Lord Chris Rennard's Recent House of Lords Appearances

From https://www.theyworkforyou.com/peer/13277/lord_rennard

  • May 7, 2019:
    • Atrial Fibrillation - Question for Short Debate | Lords debates

      My Lords, the noble Lord, Lord Black of Brentwood, is to be congratulated on securing this debate and on his personal tenacity in pursuing this issue through many other debates and questions and through the activities of the all-party parliamentary group. I have been pleased to take part in some of these, including the one to which he referred, in 2015, which focused on detection of AF. His question today refers to the Menu of Preventative Interventions published by Public Health England in 2016. This communicated an ambition to increase optimal management of people with atrial fibrillation from 74% to 89% over the five years to 2021.

      As the noble Lord said, AF is the root cause of one in five strokes, and people with the condition are five to six times more likely to suffer a stroke than those with a regular heartbeat. Aside from the human cost and many indirect costs, strokes directly cost the NHS more than £2.2 billion each year, but the risk of an AF-related stroke can be substantially reduced by providing effective anticoagulation therapy to prevent the formation of clots. Too often, however, AF remains underdiagnosed and undertreated. In 2014, NICE estimated that around 250,000 people in the UK have undiagnosed atrial fibrillation, and the King's Fund says that a huge proportion of those who have been diagnosed with AF are not receiving the correct anticoagulation medicine to prevent stroke.

      Better diagnosis and treatment could prevent around 7,000 strokes, prevent more than 2,000 people suffering severe disability and prevent 2,000 premature deaths each year. With an ageing population, AF prevalence is likely to grow, so why are we not identifying the condition and treating it as effectively as we might? Much of the problem is that there are significant gaps and inequalities in our health system, as shown by the rates of AF detection and access to therapies and treatment for stroke. Cardiovascular disease is one of the conditions most strongly associated with health inequalities, and if you live in England's most deprived areas you are almost four times more likely to die prematurely than someone in the least deprived. Cardiovascular disease is also more common where a person is male, older, has a severe mental illness or is south Asian or African-Caribbean in ethnicity.

      Action to address health inequalities, as proposed in the recent NHS Long Term Plan, is of course very welcome. The plan states:

      "Early detection and treatment of CVD can help patients live longer, healthier lives. Too many people are still living with undetected, high-risk conditions such as high blood pressure, raised cholesterol, and atrial fibrillation".

      A new return on investment tool confirms that savings can be made from better identification and management of patients. This suggests that more than 14,000 heart attacks and strokes could be prevented each year through earlier identification, diagnosis and effective management of AF. However, we are not doing what we could because suboptimal treatment of AF is widespread, particularly through the prescribing of aspirin monotherapy.

      The National Institute for Health and Care Excellence recommends that people with AF who are at risk of stroke should be offered either warfarin or a non-vitamin K oral anticoagulant, known as a NOAC. NICE also makes explicit that people with AF should not be prescribed aspirin on its own for preventing stroke, as the bleeding risks outweigh the clinical benefits. This is reiterated in the NICE AF quality standard, QS93:

      "Adults with atrial fibrillation are not prescribed aspirin as monotherapy for stroke prevention".

      But some healthcare professionals still believe that aspirin is an effective alternative to other NICE-recommended therapies. This practice puts a significant number of patients at unnecessary increased risk of stroke. The most recent national audit for stroke reveals the extent of suboptimal treatment with aspirin monotherapy and the impact on patient outcomes. In 2017-18, approximately 2,400, or 14%, of AF-related stroke patients were being prescribed aspirin on its own when they were admitted to hospital. This issue can be addressed with better education for healthcare professionals, particularly in primary care, to prevent aspirin on its own being prescribed when new cases of AF are diagnosed. Just as importantly, local GP practices and the new primary care networks can take proactive steps to ensure that existing AF patients are appropriately anticoagulated by identifying and reviewing those currently prescribed aspirin alone for AF-stroke prevention, as a priority.

      At a population health level, addressing inappropriate treatment in individuals whose clinical risk factors are suboptimally managed provides the opportunity for every health economy to improve AF-stroke prevention at scale in a short timeframe. This can be achieved by undertaking a systematic audit of primary care data to identify AF patients being treated with aspirin monotherapy, and offering them more effective long-term treatment with a NICE-approved anticoagulant therapy such as warfarin or a NOAC. The new NHS Long Term Plan included a commitment to support the creation of CVDprevent, a new national cardiovascular disease prevention audit, to support healthcare professionals in primary care to improve the identification and management of patients with high-risk CVD conditions, including AF. It is critical that this system incorporates metrics to systematically identify patients with AF currently treated with aspirin monotherapy.

