Policing and Crime Bill

Baroness Finlay of Llandaff Excerpts

Committee: 5th sitting (Hansard): House of Lords
Wednesday 16th November 2016 Lords Chamber

Moved by

[Baroness Finlay of Llandaff]

228F: After Clause 145, insert the following new Clause—
“Coroners’ investigations into deaths: meaning of “state detention”
(1) Section 48 of the Coroners and Justice Act 2009 (interpretation of Part 1: general) is amended as follows.(2) In subsection (1), in the definition of “state detention”, after “subsection (2)” insert “(read with subsection (2A))”.(3) In subsection (2), at the beginning insert “Subject to subsection (2A),”.(4) After subsection (2) insert—“(2A) But a person is not in state detention at any time when he or she is deprived of liberty under section 4A(3) or (5) or 4B of the Mental Capacity Act 2005.””

--- Later in debate ---

[Baroness Finlay of Llandaff (CB)]

My Lords, I thank the Minister and her officials for their time and help over the issue of this amendment. I declare my interest as independent chair of the National Mental Capacity Forum, and it is in that role that I have heard repeatedly about a problem relating to people who die when subject to deprivation of liberty safeguards. This new clause amends the meaning of state detention in Section 48 of the Coroners and Justice Act 2009 to correct the problem that I will now explain. I want to explain first how the amendment works and then some of the background as to why it really is needed.

The amendment removes the duty on coroners to conduct an inquest in all cases where the deceased had an authorisation for the deprivation of their liberty in place either under deprivation of liberty safeguards or a Court of Protection order or because the deprivation of liberty was otherwise authorised by the Mental Capacity Act 2005.

Subsections (2) and (3) of the new clause amend Section 48 of the Mental Capacity Act 2005 to provide a new definition of state detention. To do this, there is a new subsection inserted into the Coroners and Justice Act 2009 to provide that a person is not considered to be under state detention for the purposes of that Act when they are deprived of their liberty under the relevant sections of the Mental Capacity Act 2005. This covers the deprivation of liberty safeguards, which can be from a Court of Protection order, from a DoLS authorisation or, where the deprivation of liberty was urgently required, pending a decision by the Court of Protection on the authority to restrict the person’s liberty. The second amendment makes a consequential change to the Long Title of the Bill.

Let me explain why this new clause is needed. After the Cheshire West judgment, the number of DoLS applications has risen enormously. This was the subject of a debate in this House on 16 March 2015. Prior to the Cheshire West judgment, in 2012-13, there were 11,887 DoLS. In 2014-15, 122,775 individuals had an active DoLS application either granted or in process. That is more than a tenfold increase in the number of DoLS. Some of these people were seriously ill and some died. In 2015, there were 7,183 such deaths. The vast majority of those were expected, anticipated and accepted by the family and those responsible for care. These were not deaths that came as a surprise to anyone. When that family was then told that the death must be referred to the coroner for an inquest they were often shocked and worried, as if there were some sort of accusation against them or others. They could not progress with their grieving and arrange the funeral, as they then had to wait for the inquest.

In 2015 the average time for inquests was 20 weeks, although coroners tried very hard to ensure that deaths under DoLS, when clearly of natural causes, were dealt with more quickly. To put the numbers in context, of the more than 7,000 deaths under DoLS, 6,760—or 94%—were found at inquests to be natural.

The distress to the bereaved has become a common cause of complaint to the Department of Health. In addition, it is not a good use of coroners, who should be investigating deaths where there is any suspicion whatever. Indeed, I remind the House that the Ministry of Justice’s Guide to Coroner Services states:

“Registrars of births and deaths, doctors or the police must report deaths to a coroner in certain circumstances. These include where it appears that: no doctor saw the deceased during his or her last illness; although a doctor attended the deceased during the last illness, the doctor is not able or available, for any reason, to certify the death; the cause of death is unknown; the death occurred during an operation or before recovery from the effects of an anaesthetic; the death occurred at work or was due to industrial disease or poisoning; the death was sudden and unexplained; the death was unnatural”—

so that includes all suspected suicides—

“the death was due to violence or neglect; the death was in other suspicious circumstances; or the death occurred in prison, police custody or another type of state detention”.

The Ministry of Justice document goes on to say:

“If you believe that a death of this kind has not been reported to the coroner, you may report it yourself”.

In other words, relatives who have any concern can themselves report to the coroner. It goes on to say:

“You should do this as soon as possible and before the funeral. The coroner will then inform you of the action he or she proposes to take”.

Nothing in the amendment removes the obligations to inform the coroner if there is any suspicion whatever around a death. The amendment is to remove the mandatory requirement to hold an inquest where the deceased was deprived of their liberty under all relevant sections of the Mental Capacity Act—or, indeed, where the deprivation of liberty was to provide care to them.

Under the Mental Capacity Act a person who lacks capacity may be detained in circumstances which amount to deprivation of liberty. No detention amounting to deprivation of liberty may be permitted without lawful authorisation, because it would otherwise constitute false imprisonment. The Mental Capacity Act provide safeguards known as DoLS and Court of Protection orders to be made depriving a person of liberty for their care. It also allows for the deprivation of liberty of a person for the purpose of giving life-sustaining treatment only where a decision of the court is pending.

