Health and Care Bill

Lords Hansard _ Part 1 & Report stage
Wednesday 16th March 2022 Lords Chamber

Report (4th Day)

Relevant documents: 15th, 16th and 19th Reports from the Delegated Powers Committee, 9th Report from the Constitution Committee

15:52

Amendment 158

Moved by

[Lord Crisp]

158: After Clause 164, insert the following new Clause—
“Tobacco products statutory scheme: consultation
(1) The Secretary of State must, no later than six months after this Act is passed, consult and report on the desirability of making a scheme (referred to in this section and section (Tobacco products statutory scheme: supplementary) as a statutory scheme) for one or more of the following purposes—(a) regulating, for the purposes of improving public health, the prices which may be charged by any manufacturer or importer of tobacco products for the supply of any tobacco products;(b) limiting the profits which may accrue to any manufacturer or importer in connection with the manufacture or supply of tobacco products;(c) providing for any manufacturer or importer of tobacco products to pay to the Secretary of State an amount calculated by reference to sales or estimated sales of those products (whether on the basis of net prices, average selling prices or otherwise) to be used for the purposes of reducing smoking prevalence and improving public health.(2) The consultation must ask for views on a draft statutory scheme (or alternative draft schemes), which may, in particular, make any provision mentioned in subsections (3) to (6).(3) The draft scheme or schemes may provide for any amount representing sums charged by any manufacturer or importer to whom the scheme applies, in excess of the limits determined under the scheme, for tobacco products covered by the scheme to be paid by that person to the Secretary of State within a specified period.(4) The draft scheme or schemes may provide for any amount representing the profits, in excess of the limits determined under the scheme, accruing to any manufacturer or importer to whom the scheme applies in connection with the manufacture or importation of tobacco products covered by the scheme to be paid by that person to the Secretary of State within a specified period.(5) The draft scheme or schemes may provide for any amount payable in accordance with the scheme by any manufacturer or importer to whom the scheme applies to be paid to the Secretary of State within a specified period.(6) The draft scheme or schemes may—(a) prohibit any manufacturer or importer to whom the scheme applies from varying, without the approval of the Secretary of State, any price charged by the manufacturer or importer for the supply of any tobacco product covered by the scheme, and(b) provide for any amount representing any variation in contravention of that prohibition in the sums charged by that person for that product to be paid to the Secretary of State within a specified period.(7) The Secretary of State must lay the report before Parliament and a Minister of the Crown must arrange to make a statement to each House of Parliament setting out in detail any steps which will be taken to implement the findings of the report.”Member’s explanatory statement
This new Clause, along with others, would require the Secretary of State for Health and Social Care to carry out a consultation about a statutory scheme for the regulation of prices and profits of tobacco manufacturers and importers. Funds raised by the scheme would be used to pay for the cost of tobacco control measures to deliver the Government’s ultimatum for industry to make smoked tobacco obsolete by 2030 and for England to be smoke-free with smoking rates 5% or below.

[Lord Crisp (CB)]

My Lords, I rise to move Amendment 158 and note that the other three amendments in this group are consequential on this one.

These amendments would require the Government to consult on a statutory polluter pays scheme imposed on tobacco manufacturers to fund measures to reduce smoking prevalence and improve public health. In 2019, when the Government announced their smoke-free 2030 ambition, they promised to consider just this sort of polluter pays approach to raising funds for tobacco control. The amendments require the Government to fulfil this commitment by consulting on a statutory scheme and reporting back to Parliament within six months of the Bill’s passage. The scheme consists of two distinct parts: a levy raised from tobacco sales volumes, which would raise an estimated £700 million a year, and a price cap on tobacco products to prevent tobacco companies simply passing these costs on to smokers.

The amendments propose that funding from this scheme be used to pay for the tobacco control measures needed to achieve the smoke-free 2030 ambition. This includes greater investment in stopping smoking services, mass media public education campaigns, targeted support for disadvantaged groups, tackling the sale of elicit tobacco and preventing young people taking up smoking. There are three sets of arguments in this regard, which are all compelling. The first is the impact of tobacco on public health. The second, bluntly, is that this is in line with government policy. The third is the need for a pragmatic approach to where we are today and how we can achieve funding.

Let me just make a few points about the first of those, the impact of tobacco. First, smoking is, of course, the largest single risk factor in ill health and early mortality. Secondly, it is not a lifestyle choice; it may have been originally—as an ex-smoker, I know that—but it is also addictive, and addiction normally starts in childhood. That is why it is really important that we target younger people. Two-thirds of younger people who start smoking carry on into adult life. The current rate of decline is insufficient; smoking prevalence is coming down around the country but, currently, it would take until at least 2047 for the most disadvantaged communities to achieve the level required. Indeed, inequality is a big issue here. Given that so many noble Lords have spoken about inequalities in relation to other amendments to the Health and Care Bill, I just draw out that smoking is responsible for half of the 10-year difference in life expectancy between the richest and poorest parts of society. Whether one smokes or not has a far greater impact on life expectancy than a person’s social position in society.

This is a fundamental health issue—and there are costs. There are costs to the individual: it is estimated that the average smoker spends about £2,000 a year on smoking; and half a million households, a third of a million children and 183,000 pensioners are living in poverty because of the costs of smoking. There are also costs to the system. It is not just about mortality; it is very much about morbidity. We know, for example, that smokers are more than five times as likely as non-smokers to have microbiologically confirmed influenza and twice as likely to develop pneumonia. Similarly, we know that smokers who quit smoking have better treatment outcomes from day one for everything from cancer to cardiovascular disease, diabetes to dementia, maternity to mental health, stroke to surgery—to the benefit not just of those smokers, but the NHS that provides the service and, frankly, the economy by ensuring that people of working age can be more productive and not take so many days off sick.

Finally, in talking about the impact, I note that there is now enormous public support for these measures. In a recent survey, some 77% of the public supported making tobacco manufacturers pay a levy or licence fee to government for measures to help smokers quit and prevent young people taking up smoking. Nobody in your Lordships’ House will be surprised to know that a levy on tobacco manufacturers has also been endorsed by around 50 health organisations of many different sorts.

As I said at the beginning, there are arguments for these amendments that are about the impact of smoking, which are compelling in themselves. There are arguments that this is fundamentally in line with government policy and that the smoking target will not be hit in 2030 without something of this sort. There is also the very pragmatic argument that in a time of financial difficulty such as this, it is very often the longer-term measures that get cut. There is nothing longer term than making sure that we stop children smoking at an early age. We have, therefore, in this levy a very practical way forward. I beg to move.

[Lord Faulkner of Worcester (Lab)]

My Lords, I support Amendment 158 and the others in this group, to which I have added my name. Last Wednesday was national No Smoking Day, and there was an excellent event in a Commons dining room hosted by the All-Party Parliamentary Group on Smoking and Health—I declare an interest as an officer of that group—to celebrate the 50th anniversary of ASH. The star speaker was the Public Health Minister, Maggie Throup. She reaffirmed the Government’s commitment to achieving a smoke-free England by 2030 and rightly said that stop-smoking services would be at the centre of the forthcoming tobacco control plan.

NICE has estimated that, for every £1 invested in stop-smoking services, £2.37 will be saved on treating smoking-related diseases and reduced productivity. However, cuts to local public health budgets have disproportionately hit stop-smoking services. They have lost a third of their funding in real terms since 2015, accompanied by a decline in the number of smokers setting quit dates.

16:00

If the Government truly want stop smoking services to be at the centre of the tobacco control plan, these funding cuts must be reversed. The spending review did not reverse the cuts and the levelling up White Paper has also not provided the additional funding. But these amendments, based on a polluter pays levy, could do the job the Government say they want to achieve. The polluter pays levy could also pay for other vital measures, because smoking is an addiction and to overcome that addiction, smokers need to be motivated to quit.

In the States, a mass media campaign called Tips from Former Smokers is funded by a levy on manufacturers. Over a six-year period, the campaign increased the number of successful quitters by 1 million; it was equally effective with ethnic minorities and smokers with poor mental health, and had healthcare cost savings of $11,400 per lifetime. All those people quit as a result of that campaign. In England, funding for mass media campaigns, which was at US levels in 2009, fell by 90% to only £2 million in 2019. This was matched by a 25% decline in the proportion of adult smokers in England who tried to quit in the previous year. If smokers do not try to quit, they cannot succeed.

I commend to the House the words of the chair of the Government’s independent review of smoking, Javed Khan. Speaking to the Times last week, he said:

“Just look at the Covid experience, mass marketing has a big effect, it really works. The Government went hell for leather, it made an enormous difference in vaccination rates. So why not do something like that again, if we really want to save people’s lives.”

We agree, but the funding must be found, and the best and most realistic option is for the polluter—that is, the tobacco companies—to be made to pay. I support these amendments.

[Lord Young of Cookham (Con)]

My Lords, it is a pleasure to follow the noble Lords Lord Crisp and Lord Faulkner in support of these amendments, which replicate the amendment I moved in Committee. They set out proposals for a statutory smoke-free 2030 fund, based on the polluter pays principles, to pay for measures to end smoking. We are grateful to both Ministers for the time that they spent with us on a Zoom call last week, when we sought to persuade them of the merits of these amendments, and time alone will tell whether those representations bore fruit.

In Committee, my noble friend Lord Naseby, whom I see in his place, suggested that these proposals had been consulted on in 2015, and that the Government had concluded they were not workable, a conclusion which he said had been reiterated by the Exchequer Secretary on 10 January 2022. While my noble friend was right to say that the Government consulted on the levy in 2015, they did not consult on the proposals before us today. What was consulted on then was an additional tax, and the decision was taken not to proceed because tobacco manufacturers and importers would pass the costs of a levy on to consumers; the Statement by the Treasury in January merely reiterated that conclusion. Back in 2015, the regulation of tobacco prices to prevent the costs of a levy being passed on to consumers was prohibited by the rules of the European Union. That is no longer the case, so the 2015 objection to the levy no longer holds true. The Government can now put the financial burden firmly where it belongs, on the polluter—the tobacco manufacturer— and not the polluted—the smoker.

Our scheme enables the Government to limit the ability of manufacturers to profit from smokers, while protecting government excise tax revenues, which is a win-win for the Government and for smokers. The scheme is modelled on the Pharmaceutical Price Regulation Scheme, the PPRS, which has been in operation for over 40 years and is overseen by the Department of Health and Social Care. It has teams of analysts who already have the skills to administer a scheme for cigarettes, a much simpler product to administer than pharmaceutical medicines.

Unlike corporate taxes, which are based on reported profits and can be—and indeed are—evaded, the levy would be based on sales volumes, as is the case in America, where a similar scheme already operates. Sales volumes are much easier for the Government to monitor and much harder for companies to misrepresent. Implementing a levy would not require a new quango to be set up, as the Department of Health and Social Care has all the expertise needed both to supervise the scheme and to allocate the funds raised. We would not be averse to the consultation mentioned in the amendment including other options, as long as it included careful consideration of our proposals.

The Government have said that they accept the polluter pays principle. My party has form in implementing that proposal through the landfill levy, the tax on sugar in soft drinks and requiring developers to pay for the costs of remediating building safety defects. Indeed, as we heard from the noble Lord, Lord Crisp, the Government promised to consider this approach to funding tobacco control nearly three years ago in the prevention Green Paper. Surely they should now welcome this opportunity to consider how it can be put into practice.

[Lord Rennard (LD)]

My Lords, I speak in support of these amendments, to which I have added my name, and which are in accordance with my party’s policy.

In Committee, there was almost universal support for dealing with health inequality issues, and there was widespread recognition that, as the noble Lord, Lord Crisp, said, half the difference in life expectancy between the richest and the poorest people in this country is caused by smoking. There are many ways in which we can further reduce the prevalence of smoking, and those of us who are members of the APPG on Smoking and Health set them out during the course of our debates.

However, we are concentrating today on just one key principle which is necessary if the Government’s target of reducing the prevalence of smoking to 5% or below is to be achieved by 2030. That principle is finding the funds to support smoking cessation and tobacco control measures through a levy on the tobacco companies. This would help to ameliorate the terrible damage done by their products, which includes shortening the lives of half the people who use them.

The funding for local authorities to pursue tobacco control policies such as smoking cessation services and enforcement and for national mass media campaigns has been cut significantly. Without the proposed levy, the NHS will face greater costs in future in dealing with the many issues, such as lung cancer and heart disease, which arise in part because of smoking tobacco.

Last month, together with other officers of the APPG on Smoking and Health, I had the pleasure of meeting Javed Khan, chair of the Government’s independent review into smoking. He listened carefully to all our proposals, particularly on the levy, and certainly understood the necessity of funding being found. The Government have asked him to say what the most impactful interventions that could be taken forward in the new tobacco control plan would be. He told us that if nothing different is done, the Government’s smoke-free target will not be met. He promised that his recommendations would be “bold and brave”, as I hope they will.

I expect that we will soon get some soothing words from the Minister. But before he replies to this debate, I ask him to consider how, in “Hamlet”, King Claudius has to admit that

“words without thoughts never to heaven go”.

I hope the Minister will give us not just warm words about tobacco control but confirm that the Government have thought about the tobacco levy and will undertake a formal consultation on it.

[Lord Naseby (Con)]

My Lords, I hasten to say to your Lordships that I do not smoke and have never smoked. In considering the amendments before us this afternoon, it is worth giving some of the official statistics rather than the aspirational ones. Smoking rates in England continue to decline year on year and that has been a trend for the last 30 years. According to the Office for National Statistics in 2021, smoking rates in England have declined significantly, from 20% in 2011 to 12% in 2020. The decline in the number of smokers has resulted in a reduction in the cost to the NHS of treating the impact of smoking. In 2015, Public Health England estimated that the total smoking-related cost to NHS England was £2.6 billion a year, when 18% of the population smoked. This figure and the corresponding cost to NHS England over the last five years have declined further, given the 12% smoking rate in England in 2020. According to NHS data published in 2019 on smoking, drinking and drug use among young people, the number of young people aged 11 to 15 smoking has declined dramatically, from 16% to just 5% in 2018. According to the Office for National Statistics in 2021, only 12% of 18 to 24 year-olds in Great Britain smoke, a major reduction from 26% in 2011 and the lowest smoking rate across all age groups except the over-65s.

By way of background, according to the most recent HMRC tax gap data, illegal smuggling and consumption of illicit tobacco cost Her Majesty’s Government £2.3 billion in lost revenue in 2019-20, a figure that remains unchanged from the fiscal year 2016-17, which reinforces the fact that the Government’s anti-illicit tobacco strategy is not working. It ought to be working, when you have a situation where a group of companies is working with the Department for Health and has done over many years. Frankly, it is a sad reflection on the status of HMRC that this illicit tobacco importation is increasing. You have only to look at what is happening in Dover or any of our other ports today to see why it is increasing. It is a pathetic and embarrassing performance at Dover at the moment, the net result being not just tobacco but illegal alcohol and so on coming in.

Now we look at the idea of a levy, something that has never been in the manifesto of a Conservative Government to the best of my knowledge. A levy on any company prescribed by government, even companies trading locally, certainly does not fit into the basic elements of our financial and economic strategy. If it was just a levy on cigarettes, there might be half a case, but this is on anything to do with tobacco. Most of all those other products have no effect on people’s health—they are a matter of enjoyment—but this idea goes across the whole lot. It has not been thought through.

It is all very well my noble friend Lord Young on the Back Benches saying that there was a consultation in 2015 on a levy on tobacco manufacturers’ profits and the Government concluded that it would be unworkable, but that was because we were in the EU so it has all changed now. I say to my noble friend on the Front Bench: I would have thought he had enough on his hands without introducing a complicated levy, but that is my personal view. There was an exchange between the Exchequer Secretary and the then shadow Exchequer Secretary, confirming

“that our position regarding the 2015 consultation stands. A levy would be a complex”—

this is not going to change—

“and costly way of raising money to fund tobacco control measures and would be unlikely to provide a stable revenue stream.”

I say to my noble friends on all sides of the House that tobacco manufacturers already invest hundreds of millions of pounds every year in R&D and highly skilled jobs to bring to market alternative smoke-free nicotine products. Some of your Lordships may use e-cigarettes, nicotine pouches or heated tobacco products. Further tax increases on manufacturers as a whole will have the effect of reducing that investment, which is not a very clever way forward.

16:15

The introduction of a levy additionally would represent only a further punitive tax on a legitimate legal product and would unfairly have a direct impact on consumers who have made an informed choice to smoke and are fully aware of the risks associated with smoking. The Government already have two tools to raise money from tobacco: excise and MET—minimum excise tax—which could be used much more efficiently.

Frankly, the chief beneficiaries of the levy will be those criminals who supply and trade in illegal counterfeit and contraband tobacco, as more consumers are pushed away from being able to afford legitimate tobacco products. We see that today—it is happening this very hour. The introduction of a profit cap on individual companies, as suggested by some pressure groups and the signatories to these amendments, is entirely inappropriate and anti-business for a highly competitive consumer goods industry with a growing range of innovative products that are already heavily taxed and highly regulated.

My noble friend raised in evidence the PPRS. That was dropped by a former Government because as far as they were concerned it was not working. The pharmaceutical dimension of the Department of Health brought in NICE instead, so my noble friend is not right to call in the PPRS as an example of a success.

The introduction of the profit cap is in my judgment entirely inappropriate and anti-business for this highly competitive goods industry. To conclude, it would send out an extraordinarily negative signal that the UK is hostile to business at exactly the time it is trying to position itself as a leading destination for global investments, enterprise and economic growth. Existing taxes on tobacco products are already among the highest in the world, accounting for over 90% of the price of cigarettes. Again according to HMRC’s figures, the Government collected £12.5 billion in excise and VAT from tobacco products in 2020.

I say to my noble friend on the Front Bench that I understand that the Government are bringing forward their tobacco control proposals, and of course we will look at those carefully. However, as someone who comes from a medical household, I know that other parts of the health service urgently need attention. The whole of the GP practice situation in our country is in very deep trouble at the moment and that is where the money should be spent, not on trying to administer some marginal levy system which will not work and will cost Her Majesty’s Government a fortune.

[Baroness Northover (LD)]

My Lords, briefly, I support these amendments; my name was on an amendment at an earlier stage. I hope that the Minister will have managed to persuade other parts of government that they will not achieve a smoke-free 2030 in the UK unless they move further and faster on tackling an industry built on promoting ill health and death—the reverse of what the health service seeks to do.

