House of Lords

Monday 26th February 2024 Lords Chamber

Monday 26 February 2024

14:30

Prayers—read by the Lord Bishop of St Edmundsbury and Ipswich.

Death of a Member: Lord Cormack

Monday 26th February 2024 Lords Chamber

Announcement

14:36

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, I regret to inform the House of the death of the noble Lord, Lord Cormack, on 24 February. On behalf of the House, I extend our condolences to the noble Lord’s family and friends.

Overseas Territories: Tax Haven Status

Monday 26th February 2024 Lords Chamber

Question

14:36

Asked by

[Baroness Chakrabarti]

To ask His Majesty’s Government what assessment they have made of the economic benefits for the United Kingdom of the tax haven status of the Overseas Territories.

[Baroness Chakrabarti (Lab)]

My Lords, in polarised times, I look across and see the significant space where the temperate voice of our friend Lord Cormack ought to be. We will all miss him. I beg leave to ask the Question standing in my name on the Order Paper.

[The Parliamentary Secretary, HM Treasury (Baroness Vere of Norbiton) (Con)]

My Lords, the UK has not made any recent quantitative assessment of the economic benefits of the overseas territories to the UK, but we continue to support the territories to build vibrant and sustainable economies, including through encouraging greater links to the UK economy. The overseas territories are an integral part of the British family. The elected Governments of inhabited overseas territories are responsible for fiscal matters, including tax, and are committed to upholding international tax standards.

[Baroness Chakrabarti (Lab)]

I am grateful to the Minister, if not exactly any the wiser. Last November, the UN General Assembly voted overwhelmingly in favour of a new framework convention on tax justice. His Majesty’s Government were among a small club of rich countries that voted against. Now that that Motion has been so overwhelmingly carried, and there will be negotiations for a treaty to deal with tax avoidance and evasion in the world, will His Majesty’s Government engage?

[Baroness Vere of Norbiton (Con)]

As the noble Baroness will know, there is an enormous amount of work going on at the moment around international tax. That has been led by the OECD and the inclusive framework, involving 130 countries and jurisdictions from around the world working on two pillars: one for the greater share of group profits to be taxed in market countries, and the second a global minimum tax, where all profits will be subject to a 15% minimum effective tax.

[Baroness Kramer (LD)]

My Lords, from these Benches I join in with the shock and sense of loss at the death of Lord Cormack. He was such a big figure in this House and I know it is a very personal feeling for many of us sitting here, as well as for those across all Benches.

On 8 February—this month—a jury in Florida found the former Premier of the British Virgin Islands guilty of drug trafficking and money laundering while in office. Do the Government understand that that kind of corruption would have been much more difficult had there been in place the long-promised public register of beneficial ownership? The Government had guaranteed to this House that it would be in place for all overseas territories by the end of last year. Where are we in this process, and do the Government recognise their crucial role in stemming corruption?

[Baroness Vere of Norbiton (Con)]

The Government absolutely recognise their crucial role in stemming corruption; we work very closely with the overseas territories on all sorts of issues when it comes to illicit finance. I refer the noble Baroness to the Written Ministerial Statement from my honourable friend in the other place, the Minister for the Americas, Caribbean and the Overseas Territories; in that is a helpful summary that sets out where each of the overseas territories is in relation to introducing a public, accessible register of beneficial ownership.

[Lord Naseby (Con)]

My Lords, I declare an interest as I have family living in the Cayman Islands. Is that particular territory not a good example that others should follow? It has a well-regulated jurisdiction with a tax-neutral framework, which supports taxes being paid where the profits are made. It has signed up to and is approved by FATF, on anti-money laundering, and also has a positive rating on the OECD Global Forum. Against that sort of background, does it not demonstrate that territories such as Cayman that are close to us have got their house in order? And, yes, against that background one would hope that any that have not would follow suit.

[Baroness Vere of Norbiton (Con)]

I am grateful for my noble friend’s support for the Cayman Islands, but it is just one of the many different overseas territories. Not wishing to detract at all from his words, I would say that the Cayman Islands is doing well, but I think it can do better. For example, the beneficial ownership register that the Cayman Islands is planning to put in place will still have a legitimate interest access filter. We believe that that is an interim step, and we would like to see fully open registers of beneficial ownership as soon as that can be implemented.

[Lord Collins of Highbury (Lab)]

My Lords, I associate myself with the comments in relation to Lord Cormack. One thing he was incredibly powerful about was encouraging others, particularly on the parliamentary fellowship across this House. He was a great person who will be sadly missed.

Perhaps I might pick up the Minister in relation to the timescale for registers of beneficial ownership. We have had some progress, I am not denying that, but the British Virgin Islands and others have got timetables that talk about five years. What are the Government doing to support these overseas territories to implement these registers in a speedier and more thorough fashion? Support is needed as well.

[Baroness Vere of Norbiton (Con)]

I absolutely agree that we need to support the overseas territories. We have the skills, capacity and capability to do that, and that is what we do—but recognising that the relationship with each of them can be very different. They have elected Governments of their own. Those Governments are responsible for their domestic affairs. The noble Lord mentioned timeframes of five years. The British Virgin Islands, which I admit is probably towards the end of introducing the beneficial ownership registers, is looking at putting a framework in place no later than quarter 2 of 2025.

[Lord Watts (Lab)]

My Lords, can the Minister explain why, at a time when British people are paying more tax than they ever have done, the richest people in the world and in this country are avoiding tax altogether—people such as the part-owner of Manchester United, who now apparently wants the taxpayer to give him billions of pounds to invest in his business? Where is the fairness in that?

[Baroness Vere of Norbiton (Con)]

Obviously, I cannot comment on any individual’s tax affairs, but it is the case that overseas territories are non-sovereign jurisdictions. They have a unique relationship as part of the British family, but they set out their own tax legislation within their own legal structures and it is certainly not for the UK Government or Parliament to drive a coach and horses through that.

[Lord Hannan of Kingsclere (Con)]

My Lords, has the Minister’s department carried out any assessment of how much higher tax rates would be in the rest of the world if there were not competition from these lower-tax jurisdictions to keep us in check?

[Baroness Vere of Norbiton (Con)]

I am afraid I have to say to the noble Lord that we have not carried out that assessment.

[Lord Sikka (Lab)]

My Lords, on 8 June, the Treasury Secretary in the other place said:

“HMRC plans to calculate and publish a new stand-alone”


estimate of the

“offshore tax not being correctly reported”

by individuals

“next year, for the ‘Measuring tax gaps’ 2023 edition”.

Well, that hat has already been published, but there is still no estimate of the offshore tax gap. Can the Minister explain why the Government are so relaxed about offshore tax avoidance?

[Baroness Vere of Norbiton (Con)]

The Government are not relaxed about offshore tax avoidance. We maintain that all tax avoidance needs to be stamped out, which is why we work so very closely with the overseas territories on tax avoidance, anti-money laundering and counterterrorism finance, including with registers of beneficial ownerships. We have very good relationships. We meet with our colleagues frequently to discuss how to put things in place such that they are implemented as quickly as possible.

[Lord Hamilton of Epsom (Con)]

My Lords, does my noble friend accept that, if some of the overseas territories ceased to be tax havens, they would become an even greater burden on the British taxpayer?

[Baroness Vere of Norbiton (Con)]

As I said in my opening remarks, we encourage the overseas territories to develop sustainable and successful economies. As I also said, they are responsible for setting their own tax rates, and we will think about how future tax rates may change. It is also the case that tax rates will be underpinned by, in particular, pillar 2, which will be implemented via domestic rules across all overseas territories where it is relevant.

NHS: Neurology Care

Monday 26th February 2024 Lords Chamber

Question

14:46

Asked by

[Lord Londesborough]

To ask His Majesty’s Government what assessment they have made of the NHS’s resourcing and capacity to provide specialist care, in line with that provided to cancer and cardiac patients, for those living with neurological conditions.

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

My Lords, integrated care boards are responsible for commissioning most services for people with neurological conditions. NHS England has established the neuroscience transformation programme, a multi-year clinically led programme aimed at improving specialised adult neuroscience services in England. The programme has developed a new model of integrated care for neuroscience services to support ICBs to deliver the right service at the right time for all neurology patients, including providing care closer to home. A toolkit is being developed to support ICBs to understand and implement this new model.

[Lord Londesborough (CB)]

My Lords, there are 11 million people in the UK living with neurological conditions—the cause of more deaths than cancer and heart disease combined and the greatest cause of lifetime disability. The NHS is clearly not set up to provide the specialist care needed. France and Germany have more than four full-time consultant neurologists per 100,000 people; here, it is just over one. Across the UK, there are no full neuro units to be found in the majority of our counties. The consequential wastage of healthcare resource by non-specialist care, plus the social and economic burdens, is put at £96 billion by the Economist in a findings report released today. Can the Minister tell us: what are the plans to address this critical imbalance?

[Lord Markham (Con)]

I thank the noble Lord. I had the opportunity to join the Neurology Alliance forum today, which was quite timely. I think its approach is entirely right in looking at what we can do to help people get on with an active life and back into the workforce, understanding that the economic impact of that is key. We have set up the neuroscience transformation programme, which the Neurology Alliance is on board with, which we think will tackle many of the issues that the noble Lord mentions.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I declare an interest as chair of the Scottish Government’s advisory committee on neurological conditions and as chief executive of Cerebral Palsy Scotland. People with neurological conditions are faced with navigating a very complicated maze of services straddling primary care, secondary care and social care. Some conditions have well-defined pathways; many other conditions, such as cerebral palsy, do not. If the Government are not going to look at an overall neurological strategy such as the one that we have in Scotland, what practical steps will they take to help people with neurological conditions navigate these confusing services, so that they get the right support at the right time?

[Lord Markham (Con)]

My noble friend is correct. The important step towards this was our appointment of the first national clinical director of neurology over the last year. The task force put out a progressive neurological conditions toolkit which sets out the pathways exactly as my noble friend mentions. It shows the treatments for over 600 conditions. This is a complex area so it is vital that the pathways are understood in each area and patients can understand how to navigate them.

[Lord Allan of Hallam (LD)]

My Lords, the Government have created a new occupational health task force, which is welcome, but it will not help somebody to stay in their job or get back to work if they face a wait of many months to see a neurologist because that is what their condition requires. Can the Minister confirm that he will be working with his colleagues in DWP to ensure that the neurology capacity is there to see referrals from occupational health services more quickly?

[Lord Markham (Con)]

Yes, absolutely. Of course, this is what the CDCs are about as well in trying to get that diagnosis capacity. At the Neurological Alliance forum I was just at, the main thing was needing help with early diagnosis, because getting treatment is key to it all and, also, seeing whether we can sometimes refer people directly to the CDCs so that the GP is not always the bottleneck.

[Baroness Merron (Lab)]

My Lords, as Lord Cormack was a fellow of Lincoln, as I am, I pay tribute today to his considerable contribution to the City of Lincoln, as well as to this House and to the other place. May his memory be for a blessing.

The Neurological Alliance has expressed concern about the lack of clarity over whether new therapies for those affected by neurological conditions and their changing needs have been factored into the workforce plan. Can the Minister set out how the workforce plan will respond to these changing circumstances both for those with neurological conditions and those with other conditions?

[Lord Markham (Con)]

I echo the noble Baroness’s comments regarding Lord Cormack.

In terms of the long-term workforce plan, I was talking this morning to the national clinical lead in this area and to Professor Steve Powis. The next stage in terms of the detail is looking at the individual specialties and neuroscience experts are part of that. In the last five years, we have seen an increase of about 20% or so in this space but understanding that need going forward is the next stage in the long-term workforce plan.

[Baroness Blackwood of North Oxford (Con)]

My Lords, I echo the comments about Lord Cormack—we are all going to miss him dreadfully in this Chamber.

There are about 600,000 people in the UK living with epilepsy. An epileptic seizure can cause significant disability and, in the worst instances, death. Only half of those living with epilepsy are seizure free, but this could rise to 70% if all those with epilepsy were targeted to the right treatments. Can the Minister say what plans the department has to improve epileptic treatment in the UK with improved specialist care?

[Lord Markham (Con)]

I thank my noble friend, and I proudly wear the Epilepsy Action badge from the meeting I was just at. As my noble friend says, it is all about trying to get that early diagnosis. If you can get that and help people get the right treatments, that is exactly the right direction of travel because it can make a huge difference to outcomes. The progressive neurological condition toolkit I mentioned earlier sets out that pathway and the model of integrated care for all the ICBs, which they will all then be held to account on to make sure patients with all these conditions—and there are 600 of them including epilepsy—are getting the right treatment in their neighbourhood.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my interests in palliative care. Do the Government recognise that many of the patients with neurological disease are living with palliative care symptoms such as pain, breathlessness, worry and fatigue, which could be managed in the community with good integration between palliative care services and neurological services? Therefore, have the Government given specific commissioning guidance to integrated care boards to ensure that they look to see how the integration is developing in their own areas to enable these patients to improve their quality of life and their ability to live actively for as long as possible?

[Lord Markham (Con)]

Yes, that is precisely what I was referring to: the progressive neurological condition toolkit is all about the pathways for that integrated approach to it all. Again, there are 15 million people affected—I think this statistic was mentioned earlier—and one in five deaths come from related conditions, so making sure we have that integration with palliative care as well as the other services is key.

[Baroness Barker (LD)]

My Lords, neurological conditions require diagnosis by a specialist. Thereafter, the individuals need the input of people from all the different disciplines of the NHS. At the moment, the expectation to manage that falls upon GPs, and they cannot manage it. The key people who can are specialist nurses, and we have a severe deficit of specialist nurses for several neurological conditions. Can the Minister say how that deficit is to be addressed by the workforce plan?

[Lord Markham (Con)]

I thank the noble Baroness. Yes, the point about epilepsy nurses was made very clear to me just half an hour ago, and I quizzed both the national clinical director of neurology and Professor Stephen Powis on that subject this morning. I was assured that the next stage of the long-term workforce plan goes into that level of detail. I have made a commitment to the House to share some of that data, so we can make sure that it really is covered properly.

[Lord Patel (CB)]

My Lords, as human beings we are one biological system. A disease in one system often impacts another: for instance, chronic cardiac failure often results in cognitive dysfunction and people with neurological conditions often have associated cancers. While this Question is about funding for neurological diseases—and in the last two weeks, we have had Questions about funding for cardiovascular disease, cancers and others—what the whole thing shows is that we have one system failure in the health service. The only way that might be addressed is to get some out-of-the-box thinking. Does the Minister agree?

[Lord Markham (Con)]

I hope the noble Lord knows me well enough to know that I am always up for some out-of-the-box thinking. We are putting a lot of resources into this space. When we talk about dementia, which is captured in this, the commitment I gave last week was to bring in the expert panel, so that we can start to really understand this because early diagnosis is absolutely key. There is some out-of-the-box thinking there. Again, just now I was caught by the spinal muscular atrophy people; they were saying that if we could add that to the baby pinprick test, for instance, we could make sure that babies never suffer those symptoms later in their life, in many cases. I am absolutely up for that out-of-the-box thinking.

Life Sciences Businesses

Monday 26th February 2024 Lords Chamber

Question

14:57

Asked by

[Baroness Jones of Whitchurch]

To ask His Majesty’s Government what further steps they intend to take to support life sciences businesses starting up and scaling up in the United Kingdom.

[The Minister of State, Department for Business and Trade (Lord Johnson of Lainston) (Con)]

The life sciences sector is among the UK’s most globally competitive, with a turnover of more than £108 billion in 2022 and employing over 300,000 people. Supporting the sector is a priority for this Government, as demonstrated through a range of initiatives. These include a £520 million fund supporting life science manufacturing, reforms to the UK’s pension market to boost funding for companies, grants for early-stage companies via Innovate UK, export support and initiatives to accelerate the NHS adopting innovation.

[Baroness Jones of Whitchurch (Lab)]

I thank the Minister for that reply. We all understand the importance of the life sciences sector to our economy and to the health of our nation. Can he explain why, under this Government, the UK’s share of global exports in this sector was down from 9% to 4%, and our share of global R&D fell from 7.2% to 3.2%, between 2012 and 2020? Does that not represent a complete failure by this Government to create the stability and certainty in which life science innovators can flourish?

[Lord Johnson of Lainston (Con)]

I am always grateful for challenge from any Peer in this House, but I have very different figures. If I look at the turnover of the life sciences sector, I find that, in 2022 alone, it was up by 13%, and it is up by 40% since 2015. There is a whole lot more that we can do, but I am proud of our record when it comes to garnering investment—FDI, which is particularly my function—into the UK life sciences sector. Over a three-year average, we are third in the world, behind only the United States and Germany. That is rather a significant tribute to the people in this sector and the Government’s support of it.

[Lord St John of Bletso (CB)]

My Lords, it is well known that there is a chronic shortage of purpose-built life sciences wet lab space. Can the Minister elaborate on what measures are being taken to build more science parks and innovation hubs?

[Lord Johnson of Lainston (Con)]

The noble Lord is absolutely right to raise this as a core issue. I am quite frustrated myself at some of our planning points, which certainly delay the building of these essential facilities. I am glad that life sciences wet lab space has been coming on stream in significant quantities, not least recently in Canary Wharf, which I hope he will join me in celebrating. However, there is more to be done; I totally agree with the noble Lord.

[Lord Fox (LD)]

My Lords, the Office for Life Sciences reports to the DHSC and the DSIT. The Office for Investment is a joint No. 10 and Department for Business and Trade unit. I spoke to a major biotech investor in this country, which said that the lack of communication between these two organisations is hampering its progress in building new biotech capacity in this country. Does the Minister agree that these two organisations ought to work closely together? There ought to be an explicit link, so that when companies are trying to scale up and invest in this country there is a proper joined-up approach.

[Lord Johnson of Lainston (Con)]

I sometimes feel that the noble Lord, Lord Fox, asks the perfect question, though we have not collaborated. Tomorrow, I have just such a trilateral meeting, between DSIT and the Department of Health, the Office for Life Sciences and the Department for Business and Trade. I totally agree with the comments made by businesses about the siloing of government, which I am afraid is an issue we all face. This working group will have enormous power in trying to drive change and there are a number of things I want it to do. First, I want it to try to identify key companies around the world that we want to bring to the UK. Secondly, it should look at how we scale up the existing opportunities we have. The noble Lord is absolutely right, and I am delighted that tomorrow will mark the first event of which he has spoken.

[Baroness Finlay of Llandaff (CB)]

My Lords, the Minister referred to the position of the US as being in advance of the UK in life science innovations. Our universities increasingly recognise the critical need to put innovations and discoveries of patient benefit through start-ups and scaling. However, costs and complexity are driving start-ups to pursue regulatory approvals via the US FDA, rather than here. This means that patients get biotech and medtech advances far later than those across the Atlantic, even from UK spin-outs. What are the Government doing to remove the redundancy and repetition to incentivise UK companies to pursue NHS deployment in this very competitive global market?

[Lord Johnson of Lainston (Con)]

I am grateful to the noble Baroness for her prompting. The Government have put more money into the MHRA, specifically for clinical trials, to assist all of our agencies to license more effectively and faster. As Minister for better regulation, it is part of my specific project to drive innovation. Clearly, this is not without risk, but, if we are to own the IP and lead the world, it is essential that we must go faster. That applies not just to the regulators but to government departments. We are working hard on this, but I appreciate the challenge.

[Lord Kamall (Con)]

My Lords, I refer to my interests, as set out in the register. When I was in the Department of Health, I had a meeting with a number of start-ups from the life sciences sector. They told me what wonderful products and services they had, but that they could not convince investors to invest in them. We looked at whether we could bring investors together with start-ups and scale-ups, so that they better understood each other—the companies could understand what the investors were asking for in returns and investors could understand the potential of these businesses. What progress has been made in bridging the gap between investors seeking to understand investing in the life sciences industries and those start-ups seeking to attract investment?

[Lord Johnson of Lainston (Con)]

I am grateful to my noble friend for that point. This is very much the work of the Office for Life Sciences, the Department for Business and Trade, and the Office for Investment. We do a huge amount of work liaising with companies and investors. One of our missions is to get more life sciences funds established in the UK, so that we can, I hope, benefit from the home buyer. I was particularly pleased a few months ago to celebrate the opening of the Flagship Pioneering office in London, which is precisely that sort of life sciences fund. It was part of the incredible investment in companies such as Moderna. We want them here and they want to come to the UK. If we can encourage them to do this, it will have a huge advantage in bridging the gaps my noble friend mentioned.

[Baroness Deech (CB)]

My Lords, I wonder whether the atmosphere is too pessimistic. The University of Oxford has propelled itself to the forefront of the world in its life sciences and science parks, notably one by Magdalen College that has more than 100 start-ups and is expanding. Does this not mean that the Government should support universities, their freedom and their ability to do science? It is from that that the great success of these life sciences start-ups has come.

[Lord Johnson of Lainston (Con)]

I totally agree with the noble Baroness. I would go further and say that one policy motor that has been successful so far is these life science investment zones, particularly in Liverpool. I had the privilege to meet with Steve Rotherham today and the metro mayors, who have been leading across the board and in Yorkshire, to find an essence of focus for the investment into these new technologies. We are doing a huge amount of work on university spin-offs as well—organisations such as Northern Gritstone and Midlands Mindforge are the absolute core of the work I am doing to get money internationally into these pools of capital.

[Viscount Stansgate (Lab)]

My Lords, my question arises out of the one just asked. Can the Minister elaborate on what the Government are doing to spread the excellent work of the life sciences in this country more evenly around the UK?

[Lord Johnson of Lainston (Con)]

I hope I have answered this to some extent. There is no limit to the amount of work that we can do to get more investment into this sector. It starts from the smallest opportunities at universities, where we can put more money into life science spin-out funds, trying to help the organisations that pool that capital, as I say. It is about trying to establish bases in London for the key life sciences funds from abroad, and working with sovereign wealth funds, the biggest pension funds and the UK pension fund industry to put money into the industry. That is an important start.

[Lord Bruce of Bennachie (LD)]

My Lords, will the Minister attend the conference on life sciences in Aberdeen on 20 March, which is designed precisely to focus on this and is being promoted not just by the Aberdeen chamber of commerce but by the Times and the industry? Will the Government attend?

[Lord Johnson of Lainston (Con)]

I am grateful to the noble Lord for raising this. It was not in my diary, but this is an area of great passion for me and, if I can attend, I certainly will. I am sure some of my officials will be heavily engaged. Earlier in the year, we attended the key life sciences summit in San Francisco, which I had the privilege of attending the year before. We have to be out there flying the flag, so I totally agree with that prompt and I will look into it.

[Baroness Blackwood of North Oxford (Con)]

My Lords, I declare my interest as chair of Oxford University Innovation. Following the excellent question from the noble Baroness, Lady Deech, I am pleased to report that university innovation is going from strength to strength. At the University of Oxford, we spun out an average of four to five companies in 2015, but there was an average of 20 in 2021. Investments in Oxford spin-outs went from £125 million a year from 2011 to 2015 to over £1 billion a year now; that is more than 45% of the country. The question is not how we get the innovation started—that is easy. The question is how we scale those companies and keep them in the UK. What are the Government doing to attract that growth capital and keep those companies here?

[Lord Johnson of Lainston (Con)]

I am extremely grateful to my noble friend for that question, and I congratulate her on the astonishing amount of work that she has done to promote the sector. I am happy to have further discussions on the technical focus of the spending and getting the right level of capital into the scale-ups. As I say, it runs from a range of university spin-outs through to the development and commercialisation of those ideas. We then have to locate funds in the UK, and, at the highest level, we need more liquidity in our stock market for the very large venture opportunities. That circles back to the Mansion House compact and the Edinburgh reforms, which the Chancellor has been absolutely right to focus on. I hope the Government will announce in the near future the result of the LIFTS competition, which is a £250 million fund specifically designed to kick-start investment from defined contribution pension savers into this industry, which will have an important impact.

Employment of People with Criminal Convictions

Monday 26th February 2024 Lords Chamber

Question

15:08

Asked by

[Baroness Burt of Solihull]

To ask His Majesty’s Government what steps they are taking to encourage businesses to employ people with criminal convictions.

[The Parliamentary Under-Secretary of State, Ministry of Justice (Lord Bellamy) (Con)]

My Lords, I am pleased to say that the rate of prison leavers in employment six months after release almost doubled in the two years to March 2023, from 14% to over 30%. New Futures Network, the Prison Service’s specialist employment team, runs quarterly recruitment drives. These national campaigns have seen more than 200 employers and partners working with HMPPS to deliver more than 230 events in prison. Several other measures support the Government’s drive to get former prisoners into work.

[Baroness Burt of Solihull (LD)]

My Lords, I know—because I told him about it this morning—that the Minister is aware of the ban the box campaign to do away with the criminal convictions tick box on job application forms so that applicants can be assessed on their skills before their past mistakes. We know that work after prison dramatically reduces reoffending rates and helps to create a safer society. It helps companies to access a rich talent pool, yet three-quarters of them discriminate against applicants with convictions, excluding millions of jobseekers from the market. I thank the Minister for agreeing to look into this campaign, led by the charity Business in the Community, to see how the Government might support it.

[Lord Bellamy (Con)]

My Lords, as your Lordships know, under the Police, Crime, Sentencing and Courts Act 2022 the Government have been progressively reducing the need to disclose previous convictions, particularly in relation to community sentences and sentences of under four years, and now even some non-violent sentences of over four years can be regarded as spent. As the noble Baroness has said, the ban the box campaign run by Business in the Community, which comprises more than 150 employers covering over 1 million roles, asks employers to delay the point at which applicants are asked to tick a box on and give details about any criminal convictions so that they can expose their skills at interview before any disclosure of convictions is made, if such disclosure is still required.

The Government are very pleased to commend the work of Business in the Community, which has now led the ban the box campaign for several years. In 2021 it passed the milestone of covering more than 1 million roles, and as long ago as 2016 the Government signed up to it for the Civil Service. The noble Baroness rightly identifies that this is a very important initiative. Increasing rates of employment on release from prison is very important, and the Government will continue to support the initiative.

[Lord Ponsonby of Shulbrede (Lab)]

My Lords, I was going to ask about ban the box as well. The Minister has given a full answer. However, can he say something about the practices of the Ministry of Justice? When it contracts with numerous companies and NGOs, does it require them to practice ban the box themselves?

[Lord Bellamy (Con)]

My Lords, I will have to come back to the noble Lord on that question, as I am not in a position to answer it straightaway.

[Lord Carter of Haslemere (CB)]

My Lords, I declare my interest as a trustee of the Prison Reform Trust. An impressive 10% of Timpson’s workforce are ex-offenders. Its chief executive said on the radio just a few days ago that they are among his best employees, no doubt because they are highly motivated to succeed. In addition to the Government encouraging businesses to employ more ex-offenders, which I strongly support as a key to rehabilitation, are government departments doing anything to recruit more ex-offenders?

[Lord Bellamy (Con)]

My Lords, the Government do recruit ex-offenders and have signed up to various programmes to do so. That is a matter for individual departments, but it is certainly part of the Government’s programme to pursue that avenue.

[Lord Bailey of Paddington (Con)]

My Lords, with the reoffending rate remaining stubbornly high, what work is being done to prepare offenders to perform properly in the job market when they leave prison?

[Lord Bellamy (Con)]

My Lords, I can give your Lordships a variety of examples. I was talking to a prisoner from HMP Winchester the other day; he was very pleased and said, “It’s been great. I’ve completed the IT course and for the first time in my life I can do a Word document and an Excel spreadsheet”.

Your Lordships may have seen the report in the press this morning about HMP Liverpool, which has been completely transformed. The brewery Marston’s has a mock-up of a pub, where prisoners can train to work in hospitality. In HMP Swansea you will find the mock-up of an HGV with which you can qualify for your HGV licence. In HMP Humber you can do the same thing with a forklift truck. There is a great deal going on in our prisons, and we should be very proud of our Prison Service for pursuing those initiatives.

[The Lord Bishop of Gloucester]

My Lords, from these Benches I add our own sadness at the death of Lord Cormack. His contributions to this House and to the Church will be sorely missed.

As has been said, there has been a serious decline in rehabilitation and release planning services in recent years. Prisoners need to be engaged with purposeful work; there needs to be planning ahead of their release—including release on temporary licence—to secure employment, if we are to prevent reoffending. What steps are the Government taking to increase release on temporary licence?

[Lord Bellamy (Con)]

My Lords, the Government are very keen to allow prisoners release on temporary licence wherever that is possible. I emphasise the work that has gone into preparing prisoners for employment; there is now an employment lead in every one of our 93 prisons, and an employment hub where prisoners can access vacancies, make applications, et cetera. Every prisoner has an ID, a bank account and accommodation arranged when they are being released. There is an employment advisory board in every prison, and these measures are taking effect.

[Baroness Jones of Moulsecoomb (GP)]

My Lords—

[Lord Polak (Con)]

My Lords—

[Baroness Williams of Trafford (Con)]

My Lords, it is the turn of the Green Benches. If everyone is quick, we can then hear from my noble friend Lord Polak.

[Baroness Jones of Moulsecoomb (GP)]

I will be quick. I will just say that I will miss Lord Cormack very much.

There is a section of prisoners—the IPP prisoners, who are imprisoned for public protection—who are constantly being called back to prison, and their mental health is very much under threat; they are a very vulnerable population. Are prisons looking to rehabilitate those prisoners in particular, by preparing them for work?

[Lord Bellamy (Con)]

My Lords, there is a specific action plan in place for IPP prisoners. The question of whether they are being prepared for work is a little premature because they first have to be prepared for release. We are going to discuss this matter in great detail in the debates on the Victims and Prisoners Bill, and I look forward to further discussions with the noble Baroness.

[Lord Polak (Con)]

My Lords, for eight years I have had the privilege of sitting on this Bench next to Lord Cormack, often annoying him by asking him procedural questions; of course, he knew every answer. Yehi zichro baruch—may his memory be a blessing.

I refer the House to my interests in the register: I am an adviser to Legacie Developments, a small construction company in Liverpool run by John Morley, which last week celebrated the 50th ex-prisoner it has employed. Does the Minister welcome this? How can we expand this sort of operation?

[Lord Bellamy (Con)]

The Government are very keen to expand all opportunities for the re-employment of prisoners. I take this opportunity to pay tribute to a range of employers—Timpson, Marston’s, Greene King, Greggs, Wagamama, Marks & Spencer and many others—of which, as a nation, we should be proud.

Registered Office Address (Rectification of Register) Regulations 2024

Monday 26th February 2024 Lords Chamber

Limited Liability Partnerships (Application of Company Law) Regulations 2024

Service Address (Rectification of Register) Regulations 2024

Principal Office Address (Rectification of Register) Regulations 2024

Motions to Approve

15:19

Moved by

[Lord Johnson of Lainston]

That the draft Regulations laid before the House on 18 December 2023 be approved.

Relevant document: 8th Report from Secondary Legislation Scrutiny Committee. Considered in Grand Committee on 19 February.

[The Minister of State, Department for Business and Trade (Lord Johnson of Lainston) (Con)]

My Lords, with the leave of the House, I beg to move the four Motions standing in my name on the Order Paper en bloc. In doing so, I declare my interest as a director and person with significant control of some companies. I do not believe there is a direct conflict, but I inadvertently omitted to declare my interests in Grand Committee last week, for which I apologise.

Motions agreed.

Victims and Prisoners Bill

Committee stage
Monday 26th February 2024 Lords Chamber

Committee (6th Day)

Relevant documents: 7th Report from the Delegated Powers and Regulatory Reform Committee, 1st Report from the Constitution Committee. Welsh Legislative Consent sought.

15:20

Amendment 133

Moved by

[Lord Ponsonby of Shulbrede]

133: After Clause 38, insert the following new Clause—
“Major incidents: duty of candour(1) In discharging their duties in relation to a major incident, public authorities and public servants and officials must at all times act within their powers—(a) in the public interest, and(b) with transparency, candour and frankness.(2) If a major incident results in a court proceeding, official inquiry or investigation, public authorities and public servants and officials have a duty to assist—(a) relating to their own activities, or(b) where their acts or omissions may be relevant.(3) In discharging the duty under subsection (2), public authorities and public servants and officials must—(a) act with proper expedition,(b) act with transparency, candour and frankness,(c) act without favour to their own position,(d) make full disclosure of relevant documents, material and facts,(e) set out their position on the relevant matters at the outset of the proceedings, inquiry or investigation, and(f) provide further information and clarification as ordered by a court or inquiry.(4) In discharging their duty under subsection (2), public authorities and public servants and officials must have regard to the pleadings, allegations, terms of reference and parameters of the relevant proceedings, inquiry or investigation but may not be limited by them, in particular where they hold information which might change the ambit of the said proceedings, inquiry or investigation.(5) The duties in subsections (1) and (2) must—(a) be read subject to existing laws relating to privacy, data protection and national security, and(b) apply in a qualified way with respect to private law and non-public functions as set out in subsection (6), and(c) not be limited by any issue of insurance indemnity.(6) The duties in subsections (1) and (2) will be enforceable by application to the relevant court or inquiry chairperson by any person affected by the alleged breach, or the court or inquiry may act of its own motion. (7) Where there are no extant court or inquiry proceedings, the duties may be enforced by judicial review proceedings in the High Court.”Member's explanatory statement
This new clause would require public authorities, public servants and officials to act in the public interest and with transparency, candour and frankness when carrying out their duties in relation to major incidents.

[Lord Ponsonby of Shulbrede (Lab)]

My Lords, there is an urgent need to introduce the duty of candour for those operating across public services such as policing, health, social care and housing. A duty of candour would place a legal requirement on organisations to approach public scrutiny—including inquiries and inquests into state-related deaths—in a candid and transparent manner. The duty would enable public servants and others delivering state services to carry out their roles diligently, while empowering them to flag dangerous practices that risk lives.

By requiring openness and transparency, a statutory duty of candour would assist in creating a culture of change in how state bodies approach inquests and inquiries. It would give confidence to those individual members of an organisation who want to fully assist proceedings, inquiries and investigations but who may experience pressure from their colleagues not to do so. A statutory duty of candour would compel co-operation with proceedings, inquiries and investigations, thereby dismantling the culture of colleague protection in, for example, the police service.