I want to address a concern that has been raised with me in relation to anyone who dies under the care of a mental health trust. A suicide or an unexpected or a sudden death must always be referred to the coroner, but I would expect there to be a routine review of any death in a mental health trust or similar organisation. Such a review should be available to the Care Quality Commission inspectors and I would expect the inspectors to ask about the number of deaths that had occurred in people subject to a deprivation of liberty safeguard application or authorisation. They should look in depth at the quality of the review of care that had taken place. Additionally, anyone who has concerns at any stage should raise those concerns, whether through whistleblowing or through the complaints process.

Complaints and how they are handled also form part of CQC inspections and I believe that such searching questions are far more likely to detect poor care than relying on a referral to the coroner, who is only looking at one instance and cannot see how care is delivered across a whole organisation. The recent incidents of poor care of those with learning difficulties that have come to light are certainly alerting inspectors that they must be more rigorous in their inquiries than before. To summarise, I hope that this amendment will correct an anomaly that has caused more than 6,500 bereaved families unnecessary distress in the last year alone. I beg to move.

[Baroness Chisholm of Owlpen]

My Lords, I am grateful to the noble Baroness, Lady Finlay, for this amendment. The Government are pleased to be able to offer our support for this amendment, which will minimise the stress on bereaved families at a very difficult time for them. The amendment will fully address the concerns that no family, having watched and comforted their loved one through his or her final days, should then be unnecessarily subject to the anxiety and confusion of having their death investigated by a coroner. I thank the noble Baroness for raising the profile of this important issue and for her valuable input, which the Government very much welcome and support. I commend her amendment to the Committee.

Policing and Crime Bill

Baroness Finlay of Llandaff Excerpts

Committee: 4th sitting (Hansard - part one): House of Lords
Wednesday 9th November 2016 Lords Chamber

[Lord Paddick]

My Lords, I rise to pay tribute to the noble Lord, Lord Brooke of Alverthorpe, and his persistent campaign against powdered alcohol and vaping. I accept what he says about these things being mind-altering substances, but surely that is because they contain alcohol, which is an accepted mind-altering substance—no more, no less than that. I understand the concern about the way you take the alcohol. Vaping, I understand, gives a very instant hit, unlike drinking alcohol, where you get a delayed reaction. However, have we not learned lessons from the past about prohibition and, in particular, prohibition of alcohol, not being an effective way of dealing with these issues? On these Benches, we would say it is far better to regulate, license and control the use of these new substances, rather than trying to ban them.

[Baroness Finlay of Llandaff (CB)]

My Lords, my name is on this amendment and we are coming on to a whole series of amendments relating to alcohol. With all due respect, I do not agree that alcohol in these alternative forms should be looked at in the same way as alcoholic drinks consumed in a social context.

The great difficulty for us and the country already is the size of the problem. In 2014 there were 8,697 alcohol-related deaths. That was an increase on the previous year and alcohol-related harms are already estimated to cost the country £21 billion a year. We know that around 9% of adult men and 4% of adult women are not taking alcohol for social consumption, but because they have alcohol dependence. Sadly, only around 7% of them are accessing any kind of treatment, so we have a huge problem. When we look at the amount of alcohol-fuelled crime and at what victims have said, over half of all victims of violence felt that the offender was under the influence of alcohol, and that is without ways of boosting the potency of the alcohol that they might be taking.

When we look at young people in particular and alcohol-related harms among those aged under 25 from 2002 to 2010, alcohol-related hospital admissions increased by 57% in young men and by 76% in girls and young women. We have a massive, looming problem of alcohol addiction and harms. The consequences of that may be handed down to the next generation, given that we know that among 15 and 16 year-olds, 11% had sex under the influence of alcohol and almost one in 10 boys and one in eight girls had unsafe sex while under the influence of alcohol. Of course, unsafe sex leads to pregnancy.

It is also important to look at children who were excluded from school, because almost half of those were regular drinkers. This is nothing to do with people’s freedom to consume alcohol socially. This is pure alcohol harm. I do not see how a school will be able to differentiate powdered alcohol from sugar or any other substance, such as sherbet that a child has in their pocket. I do not see how prison services or others will be able to differentiate alcohol vaping devices from the other types of nicotine-related vaping devices or how they will be able to have any control over the consumption of these. I have a real concern, and the reason I put my name to this amendment is that these kinds of products fuel alcohol addiction and do nothing to enhance social interaction within our society; they specifically fuel dependence and all the harms that go along with dependence. I have yet to be convinced of any benefit whatever, given that other countries that have major problems with alcohol consumption have decided that these products are too dangerous. I suggest that we should follow their lead and not risk taking these substances which we will be unable to detect or police. By allowing them for sale, they can be used to spike drinks and increase the cost to the country of alcohol-induced harms.

[Baroness Williams of Trafford]

My Lords, Clause 117 amends the definition of alcohol in Section 191 of the Licensing Act 2003. The current definition of alcohol covers:

“Spirits, wine, beer, cider or any other fermented, distilled or spirituous liquor.”