The Department of Health has come a long way in this area, with much cross-party working, and I know that the noble Earl himself has been part of that cross-party support in tackling the terrible health consequences of smoking. I have a sense of déjà vu, as I think others might. Over the years, the noble Lord, Lord Naseby, has been a rather lone voice on the other side. From time to time FOREST, which makes it plain that it is funded by the tobacco industry, kindly sends me its brief, no doubt inadvertently, and I recognise some familiar phrases that have just been voiced. I noted the rueful expression of the noble Lord, Lord Naseby, as the noble Lord, Lord Young, took apart what he had said about the levy.

The Government say that they are committed to delivering a smoke-free 2030, but keep putting off the action required. Not all parts of government are fully aligned to this in the actions taken. The steps proposed in the amendments are designed to help the Government achieve what they say they wish to do. I therefore commend them to the House.

[Lord Stevens of Birmingham (CB)]

My Lords, I want to make just a small factual supplement to the contribution from the noble Lord, Lord Naseby. In fact, it was a Conservative Government in 1957 who introduced the pharmaceutical price regulation scheme or PPRS, and that scheme has been sustained ever since by Conservative, Labour and coalition Governments. As the noble Lord, Lord Young, pointed out, if it is deemed appropriate to have a form of price and profit regulation for the medicines industry, which delivers products that are essential and life-saving, it does not seem too far a stretch to think that an equivalent mechanism might be used for an industry whose products are discretionary and life-destroying.

[Lord Lansley (Con)]

My Lords, I was not intending to intervene, but I was prompted to do so not least by the noble Lord, Lord Stevens of Birmingham. That the PPRS has been sustained by Governments, albeit amended from time to time, should not lead us to the conclusion that all products should have their pricing and regulation controlled by government. I do not think that the analogy runs at all, so we should ignore the PPRS for these purposes.

My noble friend on the Front Bench whom I believe is replying to this debate and I were in a coalition Government with the noble Baroness, Lady Northover, and we were pretty clear then. I remember a decade ago creating a bit of a storm by saying that I wanted to end up with a smoke-free England. We have reached a point now where there are tobacco companies which think that we are going to arrive at that position, and so we should. I do not think that this debate is about whether we achieve that; it is about the mechanisms by which we do so.

If my noble friend reiterates the Government’s intention, willingness and sense of urgency about bringing forward measures, as I hope he does, I would not bind the hands of the Government with these amendments. Frankly, even if they were passed, nothing would happen unless and until the Government bring forward legislation for the purpose. It would be better for us to have the debate and make the position clear. I do not disagree with the arguments presented by the noble Lord, Lord Crisp, and others—when we were in government, we implemented things such as the ban on display in shops and preventing the availability of cigarettes to youngsters through vending machines, which I think was one of the most important things we could do. We made progress; we need to make more. We need the Government to come forward with proposals for that, but these amendments are not necessary if the Government say that they are willing to make progress.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I was not intending to speak, but I wanted to counter the point made to the noble Lord, Lord Naseby, that he was simply rehearsing lines from FOREST, the pro-freedom to smoke group. I also inadvertently receive communiques from ASH, the anti-smoking lobby group—I think it has me muddled up with someone else—and I have heard many of its lines rehearsed here as well on the other side of the argument. I thought it might be worth noting that.

Secondly, I have to declare an interest: I smoke. I appreciate that this means that I am beyond any redemption—goodness knows, I am controversial enough on a range of other things, but that is probably the worst.

[A noble Lord]

Hear, hear!

[Baroness Fox of Buckley (Non-Afl)]

Well, good. I have got a few “hear, hears”.

[Lord Rennard (LD)]

Does the noble Baroness accept that a crucial difference is that organisations such as ASH are funded by organisations concerned with public health, including Cancer Research UK and people who deal with trying to save lives, while FOREST is funded by the tobacco industry, which kills half its customers?

[Baroness Fox of Buckley (Non-Afl)]

I was coming on to that point. I would really appreciate a dose of honesty in this House. If those people who are so hostile to smoking a legal product believe that it is the killer they allege, they should call for smoking to be made illegal and be done with it. At the moment, tobacco companies are legal companies. People talk about them with such distaste, as though they should be abolished. It would be better and more heartfelt if they argued that tobacco should be illegal; then we would have a different debate. Public health is not always neutral when you talk about public health lobbyists, in my opinion. The freedom to choose to do something that is bad for your health is still allowed in a free society, despite some people wishing it was not.

[Baroness Walmsley (LD)]

My Lords, I do not recall anybody suggesting in the debate that tobacco companies should be made illegal. I hope that the noble Lord, Lord Naseby, is not suggesting that, just because the number of smokers is going down, nothing more should be done. I thought I heard the noble Lord, Lord Crisp, suggest that, if we carry on at this rate, it will be another 25 years before we get to where we need to be.

[Lord Naseby (Con)]

I was suggesting that we do carry on because the evidence is there in government data, not in a forecast from the noble Lord, Lord Crisp, or some minor operation that he—

[Baroness Penn (Con)]

I remind noble Lords that only short questions of elucidation are allowed on Report.

[Baroness Walmsley (LD)]

Many thanks. I suggest to the noble Lord, Lord Naseby, that a lot more people will be dead from tobacco if we carry on at this rate. He suggested that, just because this measure was not in the Conservative Party’s manifesto, perhaps we should not carry it forward. Well, the Conservative Party does not have all the best ideas, although I congratulate the Government on the sugary drinks levy, which has been highly successful. We support the polluter pays amendment introduced by the noble Lord, Lord Crisp. I might call it the killer pays amendment because, make no mistake, this is a killer substance.

I happen to live in Wales so I want to raise a matter that has not been mentioned yet. I am glad that the Welsh Government have committed to a smoke-free Wales by 2030. However, although England announced its intention to go smoke-free by 2030 two years before Wales did, Wales has leapt ahead as regards action, which is why I hope that the Minister will either accept Amendment 158 or give adequate assurances. In the Green Paper of July 2019, the Government said:

“Further proposals for moving towards a smoke-free 2030 will be set out at a later date.”


Approaching three years later, still nothing has happened. There are no further proposals and no funding has been announced. In contrast, Wales has published concrete proposals, but many of the interventions require action from the UK Government. Examples include the polluter pays funding mechanism, which could help to fund tobacco control in Wales; raising the age of sale; and putting warnings on cigarettes and pack inserts. I am concerned that, by being so slow, the UK Government are undermining the ability of the devolved Administrations to achieve their smoke-free ambitions. We will support the noble Lord, Lord Crisp, if he chooses to put this amendment to a vote.

[Baroness Merron (Lab)]

My Lords, I am grateful to noble Lords for their contributions to this debate and for putting forward this group of amendments. In introducing Amendment 158 and the consequential amendments, the noble Lord, Lord Crisp, outlined that they would establish a consultation on a polluter pays levy whereby funds are raised by the scheme to pay for the cost of tobacco control measures to deliver a smoke-free 2030. This strikes me as wholly pragmatic; a wide-ranging consultation would undoubtedly help to strike the right balance between all the parties involved.

We know from this debate and many previous debates that tobacco use carries huge health risks, and disproportionately so for the most disadvantaged in society, whose likelihood of smoking is four times higher in the most deprived areas compared to the least deprived. If ever there was a case for levelling up, this is it. My noble friend Lord Faulkner rightly highlighted that we have seen cuts to stop-smoking services, and this group of amendments seeks to redress the situation in a practical way. It is vital that we motivate and support more smokers to quit, while reducing the numbers of children and young people who start to smoke. Greater action is clearly needed now.

The scheme proposed in this group of amendments would provide a well-funded and much-needed boost, and a consultation would allow this proposal to be tested, refined and shaped. I hope that the Minister will accept the opportunity of a consultation but if the will of the House is tested, these Benches will support the amendments.

16:30

[Earl Howe (Con)]

My Lords, I am grateful to all noble Lords who have spoken in this debate and in the informative debate we had in Committee, on which I have reflected carefully. Let me first remind the House of what we are doing in this area.

We are committed to making England smoke free by 2030 and will set out our approach in a new tobacco control plan to be published later this year. As part of that work, we are exploring a number of regulatory proposals and have launched an independent review into smoking. The review, led by Javed Khan OBE, will make a set of focused policy and regulatory recommendations to government on the most impactful interventions to reduce the uptake of smoking and support people to stop smoking for good. It is in that context that I turn to the detail of these amendments.

As mentioned in previous debates, while I speak for the Government as a whole, tobacco taxation matters are ones for Her Majesty’s Treasury. As noble Lords will know, the tobacco industry is already required to make a significant contribution to public finances through tobacco duty, VAT and corporation tax. Through these finances we are able to fund local authority stop-smoking services through the public health grant and provide extra resources as part of the NHS long-term plan commitment to help smokers quit. As part of the annual Budget process, Her Majesty’s Treasury will continue the policy of using tax to raise revenues and encourage cessation through continuing with above-RPI duty increases on tobacco products. It is a proven and effective revenue-raising system.

I am as keen as anyone to find new ways in which to bear down on the prevalence of smoking and I am proud to have been instrumental in bringing some about. However, I am afraid that I cannot accept the amendment as it stands. The proposal may look simple on the surface but it is complex to implement. It may also take several years to materialise. Our strong preference is to continue with high tobacco taxation and excise as the best means and the most efficient process through which to generate revenue that can be put back into public services. However, I can tell the noble Lord, Lord Crisp—I hope that this will at least be of some reassurance to him—that the department’s officials will continue to work with Her Majesty’s Treasury to explore whether there are other innovative financing models that can be applied to the tobacco industry to support Smokefree 2030 and be as effective and efficient as the current taxation system. It may be—I do not know—that Javed Khan will come forward with recommendations in this area. We should allow him the necessary time to conduct his independent review.

I realise my reply will be disappointing to the noble Lords, Lord Crisp and Lord Faulkner, and my noble friend Lord Young, who are understandably passionate about this issue. I hope they will realise that we are very much on the same page regarding the overriding objective to reduce and eliminate the practice of smoking in this country. I hope I have provided some reassurance that the Government have listened and thought carefully about this proposal, even if we have not felt it right to proceed with it, in the end. As the noble Lord, Lord Crisp, would expect, we will set out our financial plans to support smoke-free 2030 in our new tobacco control plan. For those reasons, I ask him to withdraw his amendment.

[Lord Crisp (CB)]

My Lords, first, I thank those noble Lords who added their names to this amendment and spoke so eloquently in this debate, which covered a range of important issues that between them present a compelling argument for what is only a consultation. Secondly, I thank the other noble Lords who spoke during the debate, including those who spoke against the amendment, because having a proper debate allows us to pull out some important issues. I will return to that in a moment. Thirdly, I thank the Minister for the time that he and his colleagues gave to meet with us, and for our helpful discussions. I very much accept the noble Earl’s statement about us being on the same side and pushing in the same direction, but we need to get there.

That takes me to picking up some of the points that were made. I thought the contribution from the noble Lord, Lord Naseby, was very helpful. The point he made about how the numbers are coming down was terrific. It is great news—so let us accelerate it. We can get behind that and really shift it. There is a problem here, as with so much in public health, in that people talk about aggregates and averages. There is a real trap in aggregates and averages. The aggregate could come down to 5%, but 20% of people in the lowest socioeconomic group could still be smoking. That is the problem when you deal in gross numbers. I said in the debate that, according to Cancer Research UK, which is a reasonably reputable body, it would be 2047 before we saw that level of achievement among the lowest socioeconomic group in the country. Aggregates and averages are real traps in public health.

I understand the good faith of the Ministers in this House. However, and I think I speak for my colleagues on this amendment, we note that the Green Paper in 2019 promised to consider the idea of polluter or perpetrator pays—whatever is the right language for that. Almost three years on, we have not yet seen that happen. Not surprisingly, we are rightly suspicious of how these things can be kicked into the long grass and continue for a long time. If we are to achieve the 2030 outcomes for all the people for whom we want to achieve them, we need to accelerate. I believe the proposals put forward here are practical and implementable, as the noble Lord, Lord Young, spelled out.

In our discussions with Ministers, we offered a number of concessions, including the idea that it did not have to be precisely this scheme that was implemented, as they could consult on others. I am sorry the Government have been unable to accept that. On the basis of everything that has been said today, I would like to test the opinion of the House.

16:39

Division 1

Ayes: 213

Noes: 154

16:58

Amendments 159 to 161

Moved by

[Lord Crisp]

159: After Clause 164, insert the following new Clause—
“Tobacco products statutory scheme: supplementary
(1) The Secretary of State may make any provision he or she considers necessary or expedient for the purpose of enabling or facilitating—(a) the introduction of a statutory scheme of the type mentioned in section (Tobacco products statutory scheme: consultation), or(b) the determination of the provision to be made in a proposed statutory scheme.(2) The provision may, in particular, require any person to whom such a scheme may apply to—(a) record and keep information;(b) provide information to the Secretary of State in electronic form.(3) The Secretary of State must—(a) store electronically the information which is submitted in accordance with this provision;(b) ensure that information submitted in accordance with this provision is made publicly available on a website, taking the need to protect trade secrets duly into account.(4) Where the Secretary of State is preparing to make or vary a statutory scheme, he or she may make any provision he or she considers necessary or expedient for transitional or transitory purposes which could be made by such a scheme.”

160: After Clause 164, insert the following new Clause—
“Tobacco products statutory scheme: enforcement
(1) The provisions of this section apply if, following consultation under section (Tobacco products statutory scheme: consultation), legislation is enacted which enables the making of a statutory scheme.(2) Regulations may provide for a person who contravenes any provision of the scheme, including any regulations or directions made under the scheme, to be liable to pay a penalty to the Secretary of State.(3) The penalty may be—(a) a single penalty not exceeding £5 million;(b) a daily penalty not exceeding £500,000 for every day on which the contravention occurs or continues.(4) Regulations may provide for any amount required to be paid to the Secretary of State by virtue of any provision in the scheme reflecting section (Tobacco products statutory scheme: consultation) (4) or (6)(b) to be increased by an amount not exceeding 50 per cent.(5) Regulations may provide for any amount payable to the Secretary of State by virtue of any provision in the scheme reflecting section (Tobacco products statutory scheme: consultation) (3), (4), (5) or (6)(b) (including such an amount as increased under subsection (4) of this section) to carry interest at a rate specified or referred to in the regulations.(6) Provision may be made by regulations for conferring on manufacturers and importers a right of appeal against enforcement decisions taken in respect of them in pursuance of the scheme, section (Tobacco products statutory scheme: consultation), (Tobacco products statutory scheme: supplementary), and this section.(7) The provision which may be made by virtue of subsection (6) includes any provision which may be made by model provisions with respect to appeals under section 6 of the Deregulation and Contracting Out Act 1994, reading—(a) the references in subsections (4) and (5) of that section to enforcement action as references to action taken to implement an enforcement decision, and(b) in subsection (5) of that section, the references to interested persons as references to any persons and the reference to any decision to take enforcement action as a reference to any enforcement decision.(8) In subsections (6) and (7), “enforcement decision” means a decision of the Secretary of State or any other person to—(a) require a specific manufacturer or importer to provide information to him or her,(b) limit, in respect of any specific manufacturer or importer, any price or profit,(c) refuse to give his or her approval to a price increase made by a specific manufacturer or importer, or(d) require a specific manufacturer or importer to pay any amount (including an amount by way of penalty) to him or her,and in this subsection “specific” means specified in the decision.(9) A requirement or prohibition, or a limit, under section (Tobacco products statutory scheme: consultation), may only be enforced under this section and may not be relied on in any proceedings other than proceedings under this section.(10) Subsection (9) does not apply to any action by the Secretary of State to recover as a debt any amount required to be paid to the Secretary of State under section (Tobacco products statutory scheme: consultation) or this section.(11) The Secretary of State may by order increase (or further increase) either of the sums mentioned in subsection (3).”

161: After Clause 164, insert the following new Clause—
“Tobacco products statutory scheme: controls: supplementary
(1) The provisions of this section apply if, following consultation under section (Tobacco products statutory scheme: consultation), legislation is enacted which enables the making of a statutory scheme.(2) Any power conferred on the Secretary of State by legislation enacted which enables the making of a statutory scheme, and by section (Tobacco products statutory scheme: supplementary) may be exercised by—(a) making regulations, or(b) giving directions to a specific manufacturer or importer.(3) Regulations under subsection (2)(a) may confer power for the Secretary of State to give directions to a specific manufacturer or importer; and in this subsection “specific” means specified in the direction concerned.(4) In this section and sections (Tobacco products statutory scheme: consultation), (Tobacco products statutory scheme: supplementary) and (Tobacco products statutory scheme: enforcement)—“tobacco product” means a product that can be consumed and consists, even partly, of tobacco;“manufacturer” means any person who manufactures tobacco products;“importer” means any person who imports tobacco products into the United Kingdom with a view to the product being supplied for consumption in the United Kingdom or through the travel retail sector, and contravention of a provision includes a failure to comply with it.”

Amendments 159 to 161 agreed.