The NHS currently has a duty of candour whereby there is no liability for breaches. The need for sanctions on a duty of candour was recently evidenced by the inquiry into deaths in Essex mental health services. Before the inquiry was converted into a statutory inquiry, the then chair had said that she could not effectively do her job and that only 30% of the named staff had agreed to attend evidence sessions—a key element of the duty of candour as put forward in the amendment, which would apply to all public authorities.

A duty of candour needs to apply to all public authorities to ensure an effective end to evasive and obstructive practices following contentious deaths. State-related deaths, particularly major incidents such as the Hillsborough tragedy or the Grenfell Tower fire, commonly involve many different public agencies, from local authorities to health services. Without ensuring a duty of candour that applies to all involved in relevant investigations, institutional defensiveness and delays will continue, and the fundamental purpose of such investigations—to prevent future deaths—will continue to be undermined. The original version of the duty, put forward in the Criminal Justice Bill, applies only to police officers. Do the Government agree that it is important that this is fixed, whether in this Bill or a future criminal justice Bill?

Institutional defensiveness has been found to be a pervasive issue in inquests and public inquiries. It causes additional suffering to bereaved persons, creates undue delay to inquests and inquiries, undermines public trust and confidence in the police and undermines the fundamental purpose of inquests and inquiries—to understand what has happened and prevent recurrence. Establishing a statutory duty of candour would go some way to addressing these issues.

In her 2017 review of deaths and serious incidents in custody, Dame Elish Angiolini concluded:

“It is clear that the default position whenever there are deaths or a serious incident involving the police, tends to be one of defensiveness on the part of state bodies”.


Additionally, the chair of the statutory Anthony Grainger inquiry, His Honour Judge Teague KC, concluded that it was his

“firm view that an unduly reticent, at times secretive attitude prevailed within Greater Manchester Police’s Tactical Firearms Unit throughout the period covered by the inquiry”.

Compelling co-operation with a statutory duty of candour would enable inquests and inquiries to fulfil their function of reaching the truth to make pertinent recommendations which addressed what went wrong, and to identify learning for the future.

Failure to make full disclosure and to act with transparency can also lead to lengthy delays as the investigation or inquiry grapples with identifying and resolving issues in the dispute at a cost to public funds and public safety. A statutory duty of candour would significantly enhance the participation of bereaved people and survivors, by ensuring that a public body’s position was clear from the outset, limiting the possibility of evasiveness. I beg to move.

[The Lord Bishop of Manchester]

My Lords, I rise to speak to this amendment to which I have added my name. I declare my interest as co-chair of the national police ethics committee.

Before turning to the amendment, I follow other noble Lords by recording the deep gratitude of both myself and many in the Church for the wisdom and friendship of Lord Cormack. On behalf of both the party he served and the Church he loved, over so many decades, Patrick wonderfully embodied that concept of “critical friend” which is so vital to the functioning of all institutions. We were all better for his wisdom and friendship, and we all learned much from his challenges. He may not have been subject to a duty of candour, but that never stopped him from being very candid in expressing his views. We will miss his contributions, here and elsewhere greatly.

The former Bishop of Liverpool advocated for a duty of candour in his report on the Hillsborough disaster, The Patronising Disposition of Unaccountable Power. That title tells its story. His report was produced over six years ago; a duty of candour was finally contained in the College of Policing’s Code of Practice for Ethical Policing in the last two months, for which I and many others are deeply grateful.

The amendment would require public authorities, public servants and officials to undertake a duty of candour. By placing a general duty of this nature on a statutory footing, the participation of bereaved people and survivors in the justice system would be enhanced. Inquest describes an

“endemic culture of delay, denial and institutional defensiveness from public authorities and private corporations that bear responsibility for the health and safety of the public”.

We do not always get it right in the Church, either.

As Bishop of Manchester, it fell to me to help lead my city and diocese in their response to one of the worst terrorist incidents on UK soil in recent years. I believe that we responded well—so well that we have been able to help other cities around the world that have faced similar tragedies since. However, when it came to learning lessons—discovering what had gone less well—we found ourselves hampered by the natural reluctance of public bodies to share their failings. This is not about finding guilty parties to blame; it is about learning from the events that happen.

A duty of candour would help to move the emphasis away from reputation management in the wake of crises, towards supporting victims, their families and survivors. I was delighted to learn that we now have such a duty in the code for policing, but it seems to me that exactly the same arguments apply to the other services involved in seeking to forestall or respond to major incidents. I contend that it is not enough for just the College of Policing to introduce this duty, although that is indeed a welcome step; we need a more general duty that extends to a far wider range of public bodies.

15:30

[Baroness Brinton (LD)]

My Lords, I have signed the amendment and it is a pleasure to follow the noble Lord, Lord Ponsonby, and the right reverend Prelate the Bishop of Manchester.

The 2013 Francis report set out the failings of the Mid Staffordshire hospital trust, explaining exactly why there needed to be a duty of candour. It said:

“This was primarily caused by a serious failure on the part of a provider Trust Board. It did not listen sufficiently to its patients and staff or ensure the correction of deficiencies brought to the Trust’s attention. Above all, it failed to tackle an insidious negative culture involving a tolerance of poor standards and a disengagement from managerial and leadership responsibilities. This failure was in part the consequence of allowing a focus on reaching national access targets, achieving financial balance and seeking foundation trust status to be at the cost of delivering acceptable standards of care”.


That could apply to many of the issues that we have debated in this part of the Bill on major incidents. Regulation 20—the duty of candour brought in across the NHS in 2015—was defined as

“the volunteering of all relevant information to persons who have, or may have, been harmed by the provision of services, whether or not the information has been requested, and whether or not a complaint or a report about that provision has been made”.

I will refer to that duty of candour in today’s debate on a later amendment.

The CQC points out that we must remember that there are two types of duty of candour—the statutory and the professional—both of which

“have similar aims—to make sure that those providing care are open and transparent with the people using their services, whether or not something has gone wrong”.

The implementation of the duty of candour covering the NHS applies to all healthcare providers, registered medical practitioners, nurses and other registered health professionals where there is a “belief or suspicion” that any treatment or care provided by them or their trust

“has caused death or serious injury”.

It is important for the NHS that it is for people who are registered, as it is with the police. If we ask to broaden it, and we do, we need to think carefully about who it should cover, because these people must be accountable—probably through registration.

Although it is a decade since the duty of candour was introduced, serious incidents, including death and injury, have continued in the NHS. Responsible hospital trusts and providers, as well as the individual regulated healthcare professionals, all know that they will be held accountable to this standard. As was described by the two previous speakers, it is a no-fault system which overcomes the old problem that saying sorry implies legal responsibility. It sets out a standard for declaring that there is a problem as soon as someone—anyone—is aware, and, where used correctly, it reduces the agony of victims and their families facing the block of institutional silence. Where it is not used, the CQC will inspect and consider why.

I support the proposal from the noble Lord, Lord Ponsonby, that the duty of candour should cover public authorities, public servants and officials at major incidents, and they should follow it. Just think if the NHS had used the duty of candour for victims and families of the infected blood scandal, or if the police had used it in relation to Hillsborough instead of blaming the fans, or if it had been used by the council and other bodies involved in the fire at Grenfell Tower. However, just as importantly, the duty of candour changes organisations so that, where possible, they think before the event, which can also prevent major incidents. Staff put the safety of people first in all that they do. It will not prevent all major incidents, but it can either reduce or stop the consequences of a potential disaster and make the aftermath much easier to live with.

[The Parliamentary Under-Secretary of State, Ministry of Justice (Lord Bellamy) (Con)]

My Lords, I thank the noble Lord, Lord Ponsonby, and all noble Lords who have spoken to this amendment, which would place a statutory duty of candour on all public authorities, public servants and officials in relation to a major incident. This is, if I may say so, a modified version of the Public Authority (Accountability) Bill that was previously put forward, which is known as the Hillsborough law, so the underlying question here is: should we have in statute, in one form or another, a Hillsborough law?

There is much common ground between us. At no point are transparency and candour more important than in the aftermath of a major incident. As the Government said in their Statement of 6 December in response to Bishop James’s 2017 report, it is of the highest importance to combat

“unforgivable forms of institutional obstruction and obfuscation”

and the “inexcusable … defensiveness” of public bodies in “their own self-interest”. We agree with Bishop James, and indeed with the speakers today, that what is needed is a change of culture. The question is: what is the best and most effective route to bring about that change?

In essence, for the reasons already set out in the Government’s Hillsborough Statement on 6 December and the debate that day in your Lordships’ House, the Government do not believe that this amendment, applying to officials across the whole public sector, would be an appropriate or effective way to prevent a repeat of the failings that occurred in the aftermath of Hillsborough. First, as a general point, a central feature of a case such as Hillsborough, and other similar cases, is the imbalance of power between the authorities on the one hand and the bereaved on the other. The creation of the independent public advocate for a major incident—who will no doubt pursue the victims’ interests with terrier-like determination, I hope—will go a long way towards rebalancing that previous imbalance of power and securing equality of arms. I suggest that the institution of the IPA is in itself a lasting tribute to the Hillsborough families who have campaigned to ensure that no other families ever have to suffer in the same way.

In addition, still on the equality of arms point, the Government have removed the legal aid means test for exceptional case funding for inquests and will consult on expanding legal aid for inquests where an IPA is appointed or terrorist offences are involved. Cabinet Office guidance will reaffirm the expectation that legal expenditure by public authorities should not be excessive and should be published. Again, those matters should go a long way towards rebalancing the position between the various parties.

The second point, which I think the right reverend prelate the Bishop of Manchester was, in a sense, already making, is that the Government have already tackled directly the central failure in the aftermath of Hillsborough, which was a failure by the police. As noble Lords will be aware, in 2020 the Government introduced a statutory duty of co-operation for individual police officers to ensure that they participate openly and professionally with investigations, inquiries and other formal proceedings. A failure to co-operate is a breach of the standards of professional behaviour and could result in disciplinary sanctions, including dismissal.

In the Criminal Justice Bill that was introduced in November 2023, which I hope will be before your Lordships’ House before too long, the Government are placing a statutory duty on the College of Policing to issue a code of practice relating to ethical policing. In advance of that, as has been mentioned, the Code of Practice for Ethical Policing, was laid in Parliament on 6 December under existing powers alongside the Government’s response to Bishop James’s report. That code, directed at chief constables, includes a duty to ensure candour and openness in the forces that they lead, to ensure that everyone in policing is clear what is expected of them and to provide confidence to the public that the highest standards will be met. That will be monitored, and chief constables will be monitored, by His Majesty’s Inspectorate of Constabulary and Fire & Rescue Services and by local police and crime commissioners.

A further area of concern, which the noble Baroness, Lady Brinton, referred to, relates to the NHS. One notes the Francis report of some years ago, and there are continuing concerns, for example, around events at the Countess of Chester Hospital that are the subject of a statutory inquiry by Lady Justice Thirlwall. There is already a duty of candour on the NHS under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 that covers everybody who is registered with the Care Quality Commission. The Government are reviewing that provision to see whether it is working properly. There may be details to discuss around exactly who it should cover and collaboration with the General Medical Council and the Nursing and Midwifery Council to ensure that the professional standards march in line with the statutory standards—that may be a matter for investigation—but, in principle, in the NHS, those duties already exist.

The same is also true, in effect, for statutory inquiries under the Inquiries Act 2005, backed by criminal penalties. It refers to court proceedings, where full disclosure is required of all litigants under well-established principles, and a duty of candour is expected by public authorities, notably in judicial review. For inquests, coroners have powers under the Coroners and Justice Act 2009 to obtain documents, administer oaths and question witnesses. There is a Ministry of Justice protocol that was specifically revised following Bishop James’s report, which requires government departments and lawyers to approach inquests with openness, honesty and full disclosure. A range of matters is already covered, so that leaves non-statutory inquiries, which the chairperson can request are converted into statutory inquiries in the event of obfuscation or non-cooperation. The Government feel that, in effect, the ground is already sufficiently covered in a very targeted way.

As for public servants working in central government, the Government have already reaffirmed their commitment to ensuring openness and transparency, as set out by my right honourable friend the Deputy Prime Minister when signing the Hillsborough Charter on 6 December 2023. The commitments in the charter are reflected in the existing framework of obligations and codes that apply to all those who work in government, such as the Civil Service Code, the Code of Conduct for Special Advisers and the Ministerial Code, to which we can add that public appointees to the boards of UK public bodies are subject to the Code of Conduct for Board Members of Public Bodies, which, in turn, incorporates the Nolan principles. Those matters, in the Government’s view, reveal a quite comprehensive coverage of the issue that we are discussing.

The Government also consider that the amendment in its present form would be practically unworkable, applying as it does directly to all public officials who may be involved in the context of a major incident. It would apparently require maybe dozens of officials, junior as well as senior, to come to individual and autonomous views on whether, for example, a particular document was in scope, or irrelevant, or privileged or covered by national security or whatever. That could easily give rise to many difficult and conflicting views, making the whole process almost impossible to manage and drawing civil servants into conflict with each other and their employers.

For those essential reasons, the Government do not feel that this is an appropriate way forward. The speakers in this debate did not raise the Post Office, which in some ways colours a lot of the background to this. On that point, I can say that the proposed legislation on the Post Office is clearly being driven by some very serious incidents of prosecutorial misconduct in breach of existing rules. We do not need new rules; they did not follow the old rules.

15:45

[Baroness Brinton (LD)]

It is good to see the Minister back in his place; we are pleased to have him back and I am very grateful for his comments. He mentioned the Post Office. I spoke about the importance of culture and making sure that things do not happen. While he is absolutely right on the legal side, there is an issue about the personal duty of candour that changes behaviour. Does he recognise that?

[Lord Bellamy (Con)]

Yes, the Government recognise that up to a point. What we are discussing is the right way to get there. The Government are not convinced that this statutory amendment is the right way, but there are other ways of doing it, through our codes and the provisions that we have for the NHS, the police and now the Hillsborough charter—the matters that have been mentioned.

I cannot go into specific detail on the Post Office, because we do not know what has happened, but the duty on a prosecutor to follow the codes that they must follow is a duty on that individual. I will not go any further than to make that comment.

Finally, in the spring, the Government hope to publish their response to a report by the Law Commission on reforming the common-law criminal offence of misconduct in a public office. We have to await that response to see whether it bears on the issues that we are discussing. With those points made, the Government recognise the sensitivity of and differing views on this matter. The Lord Chancellor’s Oral Statement on 6 December said, very explicitly, that we will keep it under review. While legislation alone and the Government’s view cannot ensure a culture of openness, honesty and candour, we do not rule out bringing forward legislation at some future point if we are persuaded that it is needed. The matter is still under reflection, from that point of view.

[Lord Ponsonby of Shulbrede (Lab)]

I thank all noble Lords who have spoken in this short debate. The noble Baroness, Lady Brinton, summed it up, really: while this is a probing amendment, it is about changing the culture and behaviour of organisations. I was talking to my noble friend Lady Thornton during this debate. She sits on an NHS trust and was saying that a culture is embedded in the way that the NHS practises its procedures now, which has come from it having a duty of candour for the last 10 or 11 years. The Minister made other points about addressing the same issues, so it is not as though one set of responses precludes another, such as the duty of candour.

Of course, I am pleased that the Lord Chancellor has said that he will keep an open mind on this and keep the matter under review. I acknowledge the Minister’s points about creating the independent advocate role, the review of legal aid and individual professional standards, which are being looked at, but none of them precludes also having a duty of candour. That was the point made by all who spoke in support of the amendment. Nevertheless, I thank the Minister for his response and beg leave to withdraw Amendment 133.

Amendment 133 withdrawn.

Clause 39 agreed.

Amendment 133ZA not moved.

Clause 40: Compensation for victims of the infected blood scandal

Amendment 133A

Moved by

[Lord Ponsonby of Shulbrede]

133A: Clause 40, page 37, line 15, after “must,” insert “on behalf of the United Kingdom Government,”

[Lord Ponsonby of Shulbrede (Lab)]

My Lords, I too have signed Amendment 133A, which is a probing amendment and states that the Secretary of State will be acting on behalf of the United Kingdom Government when they establish the body to administer the compensation scheme for victims of the infected blood scandal.

Amendment 133B stipulates that payments made under Clause 40 must be fully funded by the Treasury. In anticipation of the noble Baroness, Lady Brinton, Amendment 134 is intended to probe how and when compensation payments will be made to victims of the infected blood scandal.

I acknowledge the letter that the noble Earl, Lord Howe, sent to us—and the constructive meetings we have had—advising that there may be future amendments coming forward on Report. For now, I beg to move.

[Baroness Brinton (LD)]

My Lords, I start by recognising that one of the people who wanted to speak to this amendment is not in his place. The noble Lord, Lord Cormack, told me he was going to speak, and his death over the weekend leaves a large gap, not just in Parliament but for the victims of the infected blood scandal and their families, whom he supported.

He said in the Commons on 13 November 1989:

“No one can give back to these victims the hope of a normal life that was once theirs. No one can remove the uncertainty with which they and their families live from day to day—the uncertainty of when the bell will toll. If any group of people live in the shadow of death, they do. It is no wonder that their story has been described as the most tragic in the history of the NHS ... I hope that we shall have a full and good answer from the Minister, but whatever he says, unless he agrees to our request, the campaign will go on and we shall not go away.”—[Official Report, Commons, 13/11/89; cols. 153-55.]


Patrick, we shall go on. May you rest in peace.

I thank the noble Earl, Lord Howe, for his letter, and for the meeting we had to discuss this amendment and Clause 40. I hope he will have better news for your Lordships’ House today. It is a pleasure to follow the noble Lord, Lord Ponsonby, on Amendments 133A and 133B, tabled by the noble Lord, Lord Wigley, which talk about payments for the infected blood scheme being arranged on behalf of the UK Government and paid from the UK Treasury. It is right—this scandal has been going on for approaching 50 years, since long before devolution, and therefore it is inappropriate for Scotland and Wales to have to foot the bill for something that is clearly the responsibility of the UK Government.

Clause 40 of the Bill was an amendment laid by Dame Diana Johnson MP in the Commons and it won cross-party support in a vote. It requires the Government to establish a body to administer the compensation scheme for victims of the infected blood scandal. The clause is the original wording of the Infected Blood Inquiry’s second interim report, recommendation 13, and incorporates recommendations 3 and 4.

My probing Amendment 134 was also laid in the Commons, but, unfortunately, there was no time to debate it. It would ensure that an interim compensation payment of £100,000 is made in respect of deaths not yet recognised—specifically ensuring that, where an infected victim died, either as a child or as an adult without a partner or child, their bereaved parents would receive the compensation payment. Where an infected victim has died and there is no bereaved partner but there is a bereaved child or children, including adopted children, the compensation should be paid to the bereaved child or children, split equally. Where an infected victim has died and there is no bereaved partner, child or parent, but there is a bereaved sibling or siblings, they should receive the compensation payment.

It should be noted that the wording is the original wording of recommendation 12 of the Infected Blood Inquiry’s second interim report. It is also very helpful that both the Welsh and Scottish Governments have written to the UK Government to support the compensation in advance of the inquiry reporting in May. On 18 December last year, the Paymaster General, John Glen, made a statement raising expectations, but unfortunately provided no information on when a compensation body would be established, let alone when interim payments in respect of unrecognised deaths might be made.

Both Clause 40 and this amendment are only the latest attempts to move government—not just this Government but many Governments of differing political parties—into sorting out and paying the compensation that is due to these groups of people, whose lives over the last four decades have been severely affected or destroyed by acts of the NHS, and therefore also by the Government, which used infected blood to treat haemophiliac patients through factor 8, as well as for those receiving whole blood transfusions.

The numbers are grim. Just under 5,000 people with haemophilia and other bleeding disorders were infected with HIV and hepatitis through the use of contaminated clotting factors. Some unknowingly infected their partners. Since then, 3,000 have died. Of the 1,243 infected with HIV, fewer than 250 are still alive. Many thousands who had full blood transfusions in the 1980s and 1990s were infected with hepatitis. Some people may not even know that they were infected as the result of a transfusion.

I thank all the victims and family members who have written to me. I cannot do them and all the different campaigning groups justice in the short time today. They have been victimised time and again by the NHS and by Governments fighting them and all other victims over the years—sometimes, I am afraid, with lies and prevarication. I pay particular tribute to two indomitable women who are still campaigning after 30-plus years. Colette Wintle and Carol Grayson were part of a small group that in 2007 sued four pharma companies—Bayer, Baxter, Alpha and Armour—in the US, who had used contaminated blood from prisoners to make factor 8, which the NHS bought and used without any warning to patients and their families. The American judge acknowledged that the pharma companies had used infected blood but disallowed the case on a technicality, saying that the duty of care for patients in the UK lay with the NHS and therefore the UK Government. But the Government did nothing.

An independent and privately funded Archer inquiry, which reported in 2009, was followed by Theresa May setting up the full public inquiry, chaired by Sir Brian Langstaff. He has issued two interim reports, with the final report due in May this year. In the middle of all of that, Sir Robert Francis also completed a report on the structure of compensation, which was published in March 2022, with which Sir Brian agrees and which he has built into the recommendations of his second interim report. That report, published last year, is an extraordinary read. No Minister or official can ignore the clear language and recommendations, evidenced by witnesses to the inquiry, that show decades of government and NHS wilfully ignoring their responsibilities and lying to victims and their families.

The Government have also recently announced that Sir Jonathan Montgomery, as the chair of the group of clinical, legal and social care experts, will give the Government “technical advice on compensation”. Unfortunately, this has not helped their relationship with the victims. First, there is concern that this group will also slow down any process of compensation, and secondly, the chair, Sir Jonathan Montgomery, a well-respected ethicist, has links with Bayer, one of the four pharma companies that sold infected blood to the NHS.

Disappointingly, Ministers have recently said in Oral Questions that they will not start until the Government have considered Sir Brian’s final report. We know that it usually takes at least six months for the Government to formally respond to an inquiry report when it is published, so can the Minister tell us whether they will now change this and move swiftly to make the compensation happen, as Sir Brian recommends?

16:00

I want to end with the voice of these victims. It is too easy to talk about the history of the scandal without understanding the reality of their lives. Sir Brian’s inquiry heard Jason Evans’s experience, who was four when his father died from HIV. He said,

“it just marked every aspect of life. And, you know, I’ve now lived my dad’s entire lifespan and I’m sat here. So it’s blanketed my entire existence”.

When asked whether he had ever been offered counselling or psychological support, he said:

“No, never. And I think the thing that is particularly despicable to me is, okay, now I’m 31. But as a child … a four, five, six year old kid, how did I not have bereavement counselling? How was it never offered?”

Lauren Palmer e-mailed me. She says:

“Growing up I was a little sister to two older half-brothers in what seemed like a relatively normal family. Unknown to us, my father was co-infected with HIV and Hepatitis C via his Factor 8 … but my father had also regrettably infected my mother.

In 1993, when I was just 9 years old, both my father and mother passed away from their infections, within 8 days of each other … I was heartbreakingly separated from my two brothers … and my life and my family were completely torn apart …

It emotionally destroys me on a daily basis that both my parents’ lives have not yet been recognised when others (rightly) have. The children and parents of victims are having to fight tirelessly, for decades to be discarded with countless ‘empty promises’ of responses from the government, which have no course for action, it is degrading and greatly disrespectful!”.

Colette Wintle and Carol Grayson also had to face years of illness and the deaths of their husbands. One reported that they were not told that one of the family victims had died. His mother was not permitted by the hospital to stroke his head. Years later, they found out that was because his brain and body parts had been removed, without seeking permission from the family. His brain was finally buried, with his brother, also infected, when he too died as a result of receiving factor 8.

Colette and Carol, along with thousands of other victims, have been lied to, pushed away and denied justice by officials. This is also coming out in the inquiry. No wonder Sir Brian is urging the Government to ensure that they start right now with expanding the scheme to include affected persons, implementing interim payments and moving as fast as possible to a full settlement.

The noble Lord, Lord Waldegrave, had hoped to be able speak today. Like Lord Cormack, he had acted on this in the Commons, and I know he has told the Minister that the Government must follow Sir Brian to the letter or face immense disappointment and dismay.

This Government say they are doing everything at pace for the Post Office Horizon scheme, with most settlements paid in full by August or as soon as possible thereafter. The victims of the infected blood scandal deserve no less.

[Baroness Featherstone (LD)]

My Lords, I apologise for not having been in the Chamber at Second Reading.

Thousands of people have died because of Governments’ and officials’ lies and obfuscation about the contaminated blood scandal. This Government, and every Government for the past 40 years, should be ashamed. Perhaps this Government should be more ashamed than all because, when we finally got the long campaigned for and long literally begged for public inquiry—I praise Theresa May for initiating that inquiry—the chair, Sir Brian, said in terms what the compensation should be and that it should be paid swiftly. Unbelievably, the Government are still prevaricating. I hope they are not hoping to limp on to the next election. We need to do better to stop obfuscation and delay, and make the amends that can be made, although nothing will ever make up for what has happened. My noble friend Lady Brinton’s speech was extraordinary and laid this out far better than I can. We can never bring back the 3,000 who have died and those who are dying every single day while this is delayed, nor undo the suffering experienced by this 40-year agonising wait for justice.

I declare an interest. My nephew Nicholas Hirsch, one of my sister’s twin boys, was a haemophiliac and contracted hepatitis C. He died aged 35, leaving a 10 month-old baby daughter. Every family that has lost a loved one is in the same position. Those who are still living need to live to see justice, and the families of those who have died need to see justice. The time being taken is obscene, inordinate and cruel. The rubbish being pumped out by the Government about waiting for the final bit of the inquiry is intolerable. Sir Brian, the brilliant chair of the inquiry, has made it crystal clear that there is no need and no time to wait. Quite frankly, we should not need a TV series and public outrage to be the motivation for the Government to do the right thing.

I have been trying over the years to get redress on the issue. I remember going with Lynne Kelly, head of Haemophilia Wales, to meet Chris Wormald, Permanent Secretary at the Department of Health, to show him the proof of obfuscation and lies. He lied to us there and then, and then he lied in writing—a lie for which he later apologised in writing, and which I submitted in evidence to the inquiry. It was shameful how many lies were told by officials to victims, as well as to the parents and families of those who were contaminated. The very least the Government can do is to act, right now, before any more victims die.

Before I sit down, I want to pay tribute to all the campaigners, fighters and families who have sought justice. In particular, I thank the Labour MP Dame Diana Johnson, who has been chair of the APPG and fought so hard on this, as well as Jason Evans from the campaign organisation Factor 8.

It is important to be clear beyond doubt and lay responsibility where it lies: at the Government’s door. These amendments make it clear that the Government are responsible for fully funding payments, that they should set up the body that will administrate this on their behalf, and that they must put on the record how and when this will happen, and stop prevaricating that they need to wait for the final report. For decency, for honour and for compassion, I ask the Government to please do the right thing and do it now.

[Baroness Campbell of Surbiton (CB)]

My Lords, before I begin, I too pay tribute to the late Lord Cormack. He was a consummate parliamentarian, but he was also my friend, and he taught me so much when I arrived in the House. Equally, he gave terrific support on disability issues; on every occasion, he was very supportive.

I support Amendment 134, in the name of the noble Baroness, Lady Brinton. I declare an interest, as my first husband, Graham, had haemophilia and received infected blood products. As a result, he contracted both hepatitis C and HIV. We learned of this only after we had become engaged. Graham died 30 years ago, on 19 December 1993, aged 32. We had been married for only six years.

I apologise that my health prevented me speaking at Second Reading. As I was directly affected by the infected blood scandal and gave evidence to the inquiry, I hope your Lordships will forgive this late intervention.

The noble Baroness, Lady Brinton, addresses a matter of profound importance to the thousands of us infected or affected by the shameful events that devastated the lives of so many. Your Lordships will remember that, in July 2017, Prime Minister Theresa May ordered a fully funded independent inquiry into how contaminated blood transfusions infected thousands of people with hepatitis C and HIV. She also allocated £75 million to be available for interim payments to victims still living and bereaved families. Yet only two months ago, some seven years on, the distinguished chair of the inquiry, Sir Brian Langstaff, expressed his frustration with delays in setting up a compensation scheme. He said:

“The Inquiry’s final recommendations on compensation were published in April 2023. My principal recommendation remains that a compensation scheme should be set up with urgency”.


The Government accept the “moral case for compensation”, but these words are meaningless if actioning the inquiry’s recommendations is further delayed.

It was in 1987 that Graham, then my fiancé, and his younger brother Anthony were first told that they had HIV from factor 8 clotting agents. Anthony was first to die, leaving a widow and a one year-old daughter. Graham endured five years of misery, a barrage of associated illnesses, including pneumocystis pneumonia, epilepsy and intermittent blindness. He died 18 months after his brother. It must have been unbearable for him to watch what he knew was in store for him, but his courage took my breath away.

I count myself lucky. I eventually found a way to move on, enough to lead a good, purposeful life after Graham died, but the memory and the flashbacks do not fade. Thousands of other affected families have not been as fortunate, with the personal cost of the past ever present and haunting. Many wives of infected men lost their childbearing years. Parents and countless partners gave up jobs to care for loved ones at a time when HIV/AIDS was stigmatising and isolating. There have been over 3,000 deaths to date, with an average of one more every four days.

The Government have rightly accepted more responsibility for their part in the tragedy, but they have procrastinated in establishing a compensation scheme. Not content with the guidance given by Sir Robert Francis, who was specifically appointed to make recommendations for compensation, the Cabinet Office has now appointed Sir Jonathan Montgomery to chair a group of experts to decide who gets what. Not surprisingly, the infected blood community is concerned, given Sir Jonathan’s past links with two bodies implicated in the scandal, and unhappy about yet a further delay.

According to the chair of the Haemophilia Society,

“it has caused huge anger and upset in the community. We certainly haven’t been consulted and neither have any other members of the community as far as I am aware. This is now the third knight to be asked for his opinion on it. First, Sir Robert Francis. Then Sir Brian made his recommendations in his interim report. They are now asking for a third time. It feels like they want to keep asking the same questions until they get an answer they like”.

I hope the Minister will tell us how this latest “body of experts” on compensation will involve members of the infected blood community, whose lived experience makes them experts too. The need for such involvement is a consistent theme of Sir Robert’s report if trust is to be restored. So, in the spirit of transparency, will the Minister let your Lordships have sight of the membership and terms of reference of this new expert group? Can he also give an approximate timeline of when compensation will be paid? As the Government insist on waiting for the final inquiry report to be published on 20 May, will the Minister at least assure this House then that a compensation scheme will be ready to go live afterwards?

Every year, on the anniversary of my late husband’s death, I visit St Botolph’s church in the City of London. It has a remembrance book with the names of hundreds of haemophiliacs who have died from infected blood products. Each year, I see pages of new entries. Surely this example alone should galvanise the Government into compensating those still living as soon as humanly possible. Each delay means countless more deaths without the comfort of knowing that justice has been served for the infected victims, and their affected partners and children.

[Baroness Meacher (CB)]

My Lords, I express my strongest possible support for all the amendments in this group. I congratulate the noble Baronesses, Lady Brinton and Lady Campbell, on their powerful speeches. As president of the Haemophilia Society for many years, I have met many of the victims infected in this appalling blood scandal. Many have died before any compensation was paid to them at all. Many others soldier on with the support of their families.

We have all been moved by the Post Office scandal, but in my view far too little has been heard of the very different but equally devastating suffering of the people given infected blood, many of whom were already suffering from a serious condition. As we know, their health-wise suffering was different from that of the Post Office staff. The great thing about these amendments is that they provide clear deadlines and clear government responsibilities.

16:15

Amendment 134 provides for the £100,000 interim compensation payment to be made to the nearest relatives of victims

“within one month of the passing of this Act”,

in line with Sir Brian Langstaff’s report—no ifs, no buts. That is what these people need; they have waited too long. Amendment 133A would ensure that the body to administer the full and final compensation scheme will be established on behalf of government and be fully funded by the Treasury. All at the Haemophilia Society will be monitoring the progress of that body, to make sure that it sticks to its brief.

We are talking about contaminated blood imported from the US as early as the 1970s, often having been taken from prisoners with HIV and hepatitis C. It was not checked, yet it was given to innocent sufferers—people already suffering with conditions, as I have said. This was some 50 years ago, yet we are still talking about compensation for the widows and children of these victims. I am sure that we will return to these issues on Report and I really implore the Government, as well as the House, to support the tenor of these amendments.

[Lord Bichard (CB)]

My Lords, I too speak in support of Amendment 134. I have to apologise, for I am afraid I was unable to attend Second Reading. I speak on this amendment as someone who has spent a good deal of time in the last couple of years chairing one of the expert advisory groups for the infected blood inquiry, looking at public health and administration. As a result, like some other Members of this House, I spent a day at the inquiry giving evidence. That day made a huge impression on me, as I know it will have done on others. It made a huge impression not least because there was an audience of dozens of victims, who had suffered grievously for years and decades. They have shown immense courage, determination and resilience in the face of what the chair, Sir Brian Langstaff, has rightly said were serious failings over decades that

“led to catastrophic loss of life and compounded suffering”.

As chairman of an expert advisory group, it was not for me to draw those wide conclusions but I was able to see from the evidence—and draw my own conclusions—that during that period there had been multiple breaches of the Nolan principles and the conventions that preceded them, and multiple breaches, I am sad to say, of the Civil Service Code. In other words, the state let these people down time and again, and the state should now provide restitution without any further delay.

There is one other reason why I am supporting this amendment: because I feel that not to do so would make me complicit in what now seems to be the way in which the state, in all its forms, responds to failings such as this. We delay accepting responsibility for as long as we can. We defend the indefensible. We place the reputation and interests of institutions and the system above the interests of the people who have been harmed. We set up inquiries, which inevitably delay action. I am not in any way criticising the way in which Sir Brian has led the infected blood inquiry; it has been exemplary, and he has done a fantastic job. We then design unnecessarily complex systems for claiming compensation. We do not do this once; we do all that time and again. It happened with Windrush, Grenfell, the Post Office and, probably most heinously of all, the infected blood inquiry.

We have reached a stage where these responses themselves are a breach of the Nolan principles of public life. Let me remind the Committee that these principles include integrity, accountability, openness and leadership. This amendment seeks to change the responses and rebuild the public’s trust in the way in which we govern. It needs to be done quickly, because the inquiry report will come out in May, and it will receive phenomenal attention. It will either further undermine the public’s faith in government or, if we take this action now, perhaps people will believe that we are changing things through action and not through words.