The clause adds the words “in any state” to this definition. The purpose of this is to ensure that all alcohol, no matter in which form it is sold, is covered by the requirements of the 2003 Act.

In recent years novel products have appeared for sale in licensed premises, such as vaporised alcohol, which is designed to be inhaled either directly from the air or via an inhalation device. To our knowledge, those who have sold this form of alcohol have done so under a premises licence and there have not been problems.

However, in America there is a suggestion that a new product—powdered alcohol— may come on to the market in the near future. We wish to put it beyond doubt that alcohol, whatever form it takes, may be sold only in accordance with a licence under the 2003 Act. It is important that we make this legislative change before powdered alcohol comes on to the market. This clause will ensure that any form of alcohol sold to the public is properly regulated with relevant safeguards in place.

The current system of alcohol licensing, as provided for in the 2003 Act, seeks to promote four licensing objectives. These are: the prevention of crime and disorder; public safety; the prevention of public nuisance; and the protection of children from harm. The 2003 Act also contains a number of criminal offences, including selling alcohol to a child under the age of 18 and selling alcohol without a licence.

This amendment to the definition of alcohol will ensure that the four licensing objectives continue to be met despite innovations in alcohol products, and that the public, especially children, continue to be protected from irresponsible sales of alcohol. The clause will mean that there is no legal ambiguity over whether new forms of alcohol are covered by the Act and need an alcohol licence to be sold.

I recognise the concerns of the noble Lord and the noble Baroness, Lady Finlay. All we know about powdered alcohol is that it is alcohol in a powdered form. There is no evidence on whether it is more harmful than liquid alcohol, and we do not know whether it could be used in more harmful ways. The Government share the noble Lord’s concern that children may be attracted to this product. These are legitimate concerns. However, removing this clause from the Bill will expose an ambiguity in the law that could be exploited by those who seek to argue that these novel forms of alcohol may be sold without a licence. The Government have not sought to ban powdered alcohol because the licensing system contains safeguards to prevent the sale of alcohol to children and to protect the public from irresponsible sales of alcohol.

Powdered alcohol was authorised for sale in the USA in March 2015, although as far as the Government are aware, it is not yet on sale in the USA or elsewhere, including online. A number of states in the USA have banned powdered alcohol amid concerns about underage drinking. If powdered alcohol does come on to the market, the Government will monitor what happens in the USA and the UK, and keep our position under review. We are currently aware of only one company developing this product. It is designed to be mixed with water or a mixer such as orange juice or Coke to make a drink of the normal strength, for example, a single shot of vodka. While the licensed trade and licensing authorities are currently treating vaporised alcohol in the same way as liquid alcohol, the Government wish to ensure that there is no doubt about the legal position.

In considering this change to the definition of alcohol, the Home Office consulted key partners at two workshops held last summer. One included representatives from the Local Government Association, the Institute of Licensing, the police and PCCs, as well as licensing officers from seven licensing authorities. The second workshop included industry partners such as the British Beer and Pub Association, the Association of Convenience Stores, the Wine and Spirit Trade Association and the Association of Licensed Multiple Retailers. In these workshops there was agreement that the legal position of new forms of alcohol should be put beyond doubt. The police and local authorities were keen that licensing and enforcement decisions should be clear, while the industry representatives were keen to see clarity in the law so that alcohol licences continue to operate effectively and efficiently. In conclusion, removing the clause from the Bill would have the opposite effect to the one the noble Lord, Lord Brooke, seeks.

He asked about prisons. It may be helpful to mention that the legislative change does not affect the use of alcohol in prisons, which is prohibited. He asked what consultation we have carried out with health authorities. Home Office officials have discussed powdered alcohol with the Department of Health and Public Health England. No one has raised specific concerns about the potential harm of powdered alcohol and there is no evidence to suggest that this form of alcohol is more harmful than liquid alcohol. However, we will keep this under review if the product enters the market.

[Baroness Finlay of Llandaff]

Does the noble Baroness agree that the question is not whether the form of alcohol—that is, powder or liquid—is more dangerous; it is the quantity of the chemical C₂H₅OH that is the problem? The higher the concentration, the greater the harm, so an ordinary drink spiked with powdered alcohol will be much more harmful than the drink itself because it is a question of dose-related harms.

[Baroness Williams of Trafford]

I cannot disagree with the noble Baroness’s comments about the powdered form of alcohol. However, this obviously depends on what one compares the powder to. Some fairly lethal drinks are available. I am thinking of things such as absinthe, which was banned for years in this country. Every form of alcohol has the potential to do harm. As the relevant product is not yet on the market in this country, we will keep the situation under review.

Female Genital Mutilation

Baroness Finlay of Llandaff Excerpts

Thursday 9th June 2016 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I congratulate my noble friend Lord Berkeley of Knighton on having secured this debate and the timely nature of it given that we are coming up to the summer holidays, when prevention must be a critical aspect of the way that we behave towards young girls who are at risk. We know, as has already been said, that the estimates are that between 60,000 and 65,000 young girls under the age of 17 are at risk in the UK. At the outset, I give credit to two junior doctors, Dr Erna Bayar and Dr Jessica Gubbin, who are trying to investigate the level of knowledge among healthcare workers here in London. They are both junior doctors at St Mary’s, and they are here to listen to the debate today.