17:00

Amendment 162

Moved by

[Lord Hunt of Kings Heath]

162: After Clause 164, insert the following new Clause—
“Appropriate consent to transplantation activities when travelling abroad
(1) Section 32 of the Human Tissue Act 2004 (prohibition of commercial dealings in human material for transplantation) is amended in accordance with subsections (2) to (6).(2) In subsection (1), after paragraph (e) insert—“(f) travels outside the United Kingdom to a country or part of a country where explicit consent is not required for the legal donation of controlled material which does not meet the criteria in subsection (1A)(a) to (c) and receives any controlled material, for the purpose of transplantation, without—(i) the free, informed and specific consent of a living donor, or(ii) the free, informed and specific consent of the donor’s next of kin, where the donor is unable to provide consent;(g) travels outside the United Kingdom to a country or part of a country where explicit consent is required for the legal donation of controlled material and receives any controlled material for the purpose of transplantation where the material was obtained without—(i) the free, informed and specific consent of a living donor, or(ii) the free, informed and specific consent of the donor’s next of kin, where the donor is unable to provide consent;(h) travels outside the United Kingdom to a country or part of a country and receives any controlled material for the purpose of transplantation for which, in exchange for the removal of controlled material—(i) the living donor, or a third party, receives a financial gain or comparable advantage, or(ii) where the controlled material comes from a deceased donor, a third party receives financial gain or comparable advantage.”(3) After subsection (1) insert—“(1A) The Secretary of State must publish an annual assessment of countries where, explicit consent is not required for the legal donation of controlled material, determining whether each of those countries—(a) provides a formal, publicly funded scheme for opting out of deemed consent for donation of controlled material,(b) provides an effective programme of public education to its population on the deemed consent system and the opt-out scheme which delivers a high level of public understanding of both, and(c) is not considered to be committing Genocide by resolution of the House of Commons.(1B) In paragraph (h) in subsection (1), the expression “financial gain or comparable advantage” does not include compensation for loss of earnings and any other justifiable expenses caused by the removal or by the related medical examinations, or compensation in case of damage which is not inherent to the removal of controlled material.(1C) Subsection (1E) applies if—(a) an act which forms part of an offence under subsection (1) takes place outside the United Kingdom, but(b) the person committing the act has a close connection with the United Kingdom.(1D) For the purposes of subsection (1C)(b), a person has a close connection with the United Kingdom if, and only if, the person was one of the following at the time the acts or omissions concerned were done or made—(a) a British citizen;(b) a British overseas territories citizen;(c) a British National (Overseas);(d) a British Overseas citizen;(e) a person who under the British Nationality Act 1981 was a British subject;(f) a British protected person within the meaning of that Act;(g) an individual ordinarily resident in the United Kingdom;(h) a body incorporated under the law of any part of the United Kingdom;(i) a Scottish partnership.(1E) Where this subsection applies, proceedings for the offence may be taken in any criminal court in England and Wales or Northern Ireland.”(4) In subsection (3), after “subsection (1)” insert “(a) to (e)”.(5) In subsection (4), after “subsection (1)” insert “(a) to (e)”.(6) After subsection (4) insert—“(4A) A person guilty of an offence under subsection (1)(f) to (h) shall be liable—(a) on summary conviction—(i) to imprisonment for a term not exceeding 12 months,(ii) to a fine not exceeding the statutory maximum, or(iii) to both;(b) on conviction on indictment—(i) to imprisonment for a term not exceeding 9 years,(ii) to a fine, or(iii) to both.”(7) In section 34 of the Human Tissue Act 2004 (information about transplant operations), after subsection (2) insert—“(2A) Regulations under subsection (1) must require specified persons to—(a) keep patient identifiable records for all instances of UK citizens who have received transplant procedures performed outside the United Kingdom; and(b) report instances of transplant procedures performed on UK citizens outside the United Kingdom to NHS Blood and Transplant.(2B) Regulations under subsection (1) must require NHS Blood and Transplant to produce an annual report on instances of UK citizens receiving transplant procedures outside the United Kingdom.””Member’s explanatory statement
The amendment is aimed at ensuring that in relation to organ tourism, there must be informed consent with no coercion or financial gain for the donation of organs. Thus prohibiting organ tourism which involves either forced organ harvesting or black market organ trafficking.

[Lord Hunt of Kings Heath (Lab)]

My Lords, this was debated two weeks ago, but I know that the noble Earl, Lord Howe, wishes to say a few brief words to your Lordships’ House. With the permission of the House, I will say very briefly, without seeking to open the debate, what the amendment does. It is to amend the Human Tissue Act to prohibit UK citizens from travelling to countries such as China, although the wording in the amendment is not country-specific, for the purpose of organ transplantation. The restrictions are based on ensuring that there is appropriate consent, no coercion and no financial gain.

Forced organ harvesting in China is the crime of forcibly extracting organs from prisoners of conscience, killing the victim in the process. The harvested organs are sold to Chinese officials, Chinese nationals or foreigners for transplantation. This is a very modest amendment, doing our bit to try to prevent this obnoxious habit. I beg to move.

[Earl Howe (Con)]

My Lords, I am very grateful to the noble Lord, Lord Hunt, for allowing me to say in a few sentences why the Government advise noble Lords not to support the amendment.

Reason number one is the effect on patients. In my submission, very sick patients who may be taken overseas for a transplant but are not fully made aware of how their organ was sourced should not have to face prosecution when they return to the UK. The existing legislation rightly targets those who buy and sell organs, not recipients who may have been quite unaware of any commercial dealing taking place. If we target the organ recipient, we will find that those who legitimately receive organs overseas—incidentally, individuals who are more likely to come from ethnic-minority backgrounds—will be deterred from seeking follow-up treatment for fear of being treated like a criminal suspect.

Reason number two is that the mischief the amendment seeks to address is dwarfed by the considerable burdens it would impose on the NHS. All the information indicates that we are dealing, at worst, with tiny numbers of illegal transplants performed overseas. The amendment would require officials, whose focus should be on promoting legitimate donation, to research and write a report every year on the status of every other deemed consent system in the world and on the public understanding of each scheme. That is not a drafting criticism but a necessary consequence of what the noble Lord seeks to achieve. In my view, it is an unreasonable ask and a hugely disproportionate use of resources.

To address the issue at first base, we will take forward the excellent suggestion from the noble Baroness, Lady Finlay, to work with NHS Blood and Transplant. My noble friend Lord Kamall has already instructed officials to engage with it on how we can help clinicians make their patients aware of the health risks, the risk that they may be exploiting others and the risk of breaking the law if they travel abroad in search of an illegitimate transplant. I truly think that is a better way forward, and I invite the noble Lord to change his mind about pressing his amendment.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I will not detain the House. It is time for the House to make a decision. I am very grateful to the Minister for picking up the point made by the noble Baroness, Lady Finlay, in relation to NHS Blood and Transplant. In the end, it may be a small gesture but it is an important gesture—a mark against this obnoxious habit. I would like to test the opinion of the House.

17:03

Division 2

Ayes: 203

Noes: 159

17:23

Amendment 163

Moved by

[Baroness Finlay of Llandaff]

163: After Clause 164, insert the following new Clause—
“Alcohol labelling
(1) The Secretary of State must, no later than one year after this Act is passed—(a) publish a report on alcohol labelling, assessing which elements should be mandatory on labels to improve consumer knowledge, and this should include, but not be limited to—(i) warning about alcohol harms,(ii) calorific and other nutritional information,(b) lay the report before Parliament, and a Minister of the Crown must arrange to make a statement to each House of Parliament setting out any steps which will be taken to implement the findings of the report.”Member’s explanatory statement
This amendment requires the Secretary of State to publish a report on alcohol labelling to improve consumer knowledge.

[Baroness Finlay of Llandaff (CB)]

My Lords, we now come to an amendment on alcohol, and I declare that I chair the Commission on Alcohol Harm. This amendment is designed to get the Government to produce a report on labelling, which is long overdue. Some people in this Chamber have been asking for it for 20 years or so, and nobody can quite understand the delay.

My amendment looks at the feasibility of putting information on labels about the harms and calorie content, and it runs completely in line with the Government’s strategy on trying to do something about obesity across the nation. I know that some people in the alcohol industry have suggested that they would like to put a QR code on, but it seems almost impossible to imagine people going with their mobile phones along a supermarket shelf looking at all these QR codes. If they can put some printing on the QR code, they could put on some printing with proper health information, harms information and calorie information in a way that one can read it in a reasonably sized font.

Alcohol is the leading cause of death and ill-health among 15 to 49 year-olds. It is linked to more than 200 health conditions. Alcohol is highly calorific: two glasses of wine can contain almost the entire daily recommended sugar limit. If you have two glasses of some wines, you will have a calorific intake that is the same as that of a big burger. This is not small numbers of calories.

Currently, the only legal requirements on alcohol labels are alcohol by volume, the volume itself and the common allergens that may be present. This does not match up with other food and drink. Alcohol labels do not list ingredients, calories or other information such as health impacts. There is more information on a bottle of orange juice or a carton of milk than there is on a bottle of wine.

The Government have committed money for the drugs strategy. That is most welcome, but I hope it will not all get diverted into drugs of addiction and that it will actually be used to support alcohol treatment services. We know that, in the last few years, only about one in five dependent drinkers have been able to access treatment services for their alcohol addiction.

The problem for consumers when they start out is that they do not know what they are consuming. They do not realise how calorie-laden the drinks are, and they cannot make informed choices about their health. Nor can they make informed choices about the dangers they pose to others, which includes other people with whom they interact when they are intoxicated as well as the dangers in driving.

Voluntary labelling has failed. We have seen again and again that consumers will not get the information they need on alcohol labels unless it is required in legislation. Seven in 10 people think that the warning should be displayed on alcohol labels as a legal requirement. Even the symbol not to drink in pregnancy is so tiny that it is not getting the message across, and foetal alcohol syndrome featured on the “Today” programme just this morning.

I remind the House that we took forward the Domestic Abuse Act, and one in five people are harmed by other people’s drinking.

As for driving, the road death figures show that problem drinkers are responsible for many of the 2,000 seriously injured or killed each year in alcohol-related crashes. The long-awaited consultation on labelling must also look at lowering the blood alcohol limit to 50 milligrams per 100 millilitres of blood, with its potential to reduce fatal alcohol-related crashes by 11%. There is good evidence that those with blood levels between 50 and 80 milligrams per 100 millilitres are six times more likely to be involved in a fatal accident than people who are alcohol free.

The Government’s intention to consult on including more information on alcohol labels is welcome if it is realised, but we have been waiting almost two years for the announced consultation to be launched. During this time, alcohol harm has increased, and deaths from alcohol reached record highs in 2020. Can the Minister tell us when the consultation’s report will be formulated and when it will appear? We cannot leave this unattended to, with consumers not knowing what they are taking whenever they take a drink. I beg to move.

[Lord Shipley (LD)]

My Lords, in moving this amendment, the noble Baroness, Lady Finlay of Llandaff, has emphasised its importance to improving personal and public health. The amendment requires the Secretary of State to publish a report on alcohol labelling, with the aim of improving consumer knowledge about the contents and potential harms of alcohol products. Surely it is in the interests of consumers for labelling on alcoholic products to meet the standards we have come to expect from food labelling.

The context really matters. As the noble Baroness, Lady Finlay, said, alcohol is the leading risk factor contributing to ill health and death for 15 to 49 year-olds, and it is the fifth leading factor across all age groups. Drinking a bottle of wine is, for example, the equivalent of smoking 10 cigarettes, yet a packet of cigarettes must carry a health warning. Surely consumers should be entitled to know how many units of alcohol, how many calories and how much sugar is in a bottle or can. It is very clear that the alcohol industry’s self-regulation has failed, as the noble Baroness, Lady Finlay, said. Commitments were made a decade ago that labelling would improve in line with Department of Health recommendations, yet that has not happened.

17:30

I have concluded that the time has come to regulate properly. Food is labelled, showing calories, fat, carbohydrates, sugar, fibre, protein and salt. Much less is shown on alcohol. Wine can show little more than sulphites. Beer can show little more than calories and strength. However, the consequences of high alcohol consumption are there for us all to see. It surely is time for the Government to act. I signed this amendment because it is a very straightforward proposal which all parts of the House should be supporting. I hope very much that the Minister will accept it this afternoon.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I support what has already been said and the amendment in the name of the noble Baroness, Lady Finlay. I also declare an interest in that I was a member of the commission she so ably chaired.

I have been on this, along with others, for a decade. Back in 2011 we had The Government’s Alcohol Strategy, which was very good but regrettably fell by the wayside. I was heartened back in 2019 when the Government, while they are prepared to give details about sugar and calorific effects on almost anything we eat or drink apart from alcohol, were given cause to think about consulting on extending it to alcohol too.

We had a short debate last autumn with the noble Lord, Lord Bethell, who was then the Minister responsible, on calorie and labelling regulations. I was persuaded not to divide the House on the basis of promises given of change coming. The Minister said:

“I give the noble Lord, Lord Brooke, the noble Baroness, Lady Finlay, and all those who have expressed concern about the issue this commitment: the Government will be consulting shortly on whether calorie information should be mandated on prepacked alcohol and alcohol served in pubs and restaurants. Covid-19 makes it more important than ever to support the nation to achieve a healthier weight, and the Government are taking action to help people to lead healthier lives.”—[Official Report, 22/7/21; col. 456.]


It is now 2022 and we still have not got the consultation, so the noble Baroness, Lady Finlay, has posed a fairly simple question.

I think in their heart of hearts the Government know they have to do something on this; it is quite ludicrous that alcohol is out of step with almost all other drinks and food. It is time we brought it into line. Can the Minister please tell us when we are going move on this issue? When are we going to have some definite dates and when will the consultation be concluded?

[Lord Bethell (Con)]

My Lords, I too support the amendment in the name of the noble Baroness, Lady Finlay. I declare my interest as my wife is a director of Diageo. There is no doubt that mandatory calorie labelling of alcohol is one of the most basic steps we need to take to make this country healthier. We have a moral obligation to give people the information they need to make an informed choice. We must take reasonable steps to prevent illness so that we can keep our spiralling health costs down. We must address the health inequalities the Minister has spoken about so thoughtfully on previous occasions. We should do all we can to nudge drinks companies to bring down the calorie levels of some drinks.

As the noble Lord, Lord Brooke, said, these measures have been promised for years. They were made in Tackling obesity: empowering adults and children to live healthier lives, published in July 2020. In October 2020, the then Minister responded to a Written Question, saying:

“we are committed to consult before the end of the year on our intention to make companies provide calorie labelling on all pre-packaged alcohol they sell. The consultation will also cover introducing calorie labelling on alcoholic drinks sold in the out of home sector, for example bought on draught or by the glass.”

The then Minister wrote on June 21 2021:

“We are committed to consult shortly on our intention to make companies provide calorie labelling on all pre-packaged alcohol they sell. The consultation will include further details about the proposed timescale for implementation of the policy.”


In the debate on calorie labelling regulation on 22 July 2021, when alcohol labelling was left off at the last minute by the then Minster, he said—well, the noble Lord, Lord Brooke, said what the Minister said and I will not repeat it, but it was pretty emphatic.

As the Minister who said and wrote all those words, I ask the current Minister to make the very specific time commitment the amendment seeks.

[Lord Vinson (Con)]

My Lords, there is a sheer impracticality to this suggestion. Whatever the need to get people to drink less, there is the actual practicality of getting millions of bottles of wine shipped from all over the world pre-packaged with this label stuck on them, quite apart from the number of drinks, as has been mentioned, served in carafes or over the counter freely. This is not the way to tackle the problem. It goes to the heart of people’s freedom of choice. They may be overdoing it, but labelling like this is expensive, impractical and it does not work.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I feel I have to respond immediately to that. I intended to speak anyway, having attached my name to an amendment on alcohol advertising in Committee. I would have attached my name to this amendment both in Committee and on Report, had there been space.

The noble Lord, Lord Vinson, talked about freedom of choice. I do not know how many people know that a bottle of wine can contain anywhere between zero and 59 grams of free sugar per bottle. Surely the public do not have the freedom of choice to decide which wine they consume and which level of sugar they consume.

The noble Lord made a point about the difficulty of labelling. Bottles of wine are shipped to many different countries with labels in different languages. We have computers these days which can cope with these things quite simply and easily. It is clearly not beyond the wit of producers to achieve this.

The Government often like to talk about being world-leading. I point them to an editorial in the Lancet Gastroenterology & Hepatology titled Shining a light on international alcohol industry lobbying, showing just how powerful this incredibly wealthy industry is in influencing and damaging public health messages around the world. Would the Government not like to be world-leading in standing up against this industry lobbying, in the interests of public health?

[Baroness Walmsley (LD)]

My Lords, at the risk of being boring, I am one of those people who has been asking for this for the last 20 years. I started off asking for the number of units of alcohol in a bottle of wine. Every manufacturer of these alcoholic drinks knows exactly what goes into them. On the issue of labelling products from abroad, there are a lot of foodstuffs that come from abroad and they have to abide by British rules on labelling, so why not wine and spirits? It is time we did this. It is terribly important for public health, and I hope the Minister will say yes.

[Baroness Merron (Lab)]

My Lords, I thank the noble Baroness, Lady Finlay, for bringing forward Amendment 163, and thank other noble Lords for outlining their support for or concerns about it. The amendment refers to publishing a report on alcohol labelling to improve consumer knowledge.

Government data comparing pre-pandemic and post-pandemic figures has shown that sales of alcohol increased by some 25%. This is, as we know, a booming market and consumers need to be equipped with the right information to make informed choices. They have a right to know what is in their drinks and decide what and how much to drink. The consultation promised by the Government, with this in mind, remains something of a consultation in long-overdue waiting.

Currently there is no requirement for alcoholic drinks to include health warnings, drinking guidelines, calorie information or even ingredients. As my noble friend Lord Brooke said, this is very much out of step with any other information on what we consume. There is, as always, a balance to be struck between health improvement measures, consumer information and industry regulation, but this amendment supports a necessary move in the right direction and I hope the Minister will agree to it.

[Lord Winston (Lab)]

My Lords, as a doctor and a wine drinker, I have serious concerns about this amendment, particularly, for example, when it comes to the use of fine wine—I think there is broad understanding in the House of what that is—where, in every case, those bottles are labelled with the amount of alcohol. One has to accept that labelling bottles in this way does not change behaviour. We have had committees looking at behaviour change, and the only time we managed to induce behaviour change was with smoking—certainly never with labelling. That is the only time it happened and there were all sorts of reasons for that.

Much of the evidence for alcohol being harmful in minor doses is still dubious and, more importantly, there is real concern that a lot of the so-called evidence is not being put to the real test of whether it makes a difference to behaviour. I must say to the House that I think the noble Lord—I am afraid I do not know his name; my eyes are bad enough not to have been able to see his name on the screen—is right that this is unworkable. It would probably do all sorts of untold damage to what is, for me and no doubt many others, a very fine drink. We need to look seriously at whether we can simply label all bottles.

I just remind the House that there is one amendment that I could have put down. In in vitro fertilisation, embryos are cultured in culture media, which are in fact commercially made and a commercial secret—nobody knows exactly what the composition of those media is. My laboratory is looking at this at the moment. It is really interesting, because some of the products in those culture media may indeed be quite dangerous in terms of epigenetic effects. To me, that seems far more important to regulate than what we are trying to do here with bottles of wine, which is probably not really workable.

[Earl Howe (Con)]

My Lords, this is an important topic, so let me start with an immediate reassurance to the House, which I hope will enable to the noble Baroness to consider withdrawing the amendment. The amendment calls on the Government to publish a report on alcohol labelling. The Government already plan to report on alcohol labelling, as it is a key part of our overall work on reducing alcohol harm. In no sense do we propose to ignore it and I undertake today that we will report on it. Part of what is taking the time is formulating what the proposals should look like, but I will come on to that.

As part of the Government’s tackling obesity strategy, published in July 2020, we are committed to consulting on whether mandatory calorie labelling should be introduced on all pre-packed alcohol as well as alcoholic drinks sold in the out-of-home sector. In addition, as part of our public consultation, respondents to the consultation will be able to provide suggestions and evidence for additional labelling requirements that they would like the Government to consider, including warning labels and nutritional information. In that sense, the consultation will be even more of a two-way process than perhaps noble Lords might have been expecting. Naturally enough, we make no assumptions in advance about any such proposals; they will have to be looked at on their merits. The consultation will be launched in due course and I can assure noble Lords that the Government will feed back the results to this House. Although, for reasons beyond my control, I have not been able to provide definitive news on the timing of the consultation—much as I would like to—I hope nevertheless that the firm commitment that I have given on the Government’s intention to carry out the consultation and on its scope will have provided the noble Baroness with sufficient reassurance to enable her to question whether she wishes to press her amendment.

