Health and Care Bill

Debate between Baroness Finlay of Llandaff and Baroness Bennett of Manor Castle

3rd reading
Wednesday 23rd March 2022 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

From these Benches, I very briefly thank the Minister, the noble Baroness, Lady Penn, the noble Earl, Lord Howe, the whole Bill team and all the officials who have worked with them for the way that they have listened—repeatedly listened—as we made our points over and again and as they sought sometimes to try to understand what we were trying to get across and why. I also thank everyone across the House, on all the Opposition Benches, the Cross Benches and the Government Benches, who have worked with us as Cross-Benchers in a very collaborative way and made their own offices available for background support to all of us.

I echo the words of the noble Baroness, Lady Thornton: this Bill leaves us better. It has been a genuine pleasure to work on it. Some of us have worked on previous Bills, and I have to say that this was a more enjoyable and rewarding experience because the dialogue involved a better interchange at many points.

We have made some points of great significance, one of which was over palliative care, which has been dear to my heart. Palliative care has come of age. I think the House will be pleased to know that, on Friday morning, the annual meeting of the Association for Palliative Medicine has a specific session dedicated to understanding the changes and what it now needs to do in the light of those. The word goes fast from here, and that is very welcome.

I hope that I have not forgotten anybody in my thanks, which are open and sincerely expressed.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I rise very briefly, with the Green group having made quite a large contribution—certainly in hours—to this Bill.

This House has improved the Bill, but I feel I need to say that I have received in the last few days a significant number of emails. They are not part of a co-ordinated campaign; they are cries from the heart, many from long-term NHS campaigners who I have known for a long while. I quote just one of these, which says that:

“The Bill is still not in the interests of the public or indeed of the NHS itself as a comprehensive, universal public service”.


That is an expression of feeling that I am hearing very strongly. I hope that the Minister will listen to that and understand that there are very grave concerns out there among the public about the direction of the NHS.

The improvements that we have at least delivered, as other noble Lords have said, should stay, but the Government really need to safeguard this universal public service.

Health and Care Bill

Debate between Baroness Finlay of Llandaff and Baroness Bennett of Manor Castle

Lords Hansard - Part 1 & Report stage
Monday 7th March 2022 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I rise briefly to offer support from the Green group for both these amendments. In Committee, I spoke extensively on the issues around creative health, and I will not repeat any of that. I just note that, looking at the Government’s response, I get no sense that they have got the point that this is not an additional “nice to have”—something that is done after you have done the medical stuff—this has to be a core part of allowing people to get well again, and keeping people well.

On Amendment 184ZB, it is interesting that the Covid pandemic has seen a really large increase in private medical provision, such as testing on our high streets, et cetera. Now that they are there, those businesses will be looking out for different procedures to keep them going, and it is really important that we have full transparency about the advice that people are getting at those kinds of places.

[Baroness Finlay of Llandaff (CB)]

My Lords, I say very briefly that I hope the Government will look favourably on this amendment from the noble Lord, Lord Howarth, and others. I hope that they will build into a review an assessment of the cost efficacy because as well as all the positive aspects that we have heard about, we must remember that, if you can decrease medication prescribing, you will decrease not only costs but adverse side-effects, which also have a cost. All these initiatives tackle the problem of loneliness, isolation and not having contact with other people—people who may be able to empathise with the way that you feel about your condition when you are undertaking a common activity with them. That can become particularly important for the psychological well-being of patients as well as their physical improvement.

Health and Care Bill

Debate between Baroness Finlay of Llandaff and Baroness Bennett of Manor Castle

Lords Hansard - Part 2 & Report stage
Monday 7th March 2022 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, the hour is late and I shall be brief. The findings of the systematic review of the subject need to be taken into consideration. Screening of over 3,000 papers resulted in careful analysis of 254—quite a large number for a systemic review. Going through this, there are overall benefits. The benefits outweigh any documented harms, and I welcome the clause.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I am also aware of the hour, and offer Green support for the amendment of the noble Baroness, Lady McIntosh. We are talking here about a cost-benefit analysis. Some of the costs on which I would focus, and their impacts, go beyond the narrowly medical impacts of the people who consume the water. The question I raised in Committee was whether people today actually consume tap water, and whether they will continue to do so. I made the point that 90% of people drank tap water in 1978, but that figure had fallen to 73% by 1998. I do not believe that there have been detailed national figures since then.