With regard to the report from the House of Commons and the figure of 137,000 victims in the UK, which has already been alluded to, it is worrying to note that only one-third of the cases referred to the Metropolitan Police—although there were no prosecutions—came from health and education. The Serious Crime Act 2015 has already been referred to, but it is worth noting that there seems to be enormous ignorance about the Act itself and the extraterritorial offences, as well as exactly what the duty of care is—in particular, the offence of failing to protect a girl from the risk of FGM.

A study from Birmingham, conducted through members of the Royal College of Obstetricians and Gynaecologists, was the first UK-wide survey of its nature. It revealed that one-fifth of respondents were not aware of the FGM Act, although over 93% knew that it was illegal in the UK—but there is a difference between it being illegal in the UK and the extraterritorial offence created in the Serious Crime Act. Appallingly, fewer than 10% of respondents were aware of the psychiatric morbidity in the victims of FGM. There did not seem to be any difference in the knowledge scores among different grades of staff, but it was worrying to read that there were lower knowledge scores overall among those who had been in obstetrics and gynaecology for more than 15 years. In other words, the younger generation had a greater level of awareness than the older generation, although it does not seem to feature in the curricula of all medical schools, which I suggest that it should.

In 2010, the Royal College of Midwives published a report in which it found that 70% of midwives were aware of UK law and one-fifth stated that it was illegal to resuture after birth, but there was little knowledge of where to refer a victim to, and only 15% of midwives reported having any training. To date, I have not been able to find a survey of paediatricians. There needs to be education across all levels, in medicine, nursing, midwifery, social work, physiotherapy and so on. There are some very useful educational tools out there. Health Education England has produced one, and there are e-learning modules that healthcare professionals can sign up to. But there seems to be an ignorance about how to report within a trust, whether to go to the police, and exactly where the interface is with safeguarding and domestic violence.

The worrying figure from the literature is the large number who do not even know how to ask about FGM, do not know what to look for, do not know how to document it, and certainly do not know the complexities of the law. However, we are looking at children under the age of 17, in general, as victims, and we know that over 80% come from the populations of Somalia, Eritrea, Ethiopia, Yemen, Sierra Leone, Egypt, Mali and Sudan, even though, in some of those countries, FGM is deemed to be illegal. There is good WHO guidance out there, but it is not being accessed, and it was worrying to find a study of a small number of UK victims suggesting that, of 27 victims who had been mutilated to a varying degree, the majority of them severely, for 71% it had happened in some kind of medical setting, where it had actually been performed by a doctor.

Teachers in primary schools—and in secondary schools particularly teachers of the lower age groups—have spoken about recognising girls who come back after the summer holiday who are completely different to the lively, bright and happy child who they saw before the summer holiday started. They are pretty sure that these girls have been taken away. They are never the same again. They remain inhibited, depressed and mistrustful within the class. These are girls who will have been at risk.

Much has already been said about obstetrics, and in a previous debate I have spoken about some of the obstetric disasters that can happen to these women. They are at risk of HIV and hepatitis B as well as of pelvic infections and so on. There is another pointer that is often missed, and that is where girls fail to attend GP appointments and when mothers fail to take their daughters along for routine checks, even when they are babies. This failure to engage with the NHS and the general practice system seems to be linked to later becoming victims of FGM.

It is about time that the Government changed gear on this. I know there have been a lot of campaigns to raise awareness, that there are so-called cultural sensitivities around this and that there is a fear of being branded somehow racist or discriminatory. However, these are children, and this is child abuse. It is abhorrent, and we have a duty to protect the victims. We have those who are already victims, but we have to protect the victims of the future. Have the Government considered using Section 75 of the Serious Crime Act to produce further statutory guidance before the summer holidays to go to schools to require them to engage with the parents of children who are in the at-risk population, to open up the subject and the discussion and let it be known that this is an offence here and extraterritorially? There is a duty of care that rests on teachers as well as on healthcare professionals. That must be done before the summer holidays, otherwise we will have another cohort of girls who have been terribly damaged by this deeply abhorrent practice.

Airports: London

Baroness Finlay of Llandaff Excerpts

Tuesday 2nd June 2015 Lords Chamber

[Lord Ahmad of Wimbledon]

As I have said already, we will await the report of the commission. I am mindful of the fact that the noble Lord said that after the election, an incoming Labour Government would consider the report. I am delighted to say that, as the whole House and indeed the whole country recognises, it is an incoming and new Conservative Government who will be acting on the report.

[Baroness Finlay of Llandaff (CB)]

Could the Minister inform the House whether there have been discussions with the National Assembly for Wales over the development of Cardiff Airport, given that its runway is large enough to take jumbos and that the engine-servicing facility at Caerphilly has been there for some time?