17:45

[Baroness Finlay of Llandaff (CB)]

My Lords, I am very grateful to everyone who has spoken and I note the tone with which “in due course” was uttered, which is really disappointing. Some very important points have been made, particularly about people really having the choice to know what they are taking into their bodies in the name of alcoholic drinks. May I assure the noble Lord, Lord Winston, that I really do not believe that fine wines will be sacrificed on the altar of public health? Very few people drink fine wines; most people drink drinks bottled and labelled in this country—the obesogenic effect is really important.

However, I am a realist and I am aware that the chance of this being thrown out when it goes to the other place means that it would not remain in the Bill. I hope the Government will take the message back to the Secretary of State to empower him to grasp the nettle, provide leadership in public health and, for the first time, proceed to make sure that people know what they are drinking and what the harms are—they might prefer to go out with their family and eat a large burger than have two glasses of wine. Given that, and the reality of the situation we are in, we will hold the Government’s feet to the fire over what “in due course” means; I hope it is a very short course. On that, I beg leave to withdraw the amendment.

Amendment 163 withdrawn.

Amendment 164

Moved by

[Lord Hunt of Kings Heath]

164: After Clause 164, insert the following new Clause—
“Vaccine damage payments
Within 6 months of the passing of this Act, the Secretary of State must establish an independent judge led review into the operation of the Vaccine Damage Payments Act 1979 and the adequacy of payments offered to persons seriously injured, or bereaved, consequent upon vaccination against any of the specified diseases to which the Act applies.”Member’s explanatory statement
The Vaccine Damage Payment Act is now more than 40 years old and the aim of the amendment is to ensure that a judge led review takes place into the operation of the Act.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am speaking to my Amendment 164 but I also strongly associate myself with Amendment 180 in the name of the noble Baroness, Lady Cumberlege.

In Committee, I raised concerns about a small number of individuals and families who have paid the highest personal price for the success of the Covid vaccination programme, suffering bereavement or serious injury as a direct consequence of adverse reactions to vaccination. We have the Vaccine Damage Payments Act 1979, which was intended to provide a safety net for such individuals by providing a modest ex-gratia payment to those injured or bereaved in recognition of the fact that their injuries and losses flowed directly from “doing the right thing” by having the vaccine for the benefit of society as a whole.

The scheme is 40 years old and no longer fit for purpose. The maximum payment is capped at £120,000, which is far too little to provide proper financial support for families who have maybe suffered the death of a main income earner. The current scheme also requires that all eligible applicants in the UK must meet what is called the 60% disablement criterion. This criterion is antiquated, counterproductive and unfair: many applicants could have significant injuries and may be disabled up to 59% and yet, on the basis of the current scheme, they would have no access to funds.

The current system takes far too long to provide the payment. The causal connection between certain injuries and Covid vaccination is now accepted, I believe, by clinicians and regulators. However, despite providing death certificates that identify Covid-19 as a cause of death and medical reports confirming Covid-19 as the cause of injury, the scheme still estimates that it will take more than six months to begin to process claims submitted under the scheme more than 12 months ago.

In Committee—I thank Ministers for another meeting yesterday to discuss this further—the noble Earl explained that responsibility for the operation of the scheme has transferred from the DWP to his department and the NHS Business Services Authority has taken over the operation of the scheme. This is very welcome and I am glad that it has happened. However, this is not an issue that will disappear any time soon—Covid is not an issue that is disappearing. Further vaccinations will come along and there will unfortunately be adverse effects for a very small group of people, in the interest of the greater good.

I believe that the scheme offers too little, too late, to too few and I have three asks of Ministers. First, I ask that Ministers and the NHS Business Services Authority engage with the families affected. It would be valuable if Ministers and senior executives at the NHS Business Services Authority were to meet some of the families. I know that Sarah Moore of Hausfeld will be happy to facilitate this, and I pay tribute to her. Secondly, I ask that everything that can be done is done to speed up the process of meeting claims. Thirdly, on behalf of the families and individuals, I ask the Government to consider undertaking a review of the scheme in the light of current experience and particularly look at the 60% criteria bar and the £120,000 limit which has not been updated for a number of years.

The vaccination programme has been a wonderful success both in this country and globally. It is very unfortunate that inevitably there will be a small group of people damaged in the process. I think we owe it to them to have a generous scheme. I beg to move.

[Baroness Cumberlege (Con)]

My Lords, my amendment is grouped with the amendment in the name of the noble Lord, Lord Hunt, whose persistence I admire concerning those who have suffered vaccine damage. My amendment is slightly different, but it is along the same lines in that it is about unintentional outcomes and redress for those who have suffered.

My amendment requires the Secretary of State to bring forward proposals for redress schemes to help those who have suffered avoidable harm linked to the three medical interventions that were examined in the report from the Independent Medicines and Medical Devices Safety Review, which I chaired. These are hormone pregnancy tests—the most common being Primodos—the epilepsy drug sodium valproate and pelvic mesh, which was used to treat stress urinary incontinence and pelvic organ prolapse.

I will be brief, but I make no apology for bringing this before your Lordships’ House again because the case for these schemes is so compelling. These are people who, through no fault of their own, have suffered terribly and had their lives changed for the worse and in some cases completely ruined—all because of mistakes, errors of judgment, oversights and a refusal to listen across the healthcare system. In each case—Primodos, valproate and mesh—harm could and should have been avoided. If that does not underline the moral and ethical case for providing some help, then I really do not know what does.

I believe that my noble friend the Minister and his colleagues are genuinely sympathetic to the plight of these women and their children, but I sense that they are hesitant. I urge them to overcome some of this reluctance and act now. The suffering is immense, it is continuing even today, and very sadly people are dying before they receive the help they need. I remind my noble friend that these redress schemes are not the same as compensation. We are not talking about large sums of money. We are talking only about modest funds to help with the challenges of daily life: to pay for mobility aids, a respite break, travel to hospital. This is help that they do not and cannot access at the moment from the NHS, social services or elsewhere.

In Scotland, the Government there have acted. A scheme was set up to provide help to women suffering from mesh complications. It is modest: it was given a £1 million budget and women had to apply to it to be eligible. But it was welcomed, and it has helped. That is the kind of help I have in mind. Sums of that scale are barely noticeable in the context of the hundreds of billions we spend on health and social care, yet these small sums would mean so much to so many.

Are there concerns that this might set a precedent and that before we know it dozens of other groups of people who have suffered will all want the same? I do not believe so. That has not happened in Scotland. Thalidomide did not lead to an avalanche of other groups requiring help. We have existing schemes to help others who have been harmed. If the Government really believe that compensation is the better way for these people to get help, they are mistaken. The fact is that many have tried to obtain compensation through the courts. It is time-consuming, costly, stressful, adversarial and, worst of all, it simply has not worked.

The three groups that Amendment 180 is designed to help are small in number—not millions of people, not hundreds of thousands. I do not believe that an unwelcome precedent would be set. I do not believe that these schemes would cost the earth. The cost would be modest and can be contained and managed. I believe the benefits will outweigh the cost and that we have a moral and ethical duty to help these people. They have suffered for years and in some cases for decades. Surely the measure of a decent society is how well it looks after those who have suffered harm, especially where that harm could and should have been avoided.

I have met hundreds of people who have suffered; even today I get a lot of emails, phone calls and letters. We have heard from many more people. I am clear that help is both needed and deserved. People should not be made to wait any longer. I hope that my noble friend the Minister will agree.

[The Deputy Speaker (Lord Geddes) (Con)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite the noble Baroness to speak.

[Baroness Brinton (LD) [V]]

My Lords, I speak from these Benches to support both amendments in this group. The noble Lord, Lord Hunt, introduced his Amendment 164 on vaccine damage payments, explaining that the current law as set out in the Vaccine Damage Payments Act 1979 is now over 40 years old. The amendment asks for a judge-led review on what parts of the Act need to be updated, especially the maximum payable as a result of vaccine damage.

The amendment proposes a small and focused review that will assist those who have been damaged by vaccines and will help the NHS, Government and Parliament ensure that the legislation is fit for purpose in the 21st century, especially for the families of those damaged by the Covid vaccine and of the very few who died. They may be an infinitesimally small percentage of those who have been vaccinated but their lives have been turned upside down because of doing the right thing.

Amendment 180 in the name of the noble Baroness, Lady Cumberlege, is an important pillar of delivering the recommendations from her First Do No Harm review, which outlined routes to assist those who had been harmed by an avoidable harm as a result of using certain HPTs, sodium valproate or pelvic mesh. The victims of this avoidable harm are not to blame for it either, but are living out the consequences, including needing additional care for the rest of their lives. I know that the Government have been very supportive of the First Do No Harm review. I hope that they can be persuaded that now is the time to introduce schemes that will help these people. While I fear that there may not be movement on these two amendments today, I hope that the Minister can outline when there is likely to be progress on these two financially modest but essential areas that could right some long-term wrongs.

18:00

[Baroness Wheeler (Lab)]

My Lords, my noble friend has returned with his amendment on the need for an expert-led review on the 40 year-old Vaccine Damage Payments Act, and I am pleased that the meeting he sought with the Ministers has taken place. The amendment is a timely reminder for all of us that while the vaccination programme against Covid has been hugely successful, for a small group of people suffering very serious adverse effects and deteriorating health as a result of having the vaccination, the experience has been devastating, as the noble Baroness, Lady Brinton, underlined. The current legislation dealing with compensation arrangements is not fit for purpose: in the words of my noble friend, it offers too little, too late and to too few people. I hope the Minister acknowledges the need to meet and engage with the families of those affected, and that he looks urgently at the ways in which claims under the current system can be speeded up, and he also accepts the need for the review of the scheme and the next steps that have to be taken on this.

My noble friend has also added his name to Amendment 180 from the noble Baroness, Lady Cumberlege, on her unrelenting campaign for separate compensation schemes to meet the cost of care and support for the victims highlighted in her First Do No Harm report. Once again, we have heard convincing and forceful contributions from the noble Baronesses, Lady Cumberlege and Lady Brinton, which we on these Benches strongly support, calling for an independent redress agency for the three patient groups covered by the First Do No Harm report. The Government’s positive response to another key aspect of the First Do No Harm report, to improve patient safety for the future, including establishing the patient safety commissioner, is a welcome and necessary development. But the redress agency needs to be there to provide care and support for the thousands of women who suffered, and whose needs will not be met by the healthcare system, social care support or social security benefits support.

I hope the Minister has considered the matter carefully since Committee, and will report positively to the House on the ongoing discussions and progress which will ensure the strongest recompense possible for the people we are concerned about.

[Earl Howe (Con)]

My Lords, I will turn first, if I may, to the amendment in the name of the noble Lord, Lord Hunt of Kings Heath, on the Vaccine Damage Payment Scheme, and start by thanking him for his campaigning on this issue, and for the informative debates we have had today and in Committee.

As we discussed in Committee, since the NHS Business Services Authority took over responsibility for the Vaccine Damage Payment Scheme from the Department for Work and Pensions in November 2021, we have started to find ways to improve the operation of the scheme. The most important thing the NHS Business Services Authority is looking do to is to improve the claimant journey on the scheme, and that means making engagements with claimants more personalised, as well as giving claimants access to more general support. The crucial part of this drive is to reduce response times, which the authority knows has been a cause of dissatisfaction, particularly during Covid; in other words, the whole process is being modernised.

The NHS Business Services Authority has done its best to hit the ground running. Since taking over in November, it has already contacted all applicants to update them on their cases and it has also allocated additional resource to the operation of the scheme. I can assure the noble Lord that the department will further engage with the NHS Business Services Authority to ensure that these service improvements, greater digitisation in particular, really do make headway. There is already regular dialogue on this.

With all this enhanced activity happening, I do not think this is right time to establish an independent review into the VDPS. As the noble Lord will know, reviews take significant time and they carry substantial costs to the organisation, not just financial but in terms of leadership focus and energy. Instead, we think it is a better use of resources to focus on making the changes that we know need to happen; that is, to improve the claimant’s journey, and to modernise the process for claimants, as well as scaling up the capacity of the VDPS. We will keep the progress on these under regular scrutiny, and I am sure we will report regularly to this House as we do so.

I will address the noble Lord’s three key questions. First, I should be happy to facilitate a meeting with representatives of the families, and my honourable friend Maria Caulfield, who is the Minister with direct responsibility for the scheme, will be pleased to see them. Secondly, as I have already indicated, reducing response times is one of the NHS Business Services Authority’s key objectives. Thirdly, the noble Lord asked whether the Government would undertake a review of the scheme. I simply remind the noble Lord that the scheme has been revised many times since its inception, which shows that it is reviewed regularly as a matter of course, but perhaps it is worth my making the point that the VDPS is not a compensation scheme; nor is it designed to cover all expenses associated with severe disablement, which are catered for from the public purse in other ways. I hope that is helpful to the noble Lord, and that on the basis of those assurances he will feel able to withdraw his amendment.

Before I address the detail of Amendment 180, I would like to again put on record my thanks to my noble friend Lady Cumberlege for her continued commitment to the issues she has so powerfully spoken about, and the diligence and dedication of the IMMDS team, and the brave testimonies of those who contributed to the IMMDS review. As my noble friend knows, the Government have accepted the majority of the report’s nine strategic recommendations and 50 actions for improvement, and are taking forward work to improve patient safety. This includes establishing specialist mesh removal centres, the ninth of which opens in Bristol this month, and work to improve the care pathways for children and families affected by medicines during pregnancy.

We remain committed to delivering improvements in patient safety across the board. We are focusing government funds on initiatives that directly improve future safety. For this reason, the Government have already published their decision that redress schemes will not be established for people affected by hormone pregnancy tests, sodium valproate or pelvic mesh. I realise that was a disappointing decision for my noble friend, and I am always very sorry to disappoint her, but, for the reasons I have given, I ask her not to move Amendment 180 when it is reached.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very grateful to the noble Earl, Lord Howe, the noble Baroness, Lady Brinton, and my noble friend Lady Wheeler for their support. I empathise with the comments of the noble Baroness, Lady Cumberlege, and her report, which was far-reaching. Having met some of the women who were affected, I know how keenly the noble Baroness, Lady Cumberlege, feels about these issues. It is disappointing that the Government have rejected this particular request, although they have accepted many of her recommendations. It leaves the groups of women whom we have met to continue with their long, hard campaign, but they will continue, and one day a Government will agree to give them some of the support that they deserve.

On my own amendment, I pay tribute to the work of the NHS Business Services Authority. I am very glad that it took over responsibility for the scheme, and I wish it well in speeding up the process of claims. I am grateful to the noble Earl for facilitating a meeting between representatives of the families and the Minister—that is very welcome indeed. All I would say is that as the Business Services Authority continues its work, it is bound to come across issues in relation to the operation of the scheme, and I hope the Government will reflect on that and look at further improvements to the scheme. Having said that, I beg leave to withdraw my amendment.

Amendment 164 withdrawn.

Amendment 165

Moved by

[Lord Hunt of Kings Heath]

165: After Clause 164, insert the following new Clause—
“Secretary of State: Duty to promote and ensure the full integration of self care for minor ailments within the health system
(1) The Secretary of State, in exercise of his or her functions, must promote self care for minor ailments and prepare a national self care strategy to integrate self care fully into the wider health system.(2) The national self care strategy referred to in subsection (1) must include measures to—(a) improve inequalities in health literacy,(b) enhance the understanding of primary and secondary age children on how to self care,(c) introduce self care modules in healthcare professionals’ training curricula and continuing professional development,(d) make best use of, and expand, the Community Pharmacist Consultation Service,(e) improve access to effective self care treatments,(f) enable community pharmacists to refer people directly to other healthcare professionals,(g) ensure better support for Primary Care Networks (PCNs) to deliver self care,(h) evaluate the use of technologies developed during the COVID-19 pandemic to promote greater self care, and(i) accelerate efforts to enable community pharmacists to populate medical records.”Member’s explanatory statement
This amendment would ensure that the Secretary of State promotes self care for minor ailments and publishes a national self care strategy to fully integrate it into the wider health system.

[Lord Hunt of Kings Heath (Lab)]

My Lords, Amendment 165 requires the Secretary of State to

“promote self care for minor ailments and prepare a national self care strategy”.

I hope that Ministers will just agree to this, without very much debate.

Self-care is defined as

“the actions individuals take for themselves, on behalf of and with others, to develop, protect, maintain and improve their health.”

It is an important but often overlooked part of the primary care pathway.

Given all the pressures that there are on the health service and that there are going to be over the next 30 to 40 years, surely we should do everything we can to encourage self-help for minor ailments. During Covid, the importance of self-care in reducing the burden on GPs and A&E became very self-evident. Since the outbreak started, people with minor ailments were not able to visit their GP in the traditional manner and learned, or at least practised, self-help behaviours instead. A survey carried out by PAGB, the consumer healthcare association, during the first national lockdown indicated that the pandemic has had an impact on people’s attitudes to self-care. Some 69% of people who would not have considered practising self-care prior to the pandemic said that they were more likely to do so after their experience of lockdown.

Interestingly, if the Government were prepared to run with this strategy, there are all sorts of behaviours that they could start to encourage. They could ensure that individuals understand or are willing to practise self-care; ensure a cultural shift among healthcare professionals toward well-being, enabling people to self-care; ensure that the system is supported to encourage self-care where appropriate, with pharmacies, of course, playing a big role in that; encourage the use of digital technology; enhance the national curriculum on self-care for schoolchildren; and introduce self-care modules in healthcare professionals’ training curriculum.

I come back to the point that the Minister and noble Lords know that the health service is currently under huge pressure, not just because of the backlog. Already before the pandemic, the health service was really struggling to meet its targets. The demographics, the growing older population and all these factors suggest that the NHS will struggle hugely to cope with the pressure on it over the next 20, 30 and 40 years. Surely some part of the strategy to deal with this is to encourage all of us not just to look after our own health more but, where we can, to self-help. I would have thought that message would have been accepted with alacrity on the Government Front Bench. I hope the Minister will be able to say that this is very much taken to heart and that the Government really will start to drive the new strategy. I beg to move.

[Lord Clement-Jones (LD)]

My Lords, I rise briefly to support Amendment 165, in the name of the noble Lord, Lord Hunt, and thank him for putting it forward. Self-care has an important role to play in supporting people to manage their own health needs, and also in alleviating an unsustainable demand on GP and A&E services. As the noble Lord described, prior to the coronavirus pandemic there were some 18 million GP appointments and 3.7 million visits to A&E every year for conditions which people could have looked after themselves or sought advice from a pharmacist. It is estimated that this was costing the NHS in the region of £1.5 billion a year.