[Lord Owen (Ind SD)]

My Lords, 1975 was a long time ago. I am getting on in age now, and I wondered if I would ever see the day when the decision I announced to the House of Commons with money attached—that we would go for self-sufficiency in blood products—would be honoured, at least in a way so that some of the relatives of the many people whose lives have been lost would feel some sense of satisfaction. I could make a very long speech on all those who have fought this fight with honour, dignity and integrity. They belong to all political parties; it very soon became a cross-party campaign.

I also want to make a few things clear. We knew about this earlier than 1975. A very remarkable book, The Gift Relationship by Professor Titmuss, identified the problem of the blood coming into our country from places in which there were absolutely no safeguards and very few questions you could ask about somebody’s past health. At that time, we had no way of finding out whether blood was infected with hepatitis, for example. We had to ask a simple question as a method of trying to find out whether a blood donor was suitable: we would ask if they had ever been yellow—ie, had their liver ever been affected so that they were jaundiced and, as likely as not, had been infected with hepatitis. It was as crude as that.

I want to make it clear that, through the years in which blood products which doctors knew might be infected were being used, they had an agonising choice. They had to explain the risks to the patients. Sometimes there were children who were not able to understand it, so the issue was put to the parents, who had to juggle these very difficult and complex medical facts. The paediatricians and haematologists had to do their best to explain the risks to them, without really knowing.

When I first began to look at this question, I wondered whether we could get away with having a complete ban on blood products. It soon became clear that, if we did that, we would not be able to give blood products that might well not be contaminated to a very substantial number of patients. Let us remember what the situation is. Eventually, we got a product that parents could inject at home. That meant that, if a child had fallen and was bound to bleed into their knee, arm or elsewhere, they could give the injection straightaway and the child would likely not suffer any serious damage—but that was actually one of the worst products to give. These choices were being made against this background of a lack of knowledge—but nothing explains the refusal of successive Governments to pay compensation to those affected. Nothing explains the delay, which meant that, when AIDS came, we still had no blood of our own—we were not self-sufficient with blood very likely not to be contaminated, although even then we could not be absolutely sure that it would not be contaminated.

What I would have said would have been much stronger, more vehement and angrier if not for the circulation of a letter from the noble Earl, Lord Howe, to us about this debate. I have known him in many different guises, and I know him to be a man of honour. Frankly, when I read this letter, I do not need any more assurances that there will not be any unnecessary delays. I believe his words are carefully chosen, and I think he understands, like many people from his own party and people who have been responsible for healthcare, that there can be no more ducking and weaving, and no more appeals from the Chancellor to delay it for another year or anything like that. This time, we have to honour it—and we have to do it this year.

The report will be available on 20 May, and everybody will be able to read it. Judging by the day’s evidence I gave, I think that it will be a searching and honourable report. Given the device in the House of Commons of attaching it to the Bill—of course this was a device—and now given the Government responding to this device by trying not to dismiss it but to make it more precise and effective, that battle seems to be over. We can be sure that this year—in a matter of months—payments will be made. I hope that can be made clear from the Front Bench. Nobody comes out of this with a lot of distinction, but I only say: let us read the report. I suspect a lot of people will feel very ashamed.

[Lord Horam (Con)]

My Lords, the Committee listened with great interest to the remarks of the noble Lord, Lord Owen, and the honourable part he played in this tragic situation. I was a Minister of Health much later, between 1995 and 1997, and I had to struggle with problems with the Treasury and getting reasonable compensation for the victims—the infected and the affected—as he said. I thank the noble Baroness, Lady Brinton, for raising this issue today so that we could have a debate of this kind. It is necessary, and we should keep pressing.

I was appalled by the Statement by John Glen before Christmas in the other place. It was one of the emptiest Statements I have heard from a Minister in that situation. It was as though the Government were just going through the motions of giving a Statement because they had committed themselves to doing so, without having anything at all to say, which is extremely disappointing. I was grateful to my noble friend Lord Howe for having much more sensible and positive things to say in his letters so far. We hope he can follow those up.

16:30

The noble Lord, Lord Bichard, put his finger on something very important: namely, the way we handle all these sorts of problems, not only the tragedy of this particular case, and the length of time taken by these inquiries. This inquiry was actioned in 2017 and started in 2018, so it has been going for over six years—we won the Second World War in less time—and we still do not have an end date, although we hope it will be this May. The Swedes took one year to do a Covid inquiry; we will take God knows how many years on ours. How long are we taking on Grenfell? How long did we take on Chilcot? It is ridiculous that we take so long on these things. The Government should pay attention to how we handle their length and complexity. At maximum, we should take two years to deal with these issues. That is long enough to come to some clear conclusions and get positive evidence. I hope the Government will take that into account as well as all the other important issues raised by the noble Baroness, Lady Brinton, and the noble Lord, Lord Owen.

[Baroness Altmann (Con)]

My Lords, I apologise to the Committee that I was not available to speak at Second Reading. I had not intended to speak and will not delay the Committee long, but I add my plea to my noble friend the Minister that this is finally resolved. The speech from the noble Baroness, Lady Brinton, and the examples given by the noble Baronesses, Lady Featherstone and Lady Campbell, should speak for themselves. As a tribute to Lord Cormack, who campaigned on this issue for so many years, it would be fitting if my noble friend could give us concrete reassurance from the Front Bench that this injustice will, finally, be properly remedied.

[Lord Marks of Henley-on-Thames (LD)]

My Lords, this group of probing amendments, which have the aim of ensuring decent and necessary payments to all those bereaved in this disastrous scandal, has given the Committee the chance to consider the appalling plight of the victims of the infected blood scandal.

We welcome Clause 40, in particular Clause 40(3)(a), which says that:

“In exercising its functions, the body must … have regard to the need of applicants for speed of provision, simplicity of process, accessibility, involvement, proactive support, fairness and efficiency”.


It is only to be hoped that the Government live up to the promise of that clause in future, because they have signally failed to do so in the past.

If this Bill has taught us anything, it is that all victims of crime, major incidents and appalling and deeply shocking medical errors such as this, as well as other administrative disasters such as the Post Office Horizon scandal, have so many needs that resemble each other. We need early admissions of responsibility and culpability. We need government and administrative bodies to face facts. We need to ensure that victims have early access to the services and support they need and that such services and support are in practice provided in full and in good time.

Of course, one of the tragic aspects of this scandal is that the need for speed is particularly severe. It is worth reminding ourselves that, since Sir Brian Langstaff’s interim report of April 2023, more than 70 victims have died. The noble Lord, Lord Bichard, gave evidence to that inquiry, as did the noble Lord, Lord Owen. Both spoke eloquently of its conduct, and it is worth remembering the conclusion of the noble Lord, Lord Bichard, that the state let people down and should accept responsibility. He spoke of defending the indefensible, and the noble Lord, Lord Horam, echoed his words. Delaying compensation is denying responsibility. As all noble Lords who have spoken have said, there is no reason at all to wait any longer—certainly not until the Government have digested at length the contents of Sir Brian’s final report. Any such delay would be a travesty of Sir Brian’s principal call, which was for urgency.

Sir Robert Francis’s recommendations, in his report in June 2022, on the way that compensation should be handled, along with Sir Brian’s report, now need urgent implementation. It is to be hoped that the work of the expert panel—established under the chairmanship of Jonathan Montgomery, who is the chair of Oxford University Hospitals NHS Trust, which was not a mile away from involvement in the crisis—does not delay or water down the recommendations of the two reports. It is right to say that the campaigners are deeply concerned, as the noble Baroness, Lady Campbell, stressed.

In opening the debate, my noble friend Lady Brinton and the noble Lord, Lord Owen, pointed out the strength and determination of this very long campaign. We mourn Lord Cormack, whose involvement in the campaign was also extensive and long lasting.

The noble Lord, Lord Owen, spoke of the difficulties facing doctors, and the lack of political will needed to ensure self-sufficiency in blood products in this country. We can only hope that the noble Lord’s optimism in expecting the Government now to react quickly and finally, following the report due in May from Sir Brian Langstaff, is justified. My noble friend Lady Featherstone and the noble Baroness, Lady Campbell, added their accounts of personal tragedy, and thereby movingly added to the demand for urgency.

We know that the Horizon case led to definitive action only following ITV’s television drama. It should not be the same with the infected blood scandal, but we understand that ITV has commissioned Peter Moffat to write such a drama, so perhaps public opinion will come to the rescue once again. The burden of my speech, and the speeches of all noble Lords who have spoken today, is that this should not be necessary in a civilised and compassionate democracy.

[Earl Howe (Con)]

My Lords, in arriving, as we now have, at Part 3 of the Bill, I should like to begin by thanking all noble Lords who have spoken so powerfully and movingly on a set of events which many regard as constituting the worst disaster in the history of the National Health Service. The story of those who received infected blood as part of their NHS care and treatment is one of unimaginable suffering and terrible tragedy over more than four decades. It is a story that is still not yet over. The victims’ suffering has been made even worse by an absence of full justice for those individuals and, alongside that, a failure to reach—as far as may be possible—a sense of closure.

The official public inquiry currently under way, under the chairmanship of Sir Brian Langstaff, is the start of delivering the justice that is needed. The inquiry has been informed by the expert work of Sir Robert Francis, and Sir Brian has so far published two interim reports on his findings, with his final report due on 20 May. Meanwhile, in the other place, Clause 40—as it is now—was added to the Bill to speed up the delivery process.

The Government accept the will of Parliament that arrangements should be put in place to ensure, as far as reasonably practicable, that the victims receive justice as quickly and efficiently as possible. Therefore, my desire—and, I trust, that of all noble Lords—is to see the Bill added to the statute book as soon as is reasonably practicable. The Government are well aware that every passing season sees more suffering, death and bereavement. We are therefore eager to avoid more needless delay.

Ministers have already taken action and given a number of undertakings. First, we have promised that within 25 sitting days of Sir Brian Langstaff’s final report being published, we will make a Statement to Parliament setting out the Government’s response. The period of 25 days is not a target but a deadline. We will issue our response as soon as we possibly can.

Secondly, in response to a recommendation from Sir Brian, we have made interim payments amounting to £440 million to infected individuals or bereaved partners registered with existing infected blood support schemes.

Thirdly, in readiness for Sir Brian’s final report, we have appointed Sir Jonathan Montgomery to chair an expert group whose remit is to advise the Government on some of the legal and technical aspects of delivering compensation. I realise that some have questioned Sir Jonathan’s appointment because of his former connection with Bayer. Noble Lords may wish to note that Sir Jonathan ceased to be a member of the Bayer bioethics council on 31 October 2023. The council was an independent advisory group which had no role in the day-to-day operations of the company. It has had no executive power in the operational business of Bayer.

I emphasise that nothing in the work of the expert group is intended to cut across the conclusions of the inquiry or the advice of Sir Robert Francis—quite the opposite, actually. The expert group is there to enable Ministers to understand certain technical issues and thus enable decisions to be taken more quickly.

On the amendment passed by the House of Commons, which we are now considering, noble Lords will understand that the provisions of any Bill need to be legally coherent and should not cut across the integrity of the statute book. There are two principal defects with Clause 40: first, its coverage does not extend to the whole of the United Kingdom. The Government are clear that infected blood is a UK-wide issue. For that very reason, the infected blood inquiry was set up on a UK-wide basis. In March 2021, we announced uplifts to achieve broad financial parity across the UK’s infected blood support schemes, increasing annual payments to beneficiaries across the country as a whole. Maintaining a commitment to parity across the UK is extremely important.

We also need to agree on a set of arrangements that are workable and, above all, work for victims. It is therefore essential for the UK Government to engage with all the devolved Administrations with those aims in view. That is what we are now doing. My right honourable friend the Minister for the Cabinet Office met counterparts from the Welsh Government, Scottish Government and Northern Ireland Executive earlier this month to discuss this matter; those discussions will continue.

The second principal defect of Clause 40 is that in proposing the establishment of an arm’s-length body, as Sir Brian recommended, it does not also propose any specific functions for that body. The Government’s intention, therefore, is to bring forward an amendment on Report which will correct these two deficiencies and add further standard provisions to ensure a more complete legal framework when setting up an ALB. I plan to engage with noble Lords in advance of Report to discuss the content of the government amendment once it has been drafted.

16:45

That drafting is not yet complete. One of the main reasons for this—which I personally felt strongly about—was that we should use this Committee stage as an opportunity for a general debate on the infected blood scandal and, in advance of Report, for the Government to be made aware of the views expressed by noble Lords from around the Chamber. I hope the Committee will agree that this was a reasonable approach.

My remarks thus far, have, I hope, given some reassurance to the noble Lord, Lord Ponsonby, as regards Amendments 133A and 133B. I listened carefully to the noble Lord’s speech, and I entirely appreciate the concerns that he has raised. I have already made it clear that it is our aim is to achieve parity of treatment across the entire UK. However, in the light of what I have said, I hope the noble Lord will understand why I cannot at this stage say anything about the funding of compensation. In regard specifically to Amendment 133B, it would not be appropriate for the Bill to seek to override the existing processes that are in place to secure His Majesty’s Treasury funding. I cannot provide further reassurances at this stage, other than to say that the UK Government have accepted the moral case for compensation.

I now turn to Amendment 134, tabled by the noble Baroness, Lady Brinton. I am grateful for this amendment, which seeks to probe—as she made clear—how and when interim compensation payments will be made to affected victims of the infected blood scandal. Many noble Lords will, I am sure, share the noble Baroness’s sense of urgency—expressed equally powerfully in the other place—on the need to deliver justice swiftly to the victims of the infected blood scandal.

Victims of infected blood have suffered terribly over many years, and that distress has been compounded by the financial uncertainty that they have faced. The Government recognise the imperative of providing justice for these victims as soon as is reasonably possible, and we are well aware that many have short-term needs. Interim compensation of £100,000 to those infected, or their bereaved partners, registered with the existing infected blood support schemes was paid in October 2022 for precisely that reason.

I realise that the noble Baroness would like us to go further, faster. The need to move quickly and provide certainty is being taken very seriously. In advance of the Government’s formal response to the inquiry—which, in turn, depends on the publication of the final report—regrettably I cannot commit to specifics as regards the cohorts of those individuals identified in the amendment, or provide answers to questions around eligibility generally. I wish it were otherwise.

I cannot yet overcome a legal impediment either. The interim payments made from October 2022 have been made through the current infected blood support schemes, which are run separately in England, Wales, Scotland and Northern Ireland. The schemes can make payments only to people registered with one of them. To extend interim payments to the cohorts identified in this amendment would not be possible across the UK as a whole, because the legal powers to register, and make payments to, the new cohorts do not exist.

Indeed, the alternative to registering individuals with existing schemes is making payments through a new arm’s-length body, as defined by Clause 40. I heard the concerns around a delay and procrastination, but Sir Brian has recommended setting up an arm’s-length body. Establishing such a body is a significant undertaking for the Government; unfortunately, there are processes that cannot be expedited, including the appointment of staff, the procurement of any required IT systems and ensuring that there is proper accountability to both the Government and Parliament for expenditure of public funds. That takes a certain amount of time to achieve, with the best will in the world.

Against that background—again, I wish that matters were otherwise—I regret that I cannot commit to a timetable or comment on the scope of any further interim payments at this time. However, I come back to what I emphasised earlier: the Government’s twin priorities are certainty and speed. With those aims in mind, I assure the Committee that the government amendment on Report will have the desired effect of speeding up the implementation of our response to the inquiry’s findings. To provide further reassurance to the noble Baroness—

[Lord Marks of Henley-on-Thames (LD)]

The Minister mentioned that there will be government amendments on Report to address the deficiencies in Clause 40 that he has identified. Does he envisage having the opportunity, between now and Report, to prepare amendments to address some of the other legal impediments—for example, to widening the cohorts—that he has identified? That could accelerate clarification and speed up the process.

[Earl Howe (Con)]

I anticipate using every opportunity available to engage with noble Lords on not only what the amendments will comprise but what we intend to do thereafter. As the noble Lord will appreciate, there is a wealth of regulations in this space. I venture to say that quite a lot of the detail of the arrangements will be contained in regulations, which will be laid as soon as possible. To the extent that I can go into detail on what those regulations will contain, I shall be happy to do so, but I hope that the noble Lord will understand that I am not in a position to do so today.

[Baroness Meacher (CB)]

I apologise for interrupting the Minister. He referred to the payment of £100,000 to a lot of people in 2022, but is he aware that the whole point of Amendment 134 is to fill the gaps for all the people who did not receive an interim payment? When he referred to speeding up their response to the Langstaff inquiry, that was a verbal commitment, as I understand it. The point is that these people need an urgent payment of £100,000; as I understand it, they have not received any compensation, so it is urgent. We are talking about something that happened 50-odd years ago. The idea that we still need more time cannot be right, so I hope that the Minister can reassure us that absolutely everything will be done to get a payment of £100,000 out to the groups of people who have not yet received compensation—immediately and within a month of the passing of the future Act, as the amendment says.

[Earl Howe (Con)]

I perfectly understand the noble Baroness’s strength of feeling on this long-standing scandal. It may be of some reassurance to her if I repeat the words of my honourable friend the Minister for the Cabinet Office in the other place, who said in December:

“The victims of the infected blood scandal deserve justice and recognition. Their voice must be heard, and it is our duty to honour not only those still living and campaigning but those who have passed without recognition”.—[Official Report, Commons, 18/12/23; col. 1147.]


I met the Minister for the Cabinet Office to discuss these matters. My right honourable friend assured me that this is indeed his highest priority, and I undertake to the Committee that I will continue to work closely with him ahead of the next stage of the Bill.

I am grateful to noble Lords for their contributions to the debate and for highlighting so compellingly the issues that bear upon this appalling human tragedy. Ministers will reflect carefully on all that has been said. I hope my response has provided the noble Lord, Lord Ponsonby, and the noble Baroness, Lady Brinton, with enough by way of assurance—although I wish I could reassure them even further—about the Government’s intended course of action to enable the noble Lord to withdraw his amendment and for the other amendments in the group not to be moved when they are reached.

[Baroness Brinton (LD)]

Before the Minister sits down, I would like to ask him a couple of questions. I am grateful to my noble friend Lord Marks, who asked exactly the question I wanted to know about: what is going to happen between Committee and Report?

In other instances, it has been quite speedy to set up a shadow body—after all, the Government now know how to do it. Is there any capacity to start setting up a shadow body that will be ready to go?

We do not yet know the timetabling for the Report days, but clearly Members of the Committee are going to need to see the Government’s amendments in enough time, particularly—to pick up the point raised just now by the noble Baroness, Lady Meacher—to try to address the deficiencies if those who are not currently included remain so.

[Earl Howe (Con)]

On the noble Baroness’s latter point, I hope to have extensive discussions with noble Lords about the Government’s amendments and their intended and literal effect.

On setting up a shadow body, I myself asked that very question. There are some issues here. I am advised that it would not save any time. There are still a number of decisions to be made on the government response to infected blood, and clearly we cannot pre-empt those decisions by establishing an arm’s-length body without clarity on what its precise functions or role would be. As I have said, our intention is to table amendments on Report that will correct the defects in Clause 40 and have the desired effect of speeding up the implementation of the Government’s response to the inquiry.

However, I will take that point away to make sure that there really is no advantage in not having a shadow body. The Government have done that before in other circumstances and it is worth thoroughly exploring as an option. I think I will be told that any idea of a shadow body would need to be considered alongside its interaction with the passage of the legislation and the Government’s response to the recommendations of the second interim report, and indeed the report as a whole, but I hope the noble Baroness will be content to leave that question with me.

[Lord Ponsonby of Shulbrede (Lab)]

My Lords, this has been an important debate. In fact, I go further: it has been a historic debate, because in a relatively short debate we have had the noble Baronesses, Lady Featherstone and Lady Campbell, who spoke about very close relatives who have been affected by this tragedy; we have had the two noble Lords, Lord Bichard and Lord Owen, who gave evidence to the inquiry; and the noble Lord, Lord Owen, in his speech, went back the furthest, if I can put it like that, to 1975. There are Members who have spoken in this short debate who have tracked this issue for the many decades that it has lingered.

Nobody is questioning the best intentions of the noble Earl, Lord Howe; he has been involved in this issue in a number of ways over many years. My amendments are essentially probing amendments, and I acknowledge the letter that the noble Earl has sent to us. We will not press the amendment, but I was going to ask the same questions as the noble Lord, Lord Marks, and the noble Baroness, Lady Brinton, about process. The Government have said they will table amendments on Report, and the Minister said there will be an opportunity for noble Lords to see the amendments before then and to discuss them, but we may want to table amendments to his amendment and we will want to make sure we have ample time to do that. I know the noble Earl understands that point, but I repeat it from these Benches as well.

17:00

This has been a comprehensive discussion of the issues. The essential point is that all noble Lords want to reach a conclusion and start distributing funds as soon as practicable. It is for a sense of decency that the Government, aided by all opposition parties, must achieve this. As a number of noble Lords have said, it is the worst scandal in NHS history. It is incumbent on us all, on all sides of this House, to make sure that the matter is concluded as quickly as possible. I beg to leave to withdraw Amendment 133A.

Amendment 133A withdrawn.

Amendment 133B not moved.

Clause 40 agreed.

Amendment 134 not moved.

Amendment 135

Moved by

[Baroness Brinton]

135: After Clause 40, insert the following new Clause—
“Victims of the Horizon system: timetable for compensation payments(1) Within seven days of the day on which this Act is passed, the Secretary of State must publish a timetable for making payments in respect of schemes or other arrangements to—(a) compensate persons affected by the Horizon system;(b) compensate persons in respect of other matters identified in High Court judgments given in proceedings relating to the Horizon system.(2) In considering a timetable under subsection (1) the Secretary of State must have regard to the importance of speed and fairness to victims of the Horizon system.(3) In this section “the Horizon system” means previous versions of the computer system known as Horizon (and sometimes referred to as Legacy Horizon, Horizon Online or HNG-X) used by Post Office Limited.” Member’s explanatory statement
This amendment requires the Secretary of State to publish a timetable for the payment of compensation to victims of the Post Office Horizon scandal.

[Baroness Brinton (LD)]

My Lords, I tabled Amendment 135 some weeks ago, after there seemed to be some difference in timing for the compensation scheme for those sub-postmasters who were accused of stealing, prosecuted and convicted, lost their jobs and their homes, were made bankrupt, lost future employment and, worse, lost their relationships; some were so distressed that they took their own lives. This House has debated this issue a lot, and I will not go through the detail, even of the compensation schemes, because I believe that they are familiar to many people in your Lordships’ Committee, unlike the previous group.

On Saturday the Times reported that more than 250 of the affected sub-postmasters have already died. Like the infected blood compensation scheme that we discussed in the debate on the last group, time really is of the essence. The amendment says that within seven days of this Bill passing,

“the Secretary of State must publish a timetable for making payments in respect of schemes or other arrangements”,

both for those affected by the Horizon scheme and in relation to

“other matters identified in High Court judgments”

about the Horizon scheme. It emphasises that speed and fairness must be priorities, echoing the points the Prime Minister made last month. The amendment also refers to the scope of the Horizon scheme, including its predecessors and successors.

It is important to state that the High Court was absolutely clear that any prosecution that relied on Horizon is unsound. It was worrying that on 9 January this year the chief executive of Post Office Ltd—or POL—wrote an email that was published last week, stating that POL believed that around 360 sub-postmasters were probably guilty; that is, in POL’s view, the prosecution was not totally reliant on Horizon. I am afraid that this letter shows that the culture inside POL has not changed, and that is truly shocking.

The evidence to the public inquiry demonstrated that POL’s approach to investigation and prosecution was unfair and inappropriate, because POL was the victim, the investigator and the prosecutor. It often denied postmasters access to information that they needed for their defence, which is against our court rules.

Last week the press reported that POL has now instigated an “independent investigation” by retired police officers into the behaviour and actions of POL investigators. Can the Minister assure your Lordships that it will be a truly accountable and independent investigation whose results will be fully published, unlike POL’s behaviour with Second Sight, which it commissioned to investigate the sub-postmasters and Horizon? It was then gagged and sacked when it uncovered the truth. While it is good that these prosecution powers will not be used again, can the Minister confirm that this group of victims—the 360 who the chief executive of POL says are probably guilty—will still be fully eligible for compensation in line with others?

On the compensation schemes, yesterday’s Sunday Times reported that some former postmasters are still waiting to hear from POL about their claim. There is a simplified form now, 14 pages long, with 100 supplementary questions that remain—as on the previous form—absolutely impenetrable. They make clear that POL fails to believe certain claims about hardship, personal injury, harassment and mental health. Some are being asked for specific documents going back over two decades. I am not sure that I could put my hands on my P60 from two decades ago.

The guidance clearly states that POL is supposed to accept some claims, even when it does not have the exact detail. I quote from the guidance:

“Where the postmaster is unable to satisfy the burden of proof in relation to their claim, their claim may nonetheless be accepted in whole or in part if the Scheme considers it to be fair in all the circumstances”.


But POL is not telling the postmasters what is fair. Once again, it is using its powers to hobble these victims.

I will not go into the detail of the three schemes. We understand why they are different and we debated them in some depth when, on 16 January, the Post Office (Horizon System) Compensation Bill went through all stages for quick enactment. My concern is that, despite promises from the Dispatch Box in both Houses that the scheme would be simpler and accept a wider range of damages, including the elements I just outlined, unfortunately, in the hands of POL once again, the exact opposite seems to be happening.

I do not seek to open personal cases in Committee, but there are enough postmasters now saying that POL is offering them only a very small fraction of the actual losses suffered by them as compensation. Some, including Alan Bates, have said that they have been offered a sixth of their claim. This is outrageous. Can the Minister say whether the Government have oversight of these issues and how they can be resolved?

At the Post Office (Horizon System) Compensation Bill Second Reading, I mentioned a scheme that Dan Neidle, who runs Tax Policy Associates, thought would be most fair. He is an expert in compensation and taxation, and he made two or three points that have not been picked up in the compensation schemes as they are currently being run.

First, all applicants should receive a grant for legal advice. This is particularly vital when complex forms have to be completed and official data needs to be found. He also thought that there should be a large fixed amount when it is confirmed that they are a victim of the scheme, whether convicted or not. That would remove the current shameful divide between different types of cases for those convicted and those imprisoned. He thought that figure should be considerably higher than £100,000, but that is entirely up to the compensation scheme and the Government to agree.

There should also be—this is part of the fog from POL—an amount that reflects their loss of earnings from the day they could no longer work, the loss of the home and any subsequent loss accruing from that, their pensions and any amounts relating to specific damage above and beyond that outlined in previous areas. I mention this because it is exactly the sort of detail that sub-postmasters need to see laid out in a very clear form, which they are still struggling to find.

Last week, I asked a question of another Minister following either a Statement, an Oral Question or a PNQ. I note that, on page 93 of the Green Book for the 2023Autumn Statement—and in the chart on page 84—it says:

“Post Office Compensation Schemes, Corporate Entities … The government will legislate in the Autumn Finance Bill 2023 to exempt from Corporation Tax compensation payments made under the Historical Shortfall Scheme, Group Litigation Order schemes, Suspension Remuneration Review or Post Office Process Review Scheme. The legislation will align the taxation of onward payments of compensation to that of individual recipients”.


It is interesting that we have had, just before Christmas, regulations relating to taxation for both the Horizon scheme and the infected blood scheme in one set, so the Government can put the two together if they so choose to do. However, I cannot find anywhere in the Green Book the £1 billion that the Government say they have set to one side to pay for the compensation. It is not visible in the Treasury elements or BIS bits. Can the Minister show me where it is? I am not expecting him to do so this afternoon, but this is the second time I have asked about this and had no answer. I want to know where in the government books it is being held and whether the whole £1 billion is being held.

Over the past two weeks, the Independent has been gathering reports on one of the two predecessor programmes to Horizon, known as Capture. In 2003, June Tooby discovered that she was being sued by POL for £50,000 in a case that dated back to 1994 and bears many similarities to the Horizon scheme. She was not alone; other sub-postmasters from that era were also sued and bankrupted by POL. Sadly, June has now died. Can the Minister say whether sub-postmasters prosecuted as a result of the Capture scheme will also be covered by the Horizon scheme? It is a predecessor, after all, and we know that sub-postmasters were asking Ministers as early as 1997 about problems with the IT systems that were the predecessors to Horizon.

Finally, can the Minister please resolve the issue around the timings of the completion of the compensation scheme, as currently outlined? On 10 January, the Prime Minister said in Prime Minister’s Questions that the sub-postmasters will be cleared and compensated swiftly. On the same day, Kevin Hollinrake MP said at the Dispatch Box that all compensation should be paid by August, barring those where a few details are not completed. However, on 28 January, the Secretary of State, Kemi Badenoch, said on the BBC that the deadline of August was not a priority and that getting governance sorted out at the Post Office was more important. I do not want to get into the arguments that she and Henry Staunton have been having over the past few days but this urge to get the compensation sorted remains an absolute priority for the victims. Can the Minister say who is right? Equally importantly, will the Government unblock the logjam inside the Post Office over what is a fair claim, which was the other key element of the announcements made at the beginning of the year?

I beg to move.

[Baroness Thornton (Lab)]

My Lords, I was pleased to put my name and that of my noble friend to this amendment. The noble Baroness, Lady Brinton, has given us a comprehensive introduction to this issue. Given that this is an issue of current discussion across the country, there is not much point in me going into detail on the rights and wrongs, as well as the injustices, that we all know the Horizon scandal involved. It is shocking; it is a scandal that we should all be aware of and seek to remedy as quickly as we can.

This amendment and the one before show that this Bill is important because of its inclusiveness—I look to the commissioner—and it is not the first time I have said that in this discussion. It is very important that, in the course of the Bill, we recognise the different sorts of victims that there are in terms of the way the state has behaved, the major catastrophes that people suffer, and the issues of the courts and our justice system. That is all to the good because we will, I hope, end up with an Act that will really serve victims in all of those areas well.

17:15

The important point about this amendment is this: it is clear that cover-ups and bad behaviour have been rife throughout the Horizon scandal. Dealing with those must not stop the compensation and the justice that the victims need. We must be able to go forward from this point to make sure that those victims get the compensation they need as quickly as possible. Although this may not be quite the right amendment—they are often not—I encourage the Minister to tell us, as he did in the previous discussion, how the Government intend to take this forward in a positive fashion.

[Earl Howe (Con)]

My Lords, I am grateful to the noble Baroness, Lady Brinton, for her amendment, which, as she explained, would require the Government to publish a timeline for the payment of interim payments for victims of the Horizon scandal. As she knows, the amendment takes us back to a subject that the House has discussed several times in recent weeks. In all parts of your Lordships’ House, there is a strong desire to see justice for the victims of the Horizon scandal—in particular, to see them receive prompt financial redress. The Government share that desire.

The effects of the scandal on some postmasters have been, to put it at its mildest, truly awful. Some of them have lost their livelihoods, their homes or their health—or even all three. Others have faced serious financial impacts. The noble Baroness’s question is therefore extremely pertinent.

For reasons of history, there are three separate compensation arrangements in place; I hope that the Committee will allow me to put them on the record. One is for people who have had convictions for criminal offences overturned. A second, which is delivered by the Department for Business and Trade rather than the Post Office, is to top up the compensation settlement for unconvicted postmasters made at the end of the original so-called GLO High Court case, which exposed the scandal. The third—the Horizon Shortfall Scheme or HSS—is for postmasters who were neither in the GLO group nor convicted.

In two of the streams, we have recently announced fixed offers of settlement: £600,000 for those with overturned convictions and £75,000 for the GLO group. These fixed offers allow postmasters to receive substantial compensation without delay or hassle. Of course, those with larger claims will not generally want to accept these sums. They will instead, quite rightly, have their compensation individually assessed. For both groups, substantial interim payments are made promptly. Further payments are available to those facing hardship while their full claims are being assessed. We have undertaken to make first offers within 40 working days of receiving a completed application for the GLO scheme.

The HSS is already well advanced. All 2,417 of the people who applied by the original scheme deadline have had initial offers. More than 2,000 of them have accepted settlements and been paid. Late claims are still coming in—some stimulated by the ITV drama, in fact—and are being dealt with promptly.

However, two crucial drivers of the pace of compensation are not controlled by either government or the Post Office. First, the overturning of convictions has, of course, been in the hands of the courts, and it has been frustratingly slow. We believe that more than 900 people may have been wrongly convicted in this scandal, but, to date, only 97 of them have had their conviction overturned. The process has been not only slow but uncertain. In too many cases, the evidence has been lost or destroyed over time, and many postmasters have understandably lost all faith in authority and cannot face the prospect of yet another court case to clear their name.

That is why, on 10 January, the Government announced that they will be introducing legislation to overturn all the convictions resulting from this scandal. We recognise that this is an unprecedented step, but it is necessary if justice is to be done. I can tell noble Lords that, this afternoon, my honourable friend in another place has made a Statement about that legislation. We hope to introduce this legislation within a few weeks. I am sure that it will be widely supported across the House and in the other place, and that it will therefore be able to progress quickly. We hope to see it become law before the summer, with prompt compensation to follow.

That takes me to the second area where we do not have control of the timescale: postmasters and their lawyers need time to formulate claims and gather evidence, with some needing specialist reports from medical or forensic accounting experts. Setting arbitrary deadlines for the submission of claims would, I suggest, be deeply unfair to postmasters, and we therefore should not do it.

That is why the House recently and enthusiastically passed the Post Office (Horizon System) Compensation Bill, which implemented the Williams inquiry’s recommendation to remove the arbitrary deadline of 7 August 2024 to complete the GLO compensation scheme. It remains the Government’s goal to complete that scheme by August, but if postmasters need longer, that is fine.

The Government are determined to see financial redress delivered as quickly as possible for all postmasters, including those whose convictions will be overturned by the forthcoming Bill. However, setting a fixed timetable would entail rushing postmasters into major decisions about their claims and the offers they receive. I hope that, on reflection, the noble Baroness agrees that we should not do that, and will therefore feel able to withdraw her amendment.

The noble Baroness asked me a number of detailed questions. If she will allow me, I will write to her as fully as possible in response to her particular questions about legal advice, the Green Book, the logjam of claims and a number of others.