[Lord Ahmad of Wimbledon]

As I have already said, regional airports are part and parcel of the offering, but on that specific issue I will write to the noble Baroness.

Serious Crime Bill [HL]

Baroness Finlay of Llandaff Excerpts

Monday 2nd March 2015 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

Before the noble Baroness sits down—I was waiting in case she covered an area which I think may be important—can she confirm to the House that the guidance about the investigation of a reported case will include the ability to see whether it may be an index case in an area where FGM is being promoted, so that the prevention aspect of discovering one case can be built in and built on so that the community at risk is actively targeted with education and support to try to ensure that the girls at risk who are not yet subject to FGM are more adequately protected?

[Baroness Williams of Trafford]

My Lords, I do not know the ins and outs of particular cases, but I see where the noble Baroness is coming from, which is that there may be learning about raising awareness in the communities involved. She certainly has a point, but perhaps I could write to her in due course.

Passports

Baroness Finlay of Llandaff Excerpts

Thursday 11th December 2014 Lords Chamber

[Lord Bates]

There was a failure. That is why the Home Secretary intervened to annul agency status and to bring the problem into the Home Office to get a grip on it. That is why the delay in the process time for applications—which had sunk as low as 20%, which is appalling and for which we apologise—is now above 50% and heading towards 60% to 70%. That is as a result of the actions that have been taken and the grip that the Home Secretary has on the situation.

[Baroness Finlay of Llandaff (CB)]

Can the Minister outline what powers an ambassador or consulate has in the event of an urgent need to repatriate a family with a newborn baby, because of either illness or tragedy?

[Lord Bates]

Where there are exceptional cases then it is possible to apply for emergency travel documentation. Of course, such a matter is dealt with through the local embassy and the local consulate.

Asylum Seekers: Mental Health

Baroness Finlay of Llandaff Excerpts

Monday 10th November 2014 Lords Chamber

[Lord Bates]

Absolutely; I am happy to clarify that. I was talking about people who had a legal right to seek employment in this country. They should be protected and be able to apply for jobs in the first instance.

[Baroness Finlay of Llandaff (CB)]

The Government have to date not allowed retired NHS doctors who volunteer to work with asylum seekers to set against tax the cost of their General Medical Council and defence union payments. Will the Government undertake to look at this again? These doctors are acting as volunteers to meet the health needs of this group but are incurring huge expense in so doing.

[Lord Bates]

I am very happy to look at this but doctors are in one of the shortage occupations and would be eligible to apply for work after the 12-month period.

Serious Crime Bill [HL]

Baroness Finlay of Llandaff Excerpts

Tuesday 28th October 2014 Lords Chamber

[Baroness Brinton (LD)]

My Lords, when I was chair of education in Cambridgeshire some 20 years ago, it was brought home to me very starkly how the lack of mandatory reporting had allowed a caretaker to abuse children in a school over a 16-year period. It was not taken seriously at any point over that time when parents, or even some of the children, reported concerns. Had that system been in place—even the first report—the head would have been under a requirement to force a proper inquiry. As a result, this man’s actions would have been curtailed and a large number of children would not have been subsequently abused.

Even though that happened some time ago, the problem still continues. We have heard from the right reverend Prelate the Bishop of Durham about some of the larger cases at the moment. I should have declared an interest: I am a trustee of UNICEF. I echo the point of the right reverend Prelate that if we are talking about mandatory reporting for female genital mutilation, which is a form of child abuse, we should also be considering it for wider child abuse as well.

Another point that has been raised outside the Chamber refers to concerns felt mainly by professional psychotherapists about an exemption in their treatment of perpetrators of child abuse, or would-be perpetrators, under the normal terms of confidentiality if there is a requirement to report. The exemption is in proposed paragraph (8) of the amendment. It quite specifically says that it is possible for a person to have that exemption. We need to reassure professionals that important work such as that should be one of the few exemptions allowed to continue without further report to the law.

I want to raise a more topical concern. Much has been said about the Jay report and what has been happening in Rotherham and subsequently in Sheffield and other places. I am very concerned that yesterday UKIP published a photograph showing a young girl who might be deemed to be a victim of abuse while the headline said something like, “1400 reasons why you should not vote Labour in the PCC election” .

Frankly, UKIP’s hypocrisy is breathtaking. Its record on tackling serious child abuse is disgraceful. The only record of the noble Lord, Lord Pearson of Rannoch, asking Questions about child abuse is on 13 October this year, after the by-election was called, and he has been in this House since 1990. Even that Question was focused entirely on the UKIP obsession with Muslims, ignoring the fact that child abuse happens in all areas of the country and is not exclusive to any culture, community, race or religion.

However, it is not just UKIP in the Lords. In the European Parliament, its Members abstained in a vote to strengthen legislation about sexual abuse and the sexual exploitation of children and child pornography. Further, UKIP’s candidate in the Croydon North election in 2012, Winston McKenzie, said that gay adoption was child abuse. Gordon Gillick, a UKIP Cambridgeshire councillor, told a meeting of some children in care that they were takers from the system and wanted to know what they would give back to society. As we have heard, many children in care are the most vulnerable to grooming and abuse.