During the coronavirus, again as the noble Lord described, surveys have shown a much greater willingness among members of the public to self-care for these self-treatable conditions. But it is vital that appropriate policies are put in place to ensure that, as we emerge from the pandemic, people who can self-care continue to do so. It is evident now that self-care can help address many of the challenges we face in the NHS today, but to do so we need to address some of the system barriers to self-care, as described in this amendment, and unlock the important behavioural shifts that enabled people to self-care during the pandemic.

In particular, I will highlight how the NHS can make much better use of digital technologies and community pharmacists to enable people to self-care. We need to make better use of the technologies that the NHS has embraced over the course of the pandemic, such as the Covid-19 symptom checker on the NHS website. The digital triaging technology should be used to support the expansion of the community pharmacist consultation service to enable people to follow an algorithm online to get a referral for a consultation with a local pharmacist. It is critical, if we are to optimise the role of pharmacists—I am a big supporter of community pharmacists—that we give them the digital tools and information they need to support people. At present, a pharmacist cannot routinely record the advice or medication they give people, despite receiving training. The NHS must address the question of interoperability in IT systems, so that pharmacists can have access to read and to input into people’s medical records and enable pharmacists to be a core part of an individual’s primary healthcare team.

6.15 pm

The pandemic has highlighted how quickly the NHS and patients can adopt technological and digital changes. Realising the Potential: Developing a Blueprint for a Self Care Strategy for England, a document launched last October, is an excellent blueprint for this. A whole range of organisations, including NHS clinical commissioners, the RCN, pharmacy organisations, the Self Care Forum and, of course, the PAGB, have worked together to develop this blueprint for a comprehensive national self-care strategy to support the introduction of self-care policies throughout the NHS in England. It contains policy proposals and case studies, in particular in relation to digital technologies, which set out how the NHS can fully embed self-care and pharmacy into primary care.

I hope the Minister today will outline how the Government are ensuring that the NHS can adopt these proposals, which learn from the pandemic, and will expand them to support individuals to enable self-care.

[Baroness Wheeler (Lab)]

My Lords, we had a good debate in Committee on the issue of self-care and the management of health conditions, particularly on its importance as a key part of the primary care pathway. This was underlined in diabetes care and, as I also emphasised, in the care and treatment of people with rare diseases, most of whom are living with lifelong conditions. As vice-chair of the Specialised Healthcare Alliance of charities supporting this key group of patients, I know that they often do not feel sufficiently supported in terms of care and support and health and system information, and with physical and daily living.

As the two noble Lords have stressed, the Health Foundation’s research on the effective self-management by patients has shown a significant reduction in the need for emergency admissions to hospital and in A&E attendances, and fewer GP appointments. In this context, Amendment 165 makes a great deal of sense. If patients with, for example, rare diseases receive appropriate support to manage their less intensive care needs, then promoting self-care has the potential to help them prevent their conditions from deteriorating, to improve their lives and to reduce demands on the NHS, as the noble Lords have stressed.

We therefore strongly support the need for the development of a national self-care strategy, starting with awareness raising among primary and secondary children on how to self-care, and with appropriate staff and management training of healthcare professionals. Improved technologies, as underlined by the noble Lord, Lord Clement-Jones, especially those developed during the pandemic, will have a key role in broadening access to effective self-care and ensuring the better support from primary and community pharmacists that we all want to see. I hope the Minister will respond positively to this amendment.

[Baroness Penn (Con)]

My Lords, I thank the noble Lord, Lord Hunt, for bringing forward a debate on this issue. I reassure him and other noble Lords that the Government absolutely agree that supporting people to maintain their health and well-being and to manage self-treatable conditions is a vital part of delivering a comprehensive health service. Indeed, much of what the amendment seeks to achieve is already government policy. However, I do not agree that requiring the Secretary of State to prepare a single national strategy would add value. Instead, we are threading self-care through a wide range of work, reflecting the range of areas that it impacts upon.

A good deal of work is already under way. The community pharmacy contractual framework for 2019 to 2024 five-year deal sets out how community pharmacy will support the NHS long-term plan. Community pharmacies, which provide easy access to the NHS, are already required to support patient self-care, signpost to other parts of the NHS and local services as necessary, and help people to live healthily.

I am especially aware of the interest the Proprietary Association of Great Britain has shown in this area. The Department of Health and Social Care officials have met with it to discuss its blueprint for a self-care strategy in England and will continue to engage with it about further supporting self-care throughout our healthcare system.

We do not think placing an additional duty on the Secretary of State would be the right way to support this work, as it would take it out of the NHS long-term plan, where it belongs as part of a holistic approach to the provision of a health service. It could risk making it more disjointed rather than integrated in its approach, but noble Lords made a really important point about demand on our health service and the role that self-care has in this. Prevention was a key theme of a speech by my right honourable friend the Secretary of State last week and, clearly, elements of self-care and prevention go hand in hand with each other, particularly in the use of new technology.

Noble Lords also made an important point about how we can use self-care, particularly at community pharmacies, to reduce pressure on GPs and A&E departments. All community pharmacies are required, as I said, to provide support for self-care. To ensure that people get directed to the right support for their health needs, we have introduced referral systems from NHS 111 and GPs to pharmacies for advice and treatment for minor illnesses. We are also exploring expanding referrals from other settings, including urgent treatment centres and A&E to community pharmacies.

I hope that gives noble Lords some reassurance that we place an importance on self-care, as part of our health service. That will only increase in future and work is under way in multiple areas of the health service to do that. I hope, therefore, that the noble Lord is able to withdraw his amendment.

[Lord Hunt of Kings Heath (Lab)]

I am grateful to the noble Lord, Lord Clement-Jones, and my noble friend Lady Wheeler for their support, and to the Minister. I am glad to hear her recognition of the importance of community pharmacy, and about the meetings between officials and the PAGB. That is very welcome.

I agree that the interrelationship between self-care and prevention is important—as is, may I say, personal responsibility. I also agree that the pressure we face in the system is such that this is important for the future. The Government may not want a strategy but, at some point, setting out their aim in this area and giving the right signals to us as individuals, but also to the system, would be very helpful. I beg leave to withdraw my amendment.

Amendment 165 withdrawn.

Amendment 166

Moved by

[Lord Moylan]

166: After Clause 164, insert the following new Clause—
“Guidance on Pancreatic Enzyme Replacement Therapy
(1) The Secretary of State must, within six months of this Act being passed, publish national guidance making the appropriate prescription of Pancreatic Enzyme Replacement Therapy a priority within pancreatic cancer care in the NHS through the implementation of national targets.(2) The Secretary of State must, within a year of this Act being passed and every year thereafter, publish data on the prescription of Pancreatic Enzyme Replacement Therapy for pancreatic cancer patients.”

[Lord Moylan (Con)]

My Lords, pancreatic cancer is a terrible disease, as noble Lords know: 10,500 people in the UK a year are diagnosed with it, 9,000 people a year die from it and five-year survival rates in the UK rank us 29th out of 33 countries with comparable data. The Government recognise that this is not good enough, so they are commissioning an audit of existing services as a first step to improvement. That is wholly welcome but it is turning out to be a very slow business, with the first data expected in 2023 and no timetable for action to follow.

Amendment 167 in my name is intended to add a sense of urgency to that. I am grateful for the support it has received from the noble Lords, Lord Aberdare and Lord Patel, and the noble Baroness, Lady Hayman of Ullock. However, I turn my attention this evening principally to Amendment 166 in my name, which is also supported by the noble Baroness, Lady Finlay of Llandaff. It relates to improving the treatment of those diagnosed with pancreatic cancer and can be delivered immediately.

The end-of-life experience of pancreatic cancer sufferers includes huge difficulties in eating and digesting food, because of the lack of an enzyme normally produced by a healthy pancreas. Pancreatic enzyme replacement therapy, or PERT, is a simple tablet costing only £7 a day. It is fully approved by NICE and allows sufferers to eat, but it reaches only about 50% of pancreatic cancer sufferers. Why is that? The truth is that we do not know exactly and, pending the audit, may not be able to say exactly. But a likely reason is that diagnosis of pancreatic cancer occurs so late because the symptoms present so late that a prompt decision has to be made about those who might be saved by surgery and those for whom nothing can be done. The former go to specialists, who tend to be aware of PERT and prescribe it. The latter, on the whole, move into more general palliative settings, where it seems that knowledge and understanding of PERT is less widespread.

Amendment 166 obliges the Government to make increasing prescription rates for PERT a national priority, without waiting for the outcome of the current audit. It was tabled in Committee and got a somewhat dusty answer from the Government Front Bench, hence its return today. To say that emphasising PERT should await the outcome of the audit would be to condemn literally tens of thousands of people to unnecessary suffering at end of life so I think these amendments, especially Amendment 166, will find general support across the House. Happily, I understand that my noble friend the Minister will be able to offer certain assurances when he speaks that would make any such Division unnecessary.

Before I conclude, there is one extra step that the Government could make early progress on that would be welcome. It is in disaggregating the data about the prescription of PERT, which can be prescribed for conditions other than pancreatic cancer. While the Government and the National Health Service are able to point to figures showing slowly increasing PERT prescription rates, what they cannot do at the moment is to say whether it is being prescribed for pancreatic cancer or some other condition. Disaggregating that data will be an important job for the Government to do, even to make progress with their own audit. Some comments on that today would also be welcome so, for the moment, I beg to move.

[Lord Aberdare (CB)]

My Lords, I am pleased to speak in support of Amendments 166 and 167 in the name of the noble Lord, Lord Moylan, addressing pancreatic cancer, to which I have added my name. I shall be brief as he has already made the case for these amendments so strongly. Both amendments include deadlines: for guidance on pancreatic enzyme replacement therapy to be published within six months; for data on PERT prescription to be published within a year, and yearly thereafter; and for a report on the audit of pancreatic cancer services to be laid before Parliament within six months and updated six-monthly. The reason for these deadlines comes down to a single word: urgency.

On average, pancreatic cancer sufferers live for only six months following diagnosis and more than half of the 10,000 a year will die within three months. That is hardly enough time for them to say proper goodbyes to their family and close friends, let alone to put their financial and other affairs in order, so the usual government timescales of “in due course” or even “shortly” are nowhere near fast enough for action to improve their treatment. I hope we may hear something more encouraging from the Minister.

Some such improvements may help extend their lives, even if only by a matter of months, but others equally important, such as PERT, may make a significant difference to the quality of the time remaining to them, however short. PERT enables pancreatic sufferers to digest their food; in some cases, it may even help them to gain the strength needed to undergo life-saving surgery. It is recommended by NICE and widely available. It costs just £7 a day per patient. I find it shocking that, as the noble Lord told us, half of patients who need PERT are not being prescribed it, mainly because of lack of awareness among non-specialist staff. Surely the Government can and should investigate and address this with urgency, as required by Amendment 166.

18:30

Amendment 167 would impose a broader requirement on government to take action on the findings of the very welcome audit of pancreatic cancer services currently under way. Given the short survival times of pancreatic cancer patients and the need to ensure that the treatment they receive during that period is as effective as possible at minimising their suffering, it is not good enough to wait for final completion of the audit before taking any action. Progress on the audit should be regularly reported at six-monthly intervals, so that improvements in pancreatic cancer treatment and services can be implemented with the urgency owed to patients.

I strongly support these two amendments and hope the Minister is at least able to commit to urgent action to improve the experience of pancreatic cancer patients, preferably by accepting both the amendments but, if not, in some other way.

[Baroness Finlay of Llandaff (CB)]

My Lords, I was glad to have been able to put my name to Amendment 166 about PERT. In this Bill, the Government have introduced a milestone in changing the care of people who are facing serious illness at the end of life.

The reality, as we have already heard, is that the majority of patients with pancreatic cancer are diagnosed late, because it comes in the head of the pancreas. The pancreas has two parts—the head and the tail. But, because it can grow without causing much pain in the initial stages, it often goes undetected until it is fairly advanced. That means the outlook is poor. The other thing it does, as it grows, is block off the flow of enzymes into the gut. Without replacement, these patients get a malabsorption syndrome; they can get terrible diarrhoea and muscle wasting, because they are not absorbing the nutrients they need.

This amendment is very important. It could quite easily build on the network that will now be in place to commission specialist palliative care services. The move the Government have made has been welcomed across palliative care in this country and is being seen as a way to dramatically change the care of patients. With data information flows now integrated and networked across the NHS, we will be able to get accurate data on how many patients with pancreatic cancer are getting replacement therapy when they need it. Some people do not need it; some need it later on. This is part of building on the important foundation the Government have laid. It was that which persuaded me to put my name to Amendment 166.

Another point I would like to make is about improving things for the lowest quartile of the population. Incidence of pancreatic cancer is highest in the most deprived areas and it is higher in women than in men. Part of levelling up, to help people to live well for as long as they can, is making sure they get the enzyme replacement they need.

[Baroness Walmsley (LD)]

My Lords, I have in my hands the latest cancer waiting time figures. It is very unfortunate that, despite the hard work of NHS staff, every single metric was worse in January than in December. It therefore seems a great pity that not all patients who have a diagnosis of this dreadful disease of pancreatic cancer can get this medicine, which can improve and even extend their lives.

I well remember a senior, well-loved and well-respected Member of the Labour Benches who died of this dreadful disease. We lost him far too early, because this disease takes people very quickly. Anything at all the Minister can say to encourage us that this effective and approved medicine can be made fully available to everybody who needs it—depending on the conditions, as outlined by the noble Baroness, Lady Finlay—would be helpful.

[Baroness Thornton (Lab)]

My Lords, can I say how much I support this suite of amendments? I congratulate the noble Lord, Lord Moylan, for tabling and speaking to them. This most lethal of killers has been defying science—or we at least have not had enough investment in the science—for many years. This means the survival rate is still not as it should be and as it is for other cancers. Anything that pushes the NHS and research community to tackle this and to set the targets that are needed to do so is very welcome. I look forward to what the Minister has to say.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

I thank noble Lords for bringing forward this further debate on the subject of pancreatic cancer services. I begin by confirming that the pancreatic cancer audit is included in the national cancer audit collaborating centre tender, which is currently live. Reporting timelines are included in the specification for this audit, developed in partnership with NHS England and NHS Improvement. However, I hope noble Lords will understand that, during a live tender, the document is commercially sensitive and cannot be shared beyond the commissioning team, as this would risk jeopardising the procurement process. While I recognise that it may be disappointing that I am unable to confirm the timeline for the pancreatic cancer audit until the procurement process is completed, I can say that the future contract to follow the procurement process in relation to the clinical audits is anticipated to start this autumn.

The normal process for a new national audit is a year of development and set-up, followed by data collection and analysis. The publication of the data would then follow. However, on a more positive note—and I hope my noble friend Lord Moylan considers this response less dusty—I can confirm that, alongside the audit of cancer services, important actions are being taken to ensure that clinicians are able to take informed decisions. NHS England and NHS Improvement have ensured that guidance on pancreatic enzyme replacement therapy is shared with cancer alliances to disseminate to clinical teams in their area. NHS England and NHS Improvement will also continue to work with Pancreatic Cancer UK to raise awareness among the clinical community about the value of PERT for many patients with pancreatic cancer.

Noble Lords will be aware that NICE has a clinical guideline, NG85, recommending that PERT should be offered to patients with inoperable pancreatic cancer, and that NICE has also included PERT in its quality standard on pancreatic cancer. NICE clinical guidelines are developed by experts based on a thorough assessment of the available evidence, but they do not replace the judgment of healthcare professionals. They are not mandatory, but they represent best practice. The NHS is expected to take them fully into account in ensuring that services meet the needs of patients. Ultimately, the use of PERT in individual cases is for clinical decision-making, following a discussion between doctor and patient. As such, national targets would not be appropriate.

My noble friend asked another question on data. PERT prescription data is already published online through the English prescribing dataset. This shows that levels of prescription have been rising. The data does not currently differentiate between prescription for pancreatic cancer patients and for people with other conditions. However, NHS England and NHS Improvement will consider PERT prescription data during the scoping of the pancreatic cancer audit.

I end by thanking my noble friend Lord Moylan for his constructive engagement and for pushing the Government on this. But I hope that the reassurances I have given are sufficient to persuade him to withdraw his amendment.

[Lord Moylan (Con)]

My Lords, I am very grateful to noble Lords who have spoken, particularly the noble Lord, Lord Aberdare, and the noble Baronesses, Lady Finlay of Llandaff, Lady Walmsley and Lady Thornton. I know that support for the principle behind these amendments is widespread throughout the House. The Minister has also taken that on board, and I am grateful to him not only for his engagement before this short debate but for the words he uttered from the Dispatch Box. He will be in no doubt that noble Lords will be paying attention to these prescribing rates in the future, carefully following what is happening, monitoring and asking questions to ensure that the information is getting to clinicians and that the medicines are getting to the patients who will benefit from them.

Before I sit down, I want to say a word of thanks to the excellent charity Pancreatic Cancer UK, with which I have worked on this and which I know also works with officials at the department to improve treatment for pancreatic cancer patients. I will test my licence a little further by saying that it is not only pancreatic cancer; there are also conditions such as bile duct cancer, which are just as devastating and which we, as a nation and a National Health Service, need to bring to the fore so that people get better treatment, better care and early diagnosis. We really can do this.

With that, I express gratitude to my noble friend the Minister and the other noble Lords who have spoken. I beg leave to withdraw the amendment.

Amendment 166 withdrawn.

Amendments 167 to 169 not moved.

[The Deputy Speaker (Baroness Henig) (Lab)]

My Lords, I inform the House that the noble Baronesses, Lady Masham of Ilton and Lady Brinton, and the noble Lord, Lord Howarth of Newport, will take part in the following debate remotely.

Amendment 170

Moved by

[Lord Forsyth of Drumlean]

170: After Clause 164, insert the following new Clause—
“Assisted dying
(1) The Secretary of State must, within the period of 12 months beginning with the day on which this Act is passed, lay before Parliament a draft Bill to permit terminally ill, mentally competent adults legally to end their own lives with medical assistance.(2) In preparing the draft Bill and any accompanying documents and in making arrangements to lay them before Parliament, the Secretary of State must take account of the need—(a) to respect that this is a matter of conscience, and(b) to enable Parliament to consider the issue.”

[Lord Forsyth of Drumlean (Con)]

My Lords, we are on Report and I know that a number of colleagues have engagements and want to see this matter resolved as speedily as possible, so I will be brief and stick to the substance of my amendment.