[Baroness Brinton (LD)]

I am grateful to the Minister for his response. As ever, it was thoughtful and very helpful.

I laid the amendment principally because it seemed to me that there were two issues. The first was about everything being done, where possible, by August, which seemed encouraging but clearly is not going to be hit in many cases. The detail that I gave to the Committee in the speech is what worries me more: there seems to be a chasm between Post Office Ltd and the postmasters about what is eligible in damage. I do not think it is just about whether people can get access to information, because of this proviso. I will be grateful for any letter, but would the Minister be prepared to meet between Committee and Report to discuss the detail? The most urgent thing, from their perspective, would be a grant for legal advice, given the complexity of applying. If that can be speeded up in any way, shape or form, that would be enormously helpful.

I suspect I will bring something back on Report, though probably not the same thing at all. In the meantime, I beg leave to withdraw the amendment.

Amendment 135 withdrawn.

Amendment 136

Moved by

[Lord Ponsonby of Shulbrede]

136: After Clause 40, insert the following new Clause—
“Review: National Oversight Mechanism(1) The Secretary of State must launch a review into the merits of introducing an independent National Oversight Mechanism responsible for collating, analysing and addressing recommendations arising from the post death processes of investigations, inquests, public inquiries and official reviews following a major incident.(2) The review under subsection (1) must be launched within six months of the day on which this Act is passed.(3) The Secretary of State must publish and lay before Parliament a report summarising the findings of the review under subsection (1) within 18 months of the day on which this Act is passed.”

[Lord Ponsonby of Shulbrede (Lab)]

My Lords, this is a probing amendment to enable debate on the concept of a new national oversight mechanism. The amendment proposes:

“The Secretary of State must launch a review into the merits of introducing an independent National Oversight Mechanism responsible for collating, analysing and addressing recommendations arising from the post death processes of investigations, inquests, public inquiries and official reviews following a major incident”.


With regard to public inquiries, there is no legal mechanism to require consideration, action or reasoned rejection of a recommendation made in the course of a statutory inquiry under the Inquiries Act 2005. In other words, recommendations made by a statutory public inquiry or a non-statutory inquiry have no legal force on the Government, public authorities, corporations or anyone else.

With regard to coroners’ prevention of future death reports, a large proportion of public bodies that receive recommendations fail to respond, and analysis using the Preventable Deaths Tracker developed by researchers at the University of Oxford found that only 33% of all PFDs issued by coroners had expected responses published, with 29% of responses overdue. Further, the researchers found that response rates to PFDs examined in 25 of their studies ranged only from approximately 10% to 60%, with no study resulting in a 100% response rate.

The Grenfell fire is a shocking example of this accountability gap. In 2009, the Lakanal House fire killed six people in a 14-storey tower block in Camberwell. Following the inquest into their deaths, the coroner, Frances Kirkham, made recommendations to the Secretary of State, the Mayor of London, the London Borough of Southwark and London Fire Brigade. These included making crucial improvements to building regulations, control room and incident command system training, awareness of the risk posed by cladding fire, and guidance on high-rise residential evacuation. In 2017, the Grenfell Tower fire killed 72 people in a 24-storey tower block in North Kensington. The Grenfell Tower inquiry exposed the fact that many of the Lakanal House recommendations were not implemented before the fire. Implementation was not considered to be urgent and was instead included in a medium to long-term programme of work.

During the inquiry, Dame Melanie Dawes, the former Permanent Secretary at the Department of Housing, Communities and Local Government, told the inquiry that

“there was no tracking recommendation put in place, something that I think was really important and there should have been”.

The lack of a mechanism was described as a gap in the Civil Service that

“could have happened in any department”.

The department itself stated that it missed the opportunity to look beyond recommendations and consider the widespread use of non-compliant materials on high-rise buildings and the associated risk of fire. That is just one example.

To address this accountability gap, the lobbying group Inquest, through me, is calling for the Government to establish a national oversight mechanism, which would be an independent public body responsible for collating, analysing and following up on recommendations arising from four post-death processes: investigations, such as those carried out by the Prisons and Probation Ombudsman, the Independent Office for Police Conduct or serious incident reviews; inquests; public inquiries; and official reviews into deaths, such as the Angiolini review into deaths and serious incidents in police custody. Inquest has put forward a mechanism by which this could be achieved, through the collation, analysis and follow-up of the data.

This amendment calls for a review into the processes and merits of creating such a mechanism. I look forward to hearing the Minister’s response and hope that he will commit to undertaking such a review. I beg to move.

17:30

[Baroness Brinton (LD)]

My Lords, I am really grateful to the noble Lord, Lord Ponsonby, for raising this issue and laying this amendment. I declare my interest as the vice-chair of the All-Party Fire Safety and Rescue Group so his comments about the Lakanal House and Grenfell Tower fires really chime with me. From these Benches, my noble friends Lady Pinnock and Lord Stunell have both raised these issues repeatedly.

It is really important to remember that one of the big lessons that I hope we will now begin to learn from Grenfell Tower and the many other fires before it rests in Dame Judith Hackitt’s report on the construction industry and Grenfell Tower. She talked about the importance of the “golden thread” through every part of the construction. The same is true when things go wrong and it seems to me that a national oversight mechanism is exactly the golden thread that we need to ensure that we do not have to time and again relearn the lessons of disasters after they have happened. From these Benches, we support the amendment.

[Lord Roborough (Con)]

My Lords, I thank the noble Lord, Lord Ponsonby, for this amendment and the noble Baroness, Lady Brinton, for speaking in support. The amendment would require the Secretary of State to conduct a review into whether to establish an independent national oversight mechanism to collate, analyse and address recommendations from investigations, inquests, public inquiries and official reviews following deaths after a major incident.

In 2014, the House of Lords Select Committee published a post legislative scrutiny report on the Inquiries Act 2005. In their response, the Government agreed with the principle that bodies should set out their plans for implementing recommendations directed at them. When an inquiry’s recommendations are directed at the Government, it is the responsibility of the lead department to determine how best to progress and implement the recommendations. An official review would follow the same principles.

Parliament has a crucial role in scrutinising the activities of government departments. Select Committees, in particular, hold individual departments to account, including in their response to recommendations made by statutory and non-statutory inquiries and reviews. The Government remain of the view that Parliament already has the ability to hold government departments to account on their response to and implementation of recommendations and that Parliament is best placed to carry out this function.

Noble Lords will also be aware of the Statutory Inquiries Committee that was set up by the Lords Select Committee very recently. It has been appointed to consider the efficacy of the law and practice relating to statutory inquiries under the Inquiries Act 2005. It may be well placed to consider the merits of an independent national oversight mechanism for statutory inquiries.

Turning to inquests, a coroner has a statutory duty to make a report to prevent future deaths if action should be taken to prevent or reduce the risk of future deaths. Recipients of PFD reports must respond to the coroner within 56 days of receipt, setting out what actions will be taken, or explaining any not taken. The Government in their response to the Justice Committee’s 2021 report committed to consider the merits of a recommendation to establish a national mechanism to ensure that actions highlighted in PFD reports which could contribute to public safety and prevent future deaths are implemented. The Justice Committee is currently undertaking a follow-up inquiry into the coroners service and will revisit this issue; the Government are due to give evidence shortly.

In response to some of the points made by the noble Lord, Lord Ponsonby, and backed up by the noble Baroness, Lady Brinton, recipients of PFD reports, as I say, must respond to the coroner within 56 days. However, it is not the coroner’s role to review whether—and if so what—actions should be taken in response to a report. This would be inconsistent with their status as independent judicial officers.

The Government in their response to the Justice Committee’s 2021 report committed to consider the recommendation to establish a mechanism to ensure that actions in PFD reports which could contribute to public safety and prevent future deaths are implemented. The Justice Committee’s follow-up inquiry into the coroners service will revisit issues around PFD reports on preventing death and improving public safety.

While I understand the intent to ensure that the merits of setting a national oversight mechanism are considered, it is likely this would duplicate ongoing parliamentary inquiries into these matters. I therefore ask the noble Lord to withdraw this amendment.

[Lord Ponsonby of Shulbrede (Lab)]

I thank all noble Lords who have spoken in this very brief debate. I want to pick up a point made by the noble Baroness, Lady Brinton, about the golden thread of establishing a mechanism to ensure that any findings which come out of either public inquiries or coroners’ reports are tracked through and implemented.

I quoted a civil servant as saying that the established mechanisms have not worked, and the example I gave was of the cladding on Grenfell Tower. The Minister spoke about considering whether to establish a mechanism for reviewing PFD reports and coroners’ reports. When will that review be complete and does the noble Lord believe that that review will adequately establish some sort of overall mechanism for dealing with coroners’ recommendations?

To circle back a bit to the public inquiries point, the Minister said that Parliament is best placed to carry out the functions of public inquiries and look at recommendations. I have to say that I really cannot think of Parliament looking at cladding issues. There needs to be a more systematic way of dealing with these matters to ensure that there is that golden thread that the noble Baroness, Lady Brinton, talked about, so we have some comfort that these processes are being properly reviewed and implemented. I beg leave to withdraw the amendment.

Amendment 136 withdrawn.

Clause 41: Public protection decisions: life prisoners

Amendment 137

Moved by

[Lord Burnett of Maldon]

137: Clause 41, page 39, line 26, leave out from second “the” to end of line 27 and insert “Divisional Court of the King’s Bench Division”

[Lord Burnett of Maldon (CB)]

My Lords, in the absence of the noble and learned Lord, Lord Thomas of Cwmgiedd, who is abroad at the moment, I move this amendment and will speak to the others in this group, save for Amendments 146A, 174 and 175 which stand in the name of the noble Baroness, Lady Hamwee.

Clause 44 enables the Secretary of State to refer a decision of the Parole Board to release what is known as a top-tier prisoner for a judicial decision either to affirm or to quash a decision of the Parole Board. Top-tier prisoners are those who have committed the most serious offences. The Bill identifies the Upper Tribunal as the court to which referrals will be made, save in cases where there is sensitive material, in which case the court is the High Court.

The principal amendment in this group, which would amend Clause 44, is to propose that all referrals go to the High Court; in particular, a

“Divisional Court of the King’s Bench Division”.

The other amendments that we propose make necessary changes elsewhere. The reason for proposing these amendments is to ensure that the judicial decision is made by a court whose members are well equipped by experience to make the necessary assessment of risk.

The background is that the cases will necessarily involve serious offending and be referred by the Secretary of State because of at least an unease about the decision of the Parole Board. That Parole Board will be made up of individuals with considerable experience in evaluating risk in the context of criminal offending. Any review or reconsideration should be conducted by a court that comprises judges with similar such experience. None of the chambers of the Upper Tribunal currently has members with that necessary experience, but the High Court does.

A Divisional Court of the King’s Bench Division deals with criminal cases in the High Court. It is almost always composed of judges who sit in the Criminal Division of the Court of Appeal; that is, a Lord or Lady Justice and a High Court judge. Those judges have extensive criminal experience; in particular, when dealing with sentencing, either at first instance as trial judges or on appeal. They are used to making decisions which require them to evaluate risk and, in particular, whether an offender is a dangerous offender, which leads to a suite of different sentencing options. In those circumstances, they are well suited to the task which the Bill will empower the Secretary of State to require a court to undertake.

The Bill itself envisages that the High Court will perform this role in some cases. This amendment suggests that it would be more effective, and deliver the outcome that the Bill seeks, were the High Court always to be the destination for these referrals. I beg to move.

[Lord Marks of Henley-on-Thames (LD)]

My Lords, I agree with every word uttered by the noble and learned Lord, Lord Burnett of Maldon. I am sure that the same words, or words to similar effect, would have fallen from the lips of the noble and learned Lord, Lord Thomas of Cwmgiedd. They echo the sentiments of a number of those who have briefed noble Lords on these issues relating to the Parole Board.

I will be brief. There is one overriding principle, which is that the Parole Board should be, in effect, an independent, quasi-judicial body. A number of concerns have been expressed about the prospect of the Secretary of State having the power to refer decisions of the Parole Board to another body. One reason for the amendments in the name of my noble friend Lady Hamwee, to which I will turn shortly, is that concern.

The idea that this jurisdiction to consider referrals by the Secretary of State should be a matter for the Upper Tribunal, which is not a body involved with the prison system at all—it has, as the noble and learned Lord pointed out, no relevant chamber—and is not concerned with the sentencing, treatment or release of offenders, is an odd one. That decision should plainly be, we would suggest, the decision of a court used to dealing with criminal justice and with the sentencing and imprisonment of offenders. Loosely stipulating that it should be the High Court, without the division named, or the Upper Tribunal is wrong.

17:45

The Divisional Court is plainly, as the noble and learned Lord has said, the appropriate body for the task. I invite the Minister to explain why the Bill, as drafted, allocated these cases to another body with no relevant experience or expertise when there is an obvious court to decide these cases—a view powerfully endorsed in these amendments by two former Lord Chief Justices with a great deal of experience and expertise in precisely this area.

In addition to my support for the noble and learned Lords’ amendments, I note that my noble friend Lady Hamwee has tabled amendments to Clauses 44 and 45, in relation to the whole question of the referral of release decisions by the Secretary of State to a court or the Upper Tribunal for life prisoners and fixed-term prisoners respectively. My noble friend is now here but both those amendments and the consequential amendments in her name would provide that the clauses should not come into force until the Secretary of State has laid a report before Parliament regarding their implementation.

Our suggestion is that this is a new process or procedure, which has not been adequately researched. It breaches the fundamental point: that the Parole Board is, in effect, a quasi-judicial body exercising an independent jurisdiction, whereas if the Secretary of State is going to have the power to refer it should be to a Divisional Court, as we have suggested. Before these clauses are brought into effect, there should also be a report laid before Parliament which it can consider. This departure would be delayed until that report had been laid and considered.

[Lord Bach (Lab)]

My Lords, briefly, I support the amendments moved and spoken to in this group by the noble and learned Lord, Lord Burnett of Maldon, and the noble Lord, Lord Marks. I spoke on this matter at Second Reading and agreed with what the noble and learned Lord, Lord Thomas of Cwmgiedd, said in his speech then.

The Committee may know that, along with others, including the noble and learned Lord, Lord Burnett of Maldon, I have put my name to later amendments that question the changes proposed by the Government to the Parole Board. In my view, those changes attack pretty fundamentally the independence of that board and allow the Secretary of State to interfere in these matters to an extent that affects the separation of powers. As a rule, I argue that it is never a good idea, however tempting for Governments, for the Executive to interfere with matters that should be the role of the judiciary. Taken as a whole, these changes are unnecessary and overcomplex, and will prove to be extremely costly.

Today, we are discussing the amendments so well put by the noble and learned Lord, who speaks with such huge authority; I am pleased to support them. They argue that the Upper Tribunal is entirely the wrong body to hear these cases. The Government would be well advised, with respect, to listen to him, and to remind themselves of the powerful speech made by the noble and learned Lord, Lord Thomas of Cwmgiedd, at Second Reading. It is not often that this House is privileged to have the support of the last two Lord Chief Justices on a matter that they are profoundly expert in. I ask the Minister, who is always very reasonable, to think very carefully about how powerful the case that has been made this afternoon is.

Of course, I strongly agree with the amendment spoken to by the noble Lord, Lord Marks, on the necessity of a report from the Secretary of State on the implementation of these proposals, which I consider to be pretty disturbing on the whole. I ask the Minister, when he replies, to consider carefully where these amendments are coming from.

[Baroness Hamwee (LD)]

My Lords, I will speak with the leave of the Committee and with many apologies; I was delayed in a committee. Amendment 143A is a probing amendment to seek to understand whether the Secretary of State will issue guidance on these matters, and if so, what that guidance will include. The Prison Reform Trust is particularly concerned about this, being aware that an overturned release decision would be likely to undermine public confidence in the parole system and so on. I am sure that the Minister will want all the actors in the sector to understand how these arrangements are intended to work and how they can be scrutinised.

[Lord Ponsonby of Shulbrede (Lab)]

My Lords, we also support this group of amendments. I want to reiterate the points made by my noble friend Lord Bach. You could not have had two more eminent Members of this Committee to table these amendments. The noble and learned Lords, Lord Burnett and Lord Thomas, are familiar with these types of decisions. I do not think I can add to the weight of the arguments put forward by the noble and learned Lord, Lord Burnett.

The only point I will make is about process. If the Minister says that he wants to think about this—I do not know what he is going to say—then it would be very helpful to know his thoughts before Report. From what I have heard of the argument, it seems that the Government have an uphill battle trying to defend the current position. If the Government are minded to think about this again, we really need to know what that is before Report.

[Lord Bellamy (Con)]

My Lords, the amendments proposed by the noble and learned Lords, Lord Burnett and Lord Thomas of Cwmgiedd, would mean that parole referrals under the new power in the Bill would be sent to the Divisional Court of the King’s Bench Division, which is part of the High Court, instead of the Upper Tribunal, which is currently used for most cases—although not for national security cases.

Noble Lords know that the Bill introduces a new power to allow the Secretary of State to refer a top-tier case—that is a case where the index offence was murder, rape, causing or allowing the death of a child, or serious terrorism—for a second check by an independent court if the Parole Board has directed release. The question is which court that should be. Noble Lords may recall that at one stage it was suggested—I think by a Select Committee—that it should be the Court of Appeal Criminal Division. The Government consulted the Judicial Office in June 2023. The result of that consultation was that a preference was expressed for the Upper Tribunal to hear those cases. The Upper Tribunal has wide-ranging powers under Section 25 of the Tribunals, Courts and Enforcement Act 2007, facilitated by the Upper Tribunal rules, which essentially gives it the same powers as the High Court. It has experience of hearing oral evidence. The Government’s view, in the light of the consultation with the Judicial Office, was that the Upper Tribunal was the appropriate court.

None the less, the Government feel that it is obviously desirable to sort this issue out in a sensible way and I am very happy to consider it further. I am even happier to say that the Government’s reflections will be shared before Report, so that everybody can consider their position. There should not be any particular controversy on this kind of point; it is a rather specialised point, if I may put it like that.

I turn to the amendments tabled by the noble Baroness, Lady Hamwee, and spoken to on her behalf by noble Lord, Lord Marks. The Government entirely agree with her that the processes ahead of us and how we are going to manage it should be very fully understood by all actors. I will briefly explain how the Government see things at the moment. First, the procedural elements of the new process may require amendments to the Parole Board rules and the tribunal rules—or the rules of whatever court we determine. That must be scrutinised by Parliament and go through a period of consultation. There will have to be a period of training of judges. We know that the referral process will need to be transparent and speedy. Work is currently in train as to how far this will be operationalised from the point of view, first, of maintaining public confidence and, secondly, on what basis the Secretary of State refers things to the relevant court—to use a neutral phrase for the time being.

Currently, the Government are working through exactly how the relevant tests would be applied. The Government propose to publish their policy on how the legislation will be applied, outlining how cases will be selected for referral and ensuring that prisoners, and importantly victims, are fully informed of who will be in scope. I envisage a transparent and open process by which the details of the new regime are sorted out.

[Baroness Hamwee (LD)]

Could I follow that up before the Minister goes on to the next point? Does he anticipate that there will be consultation with the sector—it is a very big sector of course—on the various points that he has quite rightly referred to? That would go down rather better and be much more useful than producing a policy in its final form and saying, “Here we are”. A draft policy or ideas for consultation would be welcomed.

[Lord Bellamy (Con)]

My Lords, I hear what the noble Baroness says, and it sounds entirely reasonable. I cannot, at the Dispatch Box, go any further than I have already gone, but the point is well made.

On that basis, I hope the Committee will be satisfied that the Government intend to be fully transparent and work co-operatively with the development of this new process.

18:00

[Lord Burnett of Maldon (CB)]

I thank the Minister for his response. It is a delight to see him back in his place. I also thank those who spoke in support of the amendment put down by the noble and learned Lord, Lord Thomas of Cwmgiedd, with my support.

I was intrigued by the Minister’s reference to consultation with the Judicial Office last June. I was, of course, in post as Lord Chief Justice then. For administrative purposes, the Judicial Office is the alter ego, as it were, of the Lord Chief Justice. It may well be—I put it no more pointedly than this—that Homer may have nodded in June, because I had thought that the proposal of the noble and learned Lord, Lord Thomas, which is supported by me and elsewhere, was not controversial. If there has been a mix-up in communication historically on that, I apologise, wearing my previous hat. I am grateful to the Minister for indicating that the Government will be prepared to consider this matter further. I am of course entirely at the Minister’s disposal to discuss any proposals that may commend themselves to the Government to be brought forward on Report. I beg leave to withdraw the amendment.

Amendment 137 withdrawn.

Clause 41 agreed.

Clause 42: Public protection decisions: fixed-term prisoners

Amendment 138 not moved.

Clause 42 agreed.

Amendment 139 not moved.

Schedule: Offences relevant to public protection decisions

Amendment 140 not moved.

Schedule agreed.

Clause 43 agreed.

Clause 44: Referral of release decisions: life prisoners

Amendments 141 to 143A not moved.

Clause 44 agreed.

Clause 45: Referral of release decisions: fixed-term prisoners

Amendments 144 to 146A not moved.

Clause 45 agreed.

Clause 46: Licence conditions of life prisoners released following referral

Amendment 147 not moved.

Clause 46 agreed.

Clause 47: Licence conditions of fixed-term prisoners released following referral

Amendment 148 not moved.

Clause 47 agreed.

Amendment 148A

Moved by

[Baroness Thornton]

148A: After Clause 47, insert the following new Clause—
“Licence conditions for serial and serious harm domestic abuse and stalking perpetrators under Multi-Agency Public Protection Arrangements(1) A condition of the release and licence of serial and serious harm domestic abuse and stalking perpetrators must be included in the Multi-Agency Public Protection Arrangements.(2) The Criminal Justice Act 2003 is amended as follows.(3) In section 325 (arrangements for assessing etc risk posed by certain offenders)—(a) in subsection (1), after ““relevant sexual or violent offender” has the meaning given by section 327;” insert ““relevant domestic abuse or stalking perpetrator” has the meaning given in section 327ZA;”;(b) after subsection (2)(a) insert—“(aza) relevant domestic abuse or stalking perpetrators,”.(4) After section 327 (Section 325: interpretation) insert—“327ZA Interpretation of relevant domestic abuse or stalking perpetrator (1) For the purposes of section 325, a person (“P”) is a “relevant domestic abuse or stalking perpetrator” if P has been convicted of a specified offence or an associate offence and meets either the condition in subsection (2)(a) or the condition in subsection (2)(b).(2) For the purposes of subsection (1), the conditions are—(a) P is a relevant serial offender; or(b) a risk of serious harm assessment has identified P as presenting a high or very high risk of serious harm.(3) An offence is a “specified offence” for the purposes of this section if it is a specified domestic abuse offence or a specified stalking offence.(4) In this section—“relevant serial offender” means a person convicted on more than one occasion for the same specified offence, or a person convicted of more than one specified offence;“specified domestic abuse offence” means an offence where it is alleged that the behaviour of the accused amounted to domestic abuse within the meaning defined in section 1 of the Domestic Abuse Act 2021;“specified stalking offence” means an offence contrary to section 2A or section 4A of the Protection from Harassment Act 1997.(5) Within 12 months of the day on which the Victims and Prisoners Act 2024 is passed the Secretary of State must commission a review into the operation of the provisions of this section.””

[Baroness Thornton (Lab)]

It is a great pleasure to move Amendment 148A and speak to Amendment 148B. I thank the noble Lord, Lord Russell, and the noble Baroness, Lady Brinton, for their support in this suite of amendments, both of which deal with stalking. They insert two new clauses into the Bill, and they are part of the whole suite of amendments on this.

I will be brief because my noble friend Lady Royall is in the Committee today, and she has been tireless over the years in championing this cause and using every opportunity to find remedies to deal with this pernicious crime, almost always perpetrated by men on women, wrecking lives, sometimes with fatal consequences. These two amendments, and the group following this concerning MAPPS in the name of my noble friend Lord Ponsonby, seek to bring further coherence to law enforcement, record sharing and protection for these victims.

If only the police could see stalking for what it truly is—often a stepping stone on the route to murder—perhaps they would take it more seriously. At present, I am afraid they do not—certainly, it is patchy—and stalking victims are dismissed too easily and too often. They are told, “It’s just online. It will die down. Change your number. Delete your social media accounts. It’s just a lovers’ tiff”.

I will give just one example and then sit down. When the Derbyshire police accepted that they failed Gracie Spinks—who was murdered after reporting her stalker to the police—and when they apologised to her family and promised that lessons would be learned, I could almost feel the weariness of victims, their families, the campaigners and the Victims’ Commissioner in saying, “How often do we have to be told that lessons can be learned when they haven’t been?” That is what these amendments and the ones we have already discussed are about: they seek to make a change. I beg to move.

[Lord Russell of Liverpool (CB)]

My Lords, I was happy to put my name to these to these two amendments, and I am equally happy that the noble Baroness, Lady Royall of Blaisdon, is here. She will go into some current and fairly shocking detail about some recent examples of stalking that show that it is as pernicious and present as ever.

Both of these amendments are proposed in the clear and distinctly uncomfortable knowledge that I think all parties acknowledge: we have some way to go, to put it mildly, before we can say, with any degree of truth, that we have the measure of the huge and insidious problem that is stalking. These amendments propose some changes to MAPPA, including perpetrators in MAPPA, as a condition of potential release and licence, and the creation of a register to make perpetrators subject to notification requirements as a condition of release. The important common theme to both these amendments is the requirement for the Secretary of State to commission reviews to look at the issues and challenges around stalking in a comprehensive and informed manner.

But what is repeatedly and continuously frustrating is that we have proper on-the-ground evidence of approaches to stalking that are proving to be effective. In particular, there is the multi-agency stalking intervention programme—MASIP—which has marked a significant advance in our ability to anticipate, identify and tackle the complex issue of stalking. The MASIP model, thankfully funded by the Home Office, has pioneered this approach in London, Cheshire and Hampshire, and it works. Early evidence is compelling and extremely positive. So one just asks oneself: why is it not possible to do this more widely? The approach co-ordinates activity around both the victim and the perpetrator, and it incorporates an essential pathway to address the fixation and obsession in perpetrators that might be contributing to their stalking offending. The final evaluation proves that it works, so why is it so difficult, first, to acknowledge best practice when it is staring one in the face and, secondly, to implement it more widely?

One frustrating thing—here I refer to an article in today’s newspaper—is some news about the Government’s end-of-custody supervised licence programme, which was introduced in the autumn to relieve some of the huge pressure on our overcrowded jails, enabling perpetrators to be released earlier than their recommended sentence. It was put in as a temporary scheme, but it has apparently now been extended indefinitely. That does not mean for ever; it just means that the Government have given no indication of how long they intend to continue to allow this degree of leniency, the sole reason for which is the huge pressure on our prisons.

The Government rather inelegantly call this the problem of demand and supply in the prison population. If you were to try to explain that terminology to victims, they would find it slightly difficult to understand why supply-side economics should govern the early release of some perpetrators, particularly of domestic abuse and stalking, in many cases without the victims knowing what is going on.

We will make concerted progress only when we acknowledge the complexity of stalking and finally design a proactive and joined-up approach that is implemented consistently across all jurisdictions and agency boundaries and effectively identifies, outlaws and penalises any evidence of the unfairness and madness of what we are allowing today—effectively, a postcode lottery for victims.

[Baroness Brinton (LD)]

My Lords, I have signed Amendments 148A and 148B in this group. I thank the noble Baroness, Lady Thornton, for her introduction and look forward to hearing from the noble Baroness, Lady Royall. The first amendment sets out an important addition to the arrangements for Multi Agency Public Protection Arrangements, or MAPPA. We will hear about the detail of these amendments from the noble Baroness, Lady Royall, but I want to add that, throughout this Bill and its predecessors in your Lordships’ House, including the Domestic Abuse Bill and the Police, Crime, Sentencing and Courts Bill, we have repeatedly asked for more protection for people who have been victims of serial domestic abuse and, in particular, stalking.

Laura Richards’s ground-breaking work over many years in developing the dashboard profiling and documenting the most serious repeat offenders has changed the way in which specialist police teams view these perpetrators, but—I hesitate to say this for probably the third Bill running—MAPPA are still not applied consistently across police forces. One of the aims of these amendments is to make sure that happens. As we have heard, repeat perpetrators are far too often allowed to commit further crimes, including murder. Shockingly, a couple of years ago police research found that one in 12 domestic rapists was raping outside the home. A violent and controlling man leaving a partner does not mean that the violence ends. Many have extensive histories of abusing multiple women.

Amendment 148A sets out the licence conditions for serial and serious harm domestic abuse and stalking perpetrators, saying that anyone so identified should be part of a MAPPA. Proposed new subsection (4) sets out the definition of a relevant domestic abuse or stalking perpetrator. Similarly, the other amendment says that we must have an effective register. Non-domestic stalkers always seem to be left off. I always raise this problem in your Lordships’ House; there is an assumption that stalking is carried out only by a current partner or an ex-partner—or somebody who would like to be a partner and is therefore regarded as domestic—but about 40% of stalking cases have nothing to do with that at all. As we see from many stories in the papers day after day, these days people such as celebrities face massive amounts of stalking and do not get protection. Often, when people are arrested, it appears that they have stalked others as well.

The noble Baroness, Lady Thornton, made passing reference to the Gracie Spinks case. Derbyshire police and the police force that investigated its failings have learned from that, but we need consistency. I will give one recent example from Laura Richards. Last month a victim, Sadie, had been back in contact with her about her living hell over seven years. She is terrified that her ex will kill her children. In 2018 he was arrested for battery of her eight year-old daughter and an assault on her while she was holding her other daughter. He was convicted in 2019 and received a suspended sentence and restraining order. The police did not arrest him for stalking or coercive control. They told her that, because she had moved away, they would not arrest him for stalking and they would amend the restraining order to a lifelong RO. He has repeatedly breached it. As we discussed on earlier amendments, he then started family court proceedings.

I will not go on, except to say that she has had to flee three more times, and each time has hit problems with the new police force. There has been no consistency. He has a history of abusing others—exactly the point I made about police research finding that one in 12 domestic rapists rapes outside the home. This woman has no solution nearby to stop him continuing to behave in this way and mess up her life and those of her children. We need MAPPA to work effectively. These amendments are the first step in that direction.

18:15

[Baroness Royall of Blaisdon (Lab)]

My Lords, I support Amendments 148A and 148B. I am late to participate in this Bill, for which I apologise, but, as has been said, I am not late to debates on the insidious crime of stalking—a gateway to rape, serious harm and murder in slow motion. I have read the excellent exchanges on earlier amendments to this Bill on stalking.

Stalkers must be put before the courts, and sentences must reflect the seriousness of the crime. When stalkers are released from prison, given the nature of their obsessive and fixated behaviour, stringent measures must be placed on them to close down all opportunities to reoffend. As part of this, they must be automatically managed by MAPPA and included on ViSOR, soon to be MAPPS, so that their information can be shared and accessed nationally.

In the past I have often cited the horrific case of Zoe Dronfield. Jason Smith almost succeeded in murdering her in her home in 2014. He is up again before the Parole Board for release this year. Zoe is terrified for herself and her children. Smith was not rehabilitated 10 years prior to her attack after the horrific abuse of an ex who was a serving West Midlands police officer. He went on to abuse other women until he targeted Zoe. Currently, Zoe knows very little about the release plan. Smith has never admitted trying to kill Zoe, so how can he be deemed safe for release? She does not know whether she is marked at high risk, whether he is still vengeful towards her or whether he will be tagged. No measures have been put in place for her, and she feels like a sitting duck.

How can this be right? He must be added to ViSOR and managed by MAPPA, and every opportunity for his reoffending against Zoe, her children and future women must be closed down. Many stalkers change their name by deed poll. He must not be allowed to do that either. Positive obligations must be placed on him, including not to change his name. I would be grateful for an assurance from the Minister that this case will be looked at so that Zoe does not have to live in fear.

In January there were two horrific cases of stalking by two vengeful men. Thirty year-old Bryce Hodgson was shot by armed officers in Southwark after he broke into the intended victim’s home. He was armed with crossbows, a knife, a hatchet and a sword and was wearing body armour. There was no doubt that he was there to kill the victim, and most likely others if they got in his way—people who might have been trying to protect her. He had already threatened the police. As soon as I heard about this case, I wondered about his background. No one wakes up one day and starts behaving like this in the third decade of life. From everything I have learned about male violence towards women and children, I believed that he would have a history.

Sure enough, it came to light that he was a convicted stalker. He had been convicted of stalking a woman last June and was subject to a five-year restraining order. Croydon Magistrates’ Court heard last year how Hodgson had entered the victim’s bedroom without consent, sent text messages demanding that she open her door to him and described his vivid sexual fantasies to her. He pleaded guilty, but was spared a custodial sentence with a 16-week suspended prison sentence; he was ordered to undergo 12 months of supervision and carry out 120 hours of community service.

He was the most dangerous type of stalker—a predatory stalker with sexual fantasies that he was acting on when he broke into the victim’s bedroom. He was one of the rare few who are arrested and charged but, rather than put him before the court for a Section 4A stalking offence for putting the victim in fear of her life, and despite his being one of the most dangerous types of stalker, the CPS put him before a magistrates’ court on a Section 2A stalking charge. Notwithstanding the wrong charge, he clearly should have been put on a register.

In another case, on 31 January a woman and her two children were attacked by Abdul Ezedi near Clapham Common. He threw a corrosive alkaline substance at the woman, who we now know was in a relationship with the suspect. She was there with her daughters; she suffered what are likely to be life-changing injuries. Five police officers were injured as they responded, as were four members of the public. This attack was targeted, pre-planned and premeditated. Ezedi stalked the victim and intended to cause her maximum distress, pain and suffering when he threw that corrosive substance at her and her two girls. He then picked up the three year-old girl and tried to kill her.