We need to have an honest and open debate about child abuse but it is completely inappropriate for a party that has not taken it seriously, even within its own actions when it threw out a paedophile and allowed that person to come back to receptions, particularly those with young UKIP members. We need to make sure that UKIP—it offers a policy of making sure that children are safe—can deliver that by having safe policies itself. I do not believe that the evidence is there.

Finally, I am also grateful for our discussions with the Minister on this. I hope that he will be able to offer reassurance to those of us who want a public debate and public consultation about the mandatory reporting of child abuse. I look forward to his response.

[Baroness Finlay of Llandaff (CB)]

My Lords, I have put my name to the amendment and support it strongly. Current child protection systems, which rely upon voluntary reporting, simply are not seen to be working effectively. There is ongoing underreporting of suspicions of abuse or neglect by professionals working with children. Why might this be? It is worth looking at previous studies, which have suggested that barriers to reporting include the professionals’ own values and attitudes—for example, over the acceptability of physical punishment—and confusion over the thresholds for reporting. Professionals may be worried about issues of confidentiality and the potential impact on their relationship with the child and the family.

The current position for someone reporting is that they may, in effect, feel that they are being a whistleblower on a situation that they feel uncomfortable about. Professionals may fear the consequences and the potential impact on their reputation, leading to further hesitation. Reporting a suspicion that turns out to be unsubstantiated should not be a disciplinary matter for professionals, however distressing for those involved. There is a balance of harms here, and the need to protect vulnerable children should be paramount.

I should like noble Lords to think for a moment of the situation of a GP who is seeing people on 10-minute appointments, and who may know a family, see a child, have some concerns but be unable to put a finger on it. At the moment, the hesitation to report remains there. Other pressures of work come in. I must declare an interest here. When I was a GP, I looked after children in a children’s home and became convinced that something was not right. I went to the authority in whose area I was working but we did not get anything specific to happen. I would go out to the children’s home whenever there was a request for an appointment so that I would see the children on their own territory. I tried to see the children on their own when they were referred for a sore throat, sore ear or whatever. I had this nagging suspicion that something was wrong but I could not pin it down anywhere. All that I can say is that the Christmas after my suspicions began to become aroused the children themselves burnt the home down, which confirmed to me that my index of suspicion was right. However, I had no clear evidence on which to report that abuse was going on, although I was suspicious. I would have welcomed having to report that suspicion because it would have allowed me the freedom to state, “I have a really uncomfortable feeling here”, without feeling that I had to accrue the evidence.

That is my personal experience and where I have come from with it. That is why I stand separately from my professional body, the BMA, which has reservations about this amendment. It is concerned that a degree of professional discretion is required to ensure that doctors can take account of an individual’s circumstances and always act to ensure the protection of a patient. My experience suggests that that is incredibly difficult.

Queen’s Speech

Baroness Finlay of Llandaff Excerpts

Monday 9th June 2014 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, like others I wish to focus on the protection of children and our duty to the most vulnerable in our society. The legislation on all child abuse, including female genital mutilation and slavery, must be as strong as possible if it is to be truly effective in improving the lot of children in our society. As the noble Baroness, Lady Walmsley, so strongly pointed out, shamefully we have turned a blind eye to the most vulnerable far too often. We must respect and legally enforce the rights of children and stamp out cruelty because all too often cruelty breeds cruelty. I hope the Government will support the online safety Bill brought forward by my noble friend Lady Howe of Idlicote.

Others have addressed health issues. I agree with noble Lords who have called for the awaited Bill to modernise the regulation of health and social care professions to better protect the patients and improve care delivery. Will the Government, following this debate, bring it forward for scrutiny? It is a Bill that this House would look at very thoroughly.

Let me turn to legislation that remains uncompleted. This year the clear will of both Houses was to introduce standardised packaging of cigarettes and tobacco products. As Sir Cyril Chantler’s independent review of the evidence supported this, where are the draft regulations for consultation, for notification to the European Union and then to be laid before Parliament for debate? As the noble Lords, Lord Ribeiro, and Lord Faulkner of Worcester have highlighted, if the Government drag their feet, time will play into the hands of the tobacco tycoons.

In November last year the Government amended the Energy Bill to include audible carbon monoxide alarms in a review of the private rented sector. Each year, carbon monoxide kills about 40 people in England and Wales. At least five of those who died last year were young campers and holidaymakers. Regulations are needed now to prevent yet more totally avoidable young people’s deaths over the summer.

Finally, I am glad that England is following Wales’s lead on tackling the environmental damage from plastic bags. Legislation in Wales has decreased the number of plastic bags in retail by more than 76%, but I am concerned that, without tackling all types of bags in all settings, England may see a mushrooming of paper-based bags and so-called exemptions rather than rejoice in reusable bags as we do at home in Wales.

Wales looks forward to hosting the NATO summit in September. In the mean time, I am sure that this House will carefully scrutinise all legislation affecting Wales.