      There are a number of questions to consider. How close are we to having regular systematic audits in every GP practice? The guidance on risk assessment and stroke prevention for atrial fibrillation, known as the GRASP-AF tool, can help to identify people at risk who are not anticoagulated or who are suboptimally anticoagulated. How far is this tool being used to help GPs assess the risk of AF-related stroke and provide for effective management of AF in patients? Can the Minister tell us what new measures are being taken to ensure that new and existing patients with AF are not prescribed aspirin monotherapy for preventing stroke, in line with NICE clinical guidelines? In addition, can we know the timelines for implementing the CVDprevent primary care audit programme?

      We look forward to hearing what steps are being taken to enable local NHS services to identify AF patients who are being suboptimally managed, and then supporting them to obtain the right treatment. We would like to know how local NHS clinical commissioning groups and providers are using the national audit for stroke to improve atrial fibrillation management. For example, what training is being made available to medical personnel and health staff, including pharmacists, to encourage pulse checks in routine check-ups, and in non-clinical settings, to detect AF?

      Finally, I draw attention to how researchers at the University of Birmingham have developed two apps that help patients and clinicians manage atrial fibrillation more effectively. Funding for this research came in part from Horizon 2020, the EU framework programme for research and innovation. Will this kind of funding be guaranteed in future?

  • Apr 25, 2019:
    • Electronic Cigarettes: Licensing | Department of Health and Social Care | Written Answers

      To ask Her Majesty's Government whether they published the terms of reference and membership of the working group of experts set up to consider the recommendations from the House of Commons Science and Technology Select Committee's report E-cigarettes, published on 17 August 2018, that impact the licensing of e-cigarettes as medicines; if so, when and where they were published; whether they will publish details of that working group's first meeting; and if so when and where they will be published.

  • Apr 11, 2019:
    • Local Government: Elections | Cabinet Office | Written Answers

      To ask Her Majesty's Government what plans they have, if any, to assess the likely level of personation that could occur at polling stations in the May 2019 local elections; and whether they will obtain from Electoral Registration Officers for those elections the number of tendered ballot papers issued in each local authority area.

  • Apr 10, 2019:
  • Apr 2, 2019:
    • Tobacco Harm Reduction - Question | Lords debates

      My Lords, Sweden has banned the advertising of tobacco products, introduced clean indoor air laws and increased the price of cigarettes. Together with the properly regulated promotion of e-cigarettes, have not these measures been shown across the world to be the best methods of tobacco control? Is there not a real danger with products such as snus that tobacco companies want to promote their dual use, pushing potentially dangerous tobacco products in clean air environments and continuing to push traditional tobacco smoking products elsewhere?

  • Mar 21, 2019:
    • Health Services (Cross-Border Health Care and Miscellaneous Amendments) (Northern Ireland) (EU Exit) Regulations 2019 - Motion to Approve | Lords debates

      My Lords, I am pleased that the second of the statutory instruments in this group is not being moved now, because the issues involved in that one require more consideration than we might have given them today. The Government should think rather more carefully about some of these issues because it is clear that a considerable number of UK citizens living in other EU countries are incredibly concerned about them. They would be even more concerned if they had heard the remarks of the noble Baroness at the beginning of this discussion on these SIs. The idea that they may have to apply for extra insurance policies, social insurance schemes and so on as soon as a week on Saturday illustrates why it is so important that we do not crash out of the EU on Friday of next week. People are also acutely aware of how the Government at the moment appear to be treating rather differently issues such as the voting rights of UK citizens living overseas and the healthcare rights of UK citizens currently living in EU countries.

      Tomorrow the Government will support a Private Member's Bill in the House of Commons to give permanent voting rights in UK elections to all UK citizens living overseas. However, many of them were denied votes in the EU referendum and now find themselves potential victims of that decision in terms of fundamental changes to their existing healthcare rights. The winding down of reciprocal healthcare arrangements was not really examined in the referendum campaign as a potential consequence of that vote.

      On Tuesday the Minister of State for Health, Mr Stephen Hammond, sought to allay some of their fears. But the Guardian today reports on the furious reaction of UK nationals who have retired to EU countries. The offer by the Government to cover healthcare costs for up to one year, if they have applied for or are undergoing treatment before exit day, is a terrible one. One of the people quoted in the Guardian article today says that if a person,

      "has paid into the system all their lives and retired to an EU country in good faith, with all the reciprocal arrangements in place, they could be left high and dry if they, say, get cancer after 29 March"-

      next Friday. Tuesday's Written Statement by the Minister said that pensioners will be eligible to return to the UK and get treatment on the NHS under the contingency plans. But another of the people quoted in the article today asks:

      "How can pensioners with cancer, cardiac problems or other major issues be expected to make or even afford repeated visits to the UK for regular vital treatment?"

      The present system works well and is cost effective, because healthcare is cheaper in many EU countries than in the UK, so the existing system helps save the NHS money. We are losing a benefit and incurring more expense.