This amendment has nothing whatever to do with the rights and wrongs of assisted dying, and I apologise to colleagues who have received many letters and emails urging them to vote against it from people who have been told that it does. The amendment would simply enable a Private Member’s Bill on assisted dying to be properly considered by Parliament at a time when the courts and the vast majority of the public are crying out for this to be done.

Time and again, private Members’ legislation on assisted dying is destroyed in Committee after enjoying strong support at Second Reading. The Bill from the noble and learned Lord, Lord Falconer, and, most recently, the Bill from the noble Baroness, Lady Meacher, suffered this fate. The noble Baroness’s Bill was subject to more than 200 amendments, many of them tabled by Members who expressed complete opposition in principle to it at its Second Reading. It is hard to escape the conclusion that their purpose was to ensure that the Bill ran out of time. They succeeded; it is dead. A particularly egregious example was an amendment requiring a terminally ill person to give 12 months’ notice of a diagnosis of having only six months to live. You do not need to take my word for it that some people are using these tactics, which are deliberately intended to subvert the democratic process and prevent Parliament coming to a considered view.

This is what Care Not Killing, as it calls itself, had to say in an email sent to its supporters on 24 January 2022 at 6.29 pm about new subsection (2), proposed by my amendment, which would require the Secretary of State to treat this issue as “a matter of conscience” and enable Parliament to consider it:

“It must be opposed because”—


horror of horrors—

“point 2 would force the Government to give parliamentary time and prevent it from instructing its MPs on which way to vote.”

It goes on:

“This in turn would open the way for MPs and Peers to pass a new law.”


How shocking that that should be allowed to happen.

I regret to say that, even though the Labour Party and the Liberal Democrats are rightly allowing a free vote on this amendment, the Government are instructing colleagues to vote against it—despite my offer to the Front Bench to withdraw it in return for an undertaking to provide time in future for a Private Member’s Bill to allow Parliament to reach a considered view. Everyone knows that Private Members’ Bills, unless they are government handouts or are utterly uncontroversial, have little chance of clearing the parliamentary hurdles unless they are given government time and assistance. It is fatuous for the Government to say that they are neutral on assisted dying while, at the same time, refusing to allow time for it to be considered. Without government time for private Members’ legislation, many controversial and important social reforms, such as the decriminalisation of homosexuality or the abolition of the death penalty, would never have reached the statute book. Passing by on the other side is not neutrality. It is a failure to come to the aid of the democratic process on an issue of the highest importance.

18:45

In Scotland, the parliamentary procedures for private legislation provide for proper public consultation and consideration by MSPs; this is probably the first time I have praised the Scottish Parliament in this Chamber. I am told that it is highly likely that the law on assisted dying will be changed north of the border—something for which my friend and political opponent, the late Margo MacDonald MSP, campaigned so bravely while herself suffering from a terminal illness—because Liam McArthur MSP’s private Bill enjoys strong public and parliamentary support. Of course, this opens up the possibility of people from England being forced to travel to Gretna Green for a less happy reason than today. Such an outcome would be impossible to defend if the UK Parliament had not even addressed the issue properly.

This must be serious because my noble friend the Minister, who is the equivalent of Kate Adie, is answering from the Front Bench. I am sure that he is equipped with the arguments; I remember them well. I remember the lines to take when Ministers are faced with a hopelessly weak argument against an amendment: “It is not the right Bill. It would create an unwelcome precedent. It is not properly drafted. The time is not right.” I hope that we will not hear them all again tonight. However, the Government are on record as saying that they will not stand in the way of Parliament deciding on the matter of assisted dying, which is a matter of conscience. This amendment would enable them to be as good as their word. To my colleagues on these Benches, I say this: help them to do the right thing. Ignore the Whip and vote with your conscience. I beg to move.

[The Deputy Speaker (Baroness Henig) (Lab)]

My Lords, the noble Baroness, Lady Masham, is taking part remotely. I invite her to speak.

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

My Lords, many people are fearful and dismayed about the disastrous, inhuman situation in Ukraine. The threat of a nuclear attack and a third world war frightens many people. Added to this, many disabled and elderly people here in the UK are also frightened. Many vulnerable people feel that, if the assisted dying law is changed, they could be pressured into assisted dying because they feel that they are a nuisance and because they need looking after. Whatever the noble Lord, Lord Forsyth, says, this Bill should be about care, not killing. There should be compassion and palliative care for all those people who need it.

[The Deputy Speaker (Baroness Henig) (Lab)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite the noble Baroness to speak.

[Baroness Brinton (LD) [V]]

My Lords, the noble Lord, Lord Forsyth, has introduced his amendment very clearly, so I will be brief and say that I will also support him if he chooses to call a Division.

The majority of the British public support the legalisation of assisted dying. In a Populus poll of more than 5,000 people in 2019, 84% of respondents said they supported giving dying people the right to an assisted death. I am pleased that the noble Lord, Lord Forsyth, has managed to praise the Scottish Parliament system that has enabled my colleague Liam McArthur to have time for his Bill in its Parliament.

As the noble Lord, Lord Forsyth, has said, it is important to note that the amendment would not actually change the law on assisted dying. What it would do is to ensure that some proper parliamentary time is made available, as in Scotland, within 12 months of the Bill passing into law, to ensure that there can be a planned and proper debate with the wider public and with MPs and Peers that is just not possible in the Private Members’ Bill process that we have in our Parliament.

It is important to note that the amendment does not require government to support the legislation through Parliament, merely to ask for the time, and that this procedure has happened before with Section 16 of the European Union (Withdrawal) Act 2018. I hope that the Minister will change the Government’s mind on this so that the noble Lord, Lord Forsyth, does not have to call a Division.

[The Deputy Speaker (Baroness Henig) (Lab)]

My Lords, the noble Lord, Lord Howarth of Newport, is taking part remotely. I invite the noble Lord to speak.

[Lord Howarth of Newport (Lab) [V]]

My Lords, in moving this proposed new clause, superficially so bland, the noble Lord, Lord Forsyth, beckons us along a path which leads towards constitutional and moral anarchy.

What is dangerous constitutionally about this amendment is that it would undermine the way we do parliamentary government. Forcing the Government to lay a Bill before Parliament and to enable Parliament to consider the issue, as the proposed new clause requires, would be a coup. This Back-Bench amendment would usurp control of the parliamentary agenda from the democratically elected Government. In the last Parliament we saw Back-Bench MPs, with the collusion of Mr Speaker Bercow, contriving to set aside Standing Order 14(1), which gives precedence to business tabled by the Government, in order to substitute their own agenda on Brexit. I believe the noble Lord, Lord Forsyth, was very much opposed to that.

Parliament proceeds by precedence, and these are dangerous new precedents, as any noble Lord who sees their party as a party of government must surely agree. While it is for Parliament to interrogate government and hold it to account, it is not for Parliament to claim for itself the role of the Government. Parliament is incapable of governing and it should not dictate the parliamentary programme. If Parliament makes exceptions to that principle to gratify a faction of its Members in either House, and if the principle that it may do so becomes established through reiteration so that the Government no longer control the legislative agenda, the ability of Governments to govern will suffer. Our system of parliamentary government is battered and unsteady as it is; we should not injure it further.

The moral anarchy that lurks in this new clause is that it would legitimise in a new way the taking of human life by other human beings. I readily acknowledge that the noble Lord, Lord Forsyth, the noble Baroness, Lady Meacher, the noble and learned Lord, Lord Falconer, and other proponents of what they call assisted dying are motivated by compassion and kind intentions. I profoundly believe, however, that their approach misreads human nature and that legislation to permit assisted suicide would create more suffering than it would alleviate. The offspring of this compassion would be a coarsening of our society and a diminution of the value we place upon life.

Some people make a moral case for assisted suicide on the basis of personal autonomy. I understand the appeal: I want, or I think I would want, such choice and control for myself at the end of my life. But that is not a good enough argument. Our responsibility is not just to ourselves, or even to those individuals we love the most, but to our community. For a community to be healthy, it must have norms. It has been a norm in our culture to place an especial value on human life. We reaffirmed that value when we abolished capital punishment. Since then, we have subjected our society to decades of laissez-faire ideology and chaotic individualism, and among the consequences of that have been a dissolution of community bonds and new harshnesses.

If we continue to dissolve our traditional norms, we are at risk that there really will be no such thing as society. As we look at our society now, at lethal child abuse and domestic abuse, at murderous assaults on women, as we look across the world at the millions consigned to death in the pandemic by the refusal of rich countries, including our own, to share intellectual property and technology to enable poorer countries to have vaccines, and as we witness increase discriminate mass killing in Ukraine and Yemen and genocide in Xinjiang, do we really think we should be preparing to sanction a new class of killing?

The new clause requires that a vote in Parliament on the intended legislation must be a matter of conscience. Let us examine our consciences very carefully indeed as we consider the proposal the noble Lord has put before us.

[Baroness Meacher (CB)]

My Lords, I support Amendment 170 in the name of the noble Lord, Lord Forsyth, to which I have added my name.

As the noble Lord made clear, there is no realistic prospect of a Committee day for my Assisted Dying Bill. This makes the point that the current procedures limiting Private Members’ Bills to Fridays do not enable important legislation such as the Assisted Dying Bill to reach the statute book.

The noble Lord, Lord Forsyth, introduced his amendment brilliantly. It leaves me only to reiterate that we are not discussing the pros and cons of assisted dying this evening. The House is expected to rise at 1.30 tomorrow morning. I hope for the sake of everybody in this House that noble Lords on both sides of the assisted dying debate will resist the temptation to get into such a debate—that is not as what this amendment is about. We are debating whether it is acceptable that there is no procedure at present to enable the Westminster Parliament to test the willingness of both houses to pass such a significant and popular piece of legislation. We know that not only Scotland, which the noble Lord, Lord Forsyth, mentioned, but Jersey and even the Isle of Man have procedures to enable them to pass an assisted dying law, and all those three are likely to pass such legislation within the next one to three years.

We therefore ask noble Lords: do we really think it is satisfactory that the Westminster Parliament is hamstrung without a procedure for Parliament properly to debate a Bill to legalise assisted dying for terminally ill people who are mentally competent and who are suffering unbearably? For Westminster to be upstaged on such an important and popular human rights issue by our much smaller neighbours is surely unconscionable. Amendment 170 from the noble Lord, Lord Forsyth, deserves our support.

[Lord Cormack (Con)]

My Lords, I oppose this amendment. Much as I admire my noble friend Lord Forsyth and fully understand the reasons why he has brought this before your Lordships’ House, it is not a good precedent to bind the Government in one Bill to introduce another a year or so hence. We should think very carefully about the constitutional issues.

We should remember Silverman and we should remember Steel: those Bills began in the other place—an elected House. An initiative of this sort should come from the elected House and not be imposed upon it by an unelected House. I do not think anybody would question my devotion to this House. I believe passionately in it. I believe passionately in an appointed House, as we are. I admire enormously the variety of expertise and experience that is in your Lordships’ House. However, we are not the elected House. I agree that it would be entirely reasonable in the elected House for time to be sought from government. The last time they debated this there was a fairly emphatic result, and it was not in favour of having an assisted dying Bill.

Much as we can admire the total sincerity of those who are committed to the principle of assisted suicide—I happen not to be of their number—it is very dangerous for us to begin in this House changing constitutional precedent by obliging government to introduce a Bill. Therefore, I urge your Lordships not to support this amendment.

19:00

[The Deputy Speaker (Lord Lexden) (Con)]

My Lords, I have been informed that the noble Baroness, Lady Campbell of Surbiton, would like to participate in this debate remotely. I invite her to contribute.

[Noble Lords]

She is here.

[The Deputy Speaker (Lord Lexden) (Con)]

Not remotely but present, which is very good indeed.

[Baroness Campbell of Surbiton (CB)]

My Lords, I am so thankful to be here tonight. It is a rare appearance but an important one and I am glad to be here in your Lordships’ House to oppose Amendment 170, which repeats the amendment that the noble Lord, Lord Forsyth, tabled in Committee. I apologise to the noble Lord for missing the first sentence of his contribution—I always enjoy his contributions and I am sorry to have missed the very first part.

This is a complex and highly contentious ethical issue. Opening the door to what is effectively assisted suicide would be a monumental change in the criminal law with potentially lethal consequences. If we get it wrong, it will result in some vulnerable people needlessly taking their own life.

The current Bill on assisted dying needs to be examined with the utmost care on the basis of highly informed opinion, robust evidence and a deep understanding of why hundreds of disabled people fear it. I do not think that we understand this cohort. I wish we did but we do not. We have seen a range of legislative developments in recent years in the UK and abroad, all of which demand detailed analysis.

Using this Bill to force the Government’s hand and the pace of deliberation on a matter specifically covered by an existing Bill is, I believe, as others do, a blatant manipulation of the parliamentary process. It sets a dangerous precedent and should be resisted. This is the wrong Bill, the wrong time and the wrong way in which to debate one of the most fundamental issues that we face as a society. I beg—yes, beg—noble Lords to reject the amendment.

[Lord Falconer of Thoroton (Lab)]

It is a privilege to follow the noble Baroness, Lady Campbell, whose contribution to the debate on assisted dying over many years is the admiration of all. I pay tribute to her and I know that the House thinks that as well.

I strongly support what the noble Lord, Lord Forsyth, is proposing for the following reason. We are trying to deal with an issue of conscience in Parliament. Issues of conscience generally have a bad time in Parliament because the major parties are not interested in such issues. You have to fight under our parliamentary procedures in order for issues of conscience to get dealt with. I completely agree with the noble Baroness, Lady Campbell of Surbiton, that this is a complex and difficult issue, but it is one that requires parliamentary time and, above all, Parliament to address the issue and make a decision.

I cannot convey adequately the mess that the law is now in. The law does not have the stomach to be enforced. Nobody wants a decent person who helps a loved one to die because they are having a terrible death to be the subject of prosecution, conviction and a possible sentence of 14 years. The law has been stood on its head and the Director of Public Prosecutions has been given the power to say that he will not prosecute if certain guidelines are followed. That means that the most basic principle of English law is subverted. It is not the judge and jury any more who decide whether you are guilty of the offence but the well-meaning and admirable Director of Public Prosecutions. If he says that you are not to be prosecuted, you are in the clear. If he says that you are to be prosecuted—remember you have assisted somebody to take their own life—you are guilty. He is making the decision. That reflects the way in which our society is trying to deal with the issue.

What we need is proper parliamentary time for parliamentarians to address this exceptional issue. I was a remainer, tragically, and was very much against all the strange ways in which Parliament operated. But this is an exceptional matter. The noble Lord, Lord Cormack, with respect, is not talking sensibly when he says that that we are sticking this matter on to the Commons. The Commons will have to decide whether they agree or not.

I urge this House to adopt the amendment, not because noble Lords agree or disagree on the issue of assisted dying but because they take the view that Parliament should properly address issues of conscience. Please do not be swayed one way or the other by the issues on assisted dying, because everybody knows that there are strong arguments in favour and against—I feel as passionately as those who are against. Address the issue on the basis of whether Parliament should be able to deal with issues of conscience.

[Baroness Butler-Sloss (CB)]

My Lords, it would be perfectly possible for someone in the House of Commons to raise this issue and deal with it there. What concerns me—I pick up what the noble Lords, Lord Cormack and Lord Howarth, said—is that this seems to be a constitutional issue. I am not going to say a word about the rights and wrongs of assisted suicide or assisted dying. However, I shall just read a few words of the amendment. It asks us to agree that the

“Secretary of State must, within the period of 12 months … lay before Parliament”


not just the possibility of a Private Member’s Bill being given time, which was what was suggested earlier, but a draft Bill. That is telling the Government what legislation they have to pass. This is a matter that transcends issues of compassion or whether one is on one side of the argument or the other, because what we in the Lords are telling the Commons is that they have to support us telling the Government to put forward a Bill with which they may not agree. But they do not have any choice if this amendment is passed. That Bill has to,

“permit terminally ill, mentally competent adults legally to end their own lives”.

The amendment is not asking the Government to please give time—I could understand that. It is telling, not asking, the Government to put forward a draft Bill in support of one side of the argument. Whichever side I was on, I would feel absolutely impelled to resist this amendment.

[Lord Winston (Lab)]

My Lords, I have repeatedly opposed assisted dying and it is well known that I feel, and have felt, strongly about it. I also feel that this is quite a different situation. I do not want to argue my case here, but serious issues are raised by the amendment. I am not persuaded that voting for it would make a difference, because the Commons can still consider what we have said this evening. However, it is clear—I completely agree with the noble and learned Lord, Lord Falconer—that we as a Parliament have to discuss this issue.

I remember, when I first came into this House 27 years ago, in the Prince’s Chamber there was a notice recording an Act of 1620, I think—under Charles I—that argued that we should not use intemperate language in the Chamber. In this situation, I believe this is inevitably important. I regret very much that the noble Lord, Lord Howarth, spoke in the terms he did. I do not think it is helpful to the argument. I think it probably destroys his argument to some extent. What the noble Lord, Lord Cormack, says is a very different matter—and I regard the noble Lord, Lord Cormack, as a friend. Above all, it seems that as a Parliament we have to discuss this, and this is something burgeoning in the public. Therefore, it is a duty to discuss this in Parliament. If we happen to introduce this Bill, which the Commons can then consider, whether it is passed at this stage or not, that would be utterly justifiable, and I support this amendment.

[Baroness Mallalieu (Lab)]

My Lords, this amendment surely goes to something of importance to all of us in this House, whether we support assisted dying or not, because it is about the role of Parliament and the proper exercise of the duties of an elected Government. The Supreme Court has repeatedly said that Parliament, and not the courts, should consider whether in some circumstances assisted dying should be legal. But so far, this Government have fought shy of doing so either of their own volition or by giving Private Members’ Bills time. There is now clear evidence that the public opinion has changed and wants Parliament to face up to this question and express its will. Yet the door is effectively being shut in the face of that opinion.

Dying is surely an issue of general public importance as it concerns every single one of us. Yet this subject is consistently and currently being starved of the oxygen of time in Parliament in order for the Government to avoid a controversial topic. This amendment does not require the Government to take sides or promote a Bill themselves; it merely requires them to prepare and lay a draft to enable Parliament to consider any possible change properly. I shall support this amendment, and I would hope that noble Lords, whatever their views on assisted dying, do the same, because this amendment is essentially about democracy.