Immigration Bill

Baroness Finlay of Llandaff Excerpts

Wednesday 12th March 2014 Lords Chamber

[Baroness Meacher (CB)]

In moving Amendment 62, I shall speak also to Amendment 62A. The purpose of Amendment 62 is to ensure that treatment for any injury resulting from domestic abuse or female genital mutilation is exempted from NHS charges even if the victim does not have permanent leave to remain, or indeed if her immigration status is not clear. I should explain at the outset that these are probing amendments and I understand from the Minister that these matters will be dealt with by the Department of Health in regulations. Having said that, this amendment provides an opportunity for this House to try to influence those regulations. I think that I am right that there will be no further opportunity to do that.

Clause 34 defines for the first time the term “ordinarily resident”. If the person is not ordinarily resident they may be charged for health treatment. If they have paid the surcharge they should be covered for health services but many other people are already living in this country—I understand in the realm of about half a million—who have not paid the surcharge and are eligible for NHS charges. Further, Clause 34 brings ordinary residents into line with permanent residents. That means that instead of being here with a visa for a settled purpose such as a job, a university course or to reunite with a spouse for a minimum of one year, an immigrant will need to be here for a minimum of five years in most cases before they are fully covered for healthcare. This is why Amendment 62 is important and relevant to health charges, as I understand it.

In his letter of 12 March, the noble Lord, Lord Taylor, said that short-term visitors and those without lawful immigration status will,

“continue to be liable to pay overseas visitor charges for secondary care treatment under NHS regulations”.

This is similar to the letter from the Minister for health quality, who said that,

“illegal non-EEA migrants and short-term visitors (under 6 months) will continue to be liable to NHS treatment charges as they are now”.

I am told that this is not precisely the case, as the National AIDS Trust’s excellent briefing points out. In fact, the Government plan to introduce new charges for primary care, apart from GP and nurse consultations, and for A&E services for this group and for any migrant who cannot show that they have paid the levy. The need to assess patient entitlement in primary care or A&E would be an unhelpful distraction in an emergency situation. This might be done after someone receives treatment—but that, too, is an alarming position for someone who may have little or no money.

In his subsequent note and his latest briefing, the Minister gave assurances about a number of vulnerable groups who will not be subject to the surcharge or charges for treatment under the NHS charging regulations. There is no mention of the victims of domestic violence or FGM in relation to either. Do the Minister and his colleague, the Minister for Health, intend to exclude these two groups from the surcharge and, in the case of those already here without permanent residence, from NHS charges? If not, it is a matter of great concern that the moral and humanitarian case previously accepted concerning these groups appears to have been set aside.

As to the practical difficulties in determining who the exemptions for domestic abuse and FGM would apply to, I understand that medical checks would be needed if these groups are to be exempt from the surcharge. I appreciate that could be problematic in the circumstances, but in the case of NHS charges for failed asylum seekers, irregular or undocumented migrants, short-term visitors and others without permanent residence, does the Minister not agree that if a patient in any of these groups has been domestically abused or damaged by FGM, they should not be charged for treatment? It would be helpful to have clarification on this point on the Floor of the House, if the Minister is able to give it, albeit that such provisions would ultimately be made in Department of Health regulations.

If irregular migrants and refused asylum seekers who would not have paid the surcharge cannot access primary care services, apart from GP and nurse consultations to address comparatively minor health problems, they will eventually present elsewhere—probably at an A&E department—at much greater cost, as I referred to in relation to an earlier amendment.

A different but important point is whether the NHS will be expected to report back to the Home Office if a patient’s migration status requires them to be charged for NHS services. There is a concern about this in view of the comment of the Home Office Permanent Secretary to the Home Affairs Select Committee that the Home Office intends,

“to improve its radar screen into the NHS”.

I find that rather chilling. If it became known that a visit to the doctor could lead to a report to the Home Office, people could be deterred from seeking healthcare. Can the Minister assure the House that this will not be the case?

The Government have previously recognised the important role of the NHS in identifying victims of abuse and helping them to recognise, consider and exercise their option to escape from that abuse. Also, in the case of FGM—where we have not had a single prosecution—the NHS is seen as probably the best hope of identifying perpetrators and providing evidence to support the prosecution case. I look forward to hearing the Minister’s view on that.

On Amendment 62A, the Government have agreed that no charge will be made for health services to victims of human trafficking. I am dealing with this issue separately because, in a sense, these people are in a different situation. The aim of the amendment is to put this commitment in the Bill and to require the Government to produce a strategy and procedures to ensure that the victims of human trafficking are promptly and effectively identified for the purposes of the clause. This is a probing amendment which I hope the Minister can endorse, thus assuring the House that there will be regulations in place to achieve its aims so that victims receive the necessary medical treatment. The UK would thus satisfy our international obligations.

According to the Catholic Bishops’ Conference, the UK Human Trafficking Centre shows that more than half—54%—of trafficking victims were not recorded by the national referral mechanism in 2011. UKHTC notes that people who have been trafficked are often treated as irregular or illegal migrants. They may, of course, have been given false, stolen or genuine but fraudulently obtained identity documents. They will most likely then be treated as immigration offenders despite not acting under their own volition. This is quite understandable but it will need attention to avoid this kind of thing happening.