      Campaign groups such as Bremain in Spain, British in Italy and Expat Citizen Rights in EU have all raised practical problems with the Government's plans. They are right to criticise the way in which people who have paid national insurance contributions for many years, and may continue to pay taxes to HMRC, may now be deprived of their rights to reciprocal healthcare arrangements where they now live. They may in practice be unable to return to the UK for treatment they need.

      Those of us living here who travel to Europe have come to regard the EHIC as a major advantage, and it has helped to keep travel insurance costs within Europe far lower than for the USA, for example. It is welcome that the cards may remain valid to the end of 2020, as opposed to next Friday, but only where a separate memorandum of understanding is in place with the relevant country. From what we heard a few moments ago, I understand that this is not the case with many countries so far. The basis of the statutory instruments relies heavily on the Government's ability to agree transitional reciprocal healthcare arrangements with EU member states. Few agreements have already been reached, eight days before some people want us to leave the EU. It is hard to see how the new arrangements proposed can be subject to proper scrutiny-particularly without the relative costs of the new arrangements being assessed-together with what appear to be major drawbacks for UK citizens living in or visiting EU countries in future.

      Current EU reciprocal healthcare arrangements allow UK citizens to have access to healthcare when they live, study, work, or travel in the EU, EEA and Switzerland, and vice versa. What they get in future may not be nearly as good, and the costs of the new arrangements are not known. The Government have admitted in these SIs that,

      "there is a high level of uncertainty around the precise value of the costs and benefits".

      It is also clear that the Government are relying on powers to be given to the Secretary of State via the Healthcare (International Arrangements) Bill to make any provisions for after 31 December 2020, but we do not know who that Secretary of State will be then, or what it will be possible for them to agree. Does the Minister accept that we cannot give proper scrutiny to legislation when so much is unknown and uncosted? Can she say something about what the costings really are? Does she accept that it is regrettable that the timeframe for consideration of these measures means that there has not really been any proper public consultation about them, particularly with UK citizens living across different EU states?

      Like the noble Baroness, Lady Thornton, I also want to know what arrangements the Government will make for advising travellers and expats as to their healthcare coverage status if we leave without a deal next Friday. We have seen little preparation for that so far. How will the date of 31 December 2020, outlined in the SIs as the day when all current arrangements with other member states cease, be revised if the Government succeed next week in securing an extension to the Article 50 process?

    • Nutrition (Amendment etc.) (EU Exit) Regulations 2019 - Motion to Approve | Lords debates

      My Lords, people are right to be concerned about food safety and nutrition issues, the integrity of some of the claims that are made and the effects of substances which are permitted for use as supplements for various purposes. People who are presently satisfied by the standards set by the European Food Safety Authority have legitimate concerns about future regulatory approaches and potential changes to them.

      The draft nutrition regulations in this SI may provide some temporary reassurance for consumers and businesses using these products, but, as indicated by the Minister a few minutes ago, they do not provide any sort of long-term reassurance about what may happen in future. As she said, regulations in the UK and the EU will be identical on departure day-whenever that might be-but they will inevitably divert in future when different people in different bodies come to different conclusions. Can she therefore indicate what the issues will be when a UK body begins to make different regulations to those determined by the European body?

      Can the Minister indicate what additional costs there may be in the long run from setting up new bodies to replace EU regulations with UK ones? Perhaps she can tell us what have been the recruitment costs for the new bodies and what will be the ongoing costs of running them. Before June 2016, many people were led to believe that they would be freed from sharing the cost of things like the European Food Safety Authority. However, what will be the costs of establishing and running these bodies, in particular the new UK Nutrition and Health Claims Committee?

      We are told that the processes to be undertaken will be similar to present ones at EU-wide level, but presumably businesses seeking to sell products such as nutritional supplements across the UK and the EU will in future need the approval of both EU and UK authorities. Will this not mean that the burdens and costs of regulation for us outside the EU will be increased, rather than reduced as many people were led to believe? The extra costs and burdens of duplicating UK and EU approval processes will surely hinder future research and innovation.

      Most fundamentally, will the Minister confirm that leaving the EU on a no-deal basis would mean that we deny ourselves and the rest of the EU the benefits of sharing costs and expertise on these issues across the UK and the EU?

  • Mar 19, 2019:
    • Folic Acid - Question | Lords debates

      Three years ago, in this House, the then Health Minister acknowledged that the link between folic and reducing neural tube defects was fairly well proven. As it has taken so long to act on that, and on decades of evidence in the United States and elsewhere, once we have finished this 12-week consultation period-in which all professional bodies and royal colleges are unanimously of the opinion that we should act to add folic acid to flour-how long will it take the Government to act?

  • Mar 18, 2019: