Myanmar: Health System

Baroness Finlay of Llandaff Excerpts

Thursday 29th February 2024 Grand Committee

[Baroness Finlay of Llandaff (CB)]

My Lords, I appreciate being allowed to speak briefly in the gap. Some of us will have had the pleasure—indeed, the overwhelming experience—of hearing Aung San Suu Kyi when she addressed both Houses of Parliament in Westminster Hall. A gentle light of hope emanated. Now, we see a country that is almost in freefall, with so much collapsing. There has been a collapse in health care, maternal mortality has increased to a level that one could not have imagined, and there has been such a drop in immunisation, as has been said, that infections are rife.

I was privileged to be on the call that has been referred to, and prior to that had been on a call with doctors from that country. They were risking their lives simply to tell us what was going on. They knew that if they were traced, they would be no more. They knew that their families were at risk. Many of them leave their families to go to provide health care to others, because they cannot bear to see their country’s collapse.

The attacks against hospitals are appalling. The Royal College of Paediatrics and Child Health is providing support through its global mechanisms, as other organisations are. I hope the BMA will raise this with the World Medical Association. We cannot just leave this. The journalists cannot get the images out, so we have quite a problem, because people do not realise just how terrible the situation is.

Even drivers transporting medicines are arrested, so trying to move supplies around is really difficult. It all has to be done subtly and underhand. If any of these people are caught, I am afraid that families sometimes find their family member delivered to their front door the next morning, dead. It is awful.

We cannot not intervene somehow. Many of the hospitals that are being bombed could do with early warning systems to detect aircraft, so that people can at least seek shelter. At the moment, they cannot.

Her Late Majesty Queen Elizabeth II

Baroness Finlay of Llandaff Excerpts

Friday 9th September 2022 Lords Chamber

[Baroness Morgan of Cotes (Con)]

My Lords, it is a pleasure to follow the noble Viscount. So much has already been said this afternoon, but at a time of grief it is better for us all to say something. In his message yesterday, our new King said that he and his family would draw comfort from all the sentiments of loss, mourning and gratitude that people would express in the coming days. We have heard many fantastic and moving speeches and it has been a privilege to be part of your Lordships’ House today to listen to them.

I will offer three brief thoughts. First, as has been mentioned and as the noble Viscount just captured in his tribute, the Queen’s last service was to invite her 15th Prime Minister to form a Government. Her face in that picture was still innately curious. To have that level of curiosity at the age of 96, after everything that the Queen had seen, was truly remarkable. Her curiosity was also captured, as we heard earlier, in that very simple question to those City financiers after the 2008 financial crash: “Why did no one else see that this was going to happen?” What a good question that she asked on behalf of so many of her subjects.

Secondly, we have heard that, for those who encountered her in the flesh, it was an unforgettable experience. She said that, for those who were just going to catch a glimpse, she deliberately wore bright clothes so that she could not be missed. Whatever we might think of His Majesty’s wardrobe, he is unlikely to wear that rainbow of colours that we got so used to.

As we heard, in 2012 the Queen visited Leicester with the new Duchess of Cambridge and the Duke of Edinburgh. It was a huge honour for both the city and county for that visit to be the first to any city in the Diamond Jubilee year. Of course, there was great excitement, but the tip that I took away, having watched Her Majesty during the lunch, was that it is acceptable to open your handbag, get out your lipstick and put it on after lunch. I have taken that tip and told many people about it; they found it a great insight into what was in her handbag—apart from marmalade sandwiches.

We heard a story from the noble Baroness, Lady Barker, of someone encountering the Queen and not being able to speak. In my case, when I was appointed to the Privy Council, I forgot to breathe. As the black spots appeared in my peripheral vision, I suddenly realised that I had stopped breathing as I was so close to my monarch and was observing her in close quarters. We also heard about the kissing of hands. While one is not meant to go into the details of Privy Council experiences, it is fair to say that, however experienced in life you are, that ceremony of kneeling and kissing your monarch’s hand is probably the most agonising kiss that you will ever make in your lifetime.

Thirdly, the Queen was our voice of stability at key moments. We have mentioned her Christmas afternoon broadcasts. Of course, after the death of Princess Diana, when the country needed a moment of stability, she was the one who invoked the phrase:

“Grief is the price we pay for love.”


That is worth remembering today. She was also asked to speak in spring 2020 when the Covid pandemic had struck with such ferocity.

I have no doubt that His Majesty the King will provide that same stability and that our thoughts and support will be with him over the coming days and months as he takes on his new duties. In many ways, we began to see that transition of power when he was at the State Opening of Parliament in this House just a few months ago. As we have heard, all these events will be much more of a shock for everyone at every level of society and everywhere around the globe than most of us would have expected. God save the King.

[Baroness Finlay of Llandaff (CB)]

Today, as we pay tribute, having been led so sensitively and eloquently by our Front Benches, we must remember that Her Majesty was patron of over 600 charities and each felt that they were unique to her. Hospices and hospitals benefited greatly from her support and she lifted the morale of everyone, even the sickest person. We saw that she herself lived fully and with her uniquely great dignity until death took her.

The Chartered Society of Physiotherapy had the honour of having Her Majesty as our patron since 1953—its charter having been granted by her grandfather, King George V, in June 1920. Every year of those 69 years, she sent her official royal greetings to our members to mark our AGMs. In 2020, the centenary of our charter, she particularly noted the vital contribution of physiotherapy staff in response to the Covid pandemic. Every year as president, I read out the message and the uplift in the room was palpable: it was affirmation by her while physiotherapists focused on their service to the health of the nation—her subjects—and all felt, and indeed knew, that she deeply appreciated their role. Every event that Her Majesty attended created treasured memories for all who were there. Every year, many enjoyed the honour of a lifetime: an invitation to one of the Queen’s annual garden parties, and some received honours in recognition of the impact of their work.

Her commitment to her citizens across the Commonwealth of Nations, as we have heard so eloquently, was evident throughout her long service. She unwavering dedication to all her subjects provided stability during many turbulent times. At the recent launch of the Commonwealth Tribute to Life—a memorandum of understanding across the Commonwealth—the friendship and support that she inspired were palpable among the transplant professionals in the room.

Social Security (Special Rules for End of Life) Bill [HL]

Baroness Finlay of Llandaff Excerpts

2nd reading
Tuesday 24th May 2022 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my interests as a patron of the Motor Neurone Disease Association and vice-president of Marie Curie and of Hospice UK.

I hope that when the Minister responds to this very important short debate she will be able to tell us—if I may pick up on the points made by the noble Baroness, Lady Noakes—what happens if the person outlives their prognosis and the leeway period, which, according to the government website, allows an additional two years before the benefits come up for review. As the form is to inform the claim process, will there be a process of appeal if the application for benefits is declined at the DWP, and will there be the option of an independent second opinion?

Another area of concern—I will build on the points made by the noble Baroness, Lady Brinton—is how relatives will be informed that the benefit stops as soon as the person dies. This can become particularly important when people have given up their job and have become financially dependent on all the money coming in, because they are the principal carer and acting in a greater role than any of the paid professionals who may be involved in a person’s care. There is a real problem in supporting and preparing people.

In addition, as has already been stated, the prognosis of a year is pretty well impossible. Going through the website, I recognise that the Department for Work and Pensions accepts that it is a guess to start the process, and the information on the website implies that the DWP does not attach legal responsibility to the person who is signing the forms. There is no comeback should the person outlive the prognosis—one hopes that they do.

But what if somebody is consistently wrong? What is the threshold for even suspecting that there may be abuse of the scheme? Unbelievable as it may sound, we know that the furlough scheme in the pandemic was, sadly, abused, so we must have monitoring for any system that is put in place.

Some years ago, when we were campaigning for the DS 1500, we had discussions with departmental officials on the difficulty of predicting a six-month life expectancy. Over the years since the DS 1500 has been in place, I have wanted to know how many forms have been filled out annually and the timeframe for which people have received the benefit—but I gather that this data is not kept. Given the changes now, I hope the data will be collected to map whether there are areas of underclaiming and areas where there are particularly high numbers who live for three or more years with diagnoses that would not have been expected to have high survival rates, as it may indicate excellent clinical care or it may indicate an area of inappropriate diagnostic labelling. Modern IT systems should automatically generate useful reports from the data that will be held centrally.

Patients rightly campaigned for the DS 1500 system to be modified—as did the voluntary sector. The change to one year—although prognostication is notoriously inaccurate at that time distance—has some very distinct advantages. The consistency across the Department of Health and Social Care and DWP is welcome, particularly as the government amendment to the Health and Care Bill states that patients must be able to access the palliative care they need. This should help ensure that people are referred for the support they need when they need it, rather than the “too little, too late” scenario that has happened in the past and has led, very sadly, to bad experiences and badly managed deaths.

I hope that this will also lead to more open conversations with clinicians. It is easier for clinicians to help patients plan for the worst and yet maintain hope, and therefore help patients come to terms with living with uncertainty, which is the reality of a prognosis of the last year of life—aware that the prognosis of one year can sometimes be as inaccurate as tossing a coin. For the DS 1500, it was difficult for clinicians to say, “I think that you’re in the last six months of life”, because that sounded blunt and felt like delivering a death sentence. I think that was sometimes a deterrent to those conversations happening, so I hope the important conversations will trigger advance care planning, which is already an aspiration on the website. Even more useful is to ask the patient is to ask the patient “What matters to you?”, because that can inform best-interest decision-making and prioritisation, whereas planning often fails to match the evolving clinical scenario—particularly when it evolves in a way that nobody could have predicted.

It is absolutely right that there is no age restriction on the process. As the noble Baroness, Lady Brinton, so movingly described, some very young children need a great deal of equipment and skilled attention. But here is the real problem for parents—as has been said. They give up work to care for their child, but when the child dies, all the benefits suddenly stop, so they are left both bereaved and destitute. So I hope the DWP will use careful data analysis of benefits, timelines and time of death to have a better overview and explore ways that, prior to bereavement, the parent is given the anticipatory advice and support that they will need.

Turning to the forms, there are some aspects that I think need revision for clarification, I ask the Minister and her team to meet me to go over some of the detail on the form to iron out potential difficulties. It is in the minutiae of some of the wording, but we need to make this work as well as we can. The website makes it clear that the clinician will not face an adverse consequence if the patient lives longer than expected and that the benefit received under the special rules will have the leeway of a further two years, but will claimants be informed after, perhaps, two and a half years that they should prepare to transfer their claim through the standard route rather than suddenly feel threatened at the end of that leeway period by a potential perception of loss of funding?

Then there are those patients with a catastrophic life-changing illness or injuries who need long-term care and yet do not have a prognosis of less than a year. They also need their benefits fast-tracked early on, which can later be reviewed and applied in the normal way where processes are slower. I wonder how the Government see that we might be able to accommodate somebody who, for example, following a catastrophic accident and catastrophic head injury, needs a great deal of care and attention and will not improve dramatically enough to become independent.

However, with all of those caveats, I welcome all the work that the Government have already put into this—their thought, care and attention—and I commend the charities who have been campaigning for so long to make sure that people get the benefits that really will make a difference to the quality of life and will support clinicians in having those difficult but terribly important conversations.

Queen’s Speech

Baroness Finlay of Llandaff Excerpts

Tuesday 17th May 2022 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, this gracious Speech was interesting in part for what it did not contain, despite containing a large number of Bills. The noble Baronesses, Lady Jolly and Lady Pitkeathley, have focused comprehensively on social care. I will address issues for the workforce in health, including the impact of the war in Ukraine, preparation for adulthood of children and young people with learning difficulties or autism, and the importance of kinship care and our need for an alcohol strategy.

