whole debate into the long grass—and in case anyone should be worried, I do not intend to take up the time of the House for very much longer. The long grass was certainly not my intention. As the Minister knows, I have unbounded admiration for him and he again showed why we should return to the position of Ministers in this House being Cabinet Ministers as well. However, in describing his side he still left me with three very fundamental reasons for saying that we need to have certain things in place before we vote.
First, on the two issues, he is perfectly right to say that it is reasonable to bring them before the House. The objection is that they are brought before the House without it being able to make a decision on each of them separately because they each present separate issues. I do not think he has answered that. I know why he said that. It is because the Government know perfectly well that if you divide the two it would become clear that there is an ethical distinction between them. We did not discuss that today because we knew we could not discuss that ethical distinction because only one of them held it and the other did not. So my objection to the Government’s position—not of course to my noble friend’s position—is that they could have given us that choice and they decided not to.
It is the choice that I object to, not the fact that one might use the two techniques if both were approved. I suspect that both would have been approved, but we would have been able to explain why we hoped that the work done on the maternal spindle transfer and the third mechanism, which is coming along, would be prioritised and done in an ethically acceptable way. That is the first reason why I believe it would be better to allow a committee to look at this very rapidly and to insist that it be a decision in which we have a choice.
The second reason is that there is clearly a legal disagreement. I bow to nobody in my support for my noble and learned friend Lord Mackay of Clashfern. I know that it is normal in this House to accept that what he says is infallible. If it were not for his denomination, I would use that word, but I think that it would probably embarrass him considerably if I were to use it in conjunction with his name. However, I point out that the noble and learned Baroness, Lady Scotland, spoke for a number of people, including the Attorney-General, whose statement made it clear that he felt that this was unsound for legal reasons. Incidentally, I want to say that it is perhaps surprising that the Lord Chancellor is not a lawyer. I think that the Lord Chancellor should always be a lawyer. I also think that he should not be a career politician but ought to sit in this House. I make that point while I have the chance to say it, as until now I have not had a chance to make that provocative comment. However, the fact is that there are very clear legal disagreements.
I perfectly agree with the noble and learned Lord, Lord Hope, with whom I am normally ad idem: we have marched together on most of the subjects when I have rebelled against the Government and I have taken much pleasure in our arguments. However, I say to him that there is a distinction here. It is very dangerous for this House to leave it to someone else to decide whether something is legal. I think that this House should make that decision itself, and then, if it makes the wrong decision or a questionable decision, the matter will come before the courts. I understand that distinction but I agree with the noble and learned Baroness, Lady Scotland, on that front. However, I am worried about entering into legal issues because I have always prided myself on being the only member of the Cambridge mafia who did not read law.
That leads me to the third point, which is safety. It is no good—we cannot kid ourselves about this. The terms under which we were originally told that we were going to have this debate have not been met. The experiments which we were told would be done have not been completed. The most important of those is the primate experiment to make sure that such procedures do not result in sterility. People have said that even suggesting that is an attempt to frighten people. I am not doing that at all. It is simply the case that that was what we wanted to do but there has not been enough time to do it, although it would not take very long. Therefore, I again come to the question of why this measure is being pressed at this moment when we could very rapidly have the answers to all the questions that we have raised. I want to end on that but I shall say why I think that that is important—much more important even than the issue itself.
I believe that we are moving into a society in which the search for consensus and agreement is becoming increasingly much less urgent and much less important to people. I believe that we could have gained very considerable support for this measure. The noble Earl caused a certain amount of laughter when he referred to the ComRes poll. It was intended to ask people, in the words that they had read in the newspapers, what their reaction was. That is why the poll was held. Therefore, passing the matter to the Wellcome Trust and others to look at it as though it were a scientific statement was entirely contrary. I was pleased to find out that we had so failed to communicate with the public that 90% did not want us to go ahead with these regulations, and that was the case when using words which had meaning for the public. The Government’s consultation was in fact very limited. That is not the burden of this whole debate, but I just want to say to the House that we are beginning not to try to take everyone on board. There was a real opportunity to do so here and I would still like to recapture that. That is why I would like to test the opinion of the House.