There is always a history. In 2018, Ezedi was convicted of one charge of sexual assault and one of exposure, before being granted asylum in 2020. He received a nine-week jail term, suspended for two years, for this sexual assault and, for the exposure, 36-weeks’ imprisonment to be served consecutively—which was also suspended for two years. Why was he not included on ViSOR? This has been repeatedly raised following countless horrific murders, including those of Jane Clough, Shana Grice, Hollie Gazzard, Alice Ruggles, Janet Scott, Laura Mortimer and her 11 year-old daughter Ella Dalby, and Cheryl Gabriel-Hooper, whose 14 year-old daughter was present when Andrew Hooper shot her mother dead. Hooper had a history of abusing and stalking his ex; he broke into her house in the middle of the night wearing gloves and armed with a knife. He pleaded guilty to affray and received a suspended sentence—this was stalking. Cheryl also reported him to the police for coercively controlling and stalking her and her daughter. The abuse escalated when she finally left him for good.

Separation is the highest risk time for a woman fleeing a coercive controller and stalker. We know from research and analysis of domestic homicides that if a stalker makes a threat—which Hooper did—one in two stalkers acts on that threat; that is 50%. These are the most dangerous of perpetrators, and yet his violent history was not joined up by the police. He should have been on a register, which would mean that they had to check on the perpetrator’s history.

Laura Mortimer and her 11 year-old daughter, Ella Dalby, were stabbed to death in my home city of Gloucester, on 28 May 2018, by Christopher Boon. He had a history of assaulting a previous partner and her mother, in front of two children. He received a suspended sentence for this very serious offence. Boon was a fantasist who was £28,000 in debt, and he coerced Laura into putting her income into his bank account. She reported him to the police. She was too scared to pursue a prosecution but she did ask about his history, using Clare’s law. She was told that it could not be shared, and she was sent away. Days before the murders, Laura learnt that Boon was cheating on her and she told him to leave the house. He escalated his behaviour and stabbed Laura 18 times and her 11 year-old daughter 24 times. Women are not told about these dangerous and violent men’s histories even when they report serious violence and abuse at their hands.

A new database, MAPPS, is being developed, which will replace ViSOR, and we have MAPPA, the public protection panels which police, prison and probation officers, and other agencies attend. Stalkers must be proactively identified, assessed and managed by MAPPA. Stalking experts must attend MAPPA meetings to ensure that these dangerous men are diagnosed, assessed and managed. The same tactics must be applied to serial and dangerous domestic violence perpetrators and stalkers as to organised criminals and sex offenders. Early identification, assessment and management are vital to cut off opportunities for them to cause harm, and to ensure that they face the consequences of their actions.

Currently, the law relies on victims to report the individual crimes, and the police do not flag and tag serial and high-risk perpetrators. Instead, they focus on the victims—and this does not happen with any other crime. Police must index and share information with victims about serial abusers. Each police force must proactively identify 10 to 20 serial and dangerous domestic abusers, ensure that their information is included on the local police intelligence database, and refer cases to MAPPA. Convicted stalkers must be placed on ViSOR. The postcode lottery mentioned by the noble Lord, Lord Russell, must end.

I hope the Minister does not refer to guidance, which is so often a response to questions about stalking. I hope we are not told that more lessons need to be learned; too many women have been murdered. We know what needs to be done. We do not need guidance, we need action.

The extraordinary Laura Richards, who has done more than anyone else in the world to try to protect women and their children from stalkers, started a petition to include serial domestic abusers and stalkers on ViSOR and be managed by MAPPA. Some 274,698 people have now signed this petition, including victims, bereaved families and professionals. I ask the Minister: when will the Government act?

[Baroness Newlove (Con)]

My Lords, I support these amendments, and I am so glad that the noble Baroness, Lady Royall, is back where she belongs, speaking on a topic that she is so passionate about.

Laura Richards has been mentioned by many speakers, and social media has a good way of reacting: I have her on Instagram as we are speaking, to give me some pointers, even though she is in California. Laura Richards is the expert on all this, and her patience to fight for victims over the years is commendable. She said she knows there is going to be change and she keeps doing it for victims—I admire this lady.

In the year ending March 2022, only 1.4% of reports to police about stalking ended with the stalker being convicted. That says a lot about how seriously stalking is taken by the very agencies that are supposed to protect victims. Most stalkers never see the inside of a prison cell; instead, they receive fines or community or suspended sentences, as has previously been spoken about. Really, for me, it is about listening to the human side of all these cases, and that is what we must never forget. It is not just about lessons learned or guidance. These are not items we pick up from supermarket shelves; these are human lives—people who have been brutally murdered, after several years of absolute hell, by someone who has done it on more than one occasion.

I really want to understand why the Government will not look at this register seriously. I spoke in the Domestic Abuse Bill when that came through. This has to be the end of it all. Instead of guidance, we must have proper risk management of stalkers and domestic abusers because, at the moment, it is virtually non-existent for convicted, or unconvicted, men who pose such a huge risk to women and children—now more than ever, we need to make sure that they feel safe and listened to. These are psychopathic people who do horrendous crimes to humans, and families have to pick up the pieces.

I am concerned about Zoe Dronfield, and I have picked up on certain things that my friend, the noble Baroness, Lady Royall, has mentioned. I will take that offline, because I sympathise with not having any control. As somebody who is still going through the criminal justice and parole system, I am very interested in the next stage of the Bill, which is about parole, and what it does and does not do. The victim has no control, or right to know what the offender is doing. We cannot find out what is going on, but the offender knows exactly where the victim is, because of exclusion zones and everything else. I do not speak for anyone else but as a victim who is watching out, for my three daughters, for offenders who are going to be released. When we are talking about stalking laws, this is important, because having no control more or less means that the victim has to shape their life around safety, whereas the system should protect victims more than ever.

[Lord Roborough (Con)]

My Lords, I thank the noble Baroness, Lady Thornton, for her amendment relating to Multi Agency Public Protection Arrangements, and all noble Lords who have contributed to this heartfelt debate. These are horrific offences, taken with the utmost gravity by the Government.

Amendment 148A seeks to include relevant domestic abuse and stalking perpetrators on licence within the remit of management under Multi Agency Public Protection Arrangements—MAPPA. That would create a legal requirement on the police and the Prison and Probation Service to assess and manage the risks posed by individuals whose offending has taken place in the context of domestic abuse or stalking, and who either have more than one conviction of this nature or are assessed as posing a high risk of serious harm.

Amendment 148B seeks to make amendments to the Sexual Offences Act 2003, imposing on domestic abuse and stalking offenders the same requirements that apply to registered sex offenders. This would require the offender to report personal information to the police, including where they are living, their bank account details and passport details.

The Government agree that robust management of perpetrators of domestic abuse and stalking is crucial to help keep the public safe. We completely agree with the spirit of these amendments; however, we believe the objectives can already be met through current provision and policy.

18:30

On Amendment 148A, there is already existing legislation where individuals who are convicted of specified violent offences and sentenced to 12 months’ imprisonment or more are automatically eligible for management under MAPPA category 2. These offences include domestic abuse related offences such as threats to kill, actual and grievous bodily harm, attempted strangulation, as well as stalking including fear of violence. The list is kept under review; for example, in recognition of the seriousness of the offence, we are legislating in the Criminal Justice Bill to ensure that offenders convicted of controlling or coercive behaviour will be automatically managed under MAPPA.

Noble Lords may question why all perpetrators of domestic abuse and stalking cannot be managed under MAPPA. We need to ensure that the MAPPA framework, and the resources of the police, prison and probation services under the framework, focus on the most serious perpetrators, thereby ensuring that resources are targeted at those who pose the greatest risk. As committed to during the passage of the Domestic Abuse Act, we strengthened the Secretary of State for Justice’s statutory MAPPA guidance to include a chapter dedicated to domestic abuse and stalking. It mandates that all domestic abuse and stalking offenders who do not qualify for automatic MAPPA management must be considered for discretionary management known as category 3.

The Government have also worked with MAPPA agencies to improve practice, including the publication of a thresholding document to assist practitioners making the decisions. I can report that we have since seen a steady increase in category 3 management, with a rise of 37% in the last reporting year. We will continue to monitor the numbers of discretionary cases via the published MAPPA annual reports and to work with MAPPA agencies to develop practice in this area.

On the points made by the noble Lord, Lord Russell of Liverpool, to be automatically eligible for management under MAPPA, there must be a conviction for a sexual, violent or terrorist offence, and the individual must either be subject to notification requirements under the Sexual Offences Act 2003 or be serving a sentence of 12 months’ imprisonment or more. MAPPA management is available for only those perpetrators who have been convicted of or cautioned for an offence. Where the sentence is shorter but there is concern about the risk posed, a perpetrator can be managed under MAPPA on a discretionary basis. We have strengthened statutory guidance—I apologise to the noble Baroness, Lady Royall—to clarify that MAPPA management should be considered in all domestic abuse and stalking cases. Successive annual statistics indicate a rise in the number of discretionary cases, and the majority of the 42 MAPPA areas in England and Wales report an increase in the number of cases of domestic abuse managed under MAPPA.

On Amendment 148B, also in the name of the noble Baroness, Lady Thornton, the Government believe there are already provisions in place that will allow for information on perpetrators to be collected and used to manage risk. All individuals released on licence are subject to standard conditions for the duration of their sentence which include the requirement for perpetrators to inform their probation officer of any change of name and contact details, and to stay only at an address approved by their probation officer. There are numerous additional licence conditions which can be imposed to address specific risk factors. Breach of a licence condition can result in the individual being recalled to custody.

For individuals who are not subject to licence supervision, noble Lords may be aware that the Domestic Abuse Act 2021 introduced provisions for domestic abuse protection orders. These orders—which will be piloted in the spring—will allow for notification requirements to be imposed on perpetrators, of which breach will be a criminal offence. Domestic abuse protection orders are a civil order and can be imposed without a conviction, providing an opportunity to protect a greater range of victims than the proposed amendment. Piloting will allow us to evaluate and test the effectiveness and impact of the new model ahead of an expected national rollout.

Similarly, we introduced stalking protection orders—SPOs—through the Stalking Protection Act 2019 which can impose any prohibition or requirements that the court considers necessary and also impose notification requirements. Breach of both domestic abuse protection orders and stalking protection orders can result in up to five years’ imprisonment.

On another point made by the noble Lord, Lord Russell of Liverpool, we agree that the implementation of measures to protect victims from harm should be reviewed to ensure they are fit for purpose. That is why we have committed to fund an external evaluation partner throughout the duration of the DAPN and DAPO pilot before taking a decision on rolling it out nationally and will continue to monitor the use and application of SPOs. We are aware that the police super-complaint submitted by the Suzy Lamplugh Trust on behalf of the National Stalking Consortium includes SPOs. We will take into consideration any findings and recommendations made by the investigating bodies when they report this year.

The noble Baroness, Lady Brinton, made some points about stalking protection orders and their enforcement. Some police forces, such as the Met, have been making excellent use of the new stalking protection orders we introduced in 2020. Others have applied for fewer than might have been expected. The VAWG strategy confirms the Home Office will work with the police to ensure all police forces make proper use of stalking protection orders. Among other actions, in October 2021, the then-Safeguarding Minister Rachel Maclean MP wrote to all chief constables whose forces applied for fewer orders than might have been expected to encourage them to always consider applying for them. In February 2023, the former Safeguarding Minister, Sarah Dines MP, did the same.

In answer to the point made by the noble Lord, Lord Russell, on MASIP, I am afraid I am unfamiliar with the programme and suggest a meeting to discuss further whether there is more the Government can learn from it.

In response to the noble Baroness, Lady Royall of Blaisdon, and my noble friend Lady Newlove, I am afraid I cannot comment on individual cases. However, I am happy to arrange a meeting to discuss them in private.

On the implementation of stalking protection orders, data from HM Courts & Tribunals Service shows that in their first 23 full months—February 2020 to December 2021—almost 1,000 interim and full SPOs were issued. The number issued rose by 31% between February and December 2020 and the equivalent period in 2021.

For these reasons, the Government feel that the aims of the amendments are already met through existing provisions, and I therefore urge the noble Baroness to withdraw the amendments.

[Baroness Thornton (Lab)]

Why does the Minister think we tabled these amendments?

[Lord Roborough (Con)]

I think I understand the point of the amendments, which is the belief that stalking and domestic abuse deserve to be treated the same way as terror and murder offences. I hope the explanation I have given shows that these offences, on a discretionary basis, can be treated with the same seriousness under MAPPA 2 and MAPPA 3. The Government have described an ongoing process of trying to improve the implementation of it.

[Baroness Thornton (Lab)]

I thank the Minister for the detail he has gone into. I am not making fun of him; I am genuinely wondering if he thinks it is all going in the right direction and fast enough. If so, we would not have needed to put the amendments down. We have tabled them because things are not moving fast enough.

Most of the examples my noble friend Lady Royall gave were not current, though some of them were. It is, therefore, perfectly all right to discuss them because they are a long time past and they show the failures of our systems to deal with and recognise stalking and the problems it poses. The reason we have tabled the amendments is because the systems we have at the moment are clearly not working and are very patchy. As my noble friend Lady Royall said, guidance does not always serve, and it does not serve in these circumstances.

I thank everyone who has spoken in the debate. It was very well informed. I think the Minister may have underestimated our determination on the matter. We may return to it at a later stage in the Bill. I beg leave to withdraw my amendment.

Amendment 148A withdrawn.

Amendment 148B not moved.

Amendment 148C

Moved by

[Lord Ponsonby of Shulbrede]

148C: After Clause 47, insert the following new Clause—
“Report to Parliament on including MAPPS as a condition of release and licence for certain offences(1) The Secretary of State must lay a report before Parliament on the Government’s progress in designing and creating new Multi-Agency Public Protection System [MAPPS] for prisoners subject to notification requirements and licence conditions under the Victims and Prisoners Act 2024.(2) The report under subsection (1) must be published within twelve months of the day on which this Act is passed.(3) The report must include a timetable for the planned implementation of MAPPS.”

[Lord Ponsonby of Shulbrede (Lab)]

My Lords, I beg to move Amendment 148C. I want to speak more widely than the previous group and briefly recount my experience as a magistrate. It so happens that the last two stalking cases I dealt with were of women stalking men. I have also dealt with recent cases where MAPPA—as it was called—was relevant to the bail decisions which we were making. The reason I want to speak more widely than the previous group is because, in my experience, the MAPPA system is also used for tracking and being aware of people with mental health difficulties who are perceived as dangerous. These are not stalkers but people who may well be dangerous because of their mental condition.

In fact, the last case that I dealt with—which was probably a couple of years ago now—was of a young man with a gun obsession, but who had clear mental health problems. It was going to fall to MAPPA to make sure he was properly protected—which I suppose is the right way of describing it—because he was likely to be released into the community. In that case, I quizzed the relevant offices about MAPPA, as it then was, and what was likely to be put in place for that young man. It was absolutely clear that there were a number of agencies involved. The key was multiagency working. As a court, we needed confidence that people would indeed be able to work across the agencies to try and keep proper tabs on the young man, to make sure he did not go off the rails again—if I can put it like that.

How are the types of cases dealt with by MAPPS and MAPPA recorded? They are not all stalking-related and domestic abuse-related cases; they go wider than that. They include a lot of agencies: not just police and probation, but also housing, local authority and health agencies. The whole point of that system is essentially to provide support for people who are potential offenders, to try and stop them from reoffending. How are the types of cases dealt with by MAPPA tracked? Is the Minister confident that the tracking of those releases means that the response can be properly tailored for the individuals whom they are dealing with? It is certainly my experience that very often, when things go wrong, it is because the agencies are not working together properly. This is a repeated theme of what I have seen when cases come before me in the magistrates’ court.

18:45

[Lord Russell of Liverpool (CB)]

My Lords, I would like to put my name to this amendment, because it is a continuation of the theme around stalking which we have repeatedly returned to in the Bill, as indeed we went on at length about in the Domestic Abuse Act.

In listening to the reply of the Minister to the last group of amendments, I was trying to imagine what a robust list would look like. I was somewhat puzzled as to how it would really have any effect at all. I was also pondering the term “discretionary management”, given that if only 1.4% of stalking cases actually end up in a successful prosecution, it is quite easy for the advisers who are writing the Minister’s brief to talk about percentage increases in performance. If one knows anything about mathematics, it is relatively easy to get rather spell-binding percentage increases in performance by starting from an exceedingly low base—a base of 1.4% of stalkers being successfully prosecuted, I am not a fan of percentages in a situation like this.

As the noble Lord, Lord Ponsonby, said, effective multiagency co-operation is clearly not working at the moment. This amendment gives the Government the opportunity to provide the single most important thing to make multiagency co-operation work: clear, outstanding, determined and consistent leadership. Leadership which transcends politics and different Ministers being responsible for the same area as the ministerial merry-go-round continues is incredibly important. The attempts by MAPPA to create an effective multiagency co-operation environment are so far not compelling. This amendment is an invitation for the Government to sit down and reflect on the lessons of what has not been and is not working as we would wish it, to create something more fit for purpose, and—in a non-political environment—to create a form of new MAPPS which is nothing to do with politics.

If the Great British electorate—of course, we are not allowed to participate—decide on a change of His Majesty’s Government at some point in the next 12 months, I hope that the department can come up with a form of multiagency co-operation which an incoming Government, should they be of a different political persuasion, would be positive about and could run with and make effective, rather than starting the clock all over again and losing valuable time. During this time, goodness only knows how many more victims will fall to the pursuit of stalkers, many of whom have been operating and stalking for many years, and many of whom are known all too well to the victims, but whom various multiagency authorities seem to be wilfully blind to.

[Baroness Brinton (LD)]

My Lords, I have also signed Amendment 148C and thank the noble Lord, Lord Ponsonby, for introducing it, and the noble Lord, Lord Russell, for his very eloquent contribution just now.

I too return to the Minister’s remarks at the end of the previous group, because it will help with this amendment. Part of the problem is that those of us who raise these issues about multiagency protection have assumed the corporate knowledge of the House about the previous six days and of all the amendments we have debated—in particular, those relating to domestic abuse and stalking. I fear that is not the case. One of the reasons we need this report is to ensure that Ministers and officials absolutely see what is happening in the data and bring it to Parliament to be held to account for it.

When I gave an example of a live case, I used the term “restraining order”. In his response to me, the Minister talked about a “stalking protection order”. They are completely different tools. An SPO is given by the police as a sort of special caution. It identifies the crime and says to the offender—there may not even be an offender at that point—that they have to mend their ways. A restraining order is given by the courts—it can happen at various levels of the courts—and is much more serious.

Most stalkers who are on restraining orders now will have been through the earlier processes, including, I am afraid, a number of stalking protection orders. While they may be a useful tool for the one stalker who is obsessed with one person but can get over it, the group of people that we are talking about in the MAPPA arrangements are completely and utterly different. They are extremely obsessed and manipulative people, who are physically dangerous in some cases, and certainly through coercive control. Not only are they a danger to the person for whom a restraining order may have been given but, in all the examples I gave in my speech on the previous group, they are known to be likely to offend with other people and to move around the country to get out of trouble and get away from the police force taking notice of them.

Given that we are talking about the most serious level of offences, whether it is domestic abuse or stalking, we need a consistent system across the country. Amendment 148C, through the report, would hold the Government—whatever Government, of whatever colour—to account, forcing them to produce data to show that they understand the difference. Until that happens, there will be Members of your Lordships’ House who will return, Bill after Bill, with horror stories of murders, attacks and everything else, but nothing will have changed.

[Lord Coaker (Lab)]

My Lords, I apologise for not having contributed to debates on the Bill as it has gone through its various stages. I spoke to my Front-Bench colleagues and the others who have added their names to this amendment, and I want to bring my experience as the independent chair of the Nottingham Community Safety Partnership, as laid out in the register of members’ interests, by speaking briefly to this amendment.

I welcome the Government’s intention to move from MAPPA to MAPPS and all the various comments I have read that have been made throughout the passage of the Bill about the importance of change. However, the reality is that, whether it is called MAPPA, MAPPS or something else, without the sort of change that my noble friend Lord Ponsonby, the noble Baroness, Lady Brinton, and the noble Lord, Lord Russell, and others have mentioned, nothing will change.

I am sick of having domestic homicide reviews. They say exactly the same thing, time after time. It is not a lack of desire or care on the part of the people involved; the system simply does not work. We have a situation where people do not share data because they do not think that they are allowed to—even though everyone says, “Oh, that’s ridiculous. Of course they’re allowed to”. The Minister of the Crown has to get hold of this; he needs to tell people to share the data in order to save lives—because they do not do so.

I am sorry to keep going on about this, but I am sick of reading about the same problem occurring, time after time: information is not being shared and people say that they did not know about this or that it was supposed to have happened. Again, it is not the dedication of the people that is in question—they all care and want to do good—but we need to know what is happening that does not allow it to take place.

The Minister has to get a grip of this. It does not matter whether it is called MAPPS or something else; without a change, nothing will improve. I know that that is the intention of the Government—of course their intention is not to make it worse—but what are we going to do about it?

I will tell the Committee about another problem. At times, the meetings are packed—absolutely rammed—with people representing, for hours, different parts of the system. What I say is that everybody is responsible but nobody is responsible. I repeat that: everybody is responsible because everybody cares, but nobody is responsible. The question is: who holds the ring? Who is the person accountable for ensuring that something is done and delivered, whether it is a review of a domestic homicide or prisoners coming out and being subject to the MARAC or MAPPS, as it will be called?

My final point is that the delivery of this from an office—I do not mean that disrespectfully—to a house or street is absolutely crucial, and yet nobody has done anything. I will give the Committee an instance. The Government have recruited new police officers—I am not making a political point—and so we have new front-line police officers, who are often very young and very willing, with the desire to do well. When they go to a prisoner out on licence or to a domestic incident, many of them go in blind, because they are young and inexperienced and have no idea what to do. They try to assess whether there is a threat to life, but, as we know, often with domestic homicides there is no immediate, obvious threat to life. That is the nature of domestic violence and, unfortunately, sometimes of domestic homicides; the offenders do not wear a sign saying, “I am going to kill someone”. The police officer goes there, as a 999 response officer, and deals with the immediate emergency as he or she sees it. Realising that there is no immediate threat to life, as far as they are aware, the police officer leaves.

Sometimes, the information that that has happened is not passed on. Sometimes, the police officer is rung again—“Come back, there is a problem”—and they go back but there is nothing going on. It is not as though somebody is running around with a gun, ready to shoot. If that does not change, it will not make a shred of difference whether you call it “MAPPS”, “super-MAPPS”, “extra-MAPPS”, or “brilliant-MAPPS”.

The Government want to make a difference, so they have to do something about the mechanism by which everybody is responsible but nobody is responsible, about what happens with the front-line delivery, and about the sharing of data and information. That is patchwork at best. My noble friend Lord Ponsonby, the noble Baroness, Lady Brinton, and the noble Lord, Lord Russell, say that the report has to address those problems. But the Minister does not need a report in 12 months; he could get on the phone or get a meeting now and ask why it is that the law allows you to share data but you are not.

My question to the Minister is this. When people say that they cannot share data in MARACs, or whatever else, are they right? Are they in a situation where they can do that? I think that they are wrong; I think that they can share that information. As a start to what the noble Lord, Lord Russell, the noble Baroness, Lady Brinton, and my noble friend Lord Ponsonby asked, why does the Minister not write to every single MARAC in the country and say, “Notwithstanding the Victims and Prisoners Bill that is going through Parliament, the existing law allows you to share information. Don’t worry, you will not be prosecuted or get in trouble for doing that”. They do not believe that—we may all say that that is ridiculous but that is the reality. What I want is for the Government to address on the ground the reality of what is happening. The Minister needs to get involved and do that. The Government want it to improve, as of course we all do, but that change is needed for an improvement to happen.

[Baroness Hamwee (LD)]

My Lords, the noble Lord, Lord Coaker, might like to know that, in evidence that the Justice and Home Affairs Committee took recently on community sentences, we came across various NGOs that were stuck because they were frightened of sharing information. It held up the system; it completely stopped things working as they should and could have.

19:00

[Baroness Newlove (Con)]

My Lords, this amendment is important. As someone who knows first-hand what it is like to gather information and then find out that the Home Office wants to gather information about red flags, I have to say it is amazing that all that information is shared for the Home Secretary to look at on a murder case.

I agree with the passionate assertion by the noble Lord, Lord Coaker, that data sharing is important. In a domestic homicide review, the families already know the information and have complained about it, but the Government have to wait for this review to come out with “lessons learned”. That is further insulting to the victims’ families and indeed to the victims, and it beggars belief that we have not moved on.

I want to tell my noble friend about data sharing. I attended a MARAC a few years ago as Victims’ Commissioner—not every MARAC is fantastic, I have to say—and what concerned me was that when a police officer gave evidence that the prisoner had been released, his offender manager, who was at that same table, was concerned because the last thing she knew was that he was still meant to be in prison. She had to leave the room to double-check, because he should not have been released. Unfortunately, I did not manage to find out the result, but the police and offender management had to try to establish whether the prisoner had even been released. That shows how important it is for data to be shared for the protection of victims. People need to understand what can be shared so they can find out whether a prisoner is even in their cell.

[Lord Roborough (Con)]

My Lords, I thank the noble Lord, Lord Ponsonby, for his amendment regarding the Multi Agency Public Protection System, MAPPS. I understand that the debate has not really been very much to do with MAPPS, but I will first address the amendment, which does address it. Amendment 148C would place a duty on the Secretary of State to publish a report on progress of the development of MAPPS for prisoners subject to notification requirements and licence conditions under the Victims and Prisoners Act 2024, within 12 months of Royal Assent.

It may be helpful if I provide some explanation of MAPPS. This will answer some of those questions, but I have better answers at the end. MAPPS is a Home Office IT project, currently jointly funded with the Ministry of Justice, to enable the improved management of dangerous offenders, including violent and sex offenders, under Multi Agency Public Protection Arrangements, or MAPPA. It is intended to replace the current case management system, the ViSOR database, which has been the main IT tool used by the police, probation and prison services since 2005.

The current database, ViSOR, while stable, is now almost 20 years old. The Home Office and the Ministry of Justice began work on MAPPS in 2020 to enable criminal justice agencies to share information in real time and improve their risk assessments and the management of all MAPPA nominals. That can include domestic abuse perpetrators and stalkers, as referenced in Amendments 148A and 148B.

I am sure we all agree that it is essential that police and other MAPPA agencies have the tools they need to manage the risk posed by serious offenders, and MAPPS will do just that. The new functionality will include greater capacity; a more intuitive system with push notifications; and increased mobility. MAPPS, as a new and modern system, will be more responsive to agency needs, and adaptable to any new notification requirements.

As noble Lords would expect for a project so important to public safety, we are being diligent in our approach to MAPPS development. MAPPS is a custom product, being built to meet the bespoke needs of police, prison and probation officers as well as other MAPPA authorities. While third-party contractors are used, given other discussions on the Bill, I am sure that noble Lords will want to note that Fujitsu is not involved in MAPPS development and never has been.

We welcome the interest in the MAPPS programme and, while the work is ongoing, the Government will of course further update Parliament on its development and implementation. Given that MAPPS is already being designed specifically to meet the needs of those agencies involved in the management of all MAPPA offenders, in conjunction with those very agencies, I do not consider that the proposed report would say anything more than has already been mentioned, and it is therefore unnecessary.

I turn to the debate that we have had in Committee. MAPPA deals only with convicted offenders under four categories, but much of the debate has been about information sharing in a way that is not consistent with that use of it. In answer to numerous noble Lords—the noble Lords, Lord Coaker, Lord Ponsonby and Lord Russell of Liverpool, and the noble Baronesses, Lady Newlove and Lady Brinton—on data sharing, the PCSC Act put beyond doubt the authority of agencies to share relevant information for the purposes of assessing and managing an offender’s risk, and to enable agencies and individuals who do not have a duty to co-operate to share information where they can contribute to the assessment and management of an offender’s risk. These measures clarified existing arrangements and will ensure that agencies understand how any sharing of information for the purposes of MAPPA management interacts with the obligations contained in the data protection legislation.

In answer to the noble Baroness, Lady Brinton, we are bringing coercive individuals under the management of MAPPA but it is potentially under the lower categories 2 and 3, as I mentioned in the previous debate. There have been numerous questions. I am sure I have not answered them all and I will write to noble Lords.

[Lord Coaker (Lab)]

The amendment in the names of the noble Lords, Lord Ponsonby and Lord Russell, and the noble Baroness, Lady Brinton, gives the Minister of the Crown the opportunity to jolt the system to tell people dealing with prisoners under licence or with potential domestic homicide incidents—within these multi-agency arrangements, whatever they are called or are going to be called—“You can share information in a way that you don’t believe you currently can”. If the Minister does that, it will save lives.

As I said, I am sick of reading domestic homicide reviews where people are killed and then, time after time, it turns out that it might have been avoided if information had been shared, but the people involved did not think they could do so. Why does the Minister not say to them in some way—in writing or from the Dispatch Box, using his powers as a Minister—that they can? That would make an immediate difference.

[Lord Roborough (Con)]

I thank the noble Lord for his comments, and for his comments earlier. Everyone in this Committee has the same interests at heart. We are all trying to achieve the same thing. I think I have read out a form of words that explains how data sharing is possible at the moment, but I take the point that there is the possibility of acting considerably more vigorously on this. I will take that back to the department. His words have not gone unnoticed.

[Lord Harris of Haringey (Lab)]

My Lords, that is a very helpful comment from the Minister—I apologise for not having intervened previously in the Bill—but, in other things that I have done over the last few years, there have been three separate areas of activity where the belief of professionals is that they cannot share the data despite the clear legislation, and despite the fact that a threat to life trumps most data protection legislation. It needs a bit more than the Minister saying, “I hear what has been said and we take it very seriously”. There has to be action to make those legal rights and that legal possibility absolutely clear.

[Lord Roborough (Con)]

The noble Lord makes a good point. Hardly a piece of legislation goes through this House where there is not a data protection aspect. That creates confusion and it is up to the Government to bring clarity, particularly in this area. I thank him for that interjection.

I encourage the noble Lord, Lord Ponsonby, to withdraw the amendment.

[Lord Ponsonby of Shulbrede (Lab)]

My Lords, this has been a useful debate because it has been focused on the effectiveness of MAPPA, soon to be MAPPS.

As the Minister said, MAPPS deals only with convicted offenders. However, in the previous group he spoke at length about domestic abuse protection orders and stalking protection orders. Those are not criminal convictions so the people involved would not get on to the system in the first place.

From my own experience as a magistrate, from the experience of the noble Baroness, Lady Newlove, as someone who is currently involved with the criminal justice system, and from the experience of my noble friend Lord Coaker, who is on the Nottingham Community Safety Partnership, we are all looking at the same problem from different perspectives, but it is about one thing: data sharing and being able to monitor that data.

The Minister is addressing the Committee as a Minister of the Crown. He has authority and can follow this through. The same message has come from everyone who has spoken in this short debate: it is about data sharing. I look forward to the Minister using his authority to make sure that that message is rammed home to those people who sit on those committees. I beg leave to withdraw the amendment.

Amendment 148C withdrawn,

Amendment 148D

Moved by

[Baroness Brinton]

148D: After Clause 47, insert the following new Clause—
“Duty of Crown Court to issue a restraining order for child sexual offences (1) A condition of the release on licence of child sexual offenders must include the issuance of a restraining order preventing any contact with the victim.(2) After section 244ZC of the Criminal Justice Act 2003 insert—“244ZD Release on license of certain child sexual offenders(1) A restraining order (as defined in section 359 of the Sentencing Act 2020) preventing any contact with the victim must be in place until further order at the point of release from custody under license conditions for those convicted of certain child sexual offences.(2) For the purposes of this section, “child sexual offences” means those offences defined as in the Sexual Offences Act 2003 sections 5 to 29, and sections 47 to 51.””Member's explanatory statement
This amendment requires a restraining order to be a condition of release for those convicted of child sexual offences.

[Baroness Brinton (LD)]

My Lords, we now turn to the perpetrators of child sexual abuse. I have tabled Amendment 148D, which imposes a duty on the Crown Court to issue a restraining order for child sexual offences for a perpetrator released on licence for certain child sexual offences. There is a strong reason why victims of child sexual abuse should be given this protection: they are among the most vulnerable, particularly when the abuse occurs within the family. Although there is respite for victims when the offender is in prison and while subject to licence conditions—provided that these have been properly set—the real problem is that robust licence conditions are often not in place; worse, even where they are, the victim is left unprepared once they expire.

Sexual harm prevention orders do not automatically include protection for the original victims of the crime; the onus is on the original victims to apply for a restraining order against the offender after they have been released—that is extraordinary. This not only creates enormous stress and fear but costs the Government more money through new hearings that must take place, not to mention the additional CPS and court resources that are needed. A restraining order placed at the time of release will save time and money, while affording the victim lifetime safety. It also sends strong messages to the offender that they will face criminal charges and up to five years’ prison time if the restraining order is breached.

Sexual abuse of any kind is dreadful, but child sexual abuse is particularly heinous. As the Independent Inquiry into Child Sexual Abuse evidenced, the victims’ lives are affected for decades. It destroys trust and lives; the fear of their abuser returning to their lives is very real.

One such case is Emily Victoria, whose father was sentenced to 14 years in prison for sexually abusing her—his daughter—and a foster child. On release under licence, conditions were put in place to prevent him from entering certain areas where the children, now adults, lived and frequented—these conditions were necessary for their safety. However, when his sentence was completed, the offender was no longer subject to any licence conditions, meaning he is legally able to contact, in person or digitally, the children—who are now adults—that he abused for their entire childhoods. They live in daily fear for their lives and live in hiding, subjected to ongoing trauma because the power has been given back to the offender.

Emily Victoria said:

“My dad horrifically abused me for the first 18 years of my life. I am now 33 and I have spent more of my life under his control than not. He has always been a violent man and pled guilty to many cases of child sexual abuse to myself and another.


His sentence came to an end on 21 November 2023. I am appalled that he has been given the right to contact me in person or otherwise. I live in fear that he’ll be waiting for me in the shadows of my home. There have been times when my home has been broken into and things have been moved around.


Right now, as a result of a prime-time documentary I presented which was aired on Channel 4, more children have come forward to say he sexually abused them. This can trigger a violent response with me as a target.


I am suggesting we impose a Lifetime Restraining Order at the time of release on license to prevent abusers of Child Sexual Abuse from ever getting in contact with their victims directly or indirectly. My dad tried to get in contact via a family member and it’s absolutely terrifying. I should not have to carry the burden of his mistakes for my whole life.