The Government have stated an intention to build 14 new hospitals by 2030 and upgrade another 70, including by providing new beds, equipment and technology, and they plan to set tight targets for elective recovery. We have just passed the Health and Care Act, and each statutory instrument for its 160 delegated powers will need to be debated. But the Government rejected legislated workforce planning, despite the deficits in staff at every level, including in social care.

Our intensive care bed capacity must expand, with highly trained staff to manage complex elective surgery and recovery from life-threatening illness, as well as increasing organ donation by those who have lost their lives in catastrophic circumstances, usually accidents. Our high-quality ethical transplant programme is hampered by a shortage of facilities. Here I should declare my interest as chair of the Commonwealth Tribute to Life UK committee, which has produced a memorandum of understanding for shared learning as a legacy from the Commonwealth Games.

My Lords, the war in Ukraine has resulted in many UK students returning to this country. Some 600 of these are medical students who had been unable to secure places in British medical schools originally and therefore went to study medicine, taught in English, in Ukraine. Most planned to return to practice medicine here, having secured GMC registration. Yet we have a fixed number of places in our medical schools and the current thinking is that these students will have to go back to the beginning and reapply through UCAS if they cannot continue their courses in Ukraine. Surely the Government can find a negotiated agreement between the General Medical Council and our universities’ medical schools to assess the learning needs of these students, who are at different stages of the course, and find a way to integrate many of them. We need new medical graduates; these are motivated students whose life experience from the war will have undoubtedly broadened their vision.

Just as the gracious Speech was silent on workforce planning, so it was also silent on tackling the problems that alcohol is causing in our society. I declare that I chair the Commission on Alcohol Harm. Alcohol is linked to 27 types of cancer, suicide, abuse and obesity. The Government have ducked developing a comprehensive alcohol strategy to tackle harm by addressing the affordability, promotion and inappropriate availability of alcohol. Alcohol causes more working days of life to be lost then the 10 most common cancers combined, yet where is the strategy on alcohol? Without tackling alcohol, the Government’s strategy on mental health, on crime, on obesity and on increased pressures on the NHS are, I fear, doomed to fail.

Drugs and alcohol are frequent antecedents to crises and trauma in children who enter care long term. There is good evidence that kinship care has better outcomes overall for those 180,000 children who would otherwise enter the care system and be cared for by strangers, but over half these children have additional educational needs or disabilities. Kinship care needs to be defined in legislation so that carers are properly recognised and can access the support needed, particularly in education for all ages and support for legal costs. This could result in far better outcomes for these children.

I turn briefly to the draft Mental Health Act reform Bill, in which much remains to be worked through and debated. The detention of those with learning disabilities and autism in mental health institutions has not supported people to live their lives as well as possible and has denied them opportunities, particularly as they transition from teenage years to adulthood. I had the honour of chairing the National Mental Capacity Forum until recently and I welcome the Government’s recognition that people need support to empower them to make decisions for themselves and avoid the inappropriate detention of those with unaddressed needs.

We recently had the shocking Ockenden report into maternity services, and the Government’s recognition of an urgent need for maternal mental health services is welcome, but I return to the important question of the workforce and where these teams will be drawn from.

Ukraine

Baroness Finlay of Llandaff Excerpts

Wednesday 30th March 2022 Lords Chamber

[Lord Ahmad of Wimbledon (Con)]

My Lords, at the moment this is speculation. It was clear that Mr Abramovich has a close relationship with Putin, and the fact that he was sanctioned was the right thing to do.

[Baroness Finlay of Llandaff (CB)]

My Lords, today I had a response from the Home Office that it did not know how many people had come into the UK with visas on the Homes for Ukraine scheme. Can the Government translate that website into Ukrainian so that it is more user-friendly? I have sent a list of suggested improvements to the relevant Minister.