As the Bill is currently worded, these victims would not be exempt from the charges for health services if they are in one of these obscure groups. Also understandably, people who have been trafficked and coerced into criminal activities are often treated as offenders rather than victims. They are unlikely to benefit from exemption from health charges. A 2013 report by Anti-Slavery International highlighted a lack of awareness of trafficking indicators among authorities. If these victims are not identified, they are likely to get a criminal record, go missing, be deported and be retrafficked. They become victims a second time round.

All this will increase the fear of victims and their suspicion of the authorities. Help with later investigations is less likely to be forthcoming. At the moment, the authorities rely on those who are trafficked to disclose their status quickly or face detention—and, for obvious reasons, often that does not happen. If not identified immediately on arrival, trafficking victims are unlikely to be identified subsequently, and hence the importance of subsection (2) of the amendment. There is a need for,

“a strategy and procedures to ensure that victims of human trafficking are promptly and effectively identified”.

We are particularly concerned about trafficked children. I understand that at the moment social workers receive no mandatory training in identifying a trafficked child. We know that in the context of the draft Modern Slavery Bill there is a commitment to roll out specialist training and other measures. Can the Minister give the Committee a commitment that rigorous enforcement of health charges will not be introduced until the safeguards associated with the Modern Slavery Bill are rolled out?

Let us get things in the right order. Does the Minister agree that before the planned safeguards are introduced, they will be put before the modern slavery commissioner, who is to be appointed under the modern slavery legislation? Indeed, to clarify these matters, can he provide the Committee with information about the planned timing of the introduction of the new enforcement rules for health charges and of the implementation of proposals in relation to the Modern Slavery Bill? I beg to move.

[Baroness Finlay of Llandaff (CB)]

My Lords, my noble friend Lady Meacher has introduced this group of amendments with great clarity. I have added my name to Amendment 62 and I will speak to Amendment 64. Other Peers who have added their name send their apologies for not speaking at this late hour. I do not want to add much more to what has been said about domestic abuse and female genital mutilation except to say that I have a major concern as to how this will actually work in practice unless these groups are exempt.

What happens if a girl comes into the country, her status is not established, and she has infected wounds? What happens to the girl who has been mutilated and has urinary and voiding difficulties or suffers chronic pain? What happens during pregnancy, when delivery can be incredibly complicated? If it is not properly managed, a woman may literally burst because scar tissue is not elastic. We recognise FGM as an absolutely awful form of abuse and it is shameful that there have not been prosecutions already. If we put these women into the charging category, we will almost reverse the message we have sent to society about this terrible act.

The other problem arises with domestic abuse. If a woman arrives at A&E with severe facial injuries including fractures to the bones of her face or her chest wall, they may be life-threatening. If her ribs have been stoved in, it may be a life-threatening injury such as a pneumothorax and treatment will have to begin straightaway. Emergency service personnel are going to be put into a terribly difficult position. Another problem is that, in the societies from which many of these women come, sadly they are not afforded the rights they have in our society, and they are not given the respect they deserve. I am fearful that there may be a tendency to blame the woman if attempts to stay fail because she is a burden on the man, thus making it more difficult for him to stay.

Amendment 64 is about people who are released from detention. Currently, people can receive treatment while they are being held in an immigration detention centre and the course of treatment will be ongoing when they leave, but this may not be the case in the future. The consequences will be particularly acute in the area of mental health. It is well documented that the experience of an immigration detention centre is damaging to the mental health of many detainees. Without ongoing support, those mental health problems will be exacerbated rather than ameliorated at the point of release. The problem we are faced with is where to set the boundary and how it will actually be implemented.

These are probing amendments, but when regulations come before the House we will not be able to amend them. We will be faced with either accepting or rejecting them. That is why we need to tease out these issues very carefully at this stage.

[Baroness Cumberlege (Con)]

My Lords, I shall speak to Amendment 66A on behalf of the noble Baroness, Lady Masham of Ilton, who sadly has another commitment that she has to honour this evening. Successive Governments have very good track records in safeguarding the public’s health. When I was a Minister, I was deeply involved in the Health of the Nation strategy, which was lauded at the time by the World Health Organisation as a model for other countries to follow. Since then, through the Labour Government and now our present Government, we have concentrated on looking after the public’s health. Indeed, Ministers were saying only in November last year that nothing will be done to worsen public health. Two years ago, this Government extended free treatment regardless of immigration status to include treatment for HIV infection. As was said at the time:

“Reducing transmission will reduce the risk of new infections in the wider UK population and … reduce … NHS costs”.—[Official Report, 29/2/12; col. 1397.]

They have confirmed that treatment for communicable diseases and sexually transmitted infections will remain free to all.

These are really welcome and important commitments but we have to be very careful that this proud record is not undermined by what we are now doing. Many noble Lords, I know, have a crystal-clear understanding of the Bill, as the noble Baroness, Lady Meacher, has explained to us this evening, but I would like to clarify some issues. First, who is actually going to be affected by these charges? I look to my noble friend to provide the clarity that I seek.