Nor should I have to go to trial/court to request a restraining order. The option to have a phone that directly calls the police because I’m in danger is enough. The restraining order for life sends a strong message of consequences to the offender that they will face criminal charges and up to an additional 5 years in prison.


I go to sleep at night worried about the safety of my child and myself – and I’m strong. For those victims whose offenders come out after just a couple of years and receive less chance of rehabilitation, it’s paramount we give the victims as much protection as possible.


True freedom for victims of child sexual abuse is in the hands of our Ministry of Justice and can be given to victims with a lifetime RO”.

19:15

Her experience and those of many others speak to why we need to ensure that victims of child sexual abuse are given the confidence that their perpetrator will not be able to contact them after their release. I beg to move.

[Baroness Thornton (Lab)]

My Lords, I do not need to add much to the words of the noble Baroness, Lady Brinton, because she has explained exactly why this is an important matter. I was slightly astonished when I read the amendment that this was the case and that this was something that we would need to remedy, so I look forward to the Minister’s response.

[Earl Howe (Con)]

My Lords, I too am grateful to the noble Baroness, Lady Brinton, for this amendment, which, as she explained, would require the Crown Court to automatically impose a restraining order on anyone convicted of a child sex offence; that would apply regardless of the type or length of sentence passed. There is no need for me to underline the horror of child sex offences and the lifelong harm that is inflicted on the victims. I therefore have a great deal of sympathy with the intent behind the amendment to do even more to try to minimise the impact of that harm, as well as protect the community from any further offending.

Restraining orders are a discretionary power available to judges to impose in cases where there is a need to protect people from harassment or conduct that causes fear of violence. The current regime allows for such orders to be imposed where there is sufficient evidence on conviction, post conviction or post acquittal. At present, applications for restraining orders are considered by the Crown Prosecution Service on a case-by-case basis, recognising that there is a need to keep a victim safe and take their views into account. Actions prohibited by the restraining order, such as going to certain locations or contacting the victim, may be a breach of the order which is punishable by imprisonment for up to five years. Variation or discharge of the restraining order must be undertaken by the court.

When dealing with child sex offences, the court has a range of sentencing options available that may include life sentences. The vast majority of offenders who are released are subject to licence conditions that could include conditions to protect the victim, such as prohibiting contact. Breaching the terms of any licence condition can result in an offender being recalled to prison.

Offenders are also subject to notification requirements, commonly known as the sex offender register, where individuals convicted or cautioned for a sexual offence must provide certain details to police, including address, national insurance number and bank account details. Furthermore, they will also be managed under Multi Agency Public Protection Arrangements, or MAPPA, for the duration of those requirements that, in many cases, will be for life.

Other measures to protect victims are also available. The sexual harm prevention order, or SHPO, can be made in relation to a person who has been convicted of a broad range of sexual offences, committed either in the UK or overseas. No application is necessary at the point of sentence, but courts may consider it in appropriate cases. Otherwise, applications can be made by the police, or other agencies, in preparation for the offender’s release on licence.

The prohibitions imposed by the order can be wide-ranging, such as limiting forms of employment that may involve contact with children or restrictions on internet access. The orders may be for a fixed period not exceeding five years but are renewable. More than 5,000 SHPOs were imposed in the year 2022-23, which shows that the courts are using the tools and powers available.

While I support the well-meaning intention of the amendment, I do not believe it is necessary, because there is a wide-ranging and effective set of measures to monitor and control offenders. I also suggest that the point at which these additional measures would be needed are when someone’s licence comes to an end; until then, conditions such as non-contact and exclusion can be in place on the licence. So it would be better to take decisions on the controls necessary at the conclusion of the licensing period, rather than attempt to predict them at the point of sentencing.

Requiring the Crown Court to automatically issue a restraining order as a condition of release in every case caught by this amendment would constrain the court’s discretion not to issue an order where it was not needed or desired. From a practical perspective, a mandatory restraining order imposed on an offender at the point of sentence, which could be many years before the end of the sentence, would be a duplication of some of the other controls I have already set out and it could create practical difficulties down the line, especially where the sentence is very long.

We also must remember the voice of the victim, which plays an important part in decision-making. Where an offender has received a custodial sentence of 12 months for violent or sexual offences, which of course include sexual offences against children, victims will be automatically referred to the victim contact scheme. Where the victim is a child, a parent or guardian may join the scheme on their behalf. If they choose to join the scheme, a victim liaison officer will inform them when the offender is going to be released and help them to request licence conditions that will apply upon the offender’s release, such as prohibitions on contacting the victim or entering an exclusion zone.

In conclusion, I hope I have adequately explained the wide-ranging provisions already available to safeguard victims, which we should allow the courts to impose as they see fit, according to the circumstances of a given case. I hope that, on reflection, the noble Baroness agrees and feels able to withdraw the amendment. In saying that, I make it clear, as I often do, that I am happy to talk to her after Committee to explore these matters further.

[Baroness Brinton (LD)]

I am very grateful to the Minister and I thank the noble Baroness, Lady Thornton. I am very grateful for his explanation of the system, but my difficulty with his response is that it does not make sure that the victim does not have to be proactive to go back to the court and make a statement, if they are very clear.

I hear what the Minister says about a sentence of more than 12 months, and I may return on Report with a slightly different amendment. This is a particular problem for victims of child sexual abuse of those who are discovered to have abused others and who present other issues. It is not just a one-off case that we are trying to resolve. In the meantime, I withdraw the amendment.

Amendment 148D withdrawn.

Amendment 148E

Moved by

[Baroness Fox of Buckley]

148E: After Clause 47, insert the following new Clause—
“Change in gender recorded in relevant police register(1) A condition of the release on licence of perpetrators of criminal conduct of a sexual nature is that criminal justice bodies must take all reasonable steps to identify and record any change of legal gender by such perpetrators at the point at which they are released on licence.(2) Criminal justice bodies must ensure the sexual offences register and police database record accurate name and birth sex information for perpetrators of criminal conduct of a sexual nature at the point at which the perpetrator is released on licence.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I dedicate this speech to Lord Cormack because, the last time I spoke to him, we discussed this very issue. I make no claim that he would agree with me; it is just that, as was his wont, he was very supportive of me tabling this amendment. I acknowledge that he did not agree with me on many things but he was still a great Peer.

Amendment 148E looks at identity changes and recording on registers. On the front page of Scottish newspapers over the weekend was the story of Marc Sherland, the head of the Robert Burns World Federation, who has been unmasked as a convicted sex offender who abused two boys in the past. He exploited a legal loophole that meant that Douglas Hammond, which was his name when he committed earlier offences, could change his name to get the job. Chillingly, his role at the federation allowed him access to children.

Thankfully, instances of sexual offenders changing their name to escape their past are being tackled, not least by the efforts of campaigners for Della’s law, named after six year-old Della Wright, who was raped by a man who had legally changed his name five times. I am glad that the Government have endorsed amendments to the Criminal Justice Bill that will block offenders from, for example, using deed poll to obtain a new identity.

I particularly congratulate the honourable Labour MP Ruth Jones, whose Private Member’s Bill, the Community and Suspended Sentences (Notification of Details) Bill, passed its Second Reading in the other place only on Friday, 23 February. I congratulate the Government on signalling their support for that Bill. It is designed to tackle the hundreds of sex offenders across the UK who slip off the radar because they lawfully change their names and then apply for fresh identity documents, allowing them to escape the authorities and their past and, potentially, to secure jobs working with children.

Now, you might say that, because of the Private Member’s Bill that I just mentioned and the Government’s support for it, which deal with my worries, there is really no need for my amendment. However, we are told that the Bill will mean that all offenders will have to notify their probation officers and others about any name changes, online aliases or changes in contact details when, actually, perhaps not all offenders are covered by this. My amendment probes another loophole that seems to have gone beneath the radar. I hope that the Minister will address this—I do not necessarily mean this evening, but before we get to Report.

The new arrangements that I have discussed are about not allowing sex offenders simply to change their identity to escape their past crimes. Offenders will not simply be able to change their identity on official documents. This is true for everyone, except for when a little-known exemption applies. It relates to a sensitive applications clause that applies to those who have changed their identity not simply via deed poll but via transitioning gender. This sensitivity clause can be utilised by convicted male sex offenders who change gender after committing a crime, once they are incarcerated.

I discovered this loophole from a bizarre tale that ended up being rather personal to me. Ceri-Lee Galvin is now a delightful 25 year-old mum who is training to be a paramedic, but she had a traumatic, hellish childhood. From the age of eight, she was sexually abused and raped by her own father, Clive Bundy. This horrendous ordeal went on for eight years until, eventually, in 2016, Bundy was arrested and sent to prison for 15 years. Having served only half of his sentence, Bundy was released on licence less than a year ago.

Whatever the rights and wrongs of this seemingly early release—I think it was unseemly that Bundy was released so early—one would think, after his release had been agreed, that at least Clive Bundy would be in clear sight of the relevant criminal justice agencies for protection and safeguarding. But there is a catch. Two years prior to Clive Bundy’s release, he declared himself a woman and changed his name to—wait for it—Claire Fox. For those of you who know me only as the noble Baroness, Lady Fox, my name is Claire Fox, so I noticed when I heard this story.

19:30

Think about what that means. A “Clive Bundy” might well be on the sex offenders register, but Clive Bundy does not exist anymore—Clive Bundy is Claire Fox. Clive Bundy was not let out of prison early on licence—Claire Fox was. What is more, the proposed new changes on restricting identity and name change via deed poll, which I have already discussed, will not apply to Clive Bundy, because when someone changes gender as part of changing their identity—it makes no difference whether that is achieved by self-declaration or in accordance with the provisions of the Gender Recognition Act—they are afforded an extraordinary, enhanced right to privacy, wholly unlike those granted to any other individual.

These special protections, given to them by the state, represent a concrete safeguarding risk. It means that a loophole has been created, whereby an individual is able to conceal their past identity for the purposes of, for example, the Disclosure and Barring Service checking processes. An individual such as Clive Bundy can request, based on this special category of privacy, that his past identity or name is not displayed. I am confusing myself, because it is not Clive Bundy who can request that but Claire Fox. Claire Fox can say, “I don’t want the name Clive Bundy to be displayed on any DBS certificate issued to me—my name is Claire Fox”.

A prospective employer is not entitled to know whether a candidate has used this sensitivity clause to cover up who they are. I remind noble Lords that DBS checks are supposed to play an important role in safeguarding, by helping organisations make safer recruitment decisions. They are designed to deter unsuitable people from applying to work with vulnerable groups, and to assist organisations in identifying and rejecting such people. But organisations are able to rely on the DBS checking process only to the extent that checking systems are robust, and that the information displayed on DBS certificates is both accurate and complete. Thanks to the work of people such as Kate Coleman and the campaign group Keep Prisons Single Sex, or KPSS, we now know that these sensitive application loopholes mean that organisations have no way of knowing whether information displayed on DBS certificates presented to them is an accurate or complete record concerning any individual.

Think about what that means for Ceri-Lee and her paedophile father. Since his release, Clive Bundy—Claire Fox—has gone to live in the same town as his daughter. That means that he could apply for jobs locally working with children, even with Ceri-Lee’s own daughter, and his past would be hidden. It is worth noting that, due to the special privacy rights afforded to Bundy, the victim, Ceri-Lee, had no right to know about Clive’s gender transition and found out only when Bundy gave permission for the information to be passed on via Ceri-Lee’s victim liaison officer—part of what writer and activist Julie Bindel described as an example of “coercive and controlling tactics”.

The key issue is that there is no legal requirement for a victim to be warned. Ceri-Lee would not have had any idea that Clive Bundy had been erased and that the new person who had entered the town—Claire Fox—was in fact her father. Therefore, there would have been no alert given to the family children if they were being shown attention by a local employee called Claire. I stress the familial connections point because, grossly, Clive Bundy’s argument at the Parole Board as to why he did not represent a threat to wider society was that his incestuous abuse had been kept within the family. Think about that as a sick retort.

In rounding off my remarks, I am keen that your Lordships note that this amendment is driven by Ceri-Lee’s experience, rather than my own views on gender identity, which I know not all noble Lords will agree with me on. Ceri-Lee is not involved in gender politics. She got dragged into this by her paedophile rapist, noting that:

“My father wasn’t dysphoric about his male genitals when he was abusing me”.

In a way, I have been dragged into this issue by Clive Bundy using my name. When the story was first made public in the other place, and then in the press, I was mortified and wished it would go away. It was so embarrassing to have my name being sullied by such an association with a perpetrator. But when I thought about it, and heard that Ceri-Lee had broken her own anonymity, it gave me a jolt. She appealed to those of us with influence to help her expose the loophole that could allow dangerous sexual predators to evade detection and potentially target other child victims, perhaps in female-only settings. Ceri-Lee knows that it is too late in her case, but it does not have to be for others. I hope, therefore, that we can perhaps create a “Ceri-Lee’s law”.

[Baroness Brinton (LD)]

My Lords, the noble Baroness, Lady Fox, started her speech by talking about sex offenders changing their names frequently, and there is no doubt that this happens. I will come on to explain why I think that there is help in that. However, her amendment seems to be intending to strengthen identification of individuals on licence who have a different gender assignment from that given at birth. It implies a perceived need to know that person’s birth gender, legal gender and legal identity, and that they are relevant to the prevention of a sex crime. This is, as I think the noble Baroness is aware, highly contentious and a sensitive topic, with implications for the equality, dignity and fair treatment of transgender people.

His Majesty’s Prison Service estimates that there are approximately 2.9 transgender prisoners per 1,000 in custody. There were 281 prisoners living or presenting in a gender identity different from their birth sex as of 31 March last year. At the same time, the number of prisoners with a gender recognition certificate was only 13. HMPPS already has robust arrangements in place for identifying individuals who have undergone gender change at the point of entry to custody. That is because there are already rules inside prisons for making sure that there are no risks to the prison population—or indeed to those who have changed their gender, who sometimes are attacked as well.

Nevertheless, even if an individual somehow managed to slip through the net, establishing it would require staff checking the legal gender of every person convicted of a sex event who was released from prison—effectively trying to prove that they do not have a GRC by asking the gender recognition panel. Proposed new subsection 2 of the noble Baroness’s amendment is about the database recording absolutely everybody who has committed a sexual offence in their gender at birth. Data published on 31 December last year shows there were 14,152 people serving a sentence in prison for a sex offence. I wonder whether the Minister cares to hazard a guess at how much time would be spent if HMPPS and the GRC trawled through that lot. HMPPS is required to accurately record a person’s legal gender upon entry to custody, and the policy states that, where legal gender has not been confirmed, efforts to establish legal gender must be recorded separately when different—so both are still recorded.

Furthermore, I remember that during the course of the then Police, Crime, Sentencing and Courts Bill in 2021, the noble Baroness, Lady Williams, on behalf of the Government, said:

“There are no other instances across government where there is a mandatory requirement to record both a person’s sex as registered at birth as well as their acquired gender, if that is applicable. The Office for Statistics Regulation is clear that it is for each department to decide when and how it collects data, including data on both sex and gender.


We have already stated that we do not plan to require biological sex to be recorded across the criminal justice system in our response to a recent petition calling for the biological sex of violent and sexual offenders to be so recorded”.—[Official Report, 22/11/21; col. 724.]


Given that, and given the protections that the Prison Service must follow through with every transgender prisoner, I wonder if there is actually a real reason for the need for this amendment. I appreciate the tale that the noble Baroness, Lady Fox, gave us from the individual, but I am not sure that what she requires in this amendment would actually help the victim in this case.

[Baroness Thornton (Lab)]

My Lords, I echo the worry of the noble Baroness, Lady Brinton, about this, partly exactly because it may not solve the victim’s problem that the noble Baroness, Lady Fox, outlined in proposing this amendment. We have also talked a lot about the unevenness of the criminal justice system’s data collection and everything else; I wonder how on earth it would do this, to solve what is probably a very small problem—but a challenge, absolutely—and whether there may be another way of resolving it. I look forward to the Minister’s remarks.

[Earl Howe (Con)]

My Lords, I am grateful to the noble Baroness, Lady Fox, for explaining the background to her amendment. It would require by law that the criminal justice agencies—the police, prisons and probation—identify and record any change of gender identity by a sex offender as a condition of their release on licence. It would also require the police to record the offender’s name and birth sex as a condition of their release on licence.

It may help if I outline the measures we already have in place, which I think address the spirit of this amendment. Part 2 of the Sexual Offences Act 2003 requires sex offenders who have been convicted of an offence in Schedule 3 to that Act to notify the police of their personal details annually and whenever they change. Those details include information such as names, including aliases, and addresses. They also include details of activity such as foreign travel and residence in a household with children.

Sex offenders subject to the notification requirements in Part 2 of the 2003 Act are managed under the Multi Agency Public Protection Arrangements. MAPPA is a statutory arrangement, through which the responsible authority—the police, prisons and probation—work together and with other agencies to discharge a statutory duty to co-operate, to assess and manage the risk posed by registered sex offenders and others living in the community.

In February 2023, the Ministry of Justice and His Majesty’s Prison and Probation Service created a presumption that all transgender female prisoners, whether they have a gender recognition certificate or not, would not be held in the general women’s prison estate. The Prison Service is able to verify, with the gender recognition panel, whether an offender has a gender recognition certificate. Any difference between an offender’s birth sex and assumed gender will therefore be recorded and made known to the probation and police services through their co-operation under MAPPA.

The MAPPA responsible authorities use the VISOR database to share information about registered sex offenders. VISOR enables the recording of sex, gender identity and gender presentation. An offender’s legal sex will be changed on VISOR only if they have provided a GRC to the police, probation or prison service. However, MAPPA agencies are still able to have regard to an offender’s change of gender where it is necessary to manage their risk, or prevent or detect crime.

19:45

While Section 22 of the Gender Recognition Act 2004 makes it an offence to disclose information about an individual’s application for a gender recognition certificate, there is an exemption for this where disclosure is necessary to prevent or detect crime. Accordingly, should the police or any of the other responsible authorities require information about an offender’s application for a gender recognition certificate, this can be obtained by working with relevant “duty to co-operate” bodies, such as medical professionals.

I hope that the noble Baroness, Lady Fox, will find this information helpful. While I am of course willing to write to her if I have not picked up any subtleties of the points she raised, I hope she will feel comfortable at this stage in withdrawing her amendment.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I thank noble Lords for the responses I have received. I will take what the Minister has said, and look at it myself, and maybe we can both clarify whether we have missed anything. I do not want to delay us too long now. I will say to the noble Baronesses, Lady Thornton and Lady Brinton, that if the wording of this amendment will not correctly pick up the problem I have identified, I would be happy to take their advice on how to improve it.

I think that a genuine loophole does exist, however. I was a bit concerned when the response seemed to be to suggest that there would be a lot of work involved in solving a small problem. I have listened to such passionate speeches from the noble Baronesses, Lady Brinton and Lady Thornton, about threats to women and girls, from stalking in particular, and about the importance of child protection and so on; I would have thought that they would have grabbed any opportunity to close down a loophole on safeguarding. I hope they will work with me.

The loophole in general of sex offenders changing identity has been identified by the Labour MP and backed by the Government. I have simply drawn attention to a loophole within that loophole that was being closed. I have used particularly the examples of DBS checks. They are very important; I have always thought that the Government went slightly over the top with DBS checks for people volunteering with the Brownies or what have you in the past but, if you are going to have them, you need to be able to rely on them. When the Minister gave his assurances, I did not feel they would capture the DBS point. That is what I have tried to do in the amendment. It will be improved; I will be back on Report. In the meantime, I withdraw the amendment—and I am glad that people appreciated the spirit of it.

Amendment 148E withdrawn.

House resumed.

Anaesthesia Associates and Physician Associates Order 2024

Monday 26th February 2024 Lords Chamber

Motion to Approve

19:49

Moved by

[Lord Markham]

That the draft Order laid before the House on 13 December 2023 be approved.

Relevant document: 10th Report from the Secondary Legislation Scrutiny Committee (special attention drawn to the instrument)

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

My Lords, I note that the noble Baronesses, Lady Finlay and Lady Brinton, have laid regret amendments and that the noble Baroness, Lady Bennett, has laid a fatal amendment relating to this order concerning professional titles, supervision requirements and the General Medical Council as the regulator, along with constitutional concerns about how parliamentary oversight of regulatory bodies will be maintained in the future. These are important points that I will turn to shortly. I thank the noble Lords who took the time to engage with me on this order at a briefing session last week, when we had a very helpful discussion on the key issues.

Anaesthesia associates and physician associates are already a valued and integral part of the multidisciplinary healthcare team. We acknowledge that there have been some concerns around the AA and PA roles, but regulating these professions will help to increase the contribution that they can make to the UK healthcare sector while improving patient safety and professional accountability. As well as bringing AAs and PAs into regulation by the General Medical Council, this order paves the way for full-scale reform of the regulatory frameworks for all the healthcare professional regulators. This is a rare and significant opportunity to deliver a large-scale programme of reform that will implement improvements to patient and public safety, the system of professional regulation and the health and care workforce.

This order will give the GMC powers to register AAs and PAs it assesses to be appropriately qualified and competent; to set standards of practice, education and training and requirements for continual professional development and conduct for AAs and PAs; to approve AA and PA education and training programmes; and to operate fitness to practise procedures to investigate concerns and, if necessary, prevent or restrict an associate practising. The legislation provides a high-level framework for the GMC to regulate AAs and PAs and, importantly, gives the GMC autonomy to set out the details of its regulatory procedures in rules.

The GMC has committed to developing rules and processes for regulating AAs and PAs that will be subject to public consultation to enable regulation to begin by the end of this year. Once regulation begins, in keeping with the approach taken to bring other healthcare roles, such as dental nurses and dental technicians, into regulation, there will be a two-year transition period that will enable individuals to continue to work and use their relevant professional title while they go through the process of registering with the GMC. After the transition period, it will be a criminal offence to practise as an AA or PA without being registered with the GMC.

I now turn to the fatal amendment tabled by the noble Baroness, Lady Bennett, and specifically to the concern that this order represents a significant constitutional change without the required parliamentary oversight. I thank the Secondary Legislation Scrutiny Committee for its comments on this topic.

I highlight that the delegated arrangements that give Parliament broad powers to make changes to the regulatory landscape via secondary legislation have been operating effectively for more than two decades. It is important to note that prior to the Health Act 1999 there had been growing public, parliamentary and professional concerns about the healthcare professional regulators and the delivery of public and patient protection. Important reforms had been delayed by the need for primary legislation to overhaul a number of Acts dating back to the middle of the 19th century. The delegated powers afforded by Section 60 of the 1999 Act allowed a start to be made on the large task of modernising and rationalising this legislation. These powers have facilitated some important changes and improvements to healthcare regulation, including bringing nursing associates into regulation and introducing revalidation for doctors.

In using the powers under Section 60 of the Health Act, the Government are required to consult publicly for three months on any draft legislation they intend to lay. In addition to a legislative consultation, in March 2021 the Government undertook a three-month policy consultation that invited views on the aims of this work. These consultations and the extensive engagement conducted throughout the project have been clear that one of the primary aims of the legislation is to bring anaesthesia associates and physician associates into statutory regulation by the GMC.

Following the legislative consultation, the legislation is subject to the affirmative parliamentary procedure. This requires the legislation to be debated in both Houses of Parliament and is why we are here today. This is a necessary and proper procedural requirement allowing for parliamentary consideration and scrutiny of the legislation.

The Government have sought, at every stage of the process, to engage a wide and diverse range of interested parties and to be clear on what this work will achieve. In addition to the helpful discussions I had with noble Lords at last week’s briefing session, it is my sincere hope that this evening’s debate will be a further example of this vital engagement and that fellow Peers will feel reassured.

I turn to the order itself. The principles set out in this order have long been sought by the regulators and were recommended by the Law Commission in 2014. At present, for a majority of healthcare regulators, the requirement for parliamentary approval of changes to their rules means that they are less able to respond quickly to amend their processes to reflect emerging workforce trends or concerns. We are providing the GMC with greater autonomy to set out the details of its regulatory procedures in relation to AAs and PAs in rules it publishes itself. The GMC will still be required to consult on its rules but will not need to secure the approval of Parliament or the Privy Council, giving increased flexibility to rapidly adapt its processes and procedures to changing requirements.

Although the order increases the number of areas that the GMC has autonomy over in respect of its day-to-day functions in relation to AAs and PAs, we recognise that there needs to be a system of checks and balances in place to ensure that the GMC continues to act in accordance with the needs of patients, registrants and the wider healthcare sector. The legislation places a number of duties on the GMC to ensure that the new powers are used reasonably and proportionately. For example, it must discharge its functions under this order in a way that is transparent, accountable, proportionate and consistent.

The GMC will remain accountable for any function, or part of a function, it delegates to another regulator or third party. Although the GMC already has the power to set its own fees for medical practitioners, and the same power is proposed for AAs and PAs, we are also introducing a requirement for the GMC to include in its annual report the evidence it has considered of the likely impact of any changes made to fees.

We are also retaining current accountability mechanisms. For example, the GMC will continue to submit annual reports to the Privy Council and copies will be laid before each House of Parliament, which will enable Peers and MPs to scrutinise the regulator’s activities and raise any issues in the House. There is also the Health and Social Care Select Committee, which can hold the GMC to account. As noble Lords know, it has held hearings with the GMC and other professional regulatory bodies on a number of occasions to oversee their work.

The Professional Standards Authority for Health and Social Care—the PSA—oversees the 10 health and care professional regulators and is an independent organisation accountable to the UK Parliament. It carries out performance reviews on all the regulators to see whether they have met the standards of good regulation and publishes its findings. It also has an escalation policy that would allow the PSA to escalate serious or intractable concerns to others, particularly the Government and Parliament. Finally, the Privy Council has a power to direct the GMC where it has failed to carry out its statutory functions using its default powers. I hope these points on how oversight and scrutiny of the healthcare regulators will be maintained in future will reassure the noble Baroness, Lady Bennett, and address the issues that were raised in the Secondary Legislation Scrutiny Committee’s report.

I turn to the role titles, which are referred to in the regret amendments tabled by the noble Baronesses, Lady Brinton and Lady Finlay, and the fatal amendment tabled by the noble Baroness, Lady Bennett. They have been the topic of much debate online, specifically about the use of the word “associate” rather than “assistant”. It is worth noting that AAs and PAs have been practising in the NHS for around 20 years, with the “associate” term being in use since 2019 and 2014 respectively. The titles reflect the fact that, as with nursing associates, they are part of a multidisciplinary team of healthcare professionals from various disciplines working together to deliver co-ordinated patient care.

As set out in National Institute for Health and Care Excellence—NICE—guidelines, all healthcare professionals should introduce themselves and explain their role to the patient regardless of their job title. In addition, in advance of regulation the GMC has published interim standards for AAs and PAs, which make it clear that professionals should always introduce their role to patients and set out their responsibilities in the team.

The noble Baroness, Lady Brinton, also outlined concerns in her regret amendment around the decision for the GMC to take up the regulation of the AA and PA roles. The assessment of the appropriate regulatory body for AA and PA regulation was completed in 2019 following a public consultation. The majority of respondents to that consultation were in favour of the GMC taking on regulation, including the professional bodies representing the roles and the medical royal colleges, including the Royal College of Anaesthetists, the Royal College of General Practitioners and the Royal College of Physicians.

The GMC is the right regulator for these roles. Regulation will give the GMC responsibility and oversight of AAs and PAs, in addition to doctors, allowing it to take a holistic approach to education, training and standards. This will enable a more coherent and co-ordinated approach to regulation and, by making it easier for employers, patients and the public to understand the relationship between the roles of associates and doctors, help to embed them in the workforce.

20:00

There has also been the suggestion that the AA and PA roles are being used to replace doctors in delivering NHS services, alongside concerns about the level of supervision required. Let me be clear on this: the role of associates is to work with doctors, not replace them. AAs and PAs are distinct, complementary and valued professionals who, under appropriate supervision, can enrich the workforce skill mix, freeing up junior doctors and consultants to spend more time using their specialist skills and training to focus on complex clinical duties and decisions around patient care.

It is important to note that the NHS Long Term Workforce Plan sets out an aim to double the number of medical school places in England to 15,000 places a year by 2031-32, and to work towards this expansion by increasing places by a third, to 10,000 a year, by 2028-29. We have accelerated this expansion by allocating 205 additional medical school places for the 2024-25 academic year, with the process for allocating 350 additional places for the 2025-26 academic year already under way. This demonstrates our commitment to the medical profession and that we do not see PAs or AAs as replacements for doctors. There are currently more than 139,200 full-time equivalent doctors working in the NHS in England—that is over 42,000 more than in 2010—and there are fewer than 3,500 AAs and PAs.

Across the UK, each nation is considering the operational deployment of these roles within its workforce. In England, the long-term workforce plan commits to increasing the PA workforce to 10,000 by 2036-37 and the AA workforce to 2,000 over the same period. It is of course vital that this expansion is delivered safely, and the NHS is working with partners including the GMC, royal colleges and other stakeholders to ensure that associates can be effectively trained and integrated into teams across a range of specialities.

To summarise, regulation will provide a standardised framework of governance and assurance for clinical practice and professional conduct, to enhance patient safety and to enable PAs and AAs to make a greater contribution to patient care as part of the multidisciplinary team. I am content to bring forward this legislation today. The order is a positive step forward in the safe expansion and further integration of the AA and PA roles within the NHS. I commend this order to the House.

Amendment to the Motion

Moved by

[Baroness Bennett of Manor Castle]

As an amendment to the above Motion, to leave out from “that” to end and to insert “this House declines to approve the draft Anaesthesia Associates and Physician Associates Order 2024 because it represents a significant constitutional change in regulation of healthcare professionals by omitting parliamentary oversight and approval for regulating anaesthesia associates and physician associates; and fails to address concerns within the medical profession about the supervision and titles of the roles.”

[Baroness Bennett of Manor Castle (GP)]

My Lords, I rise to move what the Minister has correctly identified as a fatal amendment that the House do not approve this order. This is on two primary grounds: the lack of democratic oversight and the concerns of the medical profession.

Before I begin, I want to make it clear that I am not opposed to the existence of physician associates or assistants, or their anaesthetist colleagues. I am not opposed to their regulation—indeed, I am keen to see them regulated—and I respect the efforts of current and future PAs and AAs who complete their studies and have the student debt to prove it.

I also want to be clear that, unless I get an indication from the House that it wishes me to do so, it is not my intention to put this amendment to the vote. My intention in tabling it was to ensure that the many hundreds of voices of concern that have reached me personally and the more than 21,000 doctors and patients who wrote to their MPs opposing this order are heard, and that the Government consider—seriously, I hope—whether they should go forward to regulate PAs and AAs in this manner, with this order.

I will first address the second part of my fatal amendment, about the views of doctors and patients. Sir Robert Peel invented the concept of policing by consent. I want to adapt that for these circumstances by saying that we must have regulation by consent. I am sure that all noble Lords engaged tonight are aware that the British Medical Association, the Doctors’ Association UK and the EveryDoctor group are opposed to this statutory instrument, for reasons on which I am sure we will hear much more from the noble Baronesses, Lady Finlay and Lady Brinton, with their regret amendments.

One of the very serious concerns is about clarity for patients and the confusion introduced by the title “associate”. On that I turn to a report from the BBC, an interview with Marion Chesterton, the mother of Emily, who tragically died after being seen twice by a PA and misdiagnosed. Marion said that her daughter

“didn’t know she hadn’t seen a doctor”.

Marion added—and this is something that I think people should focus on:

“Physician associate sounds grander than a GP”.


I pick up a point made by the Minister about PAs and AAs having been around for 20 years, an often-cited statistic. If we look back to 2014 and 2015, there were fewer than 50 PA and AA graduates. There were literally handfuls in the system. It is only when you get to 2018 that you start to see the figures leaping up to 400 graduates, and the Government’s aim is to head towards the figures that the Minister cited. So we may not have seen much confusion, but there were few people to be confused about within the system. This is a situation that is arising now, and that demands a reconsideration.

However, I will largely leave the arguments about titles, and the General Medical Council as regulator, to the regret amendments. What I want to focus on is the word “consent” and the concerns of doctors and patients in the context of the state of our medical system.

We debate as junior doctors are in the middle of their 10th strike action. We debate as one in seven British-trained doctors is working overseas. We debate after a BMA poll found last year that around 40% of junior doctors plan to leave the NHS as soon as they can find another job.

We need to make changes to the system. That is something on which the Minister and I, and I think pretty well everyone, are agreed, but we can make changes to the system only with the consent of all those involved. There is a moral argument for that, but also a very powerful practical argument. The Government need to work co-operatively and sensitively, and to listen to our medical professionals rather than ride roughshod over their serious concerns—concerns that are shared by many patients and that have filled my social media feed in recent days.

The first part of my amendment is about democracy. The order got virtually no scrutiny or consideration in the other place. We, of course, have no opportunity to amend it to tackle the issues that the noble Baronesses will focus on in their regret amendments. We have only the extraordinarily rarely used option of rejecting it. I have not had any indication from the Labour Party that it would support that, and I assume that its silence on the Order Paper means that it supports the Government’s path, but I ask the Labour Front Bench to consider whether we have to take this back to the drawing board. That is a question I put to it directly.

The Minister raised the report of our hard-working and, I fear, underappreciated Secondary Legislation Scrutiny Committee, which makes it very clear that this is not just about PAs and AAs but is meant to be the model for broad and widespread changes to medical regulation in the future. The committee’s report says that this is

“the first use of powers inserted into the parent Act by the Health and Care Act 2022 to give the GMC direct powers to make and amend standards and procedures for these associates”,

while, as it says in bold,

“removing the process from Parliamentary oversight”.

It is interesting that the Committee says:

“The Explanatory Memorandum should have been more explicit on this point and on what safeguards remain”.


In testimony, under questioning from the committee of your Lordships’ House, the department confirmed that

“changes in registration processes etc will no longer be laid before Parliament in any form, they will just be posted on the GMC’s website … however members of either House can respond to consultations if they wish”.

I am glad about that.

This has really not been made clear through the process, as the committee highlights. I think it is worth focusing on the fact that had it not been for the amendments from the noble Baronesses and me we would not even be doing this in the main Chamber. We would be in the secondary Chamber, getting, as we all well know, very little attention at all.