I want to ask also about humanitarian aid. Of the 44 cancer centres in Ukraine, only eight now remain. Patients are being moved into Poland. Lithuania and Moldova’s health facilities are at capacity. In the humanitarian aid that we are providing, is there pain relief, and are there anaesthetic agents, surgical supplies and antibiotics going into Ukraine and neighbouring countries, including anti-cancer drugs to those adjacent cancer centres? Do we recognise that many of the medical staff within Ukraine have been killed or injured and therefore that their numbers are seriously depleted? Are we supporting those agencies from the UK which are providing rapid online support to trauma surgeons within Ukraine?

[Lord Ahmad of Wimbledon (Con)]

My Lords, on the final question, the short answer is yes. We are working very closely with our colleagues in the Department of Health regarding the requirements in Ukraine and neighbouring countries. To be very open, I asked what the specific needs were for Poland in terms of beds, medicines, et cetera. As the noble Baroness will be aware, we have delivered a sizeable amount of humanitarian and medical support to near-neighbouring countries. I do not want to paint a false impression; undoubtedly, the challenge remains getting into Ukraine in a safe and secure way, as I have indicated already. On the issue of cancer patients, the noble Baroness will be aware that the United Kingdom itself evacuated 21 paediatric oncology patients from Warsaw for treatment by the NHS in the UK and will continue to work very closely with Poland and other partners to ensure that those who need urgent treatment, either in country or in the UK, will be facilitated.

Single-Use Plastics

Baroness Finlay of Llandaff Excerpts

Monday 7th March 2022 Lords Chamber

[Lord Goldsmith of Richmond Park (Con)]

My Lords, I am not convinced that the argument follows. We are among the most ambitious countries in the world in terms of where we are heading in relation to single-use plastics. The European Union is also putting a lot of emphasis on reducing unnecessary single-use plastics, as is Scotland. We may be operating in different ways, implementing different rules and using different tools, but we are heading in the same direction, and there is no doubt in my mind that we are moving to an era where the casual use of single-use plastic is coming to an end.

[Baroness Finlay of Llandaff (CB)]

Do the Government intend to have an initiative with the NHS over the use of plastics, given that it is has been estimated that 133,000 tonnes of waste plastic are produced by the NHS each year, which make up 22.7% of its total waste? Some plastics are important for infection control, yet 13.7% of all this waste is plastic film, often used just in packaging, so the approach across the whole NHS needs to be different from that across other aspects of society.

[Lord Goldsmith of Richmond Park (Con)]

The noble Baroness makes an important point. Single-use plastics that are necessary within the context of delivery of health services are well known and, clearly, they would not be caught up in the measures that the Government are introducing. Beyond those specific items, the same rules would apply in relation to the NHS. I welcome our gradual abandonment of the use of disposable face masks for even the most ludicrous events. The numbers of face masks abandoned around the world defy belief and have come to dwarf some of the plastic pollution caused by things such as stirrers, straws and balloons that we are all obsessed by. I warmly welcome the world gradually dropping the theatrics in relation to those masks.

FCDO Nutrition Policy

Baroness Finlay of Llandaff Excerpts

Monday 21st February 2022 Lords Chamber

[Lord Ahmad of Wimbledon (Con)]

My Lords, as I previously said, the Government are absolutely committed to returning to the 0.7% pledge. Indeed, my right honourable friend the Chancellor has already laid out the pathway towards that objective. However, notwithstanding the reduction in ODA spend, I believe we have again illustrated our commitment on nutrition. On the specific areas raised by the noble Baroness, we have examples of how our programming funding has assisted. In Bangladesh, for example, the Suchana multisectoral nutrition programme has targeted close to 240,000 households and impacted positively 1.4 million people. In Nigeria, our child development grant programme is a six-year investment that provides cash transfers to mothers during pregnancy. There are other, notable examples of in-country support specifically focused on nutrition. As I have already said, our commitment to ensuring that those markers are now integrated in all FCDO development programmes on nutrition going forward will also allow us to provide fully comprehensive reports to the OECD on our nutrition spend. I believe that some of the issues that the noble Baroness raised will be addressed quite directly.