[Baroness Davidson of Lundin Links (Con)]

My Lords, I rise to support the amendment moved by my noble friend Lord Forsyth. I do not do so lightly, because in 10 years of parliamentary politics, despite sometimes being seen as a bit of a rebel or trouble-maker, I have never actually broken a Whip before, that I can remember. It does help that I was a party leader for eight years and wrote the Whip, but it is still quite a big step for me. But for me here tonight, I have to, because I cannot believe, or understand why, the Government have whipped this in the first place, particularly when the amendment from my noble friend Lady Sugg, which is equally an issue of conscience, tonight is not whipped.

The reason I cannot believe this has been whipped is the reason that has been given—that of neutrality. I am absolutely content for the Government to be neutral on the issue of assisted dying. That is not just defendable but completely understandable, but not allowing time for discussion is not a neutral act. When contentious Private Members’ Bills attract clear tactics from oppositional Members to affix a deluge of wrecking amendments to slow progress through the House, denying such discussion time is not neutral. This is a convention that previous Governments have understood, and they have acted. The decriminalisation of homosexuality, the repeal of the death penalty, the legalisation of abortion: none of these measures would have passed without the Government of the day allocating suitable parliamentary time for their debate and discussion. To deny that time here is not a neutral act. It is to guarantee that this issue is killed by procedure and killed by practice. It is a de facto opposition to change.

For these reasons, I will break the Conservative Whip this evening. I encourage all people, no matter which side of the argument they happen to be on, who want us to have the deep, broad and considered debate we need on an issue as important as this to do exactly the same. I support the amendment of the noble Lord, Lord Forsyth, and I urge him to press it.

19:15

[Baroness Finlay of Llandaff (CB)]

My Lords, I feel I have to remind the House that we have had 95 hours of debate in recent years on this topic; and the implication that we have not debated this is a misrepresentation. The noble Lord, Lord Forsyth, has asked us not to talk about assisted dying but then actually did talk about some aspects. We are being asked to test the willingness in both Houses, but I remind the House that the Marris Bill started in the Commons, was debated there and was defeated there by 330 votes to 118. That is where a Bill like this should start.

It is true that, historically, there have been major changes. Those have been in Bills that started in the House of Commons, when the public understood what they were about. The public knew what capital punishment was, and they know what homosexuality is. These Bills started in the elected House, and they then came to this Chamber. That has been our procedure.

I would, though, like to challenge the claim that there is overwhelming support among the public. I think it is questionable. In the poll, when asked a bit more detail, 57% of the public did not understand what assisted dying is; 42% think it is your right to stop treatment, which is already a legal right; and 10% think it is hospice care. Dignity in Dying has said it wants to have the largest record of public support, yet to date it has less than 0.5% of the population of England and Wales signed up to this list. So I do think we have to look at some of the claims being made and think about them.

Whatever noble Lords think about assisted suicide and euthanasia, this amendment would set a dangerous constitutional precedent for any Government. It is surprising that the noble Lord, Lord Forsyth, with his deep respect for parliamentary processes and Governments being able to govern, has taken this approach, because this amendment would set a precedent enabling any Back-Bencher from any pressure group to disrupt a Government’s agenda. Does the noble Lord plan to bring judicial proceedings if his proposal is not tabled in a year? That is the criterion in the text of his amendment. A draft Bill leads to a Bill, assuming and forcing government support, before exploring evidence of the complexities of licensing doctors to provide lethal drugs.

We do indeed already have a Bill before us, and it is awaiting debate. The amendments laid are not vexatious. Based on the extensive evidence from abroad, they expose the problems with the proposals from the noble Baroness, Lady Meacher. Where assisted dying is legal, palliative care has dwindled, legislation has widened, the safeguards have been seen to fail, and non-assisted violent suicide rates rise disproportionately. Post-event reporting, as in her Bill, does not work because it relies on the clinician. I could go on, but I will not.

Yet surprisingly, no request was made for Committee until months after Second Reading, and no one seems to have sought to discuss the amendments that have been widely criticised by those who have spoken today. Some Members openly want the prognosis requirement to be dropped from the Bill to make legal drugs available on request. We have to at least know what the content of the Bill is even before we proceed. An 18 year-old with severe anorexia is already eligible under the Bill that is currently before the House. The answer to harrowing accounts of inadequate care is not to force the Government to draft a Bill that would allow doctors to supply massive overdoses of unevaluated lethal drugs to patients. Good, holistic, palliative care has been made a right in this Bill by this Government, and people should ask for it and insist on it.

This amendment is not the way to seek a careful analysis of the complexities of assisted suicide and euthanasia. It creates a constitutional headache for any future Government’s ability to govern. The procedure is to debate a Private Member’s Bill properly in Committee; and that Private Member’s Bill should start in the elected House.

[Baroness Jones of Moulsecoomb (GP)]

My Lords, I hate to disagree with the noble Lords who have spoken against this amendment, almost as much as I loathe supporting the noble Lord, Lord Forsyth, on anything. But, for me, this is a matter of democracy. Public opinion is constantly moving on this, and it becomes more and more supportive as the public understand the issues involved. It is partly the duty of the Government to explain exactly what it is about. Having a proper debate like this is something we should all support.

Personally, I want this on the statute book before I need it. I have five grandchildren, and I try to talk them all into pushing me over a cliff if I were to get too ill. As soon as their mothers told them that it was illegal, they refused me. The idea remains that this is something which many of us want for ourselves, because we fear being incapable. Therefore, I support Amendment 170.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I would like to put a point to the noble Lord, Lord Forsyth. He said that his amendment simply provides time for Parliament to consider an assisted dying Bill. I note that proposed new subsection (2)(a) also says that the Secretary of State should

“respect that this is a matter of conscience”.

But a draft Bill is a draft Bill. It will be prepared by a government department; instructions will be given by solicitors, after consultation with Ministers, to parliamentary counsel; and that Bill will eventually be approved by Ministers in the relevant department and put before Parliament. There will be a Minister in charge of the Bill. Whatever mechanism is chosen—maybe a Joint Select Committee of both Houses—to consider the draft legislation, the Minister will be in charge and will be seen by the public to be driving through a Bill. If the noble Lord had said in his amendment that more time should be given for the Private Member’s Bill, I would have supported it. Businesses managers clearly need to take account of the obvious wish of this House to have more time to debate it—

[Lord Forsyth of Drumlean (Con)]

I do not want to prolong the debate but, for the sake of clarity, I will say that the issue here is that this is a complex subject—as has been pointed out. It is a Private Member’s Bill, and the Government would provide support for that. It is not a government Bill, and it is not being piloted by the Minister. This is clear from the amendment. It could not be, because the Government then would not be neutral, as they should be, on a matter of conscience.

[Lord Hunt of Kings Heath (Lab)]

I am very grateful to the noble Lord for his intervention. However, his amendment says:

“The Secretary of State must, within the period of 12 months beginning with the day on which this Act is passed, lay before Parliament a draft Bill”.


In my book, a Minister laying before Parliament a draft Bill is in charge of that Bill.

[The Lord Bishop of Durham]

My Lords, I agree with those who have already spoken opposing the amendment. First, the amendment is not appropriate as a use of the legislative process accompanying this Bill through your Lordships’ House. There is a question of purpose. If opportunity for debate is the goal, we must underestimate neither the significance of the Bill of the noble Baroness, Lady Meacher, in October and the thorough, careful and considered debate, nor the possibilities of calling for Committee. I would also support that time being given in this House. There are important constitutional questions which arise if the amendment enacted by this House does in fact instruct the Secretary of State in the other place to propose and introduce a draft Bill—as the noble Lord, Lord Hunt, has just outlined. If that is not the case—and if the noble Lord, Lord Forsyth, is not advocating for this draft to be introduced—what is the purpose of the amendment?

Secondly, I am aware that the language of the amendment has some real problems. One example is “terminally ill”. We debated the importance of language at Second Reading of the Assisted Dying Bill. The phrase “terminally ill” is understood in a whole range of different ways in different parts of the world. Is there any guidance offered on the definition or scope behind the language in the draft Bill attached to the Secretary of State’s instruction?

The complexity of the issue in question is so great—and the lives of the people who are facing a personal debate of this kind, and feel that they would be particularly impacted, are so important—that this cannot be how we legislate on their behalf. We are on Report, so I was disturbed that the noble Lord, Lord Forsyth, intervened when he did.

[Baroness Noakes (Con)]

My Lords, ordinarily I would not support a novel procedure which overrode the precedence of the ways in which we normally do business and in which the Government expect to direct how business is taken in both Houses of Parliament. But I have been increasingly concerned that the Private Member’s Bill processes, both here and in the other place, simply do not work. They do not work for controversial Bills. It is simple to thwart the progress of a controversial Bill both here and in another place—but particularly so in this House through the mechanisms which we have seen used.

This issue is so important: it is clear that there is strong body of opinion within the British public wanting to see this issue addressed in some way. We must find parliamentary time to make a proper decision on it. I accept what the noble Lord, Lord Hunt, says about the unusual nature of a Minister having to lay a draft Bill which is not government business. But sometimes things are so important that we must find practical ways through them. I believe that my noble friend’s amendment is a practical way through a very difficult problem, and I urge all noble Lords on my Benches to ignore the Whip.

[Baroness Smith of Newnham (LD)]

My Lords, in Committee, I asked whether the Minister—I think the noble Lord, Lord Kamall, was responding on that occasion—had thought about giving parliamentary time to the Private Member’s Bill. The proponents of the current amendment are suggesting that this is not about the Government bringing forward a piece of legislation, even though—as the noble and learned Baroness, Lady Butler-Sloss, pointed out—that is exactly what the amendment says. If the intention of the amendment is to request parliamentary time—and we really are looking only at proposed new subsection (2)(b)—could the Minister, in replying, consider whether parliamentary time could be given to the issue without damaging neutrality in any way? The amendment, as drafted, would require the Government to bring forward legislation in favour of assisted dying. An amendment which gives parliamentary time to the issue would be very different.

[Lord Carey of Clifton (CB)]

My Lords, I will make a brief intervention. First, I rise to challenge the view that all bishops and religious leaders are against assisted dying. I changed my mind some seven years ago.

Secondly, we are discussing the Health and Care Bill. It so happened that this week I received a letter from two doctors—husband and wife—from Colchester. I will read a part of it because they asked me to intervene on their behalf. Their experience comes from within the National Health Service; they worked in the NHS all their careers. One of them says:

“I visited P a little more than two weeks before he died. Alone with me, he explained that he was beyond misery, from the pain of his condition and from the effects that drugs were having. The time had come, the patient asked, to request something that would allow him to slip away. The look of disbelief and horror as I explained that I could not do this haunts me still.”


The doctor goes on to say:

“The Health Service which has done everything it could to involve the patient in their care and comply with the patient's wishes waits until they are at their most vulnerable and incapacitated, to impose a course diametrically opposed to the wishes of the patient.”

19:30

The same doctor goes on to offer a personal story. His own father, an eminent scientist, had developed an aggressive cancer with distressing side-effects. He loathed what he was going through. The indignity of it was abhorrent. He struggled to the local railway station and walked under a train. The doctor recounts:

“Sadly, it was a slow train, and he took several hours to die. Still conscious, he had to argue with the ambulance crew not to treat his injuries so that he could achieve his desired outcome.”

I offer these stories, which come from recently retired doctors. They believe the time has come for a change in the law to allow rational human beings to slip away in peace. I changed my mind on this issue some seven years ago, and I know that I am out of step with my church, but I believe that those of us who take this approach are on the right side of history. Therefore, I support the amendment in the names of the noble Lords, Lord Forsyth and Lord Baker, and the noble Baroness, Lady Meacher.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, the noble Lord, Lord Forsyth, made the accusation that lots of the amendments to the Bill of the noble Baroness, Lady Meacher, were a sort of Machiavellian plot to subvert the democratic process. I want to point out that I had tabled one of those amendments, about mental health, partly because I thought that that was our job here, that when a Bill was before Parliament, we followed it through—to every Bill that I have followed through here, there have been myriad, endless amendments. I thought that our role was to scrutinise proposed laws, to debate the merits and demerits and so on. I was therefore disappointed that there was no Committee stage of that Private Member’s Bill. So I do not accept the suggestion that those who put down amendments did so somehow to avoid debate; in fact, it was the opposite.

My general view on the problems of parliamentary and democratic process was best summed up by the noble and learned Baroness, Lady Butler-Sloss. I also feel queasy that there is a kind of subverting of the parliamentary process by an amendment on assisted dying or assisted suicide being put down on the Health and Care Bill. It is totally inappropriate. It is hijacking a Bill. Whatever else assisted dying and assisted suicide is, it does not contribute to improving anyone’s health. It requires ending a life; it is not a healthcare matter, and it will require a major change in the criminal law, so this is the wrong Bill.

However, I have every sympathy with the noble Lord, Lord Forsyth, and feel his frustration. I feel all the time that there are lots of laws I want to change; there are lots of things I want to change about the country; there are lots of times when I feel as though the public think one thing and the Government ignore them. What one therefore needs to do is to lobby the Government—the noble Lord probably has closer access to them than a lot of us—or, as maybe I would do, to organise a demonstration or a protest, unless the Government had got away with banning that by the time we got there. In other words, in a democracy, there are lots of frustrations that need to be expressed if you want to change the law. Using our position as unelected legislators to add an amendment to an inappropriate Bill seems to be completely wrong on a matter of such huge importance.

[Baroness Hayman (CB)]

My Lords, I am glad to have the opportunity to follow the noble Baroness, Lady Fox, because it is important to recognise that she is quite right. We should be able to debate all the amendments that Members wish to debate, in both Houses, on a Bill of this sort—a Bill which, as the noble Baroness, Lady Campbell of Surbiton, said, addresses one of the most fundamental social issues facing society.

However, I disagree that this amendment is nothing to do with health. The last days, weeks and months of your life, the healthcare that you receive, and the options open to you are part of the healthcare provided throughout the NHS and elsewhere. So I believe that it is appropriate to discuss this here.

It is a novel procedure. It is not a procedure that mandates the Government to support the draft Bill that would be brought in. The amendment is precisely designed not to do that but to ensure that a proper and full debate is held. I normally follow the noble Lord, Lord Cormack, closely and often agree with him, but I do not accept that we are imposing something on the other House by passing an amendment to a Bill which is going to have lots of amendments made to it and will go to the other place, where those amendments will be debated and accepted or not accepted.

Most of all, I support this amendment because it is now nearly 20 years since I served on the Select Committee on the Joffe Bill. There have been numerous attempts since then to resolve this most important issue. They have all run into the sand one way or another. Our legislature has not found itself able to produce a result that satisfies everyone that there has been full debate and resolution found to how we should go ahead as a society. In that time, 20 other jurisdictions have managed that task, because they have found a way of providing adequate time so to do. For those reasons, I support this amendment.

[Baroness Greengross (CB)]

My Lords, I want to add my support particularly for what my noble friend Lady Hayman has just said. This has gone on for a long time. I have been involved in it throughout my time as a Member of this House and I do not intend to repeat what I have said before. I want just to say that the amendment in the name of the noble Lord, Lord Forsyth, offers a useful way forward so that assisted dying is given time in both Houses to be debated properly. It must be given serious consideration. Whether one is for or against changing the law on assisted dying, we all surely agree that this is a very serious issue worthy of serious scrutiny and debate. It is unacceptable that, once again, my noble friend Lady Meacher’s Private Member’s Bill risks being lost, due not to lack of support but to not enough time being allowed to take the Bill through all its stages.

Assisted dying is very much related to health and care, and it is appropriate that this amendment should be included as part of this Bill.

[Lord Baker of Dorking (Con)]

My Lords, this is the second occasion on which I have spoken on assisted dying in your Lordships’ House. Five years or so ago, I supported the Bill in the name of the noble and learned Lord, Lord Falconer, and voted for it. I did not speak on the Bill in the name of the noble Baroness, Lady Meacher, but I was ready to vote for it. However, as we know, the vote was not called because the opponents of the Bill feared that, if there was a vote, there would be an even larger majority in favour of the Bill on that occasion than there was earlier, because the arguments against assisted dying are shrinking year by year.

This House has now accepted on two occasions a Second Reading for a Bill to ensure that assisted dying is placed on our statute book. That is the political and democratic decision of this House, yet it has now been thwarted twice, and the thwarting is most extraordinary.

We managed to survive constitutionally in the 17th, 18th and 19th centuries without trying to kill legislation by tabling so many amendments. It was a device invented by Conservative Back-Benchers in the 1970s to prevent a Bill passing through the House of Commons that prevented the hunting of foxes by dogs. A small number of devoted hunters devised this trick. The Member of Parliament was Marcus Kimball; older Members might remember it. It was a political trick which has been used in this House on three occasions: on the Bill of the noble Lord, Lord Grocott, on hereditary Peers; on the Bill of the noble and learned Lord, Lord Falconer; and on the Bill of the noble Baroness, Lady Meacher.

I remind your Lordships that the only way in which we as Back-Benchers in the House of Lords can effect personal influence on social change is through Private Members’ Bills. There is no other way in which we can effect a policy—we are all controlled by the agenda of the Government—yet we are being denied this. The democratic choice of this House in passing the Second Reading on two occasions is very clear, and it is being thwarted. That is very unfair.

I told my Whip three weeks ago that I was going to come in and support my noble friend Lord Forsyth’s Bill and vote. He said, “It doesn’t matter; it’s a matter of conscience”. He confirmed that in an email to me last week and in a conversation I had with him on Monday. I do not believe my Whip was lying—it was the Government’s view—but suddenly the Whip was changed last night, right at the last minute. Somebody must have spoken to people in the House of Lords, because the view has been very clear since my noble friend Lord Forsyth tabled his amendment. It was clear that the Government—a Conservative Government—were going to be asked to prepare a Bill on assisted dying and, in a reasonable amount of time, find time for it to be debated.

The great social reforms we have had in the last 50 or 60 years all started with the Government of the day being prepared to find time for them. The Wolfenden report in 1957 recommended the decriminalisation of homosexual activity. That was opposed by many Conservative Back-Benchers, yet the Conservative Government of the day made time for it to be debated. When David Steel produced his Abortion Bill, the Government of the day—I think it was the first Wilson Government—made time for it to be debated. Thirdly, when Roy Jenkins as Home Secretary introduced a Bill to abolish hanging, the Government of the day found time for it to be debated.

That is the principle, so I expected that we were going to have a free vote tonight. I am simply amazed that the Government have now suddenly changed the Whip. Someone has spoken to them. I do not expect the Minister to accept that, but somebody from the other House has certainly spoken to the Government and said, “We don’t want to be in a position to have to draft a Bill on assisted dying and find some time in the not-too-distant future for it to be debated”.