I particularly want to highlight, in case noble Lords did not receive it, the briefing from the Professional Standards Authority, which has responsibility for overseeing the GMC’s activities. It said, in what I think one would describe in bureaucratic terms as a carefully worded briefing, that we

“need to keep under review as the reforms are rolled out the accountability framework proposed to balance the increased autonomy for regulators with greater accountability”.

I wish to make a final point to address the fear and concerns of many patient groups and communities—which the Minister alluded to—that their communities and their families will lose ready or perhaps any access to doctors and be relegated to a second tier of NHS services, with PAs with two years of medical training versus GPs with 10. In the letter following up the very useful briefing that he arranged last week—and I think him very much for that and for the letter—the Minister makes reference, as he did in his speech, to the Government’s aim of doubling the number of medical places in England to 15,000 by 2031-32.

The Minister gave, I believe, the same figures as were reported in the Observer on Sunday. These were in a leaked letter from the Health Minister and the Minister for Skills, Apprenticeships and Higher Education to the independent regulator, the Office for Students. The figures in that letter have been interpreted as significant back-pedalling on the Government’s final aim and total. I ask the Minister whether he remains confident and can guarantee to the House that we are on target to achieve that final figure, given that we do not seem to be taking very strong steps in that direction.

The way those figures came out can only amplify the fears of many communities that those who can pay can go private, as increasing numbers of Britons feel they are forced to do. Patients at the centre of well-serviced areas where doctors can supplement their NHS pay with private work will keep access to a service like that now available, while other areas—the kinds of areas that are often talked about as being in need of levelling up—will get a second-class service.

We have to think about the context of this. Our NHS is battered by privatisation, with nearly 10% of services, including more than half of under-18 inpatient psychiatric services, now provided by for-profit providers. We have seen the disaster of PFI schemes, now set to cost £80 billion for the original £13 billion investment—the equivalent of £1,200 for everyone in the UK. We have seen this jewel in the British crown worn away by austerity—a decade in which investment in infrastructure and new technology collapsed and the pay of junior doctors and midwives in particular plummeted in real terms.

Please let us not deliver another blow. Please withdraw this order either tonight or afterwards. Take the path of consensus. Take the path of democratic oversight. Bring this forward as legislation that can be debated, amended and properly scrutinised. Please listen to the fear of communities. I ask everyone in this debate but particularly the Labour Front Bench to consider that approach and the wisdom of it. I beg to move.

[The Deputy Speaker (Lord Young of Cookham) (Con)]

I should inform the House that if this amendment is agreed to, I will be unable to call the amendments in the names of the noble Baronesses, Lady Finlay of Llandaff and Lady Brinton, by reason of pre-emption.

20:15

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare that I am a doctor registered with the General Medical Council, a member of the BMA and a fellow of the Royal College of General Practitioners and the Royal College of Physicians.

We have physician associates and anaesthesia associates seeing patients, examining them and advising them, who are as yet unregulated. All responsibility for their behaviour rests with the doctor who is their supervisor from whom they have delegated responsibility. The professional scope of practice for these associates can vary widely across the country. It is determined at a local level and patients have no idea about the variation.

There is a golden thread in clinical care that the most experienced person delegates down. They delegate down tasks that they know the relevant team member has the skills to undertake. A key skill in medicine, gained with extensive experience, is the integration of all the relevant information, evaluation of risk and prioritisation. Currently a problem in the whole of the NHS is that we expect staff to refer upwards and the boundaries are unclear.

A case of non-accidental injury in a child has been brought to my notice where the expert evidence was provided by a physician associate whose relevant experience is unclear at best. This blurring is misleading to non-medical professionals, including the police, judiciary and legal professionals. Supervision must be mandatory and stipulated in the GMC’s Good Medical Practice.

The junior doctors’ discontent, which we have heard about already from the noble Baroness, Lady Bennett, is boiling over. After training, medical graduates emerge with huge student debts to work a 40-hour week for just over £32,300, only to find that after a two-year postgraduate programme a physician associate typically earns between £3,000 and £11,000 more, for only 37.5 hours a week. All this has inflamed tensions—although I would say that direct verbal attacks on physician associates and anaesthesia associates, who have trained in good faith and with good intent, are not appropriate and I would not condone them.

Doctors are the only healthcare professionals who must undergo extensive, nationally stipulated postgraduate training before being appointed to a permanent senior role. Without long-term job security, these juniors rotate through departments, sometimes commuting many miles. They find that they do not belong and do not feel part of the team or valued, while patients miss out on continuity of care.

Very importantly, patients seen by a physician associate sometimes think that they have seen a doctor. The term “physician associate” gets muddled with the specialty and associate specialist doctor, who often has years of experience. Can the Minister clarify whether the term “physician associate”, which is so misleading, will become a protected title after this order passes? How can the name then be changed to revert to the more accurate “physicians’ assistant”? Currently, no medical titles are protected: “doctor” is not and grades up to and including consultant are not, which is another source of confusion. How is that going to be cleared up?

The cost-efficacy basis for these posts has been questioned in a recent paper, showing how the cost of one consultant anaesthetist supervising two operating theatres with an anaesthesia associate in each—that is, three staff—is more expensive than having two consultants doing one list each. The risk is higher if a problem arises in both theatres, especially in an anaesthetic emergency, when deterioration and brain damage can happen in minutes.

This crisis has been 20 years coming because we failed to expand medical school places or to register these new healthcare roles and define their scope of practice. What is the solution?

I fear this order will not solve all the problems. Yes, physician associates and anaesthesia associates must be regulated. It seems an outrage that people with such responsibility have been around for 20 years, unregulated, and a decade after that was recommended. The General Medical Council, in taking responsibility for regulation, must keep the register completely and clearly separate from that of medically qualified doctors. Can the Minister confirm that this clarity will be a legal requirement?

I tabled my regret amendment because it must be clearly on the record that the concerns exist, that some current regulation around the Medical Act needs updating urgently and that the GMC must be held accountable to Parliament, as has been explained by the Minister. Regulation is essential, but it is not the end of the issue; it is only the beginning.

The GMC must tackle the inappropriate way that some courses are advertised, which state that they train PAs

“to work as a safe and competent medically trained healthcare professional”

or to

“be a medically trained, generalist healthcare professional”

—which sounds awfully like a GP to me. Some courses describe working under a senior physician, but others say nothing about supervision. The anaesthesia associate courses differ slightly. They make it clear that, at present in the UK, only doctors who have specialist training in anaesthesia can administer anaesthetics and that the anaesthesia associate works as part of the anaesthetic team.

Next, the scope of practice must be clearly defined and agreed at national level, so that any employer is aware of what the associates should be doing and how the senior doctors must supervise them on site. Employers must also ensure that all patients know the qualification level of the person seeing them. Seven-day services are essential for patients.

Medical postgraduate training itself is in crisis. The royal medical colleges, the Academy of Royal Medical Colleges and the GMC must get together urgently to address postgraduate training. Perhaps it could be shortened, with post consultant-level fellowships to develop highly specialised skills and bring innovation to healthcare. Lifelong learning is essential; it is the essence of growing a good medical workforce in the long term. Medical schools, as they welcome the increased numbers, must look at how those who might wish to convert to a medical degree can be credited with their prior learning and experience, and tackle regulatory blocks in funding and timing.

Importantly, the title must be reviewed. The terms “physician assistant” and “anaesthesia assistant”, in use until 2014, clearly denoted the role as having delegated responsibilities from a supervisor. If “physician associate” and “anaesthesia associate” are to be protected terms, then we need a designation of medicine that clearly identifies a medical degree—similar to the American MD designation, for example. Patients must know who has seen them.

To summarise: patients must know the level of training of the person whom they have seen. Physician associates and anaesthesia associates must be regulated with appraisal and ongoing learning, including revalidation. The scope of practice of this new workstream must be defined to ensure that they have clear boundaries and supervision must be defined as being closely supervised on site to ensure patient safety. People must not be misled into believing that they are completely independent practitioners.

[Baroness Brinton (LD)]

My Lords, I am grateful to follow both the noble Baronesses, Lady Bennett and Lady Finlay of Llandaff, and I have been crossing out large chunks of what I was going to say, which I hope will be helpful to Members of your Lordships’ House.

As both of the other noble Lords have, I want to start by saying that this is not an attempt to discredit the many PAs and AAs who do an extremely good job. We need to understand that, and we need to understand that our health system must change and modernise. The issue is what is happening in our NHS and how the role of PAs and AAs is impacting not just on patients—I will come to the detail of that in a minute—but on the working of supervising doctors and junior doctors. All of those groups are in crisis, and this just seems to be adding further problems.

I echo the points made by, I think, the noble Baroness, Lady Bennett, about the Secondary Legislation Scrutiny Committee, which the Minister referred to in his introduction. In the committee’s report to us, it says three times that the Explanatory Memorandum assumed understanding and that it was not good enough. I ask the Minister if he will work with his officials to ensure that any more Explanatory Memorandums that come forward, not just on this issue but on others, are very clear and do not assume prior knowledge.

All of us have said that PAs and AAs—I am not going to keep saying physician associate and anaesthesia associate because it takes too much time—are not a replacement for doctors, though not one of us believes that that is the case. I am going to start with the title. The Royal College of Physicians and the Faculty of Physician Associates, which sits within the RCP, has guidance on the associate title and introduction guidance for PAs, supervisors, employers and organisations. What it says is in complete contradiction to what is happening on the ground:

“It is our view that, when a PA introduces themselves to a patient or staff member, they must make it clear at the start of the interaction that they are a physician associate, as well as explain the use of the term ‘PA’ … PAs must correct patients and staff if they refer to them as a … doctor, nurse or other professionally protected role title. This includes verbal, written and other forms of communication”.


Like other noble Lords, I have been inundated with letters from doctors and patients saying that they have been misled—not in the deliberate sense, but that PAs have not been correcting the record when someone has called them a doctor. The BMA, in its very helpful briefing, said that:

“To patients, PAs and AAs and doctors may look the same and appear to be doing a similar job”.


The problem, as the noble Baroness, Lady Finlay, said, is that the title is confusing. “Physician associate” perhaps implies that they have the same level of expertise as doctors. Unfortunately, as the noble Baroness, Lady Bennett, said, this has already led to a tragedy. Emily Chesterton died, aged 30, after two appointments with a PA who she believed was a GP, where mistakes were made.

A further difficulty, particularly in GP practices, is that GPs are beginning to worry that they are going to spend their entire time supervising PAs, as well as seeing patients with chronic diseases, and will not see ordinary people at all. Trainee GPs are worried about how they are going to be supervised. How is the Minister going to ensure that the issues of supervising and training, which are very serious, will be dealt with after the passage of this SI—because I do not think any of us are planning to call a vote today?

We have heard that, across acute trusts and GP surgeries, doctors have reported 70 instances of avoidable patient harm and near misses caused by PAs. That includes fatalities, missed diagnoses resulting in terminal diseases, missed DVTs, sepsis, heart attacks and haemorrhages. Missed cancer diagnoses in primary care has therefore emerged as a significant issue. In England, 74 acute trusts have replaced doctors with PAs on the doctors’ rota. Even if those PAs are supervised, that means that doctors who should be seeing patients are supervising more and more people. It is not a zero-sum game. One trust—I think it was Leeds, from memory—had a paper on how much more beneficial PAs were on the rota because they were much cheaper than doctors.

Doctors at 24 trusts reported witnessing PAs illegally prescribing medications, including controlled drugs. That is a particular worry because they are not permitted, under their current training and qualifications, to prescribe any drugs. That must be done by the doctor. The PA can recommend to the doctor what they think, but it should be signed off by a doctor. In addition, 42 acute trusts in England have witnessed PAs introducing themselves as doctor or failing to correct errors.

We have heard about a number of issues. I conclude by saying that, earlier on today, on the Victims and Prisoners Bill, we were talking about the duty of candour, which the NHS introduced nearly a decade ago. One issue related to this is that every regulated member of staff must report whenever they believe that something has happened that either possibly will cause damage or has caused damage. One of the good things about regulation for PAs and AAs is that they will come under the duty of candour. However, in all the cases that we have been told about where things have gone wrong, there is no evidence that there were reports to the CQC by the supervising doctors about things going wrong. Therefore, yet again I say to the Minister that my real concern is about current practice inside our extremely pressed and busy NHS, to make it safe. Just providing regulation for PAs and AAs will not in itself do that. I hope that he can help your Lordships’ House to understand.

20:30

[Lord Hunt of Kings Heath (Lab)]

My Lords, I was a member of the GMC until the end of January, so at the council meetings I was involved in a number of discussions about the responsibilities of the GMC in the lead-up to this order being laid. Unsurprisingly, I strongly support it.

I listened to the noble Baronesses, Lady Bennett, Lady Brinton and Lady Finlay, and clearly they raised issues that the Minister will need to respond to. However, the combination of statutory regulation by the GMC and a proper governance framework within each employment body seems the most appropriate course for us to take. Therefore, I say to the noble Baroness, Lady Bennett, that passing the order is the best way to secure the safety of patients, which is why I hope the House will give it resounding support tonight.

My second point comes back to the noble Baroness, Lady Bennett, on democratic accountability and legitimacy. The Minister mentioned that a combination of the Health Act 1999 and the Health and Care Act 2022 has brought this order before us. Since I took the 1999 Act through this House, I feel some responsibility to stand up for what it essentially aims to do. The whole problem of regulation of the professions in the health service is that it has never had the priority it deserves from the Government. The Law Commission reported in 2014, and here we are 10 years later, just about getting round to the first tranche of orders that we need to modernise the regulation of our health professions.

If you rely on primary legislation to make this kind of change, nothing will ever change. It is slow enough with secondary legislation, but with primary legislation it becomes almost impossible to get sensible change made. All the regulatory bodies are utterly frustrated that they have very old-fashioned processes and procedures, because they do not have the discretion needed to make changes that would be to both the public’s and the professions’ benefit. Therefore, I am glad we have this order and I hope we can follow it through.

My third point is about the noble Baronesses saying that they do not like the campaign of what is essentially vilification that has been going on over the last few months against the physician and anaesthetist associates. I wish they had paid a little more tribute to the members of those professions and the fantastic work they do. I have met physician and anaesthetist associates, and they are going through a torrid experience. They have been subjected to a nasty campaign and, even in their own employing body, there have been reports of bullying at work and they have been subjected to rude and antagonistic comments from colleagues.

What is the context in which we are to judge this litany of mistakes that they have made? They seem to be isolated examples and, to my knowledge, there is no comparative data on errors by consultants, principal GPs or postgraduate medical trainees. I would not like to see a list of all their mistakes. What would happen if we asked people to report mistakes made by F1 medics each August? The BMA is playing with fire in the campaign it has adopted of putting these poor professionals, who are doing their best, in this frame. I protest about this and the general lack of medical leadership from the profession when it should have been defending the associates. The way it has run away from this issue has been a disgrace. It will find that its lack of leadership and strength will bite it in future. I have not been impressed by the way in which employing authorities have dealt with this either; they have left individual AAs and PAs to withstand the pressure and bullying without the support they need.

The Minister needs to reflect on some of the points raised. First, in addition to declaring his confidence in physician and anaesthesia associates, he needs to set out a long-term plan for their contribution to the NHS, ensuring that the voices of those professions are heard. The Government’s ambitions on the numbers of AAs and PAs seem very modest. Why? Does he think we need to revisit that? Secondly, he needs to make it clear to NHS England and to employing authorities that bullying and intimidation of any healthcare professional in their employment must not be tolerated.

Thirdly, in response to the noble Baronesses, Lady Brinton and Lady Finlay, the Minister needs to ensure that each employing body adopts an appropriate local governance framework to deal with some of the issues that they have legitimately raised. Fourthly, we need research on the clinical outcomes of physician and anaesthesia associates and, frankly, comparative data with other health professionals. That is the only way to deal with the toxicity of these lists of mistakes that have been circulated. Finally—here I agree with the noble Baronesses, Lady Finlay and Lady Brinton—there clearly needs to be a plan of communication to the public to explain the role of the associates and the contribution they can make in future.

The order is important. Some legitimate issues have been raised, but equally we need to defend the associates, uphold the work they do and give them confidence about the future.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interest as a NED of the NHS Executive. I support this order, for many of the reasons that the noble Lord, Lord Hunt, has just explained, but stress that I am extremely unhappy about the division between the reports from various medics and the associates that are planned. One of the big problems is that we do not value junior doctors enough. The phrase we use is inappropriate. I have been married for 43 years to a doctor who has been called a house officer, a senior house officer, a registrar and a senior registrar—those things would now be referred to as a junior doctor. I want to put that on record.

I also support what the two noble Baronesses have said, which is that we need a distinguishing factor for a qualified doctor, be that “MD” or whatever else is selected by the medical profession. I am a nurse, and I am proud of being a nurse. We have nursing associates, but I know that I am a registered nurse and I know that I have a doctorate, but I would never refer to myself as a doctor in the clinical area. These issues are difficult to deal with because we need to value people’s different experience and training.

I was appointed by a previous Secretary of State to chair the grandfathering of the paramedics on to the new register, when it came into being, and look at the success that that has been.

[Lord Winston (Lab)]

My Lords, I regret to say that I totally disagree with my noble friend speaking from the Front Bench, a person for whom I have the greatest respect, both as a colleague and as a previous Minister of Health in an earlier Government. He is not medically qualified; he is not a doctor who has been in practice. I speak simply as a fellow of the Royal College of Surgeons of Edinburgh and—it seems a bit immodest to say this—I was the triennial gold medal holder at the Royal College of Surgeons in London for innovative research. I never know quite how I got that award, but I did, and it hangs in my lavatory—I probably should not say that either.

There is a very serious issue here: anaesthesia. I do not want to frighten anybody, but I am not exaggerating when I say that there is no point at which a doctor has a patient closer to death than when the patient is anaesthetised under a general anaesthetic. It is then that things can happen which are completely unexpected, and there are all sorts of ways that the qualifications of that anaesthetist are incredibly important. Doing anaesthesiology is, most of the time, deadly dull; nothing goes wrong, you sit there quietly while the surgeon carries on acting out his wonderful role leading the operating theatre and controlling everything. The person who is really at risk is the person who is under anaesthesia, and that is something we should never forget; it is really important.

We do not even understand fully how anaesthetics work. It is true to say that even though we use gas and other agents, how they work exactly on the brain is not certain and we are still learning, years after the first anaesthetics in Victorian times. We have to recognise that this is quite a strange area of medicine, and that is why I am making this speech.

I want to tell a story about an anaesthetist friend of mine with whom I worked. Before I was doing regular in vitro fertilisation, I did a huge amount of reproductive surgery—surgery in the pelvis and telescope examinations, including laparoscopy. He and I worked as a team regularly on a very large number of patients, with complete success. On one occasion, I had a young woman, who was only 19, as my patient. She had severe abdominal pain, and I wondered, for somebody that age to have that pain, whether she had some unusual condition, and I thought she should have a laparoscopy.

My anaesthetist, as he always did, went to see the patient before the surgery and examined her to make certain she was well. He took her into the anaesthetic room and started with the anaesthesia, while I was waiting in the operating theatre. Then, quite suddenly, my anaesthetist friend wheeled the patient in on a trolley and said to me, “Robert, I think we have a spot of trouble here”. That was all he said, but there was something in his tone of voice and I thought, “This is really a weird thing for him to say”. The patient was unconscious and not intubated, and she remained unconscious. Her heart went and she had, in effect, died. We got her on to the operating table and I, as the surgeon, had a decision to make: what do I do? Do I, as the person leading the team, interfere, or do I leave it to my anaesthetist, in whom I had complete trust? I asked him whether he thought I needed to do heart massage or various other things. He said, “No, hang on for a bit”.

20:45

My colleague struggled with the unconscious unmarried young woman for almost 50 minutes. Sometimes, there was almost complete panic in the theatre—apart from my anaesthetist. There was one point when the nurse ran in with a drug she felt should be injected into the heart of the patient. My anaesthetist simply said to her, “Nurse, do not bring me what you think I need, just bring me what I ask you to bring”, in a very gentle voice. The young woman survived. My anaesthetist brought her round and she recovered completely; she walked out of hospital without any loss of memory.

We had no idea what had happened. It was extraordinarily puzzling. Only later did we realise that it was a rare and unusual effect of the drug, which had not been widely used at this stage. We put in a red card, and it was flagged up. Eventually, the drug was withdrawn. It was, in effect, an allergic response to the drug and was completely out of the blue. I have no doubt that had I had a different anaesthetist—or an assistant—in the theatre at that moment, the patient certainly would have died. If she did not die, she would have been severely brain damaged. As it was, she did not suffer lack of oxygen or have any other problem.

My other story is a difficult one that still preys on me more than 30 years later. A friend of mine—another doctor—went in for an abdominal procedure. I felt it was unnecessary and told him, “I do not really know why you are doing this”. To cut a long story short, he was put to sleep with general anaesthetic and as he was recovering, the anaesthetist saw that he was conscious and left the premises. He was left there with someone looking after him and his airway. My friend died. He died because he had a rare and unexpected deformity of the trachea and the trachea had perforated, so the airway was not what we thought it was. It would have been recognised by somebody really experienced with the trachea. It could not have been seen by an assistant who did not have the kind of anatomical knowledge that only somebody who is medically trained would have.

The House must understand that I have nothing against anybody, but I am very concerned that we might be giving associates or assistants more responsibility than they really deserve. I think it is very important to understand that no matter how safe anaesthesia is—and it is safer now worldwide than almost any other medical treatment that is generally used—it is still a procedure we need to be extremely cautious about.

I ask the Minister to think very carefully whether or not we should be blurring the notion between those who are medically qualified and those who are not. By giving those who are not medically qualified some idea that they are, we are running the risk that this sort of accident can happen. These accidents are rare, but they are completely unexpected and unpredictable. An anaesthetist has to recognise the unexpected. That is not something that most individuals can do; I, as a different kind of doctor, could not do that. I had no idea what had happened to the young woman. I was prepared to do open-heart surgery while there was nobody else in the theatre, which would have been ridiculous. But my anaesthetist was there to hold my hand—metaphorically—and rescued the young woman. We must recognise this is a very serious issue: what you call the doctor or the assistant is extremely important.

[Lord Lansley (Con)]

I am very glad to follow the noble Lord, Lord Winston, because he directs us to the central issue, of how we seek to ensure the safety of patients in all circumstances. What he was describing illustrates the essence of the relationship of a physician associate—or, for that matter, an anaesthesia associate—to the supervising doctor. That is a central issue as well. In the circumstances that we were just hearing about, the responsibility of the doctor or the consultant in charge of the patient is the central responsibility. It would be wrong to think that the devolution of tasks to an associate removes the responsibility of the doctor in charge of that patient.

I hope we agree that proceeding with the order is necessary because we want to bring physician associates and anaesthesia associates within the scope of regulation. This process has been very useful, not least because my noble friend and his colleagues have given us considerable time and energy in discussing the order and how it is to be implemented.

I confess to the House that when I was Secretary of State back in 2010 to 2012, and as the noble Lord, Lord Markham, made clear, there were relatively few physician associates. I remember them as physician assistants. I remember the desire on the part of physicians to have additional resources available to support them in that role. It was never to replace doctors; it was always to enable physicians to focus on where their responsibilities lie. That is still the purpose and the point of physician associates. I am less familiar with anaesthesia associates, and in those days, I do not remember understanding that they were there in the form in which we now have a number.

None of this debate is about trying to criticise physician associates, anaesthesia associates or the profession as a whole. We are setting out to make sure that as they are brought into regulation, that regulation works most effectively. From my point of view, the simple fact of being brought under the regulation of the General Medical Council was not a problem, because the General Medical Council was clearly addressing all the issues very efficiently and professionally. However, because the GMC regulates doctors, I confess that there is a worry about the idea of another profession being regulated by it. If one says, “I am GMC registered”, what do people assume by that phrase? They assume that one is a doctor. The distinction that needs to be made between the medical register, the specialist registers and the register that is to be established for physician associates and anaesthesia associates is critical.

As for myself, I am perfectly clear in my mind and would have started out by assuming that PAs and AAs would be regulated by the Health and Care Professions Council. That clearly was not the route that was chosen. In my view, it is too late to revisit that. However, the distinction in the registers under the GMC must be very clear.

Equally, the scope of practice and what the noble Lord, Lord Hunt of Kings Heath, said about the governance of the trusts and the bodies responsible needs to be absolutely clear. In particular, the scope of practice is the essence of how we can ensure the safety of patients, so that the whole multidisciplinary team understands what their respective roles are. I am not sure that there is any merit in trying to understand which professions are responsible for which mistakes. Let us look at outcomes. The outcomes are the product of the multidisciplinary team and a group of professionals working together—they are not the results of individual professionals. Let us put that slightly to one side.

The only other thing that I feel very strongly about—which has been referred to in a number of respects—is that patients and the public need to understand who the professionals responsible for them or providing the service to them are. Let us be clear: we start from a point where I suspect that most patients in most circumstances where they are looked after by PAs or AAs do not know who they are and how they fit into the professional scene. It is not that we are looking to ensure that everybody needs to be educated about that—that is probably too hard a task—but I urge my noble friend the Minister, the regulators and the professionals involved to recognise that PAs or AAs do themselves and patients the greatest service by being absolutely clear at any moment—including proactively—that they are not the doctor in charge of that patient but that they are providing care under the supervision of the doctor for the given purpose. If anybody appears to be in any confusion whatever, it is important that that confusion is remedied. For patients, understanding who is doing what to them and why is an essential part of “no decision about me without me”.

While the order enables the regulation to proceed, I hope that our debates on it are not “fire and forget”. This is about a process that we should be looking at very carefully to understand whether the problems that we have referred to, and the difficulties and worries that we entertain while the order goes through, are dealt with in the subsequent regulation.

[Lord Harris of Haringey (Lab)]

My Lords, I declare my interest as the chair of the General Dental Council. It is not for me to comment extensively on matters affecting a fellow healthcare professional regulator, but I will say one thing directly in response to what the noble Lord, Lord Lansley, said about the substance of the order. Unlike the GMC, the GDC is responsible for all dental professionals, including dentists, dental nurses, dental technicians and so on in the four nations of the UK. I believe that it is helpful to the public to be assured that all the professionals they encounter when they enter a dental surgery will be registered as professionals by the same regulator and that they will have equal levels of assurance about the training and standards they can expect—and within a framework that indicates what the limits are of each of their professional responsibilities, what can and cannot be done, and how they are appropriately supervised.

My reason for intervening, however, is separate. The DHSC has made it clear that this order is the first step in the reform of the way that all the healthcare professionals are to be regulated. Indeed, it told the Secondary Legislation Scrutiny Committee that the intent is to provide all regulators with “broadly equivalent powers”. While the GDC is some way down the queue—it is after the NMC, the Health and Care Professions Council and so on; although it is still helpful to get in early—this is potentially a template that will apply to all the regulated professions.

I make it clear that regulatory reform is welcome and long overdue. The GDC’s framework was set out in the Dentists Act 1984—that legislation is 40 years old, with only limited updating since then; somehow, the GMC is slightly more prominent and gets more updating than some of the other professions. The Government first consulted about the scope of reform in 2017, following Law Commission recommendations three years earlier. It has taken a decade to get even to this stage, and we are still a very long way off from orders being prepared to cover the dental professions. By the time the orders for all the other professionals are agreed, the model in today’s order may be outdated.

The GDC welcomes the intention to give the regulatory bodies more authority to update their procedures and processes without recourse to Privy Council approval and the delays inherent in waiting for the DHSC to draft regulations and lay them before Parliament. Such updating would of course be subject to full consultation in each case by the regulators concerned and would be only in the framework laid out in orders such as the one we are debating. We need such reforms to enable regulators to operate as effectively as possible to protect the public better in the light of changes in the way the professions deliver their services.

21:00

My concern, therefore, is whether tonight’s order is going to be a rigid framework for all subsequent orders. Is the template used here for anaesthesia and physician associates going to be used for nurses, midwives and dentists, as well as all the other healthcare professionals? One size will not fit all. Differences between the various healthcare contexts lead to different sorts of public protection risks, and that must be reflected in the way in which the different regulators regulate.

I will give three examples. First, in the order there is quite properly a requirement for periodic revalidation, but that will be different for associates covered by this order operating in a medical setting, often as part of larger organisations with well-developed clinical governance mechanisms, from what it would be for dental professionals, for example, many of whom work in single-handed practices or exclusively in private care. A different approach to revalidation and continuous professional development will be necessary, and that will need to be reflected in the framework laid down by a future order.

Secondly, those different ways of working also apply in terms of complaints and fitness-to-practise concerns. Associates, and indeed most doctors and nurses, will mostly be subject to existing complaint resolution processes handled via the NHS. Fitness to practise is a separate mechanism for them that comes into play often after those complaints have been through an NHS process, but such arrangements will need to be designed differently for most primary care dentistry that may well be outside the NHS.

Thirdly, the order says an offence is committed by someone who uses the title of anaesthesia or physician associate with the intent to deceive. At the moment, for dental professionals this is a strict liability offence. Maybe it is possible—although, having listened to the noble Lord, Lord Winston, I doubt it—for someone to claim they are an anaesthesia associate without an intent to deceive, but I have to say it is difficult to see why and how that could apply to someone purporting to be doing that or, for that matter, to be a dentist. If this wording were used for a future GDC order, why impose an additional requirement of proving intent to deceive rather than leaving it as a strict liability offence?

The examples that I have given all relate to dentistry but, as well as the GDC and the GMC, there are eight other professional healthcare regulators, each of which will have examples of its own. My plea to the Minister is that the DHSC should not use this template without careful consideration of the very different circumstances of each of the other healthcare professions.

Lastly, can the Minister give an estimate of when we can expect to see a draft order covering dental professionals? That is urgent because the GDC is essentially using 40 year-old mechanisms and procedures that are no longer fit for purpose, and it is in a context where more and more new models of dental practice and cosmetic dentistry are emerging—for example, remote orthodontics, where professional oversight is ostensibly being provided remotely, or non-UK providers of services offering “initial consultations” in hotel rooms. Such practices are affecting patient safety now, but the regulatory tools to address them do not yet exist. Flexibility is needed, and we cannot wait indefinitely for regulations to be brought forward.

[Lord Patel (CB)]

My Lords, I begin with a slight disagreement with the noble Lord, Lord Harris. I take his point about how dental professionals, not just dentists, are regulated by the GDC, but I agree with the comment from the noble Lord, Lord Lansley, about the impression it would give if other professions apart from doctors were regulated by the General Medical Council. Hitherto, the GMC has regulated only doctors, so it would have to be clear in the register how these people were differentiated. I am afraid that the solution of having a prefix on a register would not mean anything to patients.

In the past, if you walked around a hospital, it was easy to know who was a doctor, as they mostly wore white coats; who were the nurses, because they wore different uniforms, including the matron’s uniform, which was a different colour; and who was a trainee nurse, because they wore a pink uniform, which is why junior doctors referred to them as “pinkies”. Physiotherapists wore yet another colour of uniform. However, nowadays everyone wears suits or jackets or jerseys, so you cannot distinguish from that which profession is looking after you.

I take the point that the noble Lord, Lord Winston, made, that for all of us who have done surgery, a qualified, competent anaesthetist is our friend. But sometimes—as he and I have no doubt done—we operate on pretty vulnerable patients for whom the surgery is necessary but they are not a safe bet for anaesthesia, unless by an extremely competent anaesthetist. But I interpret the anaesthesia associate as someone who does not induce anaesthesia but only maintains anaesthetic under strict supervision by a qualified anaesthetist. And that is quite distinct from what a physician associate might do, because they might be involved in different ways in assisting the physician. The point made by the noble Lord, Lord Winston, is important because it is an example that shows up the importance of the scope of the practice of physician associates and anaesthesia associates.

It does not help—and this debate is an example of why so much concern has been expressed—when the NHS health careers website says, in relation to physician associates, that they will be trained in

“taking medical histories … performing physical examinations … diagnosing illnesses … seeing patients with long-term chronic conditions … performing diagnostic and therapeutic procedures … analysing test results … developing management plans”—

which I presume means patient management plans. If you see that, you can see why there are concerns and confusion over what their responsibilities will be and the limitation of the scope of their practice.

I absolutely appreciate the need for physician associates —I keep calling them assistants—and anaesthesia associates and the need for regulation, but I think this crosses the Rubicon since it is the General Medical Council that will regulate this. It is important that what it defines as the scope of the practice is understandable to patients and professionals clearly.

The noble Lord, Lord Hunt of Kings Heath, commented that he took the legislation through this House in 1999, and that Act will subsequently be the vehicle for SIs to be used for future regulation. I am sorry that some of us were not here at the time because some of us might have opposed it. An Act from nearly 25 years ago cannot be the one that continues to be used. If we are going to have further reforms of the regulation of doctors and nurses—where we are talking about 1.5 million health professionals, not 3,000 physician associates or anaesthesia associates—I hope we are not going to have an SI to do that, because there are lots of issues of regulation.

[Lord Hunt of Kings Heath (Lab)]

My Lords, to be fair, I said that that Act had been subsequently amended by the Health and Care Act 2022. If you do not have flexibility through regulation, you will never get anything done in relation to modernising health regulation. Governments simply do not find time in primary legislation to update regulation.

[Lord Patel (CB)]

I hope they do find time, because that allows for better scrutiny and better ability to amend, which we always claim to be our key role—to scrutinise and amend. It is a major piece of legislation to go through using SIs, and it is inappropriate to do so. Maybe we must consider how else we could do it in a way that maintains flexibility.

Moving on from that, as the noble Lord, Lord Harris, already mentioned, if this legislation is going to be the template for future legislation to regulate all health professionals, some issues will need to be discussed. This order does not require that health is considered as a category in the regulation of physician and anaesthesia associates. The statistics show that, when the GMC or, I presume, any other regulator investigates, it is a very stressful situation for the person involved. Some statistics suggest that one in three considers suicide; they are depressed by it. If the category of health is removed as a consideration when a person is investigated, as this order does, it is a backwards step. I need to ask the Minister why health has been removed as a consideration. If this is the template, I presume that this will also apply to other regulations in the future.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, the noble Lord, Lord Patel, just said many very important things, with which I agree, far better than I would. I thank the noble Baronesses, Lady Bennett, Lady Brinton and Lady Finlay, because this debate has revealed the importance of this order: it is not a minor regulatory matter that can be put through by an SI, in a back room. That it has created so much debate outside the Chamber indicates why it is important that we discuss this and that it is not nodded through behind the public’s back. I am glad of that.