Lord Winston
Before the noble Lord does that, I wonder whether he would consider this point very seriously for a moment. If we delay this measure, we will, as I am sure he understands very well, be committing a number of people to terminating pregnancies. Not only will we be terminating their pregnancies but those women will experience a number of lost pregnancies—a loss of life. Is that what the noble Lord really wants in pressing this amendment?
Lord Deben
I do not want to prolong this but the fact is that the human embryology committee and the terms under which it can give the permissions will take longer than it would take to have the committee that I am calling for in my amendment. It would not hold matters up for one moment. However, I think that the House wants to go to a vote.
Care Bill [HL]
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Lord Low of Dalston (CB)
My Lords, I shall speak briefly against Amendments 145, 146 and 149. As the noble Baroness, Lady Greengross, has just pointed out, these will take away the requirement that the CQC conduct periodic reviews of adult social care commissioning. These amendments seem perverse, coming hard on the heels of the latest care home scandal, revealed by the coroner’s finding that neglect contributed to the deaths of five residents at Orchid View care home in West Sussex.
Last week, the Close to Home report on human rights and home care by the Equality and Human Rights Commission concluded that some commissioning practices were likely to put at risk the human rights of older people receiving care. The Leonard Cheshire report, Ending 15-Minute Care, also points to problems with commissioning. It would therefore seem to make sense to leave Clause 83 unamended so that the CQC is empowered to oversee the practices of those commissioning adult social care and not just of those providing it.
Lord Deben (Con)
My Lords, in general terms, I support the government amendments. I am sure that my noble friend will want to answer the specific issue which the noble Baroness, Lady Greengross, raised. However, I support the Government with a slight caveat. Similar parts of the localism agenda of the Government have likewise seemed to have devolved in order to encourage people to take responsibility. I agree that there is a problem of prescription—if I may use that word in the context of the health service—because we all want to add in to any freedom the particular issues about which we have a special concern. I have real sympathy with those for whom dementia is one of those issues; it certainly is for me. However, we have to guard against that because, in the end, it may produce an artificial series of priorities. In this case, it is much better for the Care Quality Commission to make its own mind up, because it is going to be responsible. I take a rather different view about the recent scandals, in that the commission has to take responsibility for the claims that have been made. If it has to take responsibility, it must have as much control over its agenda as it possibly can.
My concern is simply that the Localism Act claimed to give localities all kinds of new controls over their futures. Yet, this week, we again find the Secretary of State for DCLG calling in a locally agreed solar decision, one supported by the local authority and by the inspector, but turned down—for reasons which are extremely difficult to see—by the centre. I want an assurance from my noble friend that this is real devolution; that the powers which have been given will not be circumvented by some other mechanism within this Bill or other Bills. The purpose of such devolution is to enhance responsibility. My concern is that, often, people who are given and who claim to have responsibility find that the structures are so prescriptive that they cannot take that responsibility seriously. If the amendments are an attempt to ensure that they can carry through their responsibilities in a way which enables the country to look to them to do the job they ought to be doing, that is fine and dandy. However, I hope that we can have reassurance that this is a real change, and not something that is going to be circumvented for the convenience of some Secretary of State by other bits of this or other Bills.
Baroness Barker
My Lords, I draw to the House’s attention three questions put forward by Leonard Cheshire Disability. That organisation has worked extremely hard to support the Government in their stated objective of stopping 15-minute care appointments for older people, and its questions are worth following up.
First, why is it necessary to remove this power completely from the CQC; what will the CQC be stopped from doing by the absence of this power that otherwise it would not be? Secondly, the Government are committed to tackling poor commissioning and poor practice. If it is not going to be the role of the CQC to challenge local authorities on their commissioning practices, whose job will it be? Thirdly, is there any evidence that that power, as it exists, has been misused? Whatever one’s view about where responsibility should lie—the noble Lord, Lord Deben, made interesting points about that—those three questions are worthy of an answer when we come to formulate that view.