I thank the noble Lord, Lord Kamall, for writing to me in response to that debate and providing a set of figures which the Government had researched. I will note two of the figures which the Minister cited in that letter. One was a 2010 Ipsos MORI survey in the West Midlands showing that two-thirds of surveyed people supported water fluoridation if it was going to improve dental health. That, of course, shows that a third of people are not supporting it. This is the group about which I am concerned—a group which I have encountered many times and in many parts of the country. I do not agree with all their concerns, but that is a fact.

I noted that the Minister also cited a north-east survey from 2021 where 60% of people backed water fluoridation. As the noble Baroness, Lady McIntosh of Pickering, said, we are talking about people not having a choice about consuming that water, unless they choose to buy bottled water. Anyone going to a supermarket in Sheffield, particularly in its poorer areas, will see people buying bottled water in very large quantities. One of my concerns, and where I hope the cost-benefit analysis would come in, is looking at the sociological issues. The Government should be doing a great deal more to promote the consumption of tap water and to discourage the use of bottled water. However, as the Bill currently stands, it risks pointing us in the opposite direction.

The noble Lord, Lord Storey, talked in Committee about how Liverpool City Council had very successfully engaged in a targeted programme to address the most vulnerable communities and ensure that dental health was improved. It demonstrably was improved.

The Minister said, “Oh well, any local authority can do the same thing.” I point out to him that local authorities’ budgets are enormously overstretched—something we have addressed in the social care elements of the Bill in particular. Would the Government consider perhaps taking the money that might be spent on fluoridation and giving it to local authorities for targeted campaigns to reach the children who need it most?

Police, Crime, Sentencing and Courts Bill

Debate between Baroness Finlay of Llandaff and Baroness Bennett of Manor Castle

Lords Hansard - Part 2 & Lords Hansard - part two & Report stage
Monday 13th December 2021 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I have added my name to Amendment 61. During the previous debate on alcohol limits, it was suggested that the evidence from Scotland did not support lowering the blood alcohol content limit from 80 to 50 mg per 100 mls.

Scotland changed its law in December 2014, as has been said by the noble Lord, Lord Brooke of Alverthorpe. I am most grateful to the Minister, the noble Baroness, Lady Vere, for asking her officials to provide me with the raw data on alcohol levels in fatalities year by year. I am particularly grateful to those officials who patiently went through the number of fatalities with me. I have spent some time today looking at this and doing graphs; I am sure that the House will be glad that I cannot project Powerpoint here. Looking at the data, two years before and about two years after Scotland changed the law, I am not convinced that there is not a change. In other words, I think Scotland stayed pretty well static, but the number of deaths in England and Wales went up.

I have not had a statistician go through the data with me, so I put that caveat around it—and O-level maths was a long time ago. However, we know Scotland has an alcohol problem and a problem with a culture of drinking. When I was a GP in a poor area of Glasgow, I certainly found that I almost had to redefine alcoholism, because alcohol was completely endemic; it really was a problem, and I think it still is. The importance of the data that I have been looking at, and for which I am grateful, is that the law change brought a message of not drinking and driving, and the messaging is important.

Last week, a young woman I knew, a superb musician who taught and encouraged many other young people, was killed by being run over by an intoxicated lorry driver. The tragedy is compounded by the fact that people apparently knew that this driver was repeatedly intoxicated on drugs and alcohol. This has been pretty devastating for me and my family in the week before we came to this amendment, but I want to share it with the House, because I want people to understand that this is real. Young, completely innocent, people are being killed by someone with this powerful weapon in their hand: the keys, the steering wheel, the accelerator, et cetera.