We are not suggesting that the Meacher Bill should come back and be debated in May or June this year, in this parliamentary Session, but there are other parliamentary Sessions in which it could be introduced: 2022-23, 2023-24 or 2024-25. If it has not been decided by the next election, I very much hope that all of the four major parties in our country—the Conservatives, Labour, the Liberals and the Greens—have a clear undertaking in their manifestos that, if they were elected, time would be found for the two Houses of Parliament to make up their minds whether they wanted assisted dying on our statute book. I am quite happy to leave that decision to the British people because, unlike the noble Baroness here, I happen to believe that the argument has moved decisively as far as the people of this country are concerned. There are now far too many people who have seen relatives or friends die long, lingering and miserable deaths.

The original argument against assisted dying was sanctity of life. I found it extraordinary that in the debate of the noble Baroness, Lady Meacher, not one of the Bishops or Archbishops addressed the sanctity of life. Other arguments are now put forward: the vulnerability of people who are dying, with relatives gathering around and wanting to polish them off—things of this sort, all of which can be addressed by amendments to the Bill.

I am very surprised that a Conservative Government should decide to vote against my noble friend Lord Forsyth. He and I go back a very long way. Thirty years ago he was the chairman of the Conservative Party in Scotland—that was when we had a Conservative Party in Scotland—and I was the chairman of the Conservative Party in England. I got to know him very well, and I can think of no one who more embodies conservatism in his whole mind and being than my noble friend. Whether it was a question of lower government expenditure, lower taxes, greater freedom of choice on housing or greater freedom of choice for parents, he was there. Conservatism runs in his blood—he has the bluest of blood—and I think it an insult to him and a disgrace that the Whips on my side of the House have said we should vote against him.

I hope that this amendment will be passed and that this House will recover the sense that, without it being passed, your Lordships’ democratic choice, which has been exercised on two Bills, is being totally disregarded by a political trick. That is simply not right.

19:45

[Baroness Hollins (CB)]

My Lords, I do not understand why it is a conscience vote if it is not about the substance or the subject but somehow about parliamentary process. That does not seem to me to be a matter of conscience.

The point is that people want better care at the end of their life. The amendment to this Bill from the noble Baroness, Lady Finlay, is a game-changer. I wonder how many noble Lords understand that something has changed during the passage of this Bill. For the very first time, people will now be eligible and able to have palliative and hospice care at the end of their lives commissioned by the NHS. It is the responsibility of all integrated care boards to commission proper, good palliative care so that the poor care and poor deaths that people in this House are afraid of will be a thing of the past.

This is the wrong time to talk about introducing lethal drugs as a last resort. We should be looking forward with optimism and hope about how things have changed. This is also relevant to my noble friend Lady Meacher’s Bill. Noble Lords have questioned the motives of Peers who have tried to amend that Bill. It needed to be amended and scrutinised. My amendments were all about palliative care—this was before the game-changer of universal palliative care—being available before people are offered the only option of lethal drugs. If lethal drugs are the answer, why was this not an amendment to introduce lethal drugs to enable people to be assisted in their own suicide? Palliative care will reduce the supposed demand for physician-assisted suicide.

I think the statistics have been misrepresented. Only 10 US states have legalised physician-assisted suicide, despite the supposed success in Oregon. Maybe they have recognised that palliative care decreases rather than increases when lethal drugs are available. Some 200 attempts to introduce physician-assisted suicide in the United States have been defeated.

[Lord Sentamu (CB)]

My Lords, I do not want to detain the House long. The noble Lord, Lord Forsyth, told us that this is not to open the debate in favour of or against assisted dying but, as the debate has gone on, there has been an opening up of that debate. We have to look very carefully at what was given to us by the noble and learned Baroness, Lady Butler-Sloss, on the constitutional question. This amendment is not saying that the Government must find time to debate this matter but instructing the Secretary of State.

This is a revising Chamber. It is made up of unelected people telling the Government in the elected place that they must produce a Bill and it must be given time. That is my worry. My views on assisted dying are very clear. I will debate it whenever the issue comes back again, but the issue for me now is to avoid what was happening towards the end of Theresa May’s Government, when the Back-Benchers were trying to take control of government business. That led us into a mess.

I am not against speaking in favour of any Government of any colour, because I have never been a member of any party, but I want to observe how the liberalisation of homosexuality actually happened. Michael Ramsey, as Archbishop of Canterbury, began a debate in your Lordships’ House because of what had happened to Turing and many other people. He just thought: is it natural justice that consenting adults should actually be prosecuted and have to go through horrendous treatment, some of them facing horrendous stuff? The debate happened here and what was the result? It was the Wolfenden report. That recommended that this should be debated and a Minister of the Government, and Mr Jenkins on behalf of the Labour Party, joined in the debate and what happened? The law was passed. Where did it start? It started in the elected Chamber.

I have a real concern that we, as a revising Chamber, are not even considering a Bill that has actually come from the Government but instructing the Secretary of State to produce a Bill within a year of this coming into being and saying that it must be debated. Does this respect our position and why we are here? This is not revising legislation, at which all your Lordships do a fantastic job. Without your Lordships, the Bills in this country would be horrendous. However, let us not overreach ourselves and think that we can instruct the Secretary of State to bring this in. Who is the Secretary of State in this case? is it the Secretary of State for Health and Social Care?

May I please ask that we get another amendment or another Statement to give the House a Private Member’s Bill that needs to be given sufficient time to be debated properly? Also, other people told your Lordships that on 21 September 2015, there was full a debate in the other place.

[A noble Lord]

A long time ago.

[Lord Sentamu (CB)]

Noble Lords might say that it was a long time ago, but it was debated. It is not as if this has never been debated properly. It went through all the processes and unfortunately the Bill was lost. Is this another example of once something is lost, you bring it back again and again? I do not want to be like a particular German Chancellor who lost an election and said, “This is really wrong, we must change the people.” Friends, we are a revising Chamber. We need a bit of humility about our position, and should not think that we can instruct the Secretary of State to bring in a particular Bill because time has been lost.

[Lord Ashton of Hyde (Con)]

My Lords, I detect a sense that the House would like to hear from the Front Benches, but I know that all noble Lords have a right to speak and that the noble Baroness, Lady Grey-Thompson, is very keen to say something. I am sure she will understand that the House wants to hear the Front Benches and that, if my noble friend wants to bring this to a vote, we should get on with it.

[Baroness Grey-Thompson (CB)]

My Lords, I have spoken numerous times about my opposition to assisted suicide for many different reasons. It is not, for me, about the sanctity of life. Not everybody who believes that the law should not be changed has strong faith. However, we are continually being asked to vote through the principle and think about the detail later. The devil is in the detail.

Detailed scrutiny is our role as a revising Chamber. The Commons has so many of its amendments guillotined. However, we have to take an issue such as this, which is about ending people’s lives, very seriously and we have to debate some of the detail. I know that the noble Baroness, Lady Meacher, feels strongly about this and I wish she had pressed much harder and much earlier for a Committee stage for her Bill. In an issue such as this, when we are talking about ending people’s lives, there should be hundreds of amendments, because it has to be debated properly.

I would like to briefly go on the record to thank the hundreds of people who have written in. We are really lucky right now that we live in a democracy and that people are able to freely express their opinions, whether we agree with them or not. Our role in the House of Lords is to deal with those people who write in. Lots of people from both sides have written to me. However, we must also be really careful in our language and not scare people into thinking that assisted suicide is the only option for them.



As a disabled person who sits in this Chamber with a red stripy badge, I have a huge amount of privilege. Many, many thousands—tens of thousands or more—of disabled people do not have privilege in respect of protection. This amendment and what it seeks to do will fundamentally change the political and societal landscape for disabled people. If people have not read it, they should look at the article by the noble Lord, Lord Shinkwin, this weekend about how disabled people are encouraged to think that they would be better off dead than live with an impairment. Even in this Chamber, we hear about things such as incapacity and incontinence and all the things that people fear. I push back on that, and I push back on the view that public opinion is overwhelmingly in support of this. On the Dignity in Dying website, 284,881 people have signed the public petition. On the Commons website, asking for a change in the law, 46,483 people have done so. That is not overwhelming public opinion.

I know the frustration of people who want to change the law. I can feel it; we hear it, and I admire the fact that the noble Lord, Lord Baker, says that we are a democratic Chamber. There are plenty on the outside who would not agree with that in terms of the way that we operate. This, however, is a constitutional matter. For all those arguing in favour of this tonight, I really look forward to them supporting my Private Member’s Bills asking for things such as good education, work, social care and access to trains, which are the things for which disabled people are arguing. This is not it: this is not the right time and not the right place. I do not support this amendment.

[Baroness Walmsley (LD)]

My Lords, I think the mood of the House is that the Front Benches—

[Lord Shinkwin (Con)]

My Lords, may I just be indulged by the House in following the excellent speech by my noble friend Lady Grey-Thompson? Exactly seven weeks ago, not just to the day but to the exact hour, I started to feel very ill. I was barely 36 hours out of the operating theatre after surgery that had gone incredibly well and I knew something was seriously wrong. By midnight I was in agony, my bowels totally blocked by the combined effects of the anaesthesia and the pain relief. By the morning, I was passing blood and my haemoglobin levels had plummeted. That was just seven weeks ago. It was at that point that a decision was made to transfer me by ambulance to St Thomas’ A&E so that I could have an urgent blood transfusion. I lived to tell the tale, but tell it I would much rather not have done. I would much rather forget the whole episode—the unbelievable pain, the helplessness and the acute sense of vulnerability. My family do not know any of this; I have not told them. I am hoping they do not read Hansard.

I share it with your Lordships’ House because I believe that my recent experience is directly relevant to Amendment 170. We have been assured that this is not about the merits of assisted dying, but noble Lords should not underestimate the magnitude of what is at stake in this amendment. This is not the start of some cosy conversation about a harmless, anodyne measure. The end goal is assisted suicide and the means is a Bill proposed in this amendment. If this amendment were passed tonight, I firmly believe that in years to come, we would look back and say that today—16 March 2022—was a pivotal moment.

20:00

My question to the House is: if the amendment were passed, would I have felt any safer? Would I have felt any less vulnerable as I lay in agony only seven weeks ago? The answer is unquestionably no. In the culture to which this amendment would inexorably give rise, with its nuanced assumption that my impaired quality of life somehow made my life less worth living, would I still be here? I do not know.

We are summoned by our sovereign to this place, whether physically in person or remotely, precisely because it is our obligation and responsibility—indeed, our solemn duty—to fast-forward to the worst-case scenario and to pre-empt and prevent that worst-case scenario in law. I fear that the effect of the amendment would be the opposite.

[Baroness Walmsley (LD)]

My Lords, as the noble Baroness, Lady Grey-Thompson, rightly said, the devil is in the detail. That is what Parliament does and it is what the noble Lord, Lord Forsyth, is asking your Lordships to allow Parliament to do.

Like many families across the country, my family has had discussions about the substantive issue of assisted dying. Different views have been expressed and no one has fallen out, but it is not around our dinner table that decisions must be made about an issue as serious as this; that is for Parliament. I trust Parliament, and I do not think it should be—as the noble and learned Lord, Lord Falconer, pointed out—for the Director of Public Prosecutions to make decisions about these issues. Assisted dying is happening and Parliament must decide how or if it should be done.

It has been suggested that this House should not instruct the Secretary of State to do anything. As we have gone through the Bill, we have asked the Secretary of State to do quite a lot of things; in fact, we have voted that the Secretary of State should do a lot of them. What happens to those amendments? They go to the elected House. I have great respect for the noble Lord, Lord Cormack, and I understand how important he feels it is that issues as controversial as this should be decided by the elected Chamber. Well, if we vote for this amendment, those issues will be decided by the elected Chamber. If this novel procedure of a draft Bill being laid before Parliament is used, I trust Parliament; there will be proper debate and I hope that what will come out of it will be a very measured piece of legislation that takes all the concerns into account. The game-changer that my noble friend Lady Finlay has successfully introduced to the Bill will be taken into account by the elected Chamber.

It is very important that people who want to have palliative care to ease their suffering at the end of life actually get it—everyone should get it; there should be no postcode lottery—but even in those situations there may be people who do not want it and instead want to do something else. It is for Parliament, not for my dinner table or anyone else’s around the country, to make that decision and to be given the proper amount of time to come up with something that I hope will reassure those who rightly have fears. They have fears because they do not know what Parliament will decide. If we give Parliament the opportunity, I am quite sure that even a draft Bill, however well drafted, will probably be amended as it goes through the elected House. What will come out at the other end will probably reflect public opinion—genuine public opinion, that is; I am not quoting any polls on either side—as they will have given serious thought to the issue and listened to everyone who wants or does not want this measure on the statute book.

We must give the elected Chamber the opportunity either to accept an amendment that we may pass tonight or to send it back to us, but at least we will have asked them to think again. This House does that very well. We ask another place to think again. I hope we will tonight.

[Baroness Merron (Lab)]

My Lords, I have listened very closely to the many passionate, informed and often personal contributions from noble Lords this evening. This debate has inevitably been about not only parliamentary process and legislative approach but consideration of assisted dying. I thank the noble Lord, Lord Forsyth, for opening the debate on Amendment 170, which proposes, as your Lordships’ House is more than aware, a new clause to bring forward a draft Bill on what the noble Baroness, Lady Campbell of Surbiton, described as a complex and difficult issue.

However, for me, the challenge of this debate is encapsulated in the contributions in the middle of it. The first, from the noble Baroness, Lady Davidson, was that not allowing time for discussion is not a neutral act. This was followed swiftly by my noble friend Lord Hunt taking a different tack, saying that allowing for this amendment is also not a neutral act, and it is that which your Lordships’ House has wrestled with this evening.

It is indeed a matter of profound moral, personal and legislative importance that we find ourselves dealing with in Amendment 170. The noble Lord, Lord Forsyth, will be seeking a Division and these Benches will approach this on free votes. It is a shame that this is not the case on the Government Benches. Your Lordships’ House heard from the noble Lord, Lord Baker, about the importance of principle, whereby matters such as this should be subject to nothing other than a free vote. I certainly share that view. I know that noble Lords will exercise their vote this evening with the greatest of care.

[Earl Howe (Con)]

My Lords, I must tell my noble friend Lord Forsyth that I am not with him on this amendment and nor are the Government. That has nothing to do with the issue of assisted dying, about which we each have our own views, but is about the proper process for bringing forward legislation and the roles and responsibilities of government on the one hand and parliamentarians on the other.

Governments are elected. The electorate then expect the Government to bring forward their programme of legislation, which Parliament then decides on. If alongside that process there is an issue that the Government do not choose to legislate on, but which happens to be close to the heart of an individual parliamentarian, that parliamentarian has the privilege of being able to bring forward a Private Member’s Bill for Parliament to consider. In each of those two legislative processes the roles, rights, responsibilities and privileges of the Government and of individual parliamentarians are separate. It is no more appropriate for a Government to force an MP or Peer to bring forward a particular Private Member’s Bill than it is for an MP or a Peer to force a Government to bring forward a government Bill. That includes a draft Bill. As my noble and learned friend Lord Mackay of Clashfern observed in Committee, draft Bills are brought forward by Governments only when there is an intention to legislate.

The Government have no intention of legislating on assisted dying; it is not part of our programme, nor was it part of our election manifesto. Equally, it is no part of our agenda to prevent an MP or a Peer bringing forward a Private Member’s Bill on assisted dying. The noble Baroness, Lady Meacher, has done just that because it is something that she feels strongly about. It is for her to persuade Parliament and the Government that her Bill is a good thing.

That is the proper process, and surely that is how it has to be. If it ever became possible for an MP or Peer to use a government Bill as a vehicle for obliging the Government to publish a completely separate Bill, even one on a subject which was in tune with the Government’s thinking, the due process of legislating would thereby be subverted. I ask noble Lords opposite how they would react if under a Labour Administration, an MP or Peer proposed to use a health Bill as a vehicle to oblige the Government to publish draft legislation, the purpose of which was to place all NHS hospitals into private ownership—or one might find an MP trying to use a criminal justice Bill as a vehicle to oblige the Government to publish legislation to bring back capital punishment.

My noble friend might say, “Well, in that circumstance, it would be for Parliament to decide whether or not to accept such an amendment”—but that is not the point. The point is that if one House of Parliament were to approve such an amendment and the other House were to follow suit, Parliament would thereby usurp the role of the democratically elected Government. The noble Lord, Lord Howarth of Newport, and my noble friend Lord Cormack were 100% right: it is for the Government to say what their legislative programme should be, not Parliament.

As the late Lord Simon of Glaisdale might once have said, this amendment is constitutionally offensive and it should be rejected on those grounds.

[Baroness Meacher (CB)]

Before the Minister sits down, does he believe that limiting debate on a crucial human rights issue to Fridays—when, as he knows, certainly in the House of Commons, very few MPs are around, and in the House of Lords too, many Peers are not available—is an appropriate way to consider a matter of very great importance?

[Earl Howe (Con)]

My Lords, we gave a full day’s debate to the noble Baroness’s Bill. That is surely not ungenerous.

[Lord Forsyth of Drumlean (Con)]

My Lords, it is late; we have had a very good debate. I have to say, I shall long remember being accused of leading a coup in Parliament.

My purpose was very simple. My noble friend has explained the Government’s position very clearly. I say to my noble friend Lord Baker, who was very kind in his remarks about me, that the Chief Whip made it perfectly clear to me from the beginning what the Government’s position would be. It has been set out by my noble friend Lord Howe. However, there is a problem here. It is all very well for my noble friend to stand at the Dispatch Box and say, “Well, we have the private procedure, and we have the government procedure”, but on a matter of huge importance, Parliament is completely unable to reach a view. My amendment was really an attempt to do that.

There has been some nonsense talked, I have to say, about how we are getting above ourselves and that we are instructing the House of Commons. If this amendment is passed tonight, it will go to the House of Commons and, under our procedures, it will be for the House of Commons to decide.

I have made it absolutely clear to my noble friend the Chief Whip and the Front Bench that if the Government say, “We don’t like this procedure; we think it’s a bit too novel, but we’ll give a commitment that we’ll make time available at some point in this Parliament for the purpose of discussing this really important issue”—I agree with the points made by a number of people that it is a complex and difficult issue; that is why it needs time for everyone to put their point of view and for a result to emerge, which might very well be a conclusion that we do not want to change the law—then I would withdraw my amendment. But, for some reason, the Government are refusing to do so. They seem to think that it is more important to discuss ending the lives of lobsters than addressing this hugely important issue of the end of life for people. There is time for the former, but not for this.

The Government are entitled to their programme, but having listened to the response, I would like to test the opinion of the House.

20:14

Division 3

Ayes: 145

Noes: 179

20:30

Amendment 171 not moved.

20:31

Consideration on Report adjourned until not before 9.15 pm.