I have been embroiled in discussions about this for some time. The noble Lord, Lord Hunt of Kings Heath, made a good point when he said that the discussion has become quite toxic. I thought it was perfectly reasonable to be worried about PAs and AAs; I did not anticipate this kind of savage attack on them. There has been a real scapegoating of these individuals, which is not how we should resolve this issue. We should also remember that doctors can be guilty of clinical negligence. We do not want to wander around pointing the finger at who is more negligent.

However, if there are preventable never events as a consequence of people not being fully equipped for the roles that they are asked to do—by the way, they are being asked, very often told, what to do when they are not really up to it, through no fault of their own—it is a matter for public concern. That is the way that accountability works and why we need to be very clear and have no muddle over what somebody is supposed to be doing, what they are not supposed to be doing, and what they can and cannot do.

There were a couple of things that confused me in the arguments made in the briefings we received. I lost the will to live in the rows going on about the differences between physician associates and physician assistants, as though “associate” or “assistant” was the key difference. I think the difficulty is when people think that any of them are physicians, because that means that they think they are doctors. That is the confusing bit and it shows that people can get lost in the midst of this.

It is also worth bearing in mind some context when it comes to the public. Most patients would prefer to see anyone at a doctor’s practice than wait for two weeks in pain. That makes the public vulnerable to having a lesser service. I understand that. I also thought that the noble Lord, Lord Patel, was absolutely right about a big team: when you are in hospital, you are surrounded by people wearing a million badges, different colours and lanyards. They all introduce themselves to you in great detail, but you do not care because you are ill. You want to lie back and trust them, and assume that a division of labour is going on.

Sometimes, when I was reading the briefings, it felt as though there might be a bit of vested interest about who was regulating who and what numbers were on the badges. This seemed to miss the point of the real concerns, which are whether there is sufficient clarity about the scope of PAs or AAs, or whatever we call them; that there is not too much mission creep; and that we have a clearly defined set of protocols and specific tasks allocated. I think it important that PAs in GP surgeries have a different set of protocols and scope than in hospitals—they are not the same, even though in both instances they are called PAs.

21:15

It is also important that there is a clear sense of what is taught on those courses. People talk about the training courses, university courses and two-year courses as though they will be the solution. As an aside, I worry about the credentialism that has led to too many people doing nursing degrees and not wanting to do any nursing, but I am also concerned about the fact that degree courses are being trusted in this way when, if you talk to anyone who is a lecturer, or works in a university, they will tell you about the problems of dumbing down, grade inflation and not being sure of the product you are getting. So I am not sure that I trust that.

Finally, in the NHS we definitely need a shake-up. We know that we need new members of staff. I do not want to be somebody who says only the old roles count, but I came across something I refer the Minister to: the notion of medical assistants, put forward by Maureen Baker in July 2014 when she was chair of the Royal College of General Practitioners. Having visited the United States with Jeremy Hunt, she described this new group of people—medical assistants—which basically described what I think we need. I do not know why we cannot have them and why we have come up with this idea. I work with a lot of young people and there are plenty of bright young people desperate to enter medical school and become doctors and they are not able to. Why is that? That is the kind of situation that needs to be solved, rather than just making up PAs or getting into a row about the pros and cons of them.

[Baroness Harding of Winscombe (Con)]

My Lords, I support this Motion and, not for the first time in a debate on health, I find myself in almost complete agreement with the noble Lord, Lord Hunt, and the remarks he made earlier in an extremely powerful speech. We are exemplifying the right debate here, in that this is a subtle and important issue.

I do not wish to suggest that I challenge the esteemed clinicians from a number of the different clinical tribes who have spoken this evening. I speak as a non-expert, as a manager of people, and as a patient. Non-experts in healthcare would find it completely baffling that we have 3,000 people working day in, day out in clinical roles who are currently unregulated. It cannot be right, and I have not heard any argument this evening that suggests that anyone in the Chamber thinks it is right. I think we are all united in our agreement that these hard-working, brilliant people need proper professional statutory regulation.

I hope that, therefore, the order, as it stands, passes. But it is worth dwelling on why this has created so much controversy. Fundamentally, it is because change is hard—and people change is hard and scary. There is a real danger that we underestimate how important it is to look after the people who care for us, and that what we are really hearing from a number of the different clinical tribes is fear, frustration and hurt that they are not being looked after. The real tragedy is that, as the noble Lord, Lord Hunt, said, in the process we have made 3,000 more people feel hurt, unloved and uncared for in the awful debate out in the Twittersphere or X-sphere or whatever it is called.

I will not talk for very long. I just want to register that this has been far too long unfixed, that 20 years is too long for people to be practising without regulation, and that other countries around the world are far ahead of us on this. We should be discussing how we properly define the scope of practice and how we then extend that scope of practice, with the appropriate training for prescribing rights and the ability to order X-rays, just as happens in many other countries in the world. We are all in this Chamber rightly proud of the NHS, but we must not stick our heads in the sand and convince ourselves we are brilliant when others fixed this issue 20-plus years ago.

I finish by saying that regulation is clearly not enough. I completely agree with the noble Baroness, Lady Finlay: we have to recognise that our health and care workers feel unloved and uncared for. There are far too many stories of people unable to get a hot meal when they are working night shifts or having to cancel their own wedding because they are not rostered to be allowed to take the time off. None of that requires professional regulation; that requires professional management. We need both of those.

[Lord Bethell (Con)]

My Lords, I hope that my noble friend the Minister will not mind if I say that I am very grateful to the noble Baronesses, Lady Bennett, Lady Brinton and Lady Finlay, for the regret amendments and this debate today. Secondary legislation comes through the House and too often we overlook it. Every now and again we need to put a spotlight on some of the important measures that go through.

I regret two things. I deeply regret the way in which the professions of associate physician and associate anaesthetist have been denigrated in the press, in the lobbying material that has been sent around, and, frankly, in aspects of this debate. I agree with my noble friend Lady Harding and the noble Lord, Lord Hunt, that the feelings and sentiment of these hard-working contributors to our healthcare system have been overlooked. I was sent a very robust briefing by the BMA. I replied: “Is there nothing positive you can say about these hard-working healthcare professionals?” The reply came back—the noble Baroness, Lady Finlay, was copied in on it—that there was not: there was nothing positive it could say about them. I greatly regret that tone, and wish it had not happened.

I am not a clinician and I do not have anything to rival some of the comments made by the clinicians. However, I point out that our hard-working healthcare professionals are incredibly stretched. Take GPs, for instance: 350 million appointments were conducted in primary care last year, 160 million of which were by GPs themselves. That was 50 million more than in 2019, so 44 more appointments per practice. That trend is going up. Britain is getting less healthy, and there is a large amount of immigration. The number of full-time equivalent GPs—although the number of GPs has gone up, a lot of them are working fewer hours—has decreased from 28,000 in September 2015 to 27,000 in October 2023. The complexity of many people turning up to these appointments is very high.

We have to find people from somewhere to do some of these appointments, and there are going to be people who have a lot to contribute who do not necessarily go through the 10 years of qualification to become a GP. We should be embracing them. That is what is happening in every other professional walk of life—it is happening with the astronauts who fly to the moon, the people who fly our planes, and the lawyers who run our courts. The modernisation of workforces is happening everywhere; we should embrace that. My noble friend the Minister alluded to 12,000 AAs and PAs by 2036; that would be just 8% of the number of doctors. That is not a revolution or a threat that the doctors of Britain should be worried about.

If these regulations do not go through—the noble Baroness, Lady Bennett, has said that they will—then it would be difficult to enforce standards, there would be years of delay to regulate the professions, there would be a reduction in the number of healthcare professionals to support our healthcare system, and training programmes would be on hold. I support the passage of this legislation, so that we can modernise the workforce, increase primary care capacity, improve the lot of our hard-pressed GPs and make it easier for a wide range of talents to make a difference to the British healthcare system.

[Baroness Bloomfield of Hinton Waldrist (Con)]

My Lords, I will speak very briefly in favour of these regulations. I am absolutely in favour of any way in which we can leverage the ability of our doctors to concentrate on what they want to do, and what they have been highly and expensively trained to do, which is to take responsibility for seeing, diagnosing and treating patients who are ill and in need of medical help. I am also in favour of trying to reduce the exorbitant cost of locum GPs, which bleed resources from the National Health Service—resources which could be much better spent elsewhere. Some of the Government’s initiatives, such as allowing pharmacists greater and more extensive advisory and prescribing powers, are also very welcome.

I have no philosophical objection to the concept of physicians or anaesthetists being supported by assistants, whether they are senior nursing staff or others, but I share the concern that the very term “associate” implies a greater degree of qualification than is actually the case. Two years’ training post a science degree does not a doctor make. Of course they should be regulated by an organisation which enjoys public confidence, so long as that in itself does not imply a greater medical qualification.

It is easier to prevent overreach in a hospital environment, where supervision in anaesthesia should be routine, but it is much harder in general practice. The reason I rise now is because my husband was seen by a physician associate when his throat failed to heal weeks after he burned it with a hot cup of coffee. After the young man had taken a photograph and disappeared up the corridor with his phone, allegedly to see a GP, he reappeared with an ominous pamphlet entitled “Suspected throat cancer” and suggested an urgent appointment at the John Radcliffe Hospital. I am pretty sure he was not trained to be the bearer of such bad news. So undoubtedly physician associates need to be regulated, though I acknowledge it was better this way round than ignoring something and saying that there was no issue to be dealt with when there might have been.

We have 14 GPs in our local practice, in a small town in Oxfordshire: 11 work three days per week, none of them works full-time and one of them works one day per week. Perhaps we should also address the loss of 40 working days per week from any similar team, as well as putting in place things that make doctors’ working lives more rewarding and meaningful. If physician associates are part of that then I am fully supportive, so long as they are properly regulated. The Faculty of Physician Associates code of conduct, produced with the GMC, says that physician associates will always work under the supervision of a designated senior medical practitioner and that they must work within the limits of their experience. Let us make sure that these regulations will help make that happen.

[Lord Scriven (LD)]

My Lords, I have listened to the debate very carefully. My professional experience as a former health service manager over many years is that we have had this debate about people taking on different roles in health and always the same arguments come. Whether it be physiotherapists taking on roles, nurses becoming nurse practitioners or pharmacists coming into this, the same argument always happens: that somehow this dilutes patient care and safety. The answer is that it does not if it is properly regulated, there is proper training and there is proper monitoring of what happens to patients.

I understand that there is some anxiety, but I have to say to the BMA, in particular, that its language in the briefings it has given has driven the bullying and ostracisation of colleagues in hospitals who are valued members of a clinical team. That is the word: “team”. It needs to be led by a senior doctor, normally the consultant, without ostracising people within that team. I gently say to the noble Baroness, Lady—I have forgotten.

[Baroness Bennett of Manor Castle (GP)]

Bennett.

[Lord Scriven (LD)]

The noble Baroness, Lady Bennett of Manor Castle—I remembered the Manor Castle because of Sheffield, but I could not remember the Bennett bit—that, twice during her contribution, she used the term “a second-rate service”. These people do not provide a second-rate service; they provide and augment the team service, to ensure that patient outcomes are as good as they can be.

On the whole, I support the fact that these orders are being laid, although there is one issue that I think needs to be thought through carefully: if the GMC is going to regulate, there is an issue about the way that the distinguishing of the registers is dealt with. I see that as a potential trip-up point if not thought through very carefully; I hope the Minister can give the House some assurance on that.

On the whole, I support the regulations. This is just a continuation of many years of different people in the team taking roles. With the correct regulation and the correct training and supervision, this will improve patient outcomes and service.

21:30

[Lord Allan of Hallam (LD)]

My Lords, this statutory instrument has triggered a debate that I think is happening on multiple levels. There are two meta questions around the structure of the medical professions, writ large, and the legislative process for establishing professional regulations and updating these over time. This is something on which the amendment from the noble Baroness, Lady Bennett, focuses, and around which the noble Lord, Lord Hunt, has helpfully provided some extra history.

There is one question, which I would call an adjacent question, around the treatment of junior doctors and their frustration at the moment, which they are expressing largely through industrial action. That has been mentioned, quite rightly, by a number of noble Lords, but I do not think that is core to the debate around associates; it is an adjacent question spilling over into this debate.

We have to recognise that the Government have got themselves into a mess over the junior doctor situation and that unhappiness is now having these knock-on consequences. The noble Lord, Lord Bethell, interestingly pointed out that the BMA was unable to come up with examples of the positive use of associates. I thank the Minister for bringing some associates here so that we could hear from them. I thank the consultants in emergency medicine at Leeds hospital who wrote to me and, I suspect, to other members, describing how associates work on the ground and full of praise for the work they do, which has rightly been echoed in the debate today.

There are three questions around the associate roles themselves, which are touched on more in the two regret amendments. The first is whether these roles represent a valuable innovation for the NHS and, importantly, for the patients of the NHS, and so have a long-term place in the system. I hear broad support for the answer to this question being yes, qualified by some questions around the name and the scope, which I will come to shortly. Broadly, I have not heard anybody say that they disagree with the development of these associate roles within the NHS.

The second question is whether they should be regulated by the GMC, as proposed in the statutory instrument. Here I hear a more grudging “Yes”, but still a broad acceptance that the GMC is the only game in town and that it will do a good job. I was interested to hear from the noble Lord, Lord Harris, about the role of the GDC; the comparisons between the GDC and GMC are helpful for us to consider. Certainly, there is a broad sense that the GMC will do a good job if it is the regulator; I am inclined to agree with that.

A particular benefit of the regulation is that it will provide a clear and well-established route for any issues to be investigated. Again, people have raised particular instances in the debate about where things have gone wrong. They will go wrong from time to time with any group of professionals—including politicians, dare I say? It does not matter which group of professionals it is, things will go wrong. What is important for a member of the public is that there is someone they can go to who has a clear and well-established procedure for getting to the bottom of what happened and finding a resolution. I have every confidence that the GMC will provide that for physician and anaesthetist associates and that this will add to any complaints mechanism that exists within individual trusts, which is all there is today so long as these professions are outside of a regulated entity.

Again, importantly, it has been mentioned in the debate that the GMC will provide for a regular review of these professionals to ensure that they continue to remain fit to practise. I think we all can welcome that. I hope the Minister will be able to commit to there being full transparency from the GMC about the activity that takes place on the new associates register so that we can understand how many are coming on and going off it and understand any issues that have arisen, such as the reasons they might have been taken off the register.

The Minister referred to annual reports to Parliament. In 2024, we expect a little more real-time information so I hope he will be able to commit to there being full transparency about associates coming on to that new GMC register and that we should be able to see that much more frequently than simply a report to Parliament.

The third question that has arisen and the one I want to spend the most time on—not too much given the lateness of the hour but enough to try to elaborate the point—is whether the roles are properly defined to avoid confusion and whether they are being used appropriately. Some of this is in the name, which we have discussed already, and I hope the Minister can point to some evidence about there being a lack of confusion.

It seems to me instinctively that there is confusion, partly because “physician” is not common parlance in British English—it is something we more typically associate with American TV shows. The noble Baroness, Lady Watkins, made the point about how we now talk about junior doctors. If you said to somebody, “Do you think a physician associate or a junior doctor is more highly qualified?”, I suspect a lot of people would opt for the physician associate because “physician” has a grandness.

We should be honest enough to test this with ordinary people, not people in the medical profession. That is the test we should apply and if it is true that people think that the physician associate is more highly qualified, we need either to help people understand that that is not the case or change the name. It is really important that we go out there and talk to ordinary people about how they experience those names to understand what is going on. I hope the Minister can commit to that.

More significant is the scope of the role as defined in national guidance and how that is exercised within health organisations in both the NHS and the private sector. The noble Lord, Lord Hunt, and others rightly raised the scope of practice. I think my most significant concern is not about individual physician associates presenting themselves wrongly but the decisions that will be made by their employers about how to deploy them. We need to look at general practices and large NHS trusts separately. With GPs, in many places we are already operating in a commercial market and in some cases physician associate roles have been growing quite significantly under the additional roles reimbursement scheme which has been operating over the last few years. I thank whoever in the department who is responsible for coming up with a scheme whose acronym is ARRS, which brought a smile to my face when reading the briefing notes late at night.

This issue was brought home starkly to me when I, along with thousands of other people, received a note from my practice telling me it is being sold by a large US corporation called Centene to a British private company, owned by private capital, called T20 Osprey Midco Ltd—very catchy. GP practices are bought and sold en masse between these corporations. I looked into the business of the Centene corporation and found that in 2022 “Panorama” did an investigation specifically into its use of physician associates and came up with some quite disturbing data around the preponderance of physician associates in practices being operated by this US corporation.

I am not a raging anti-capitalist but I do not think it is crazy to think that private businesses will try antod find whichever ways they can to reduce their costs and increase their margins. I would like the Minister to explain how the Government will make sure that these roles are not misused in general practice, especially where they are owned by corporates rather than being operated by some part of the NHS structure. In particular, I would like him to explain how we ensure that practices follow the Royal College of GPs’ position that the physician associates must work under the supervision of GPs and not be used as substitutes. That was something the Minister said in theory. I would like him to clarify in practice how he is going to make sure that happens in this multiplicity of individual contractors who are not NHS employees but operate independently of it.

There is a real concern that if there is a shortage in GP recruitment, that will clearly add to the pressure for practices to think, “I’ll hire the physician associates because I can’t get the GPs”. Again, if we follow the RCGP guidance—I hope the Minister will agree with this—if a practice cannot hire a GP, it has no one to supervise the associate so it should hire fewer physician associates, not more. The hiring of physician associates is contingent on practices hiring sufficient trained general practitioners.

When it comes to NHS trusts, the concerns relate to the decisions that the management may take. This is not intended to be NHS manager-bashing, particularly not with my noble friend Lord Scriven sat behind me; it is more a bit of Government-bashing. If the Government leave trusts with constrained budgets, managers will naturally look again at ways to keep the services running, including using less expensive staff where they can. The risk will be compounded again if the more expensive fully trained staff are not available because there is some shortfall in the Government’s training programme.

I know that the Minister will have to say, “The Government will meet their targets for training doctors and GPs”, but in the real world we have to imagine a scenario where, sadly, they fall short. Again, I want to hear assurances from him that where trusts start heading down the route of thinking that they can hire associates because they cannot get the doctors, the levers will be in place for the NHS centrally to stop that happening and to ensure that associates, who are valued and valuable members of teams, will not be left by their managers to do all of the job, rather than being part of a team with a trained medic leading it.

I hope the Minister can reassure us on the scope in both GP practices and NHS trusts. Again, the SI and this regulation are welcome but there are some questions to answer around how these measures present to people. However, the most significant questions that we may come back to in two, three or four years’ time will be around how individual trusts and general practices have decided to use these roles, rather than any questions around the professionalism or effectiveness of the individuals doing that work, whom we value.

[Baroness Merron (Lab)]

My Lords, the point that the noble Lord, Lord Allan, has just made about respect for the professionals we are speaking about is a very good one for me to follow on from, because I believe we are at our most vulnerable when we are in the care of the NHS. We have a right to expect to be seen and treated by a competent and regulated professional, in whom we have confidence. This debate has highlighted the sensitivities and practical challenges in trying to get that right. I am sure the Minister will take note of the many valid points that have been raised.

I start by associating myself and these Benches with thanking physician associates and anaesthesia associates for their professional and continued service. I feel particularly strongly about saying that in view of the points raised by my noble friend Lord Hunt and other noble Lords on the considerable toxicity that has been generated about this issue. That has brought bullying and intimidation to these very valued members of the NHS team. I am sure that all of us in your Lordships’ House believe that this is just not acceptable.

In the debate tonight, I feel that I have heard broad agreement that regulation is important—indeed, crucial —to maintaining high standards of patient safety and care, and providing clarity around the boundaries of the functions that can and cannot be performed. Yet, as we have heard, there has been significant delay in getting there when it comes to PAs and AAs, even though regulation needed to come alongside workforce planning. Can the Minister tell your Lordships why this regulation has taken so long?

21:45

I want to say from this side of the House that, if we are in government after the general election, we do not want regulation to take as long as it has under this Government. This is not least because, as technology advances and health needs change and expand, we need a bigger and better skill mix across the NHS. We want to work to ensure that new professionals supporting the NHS will be registered and regulated with thoroughness and speed. I will turn to the points in the amendments to the Motion before your Lordships’ House.

First, this is not a new issue. The term “associate” is one that these professions have used for many years in their education, training and deployment within the NHS. It pre-dates the decision to bring them into regulation. Just like doctors, PAs and AAs are responsible for clearly communicating who they are and what their role is in the team. I take on board the points made by the noble Lords, Lord Patel and Lord Lansley, and others, that this should not be the sole responsibility of patients. I am sure the Minister will have heard this point too.

On the regulator, the Secondary Legislation Scrutiny Committee reported that

“The proposal to register and regulate Associate Physicians and Anaesthetists is entirely in line with previous practice”.

It confirmed that, in its view,

“the GMC is experienced in that role”.

Therefore, the committee did not express any concerns about the policy intention, and neither did the Academy of Medical Royal Colleges.

On the proposal to decline to approve this order, I hope that by now it is clear to your Lordships’ House that AAs and PAs provide much-needed capacity in supporting doctors and other front-line staff as part of a multidisciplinary team, and that their numbers are to increase as part of the workforce plan. Declining to approve this order would not just send the wrong message but would set back the long overdue reforms required to provide assurance and safety standards to patients, and to help the NHS deal with ongoing pressures.

In the Adjournment debate in the other place on 7 February, Minister Stephenson said:

“The role of a physician associate is to work with doctors, not to replace them … The role of physician associates is in no way a replacement for that of any other member of the general practice team.”—[Official Report, Commons, 7/2/24; cols. 338-41.]

Those are welcome comments. Could the noble Lord the Minister give a reassurance that the expansion of PAs and AAs will not impinge on medical speciality training expansion and, most crucially, on opportunities?

Noble Lords, as we have heard throughout the debate, have heard much from those concerned about this order. It is also fair to say that we have also heard from those who support it. I understand the strength of feeling, as I heard about the life-and-death implications described so painstakingly by my noble friend Lord Winston.

I have a few questions for the Minister. Could he give an assurance that all stakeholders will be fully consulted by the GMC on the details of the draft order? What measures will be taken to ensure that patients have both clarity and improved awareness of who they might speak to and deal with in a medical setting? This was highlighted in the regret amendments in the names of the noble Baronesses, Lady Brinton and Lady Finlay. Could the Minister also indicate what support will be available to PAs and AAs? What level of supervision will be suitable and how will the Government ensure that it is in place, given how stretched staff already are on the front line? Has the Minister had discussion with the GMC about defining scope of PAs and AAs?

It would be helpful to hear the Minister’s thoughts on how the order might impact on career progression in the NHS and help with retention. To follow up on the points raised by my noble friend Lord Harris, will the Minister explain how the order fits in with the wider regulation reform to be undertaken in the next year or so?

I know we all agree that patient safety must always be our number 1 priority. Can the Minister provide any assurances about the measures in place to review this legislation over the two-year transition period, particularly given the expansion of the role of PAs and AAs in the NHS?

Some have expressed concern about the safeguards around the fitness-to-practise decisions taken by regulators, including decisions to remove or reduce regulatory restrictions on a registrant who has been found to present a possibly serious risk to the public. What assurance can the Minister give on that point? If the legislation is deemed not suitable to improve patient safety, what measures will the Government take to remedy that and keep on top of the situation?

We support this order. It is vital that all those who treat patients in the NHS do so with patient safety and quality care at the fore. I hope this debate and this order will make a significant contribution to that.

[Lord Markham (Con)]

I thank all the noble Lords for their contributions. The wide range of views and experience shows the House at its best. On the serious point of the noble Baroness, Lady Bennett, about making sure that there was a full debate, I hope noble Lords feel that this is a good example of where we have had a full and thorough debate.

I am glad to say that, within all those contributions, there was a general agreement on the importance of these roles and the vital contribution that they can make. They can allow doctors to work to the top of their profession—my noble friend Lord Bethell made that point. As the noble Lord, Lord Scriven, rightly said, they are a supplement to doctors. I hope that, when you have support and allow people to work to the top of their professions, that will cover some of the points that my noble friend Lady Harding and the noble Baroness, Lady Watkins, made about good management, making general practitioners and doctors feel valued in their roles, and making them feel that they are being offered these support service. That is very much within the scope of practice here. Oh, I now see that the noble Baroness, Lady Watkins, is on the Woolsack; I was looking all over for her and thinking, “Surely my speech is not so boring that I have lost her already”.

I hope noble Lords feel reassured by all this and that, as drawn out in the numbers referenced by my noble friend Lord Bethell, this represents only 8% of the GP workforce, so it is very much a supplemental role rather than a substitute.

All speakers echoed the point made passionately by the noble Lord, Lord Hunt, that PAs and AAs play a valued role—one always grounded, as my noble friend Lord Lansley said, in the central role: the doctor or the anaesthetist themselves.

As my noble friends Lady Harding and Lady Bloomfield said, this seeks to regulate them properly, with much clearer regulations, a defined scope of practice and the flexibility to adapt. The noble Baroness, Lady Merron, asked the very fair question of why this has taken so long; the honest answer is that I do not know, but the whole point of this is to build in flexibility. With all the will in the world, as we have seen, if it required primary legislation then, for whatever reason, there would not be time available in Parliament to make the changes quickly enough for the required flexibility. That is what we are trying to do with this order.

The noble Baroness, Lady Bennett, said that she wants to make sure all voices have been heard. I hope those voices have been well heard. During the 18 months that I have been in this role, I have had more correspondence on this than on anything else. She mentioned the Observer article on the long-term workforce plan; I assure her that there is no back-pedalling on this. The target is for incremental increases in the numbers each year. Funnily enough, the frustration expressed to me by Minister Stephenson today is that we are not only hitting the targets for this year but exceeding them. There is definitely no back-pedalling; rather, we are exceeding our targets.

I assure the noble Baroness, Lady Merron, that we do not intend to impinge at all on specialisms. Following on from the Oral Question today, the next stage is to try to get into the detail of the specialisms.

On the points raised by the noble Baroness, Lady Finlay, there is some confusion around the protected titles. As we all know, “doctor” and “consultant” are not protected titles today; you can call yourself a doctor if you have a PhD, and I called myself a consultant once when I worked as a strategic consultant. There is confusion. On the point raised by the noble Baroness, Lady Watkins—I see that she has now popped up by the Throne; it is like “Where’s Wally?”—we need to look at an overhaul of titles, full stop, and at some of the acronyms, such as AAs, as mentioned by the noble Lord, Lord Allan. The idea is that all of this will be part of a full GMC consultation process over the next couple of years on this reformed legislation; we will look at all these points there.

There are separate registers. As mentioned, it is intended that there will be separate prefixes of PA and AA in the registration numbers, but I fully accept that it will not mean anything to a member of the public that a serial number is PA1234. It is a good point that there should be a more thorough consultation on the use of titles, because it is absolutely a confusing picture.

The noble Lord, Lord Harris, with his experience of the GDC, showed that having one regulatory body looking after everything provides clarity. That is valuable, but, as the noble Baroness, Lady Brinton, said, our Explanatory Memorandum needs to be clearer, and so I make that commitment.

22:00

As my noble friend Lord Lansley, said, this needs to be an ongoing process policed by the CQC. As part of that, I take the point made by the noble Lord, Lord Harris, that you should not need the caveat about the intent to deceive. The fact that you are not using your correct title in the right place is enough in itself.

[Lord Harris of Haringey (Lab)]

It is in your order.

[Lord Markham (Con)]

That is something I will pick up on. On the point raised by the noble Baroness, Lady Fox, I say that the GMC, with the CQC, should be able to give the ongoing quality assurance.

The noble Lord, Lord Hunt, said very well that the discussion on mistakes has not been useful. We are all aware that, regrettably, mistakes happen in all areas, and we need to make sure that we understand and learn from them, rather than using them to point fingers. Moving into the regulated space, where there is duty of candour, is useful.

I do not think anyone could be failed to be moved by the passion with which the noble Lord, Lord Winston, spoke about his experience. It was a very telling story. As reassurance I cite the noble Lord, Lord Patel, on the scope of the practice: it is one anaesthetist to two AAs, and the role of the AA is very much to maintain, as he explained well. In a similar way, the PAs really do need to work under GP supervision. The numbers are set out in the long-term workforce plan. We have a foot on the throttle for those training places, particularly in regulating them. We will make sure that things are properly managed so they cannot get out of control.

I absolutely agree with the points made by the noble Baronesses, Lady Watkins, Lady Harding and Lady Bloomfield, that this is a people management issue, and a lot of the heat from this debate is a feeling from junior doctors and others that they are unloved and uncared for. I freely admit that there is a wider issue that we need to look at, concerning things like hot meals; clearly, it is something trusts need to look at it as well.

I echo the points made by the noble Lord, Lord Hunt, that passing this order is the best way to ensure the safety of patients. As we develop, there is perhaps scope to be more ambitious, but let us try to do this step by step, to make sure we really are happy and that the scope of practice works. As ever in a debate as long as this—it has been a very thorough one—I will write to fill in any details that I have not managed to cover. At this point, I hope and trust I have provided sufficient answers to the questions, and have demonstrated—

[Baroness Finlay of Llandaff (CB)]

I hesitate to rise because the House clearly wants to end the debate, but I am not sure whether the Minister, in summing up, said whether the titles of physician associate and anaesthesia associate will be protected titles when the order goes through. Are they negotiable? I ask that question specifically because I had a lot of discussions with different people involved in this, particularly the GMC, and I have been concerned that if those are the only protected titles of all the grades registered by the General Medical Council, we may be storing up further problems for the future. If this is to be a protected title, can the Minister provide assurance that further statutory instruments could be brought forward if, in the light of the consultation advised by the noble Lord, Lord Allan, a different title is suggested? Could it then be changed?

[Lord Markham (Con)]

It is a protected title. The point I was trying to make about the general overhaul and understanding of the titles, however, is that there will be the scope to do this, as doctors and consultants are not protected titles today. I think we need to develop clarity on that, which is why the further reforms and SI changes will set out to protect other titles as well.

[Lord Patel (CB)]

Sorry about prolonging the debate, but is that the only protected title of all healthcare professionals?

[Lord Markham (Con)]

My understanding is that currently none of the titles is protected. These are the first set of titles that will be protected as a part of the secondary legislation that we are passing. The idea is to understand the hierarchy of titles and start to introduce the protections. I am happy to follow up in writing in more depth on all of this. I thank the noble Lord for his intervention.

Hopefully, this order will provide a standardised framework of governance and assurance for clinical practice and professional conduct for AAs and PAs. It will enhance patient safety and enable AAs and PAs to make a greater contribution to patient care. I beg to move.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I am acutely aware of the hour, but I am also aware there are a great many people—so social media tells me—watching this debate. There are a couple of things I need to say.

First, I thank everyone who has taken part in the debate, especially the noble Lords, Lord Patel and Lord Winston, for bravely telling us about the detail of their rich experience.

I will pick up on the comments made by the noble Lord, Lord Hunt, and the noble Baroness, Lady Merron. If you look back at my speech—I have handed over my notes now—I used the word “respect” talking about the PAs and AAs, and I talked about their study and student debt. I make it clear to the noble Lord, Lord Hunt, that I have not made any listing of incidents where things have gone wrong. I cited one case relating to the issue raised by the noble Lord, Lord Allan, of the difficulty patients have in understanding what the term “physician associate” actually means.

I highlight the words of the noble Lord, Lord Patel: using an SI to do a major piece of legislation is inappropriate. That is the whole reason I put down this fatal amendment. The noble Lord, Lord Hunt, and others said we cannot get the parliamentary time for it. Well, we have talked about reform a lot tonight, so maybe we ought to look at reform in Parliament as well. I will refrain from suggesting some of the Bills that we could not be doing so we could be doing this as a Bill instead.

There are a couple of points that need to be answered. The noble Baroness, Lady Bloomfield, questioned part-time GPs. If GPs are working, say, theoretically four days a week, it is more than a full-time job in terms of the stress, pressure and time involved. If we are going to keep people in the profession, we have got to allow them to contribute as much as they can. That is an issue of sustainability.

The noble Lord, Lord Scriven, referred to me talking about a second-rate service. I was talking about a possible experience a few years in the future; if there is the situation of whole regions, areas and practices—like the noble Lord, Lord Allan, said—having only PAs, effectively that would be a second-rate service. That was the future context I was talking about.

Given the time, I will make one final point. The noble Lord, Lord Bethell, said the Government are looking for the number of PAs and AAs to be 8% of the total of doctors. The question, of course, is not just about the total but about the distribution. There is the point about private hedge fund owners of GP surgeries and what they might choose to do. There is also the point which I have been driving at all the way through, having for more than a decade been visiting northern cities and towns in particular, where people really feel that they are struggling to get a decent NHS service and struggling to get the staff, and they fear that they might not get enough doctors.

Again, I thank everyone. I thank the noble Baroness, Lady Fox, for stressing how vulnerable patients are. My final point is that in making sure that patients understand they are being seen and treated by a PA or an AA, there has to be an attempt to understand that when people are ill, vulnerable and desperate, they may not absorb something just being done to them by rote. That is really important.

With that brief summing up, and in the circumstances, I beg leave to withdraw my amendment.

Amendment to the Motion withdrawn.

Amendment to the Motion

Tabled by

[Baroness Finlay of Llandaff]

At end to insert “but regrets that the draft Order refers to “associates” rather than “assistants”, which would more properly reflect the role, scope and responsibilities of such staff and reduce patient confusion.”

Amendment to the Motion not moved.

Amendment to the Motion

Tabled by

[Baroness Brinton]

At end to insert “but regrets that the Government has failed to respond adequately to concerns over provisions in the draft Order about (1) the regulation of ‘physician associates’ and ‘anaesthesia associates’ by the General Medical Council instead of another regulator, and (2) the use of these professional titles, which risks confusion for patients over the difference between doctors and other healthcare professionals, with potential implications for patient safety.”

Amendment to the Motion not moved.

Motion agreed.

House adjourned at 10.10 pm.