In 2019 alone there were 130 fatalities where alcohol was detected on the driver of the car, motorcycle or other vehicle, some at very high levels. The purpose of a threshold is not to say that it is safe to drive below that threshold, because it is not: the threshold is the threshold for prosecution by the police, because that is the level at which the impaired reaction time and co-ordination become indefensible. That impairment, however, is not all or nothing: there is a gradient of deterioration. In some people, that deterioration happens at very low levels of blood alcohol—lower than the limit set in law. I would like to see the threshold set at 10 milligrams per hundred millilitres, but I know that that would not be acceptable to others.

Laws send powerful messages, so I ask the Government: who benefits from leaving intoxicated drivers to kill people? Who loses out if they cannot drink alcohol and hold the car keys? Are the Government in the grip of the alcohol industry? Is that why we have to accept fatalities and life-changing injuries, at enormous cost to health and social care, to education services, which have to cope with the bereaved children, and to our society overall? The current law is indefensible, and it is about time we changed it.

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a great pleasure and a real responsibility to follow the noble Baroness, Lady Finlay of Llandaff, and her hugely powerful speech. I also thank the noble Lord, Lord Brooke of Alverthorpe, for introducing Amendment 61 in particular. I speak on behalf of my noble friend Lady Jones of Moulsecoomb. She is much more of a lark and I more of an owl—so the timing works for this amendment.

I start by picking up on the account that the noble Baroness, Lady Finlay, gave the House of one death, and the fact that the Institute of Alcohol Studies estimated a few years ago that if the level was reduced to 50 micrograms, at least 25 deaths would be saved every year. It sounds like a number, and perhaps not an enormous number compared to the total number of deaths on the road. Think, however, about 25 individuals, like the single victim that the noble Baroness, Lady Finlay, just spoke about—their families, their work colleagues and the people they have helped—and ask yourself why we have the highest level of legal blood alcohol in Europe.

It is also worth picking up a point that the noble Baroness hinted at: the level we have now encourages people to think how much they can drink and still drive. I entered a search, “knowledge drink-drive units UK”, on a popular search engine—one of those that throws up a series of suggested questions based on what lots of other people have asked. The most popular question was “How many drinks can I have and drive in the UK?”, followed by “Can a man drink two pints and drive?”. That is where our current level is set—it invites people to push up to the limit.

Going back to my origins in Australia, in particular my time as a young journalist in rural Australia, I saw a great deal of drink-driving and its effects—the casualties and the families left behind. It is important, however, to stress the point made by the noble Baroness, Lady Finlay, which is that any level of drinking and driving is drink-driving. Figures from the road safety charity Brake show that in the 50 to 80 microgram range, you are six times more likely to be in a fatal crash than at zero micrograms, and between 20 and 50 micrograms you are three times more likely to be in a fatal crash. It is clear that we should be at zero or at such a low level that it is effectively the same as no drinks. Let us at least improve it.

Prior to this amendment, the Government said in 2018 that they were interested in looking at this issue and were thinking very seriously about it. That was three years ago. They might say that we have had a pandemic et cetera since then, but surely this is the time to take action to get us at least to a better place and to save lives like the one the noble Baroness, Lady Finlay, was just speaking about.

Professional Qualifications Bill [HL]

Debate between Baroness Finlay of Llandaff and Baroness Bennett of Manor Castle

Committee stage
Wednesday 9th June 2021 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I put my name down to speak to this group of amendments—the first time I have participated in this Committee—because, as the noble Baroness, Lady Randerson, said, they collectively address a basic constitutional principle.

I find myself in the slightly unusual position of standing up to speak in favour of preserving current constitutional arrangements. However, I pick up on the words of the noble and learned Lord, Lord Thomas, that what is happening here is a chipping away of devolved powers. I put it to those who wish to see the union continue that squeezing more tightly—squeezing away powers—is the way to ensure that people choose to slip out of its grasp.

I suspect that we might hear the Minister, as we have heard from Ministers in so many other debates on so many different subjects, say: “Don’t worry, we don’t mean any ill, this Government do not mean the wrong thing”. This morning, I was talking about the situation and debate around the potential Australian trade deal—about hormone-laced beef and animal welfare standards—and we said in that context, as in so many others, that words are just words. We need guarantees in a Bill.