[Baroness Finlay of Llandaff (CB)]

My Lords, can the Government confirm that they will continue to work with NGOs in areas of warfare, such as Myanmar, where the military regime is preventing any aid getting through but the Shan Women’s Action Network is able to get healthcare and food into areas that are otherwise not reached? The history of doing that in that country has been very good; we provided aid to Chin State during the mautam famine, which prevented some of the mass starvation that was going on.

[Lord Ahmad of Wimbledon (Con)]

My Lords, I can give that commitment to the noble Baroness. I have seen over a number of years the direct impact of working with civil society organisations on the ground in terms of the support they can provide. I believe very strongly that it is part of our duty to support the infrastructure of their continued work. The noble Baroness talked of Myanmar. More recently, we have seen work of that kind in Afghanistan, Yemen and Syria. I now look after the civil society organisations portfolio within the FCDO, so I would of course be willing to hear any suggestions the noble Baroness may have relating to Myanmar and to work with her.

Uighurs in Xinjiang

Baroness Finlay of Llandaff Excerpts

Thursday 16th December 2021 Lords Chamber

[Lord Ahmad of Wimbledon (Con)]

My Lords, first, I welcome the noble Lord back and we will catch up on his travels. On 8 December, my right honourable friend the Secretary of State for International Trade announced, via a WMS, a package of measures to update the UK’s export control regime. This included an enhancement to our military end use control that will allow the Government to better address threats to national security and human rights and completes the review of export controls as they apply also to Xinjiang that was announced to Parliament. The point he makes on financial services is a specific point and I will continue to engage with him on that issue, but we are sending quite specific signals and the announcement made on 8 December is a good example of that.

[Baroness Finlay of Llandaff (CB)]

My Lords, I understand that the BBC has film evidence of the atrocities that have been addressed in the Uyghur Tribunal, but has been reluctant to show the programmes to date, having set the evidential test so unrealistically high that it cannot be met. Will the Minister ask for these films at least to be available for a private viewing to inform parliamentarians, so that people may be better informed in their own thinking and have another source of information?

[Lord Ahmad of Wimbledon (Con)]

My Lords, I will certainly reflect on and take back that suggestion. I often see the written details of reports which come through, some of which are quite detailed, and they are harrowing—I use the word deliberately. I can only imagine what some of these pictures would depict, but I will certainly reflect on what the noble Baroness has said.

FCDO Staffing

Baroness Finlay of Llandaff Excerpts

Thursday 16th December 2021 Lords Chamber

[The Deputy Speaker (Baroness Finlay of Llandaff) (CB)]

My Lords, we now come to a repeat of an Answer to an Urgent Question asked in the House of Commons today on FCDO staffing.

[Lord Collins of Highbury (Lab)]

My Lords, I take it that the Minister is not going to read out the Statement.

Smuggling: Kittens and Puppies

Baroness Finlay of Llandaff Excerpts

Tuesday 7th December 2021 Lords Chamber

[Lord Goldsmith of Richmond Park (Con)]

My Lords, two years ago we introduced Lucy’s law, whose purpose was to tackle unscrupulous breeders in this country. One of its components was a requirement that, where people purchase a puppy, they are able to see that puppy first in the context of its natural family and the home in which it was raised. That would include, of course, being with its mother.

[Baroness Finlay of Llandaff (CB)]

My Lords, what assessment have the Government made of the risk of rabies being brought into the country through smuggled animals? What action is being taken?

[Lord Goldsmith of Richmond Park (Con)]

My Lords, there are no proposed changes to the animal health requirements of pets entering Great Britain within this Bill, as our focus here is on stopping low-welfare practices for pets being imported. However, the Government monitor disease risk carefully, and changes to animal health requirements will be made under separate legislation. We remain aware of the concerns around non-endemic diseases and continue to monitor the disease situation carefully, but our future policy will be guided by risk assessment.