All these amendments head in the direction that I would like to see, but I highlight in particular Amendments 41, 42 and 57. The noble Lord, Lord Foulkes, said that his amendment was not absolutely revolutionary, although, as you might expect to hear from me, I rather tend towards the total peaceful revolution. The amendment says that there would have to be a delay before a devolved Administration could be overruled. I question whether there would be any circumstances in which it would be reasonable for a devolved Administration to be overruled. I therefore repeat a question I put at Second Reading, to which I did not get an answer: can the Minister give examples of circumstances in which the Government might feel it right and justified to overrule a ruling from a devolved Administration, where that Administration say “No, these regulations on professional qualifications you are trying to impose are not good enough for us and do not meet our needs”?

In looking at why there might be different rules in different places, the noble Baroness, Lady McIntosh, pointed to the differences in legal systems, which is one very obvious area—a long-running historic circumstance. But there are also practical differences.

Somebody mentioned driving instructors. Driving in the highlands of Scotland may be very different from driving in most parts of England and there may be good, practical reasons why qualifications may be different in different nations, for obvious reasons, but also, of course, we are very much talking about politics. In something of an aside, the noble Baroness, Lady Hayter, referred to Welsh language qualifications for teachers in Wales. These are issues of intense political debate and discussion; they are not merely small, technical issues that can be ironed out by dealing with a few technical measures. These are political decisions that have been made by devolved Administrations who have been given constitutional powers that are supposed to be guaranteed. So it is very clear that we need to see change to what we have currently in the Bill.

The noble Baroness, Lady Randerson, highlighted something I have been puzzling over. At Second Reading, a lot of people questioned the whole issue of the assistance centre, and it is very hard to see how this all fits together for something so complex and difficult. As many noble Lords have said thus far in Committee, this really feels like a severely undercooked Bill; a great deal of work is needed. This is one area where I really believe we have to see change, and if we do not see change from the Government when we get to Report, we will be coming back to this and very much consulting with the devolved nations. We need to see that kind of consultation and involvement, and the first place where we really should be seeing consent from the nations is in their acceptance of the form that the Bill takes.

[Baroness Finlay of Llandaff (CB)]

My Lords, like others who have spoken, I strongly support these amendments. I am most grateful for the most comprehensive speech by the noble Baroness, Lady Randerson, who laid out clearly what the issues are, both in terms of the constitutional conflict that is in the Bill at the moment, and the consequences of it, and also the consequences for services within Wales. I think these also apply to Scotland, but I should declare an interest as someone who lives and works in Wales—that is the area of my own experience. I ask the Minister to explain quite clearly why the draft of the Bill was given to the Welsh Government only a week before it was published, and why the final version was not seen before it was laid on 12 May. To me, that does not feel like consultation or like any attempt to find a consensus agreement with devolved Administrations at all.

There is a concern that the skills shortages are being linked to the trade policy agenda, and how the new obligations on regulators could be moved and adjusted because they are driven by some trade policy, rather than by the need to ensure that we have safe and effective high-standard services for people within our nation. Although Clause 14 confers regulation-making powers on the appropriate national authority, these are exercisable only concurrently with the Secretary of State and Lord Chancellor. That seems to make it possible that the Secretary of State or Lord Chancellor could legislate in devolved areas and would not be required to obtain the Minister’s consent to those regulations. I understand that the Minister stated in a letter that these powers would not normally be used, but the problem is that once this is in legislation, such assurances do not carry any weight at all, and they are not binding on this or any subsequent UK Government. So it would seem that there are really serious risks, as the noble Lord, Lord Bruce of Bennachie, outlined.

In the event that there needs to be regulatory compromise in the interests of trade—I cannot think of a specific example, but I see the confusion and conflict between these two areas—will the Minister confirm that any such regulatory compromise will be notified to Parliament, to ensure that there is parliamentary accountability for any pressure put on to compromise any standards? We have heard in this debate already about the importance of common frameworks, but I will finish by advocating that the Government look very carefully at these amendments and make sure that they do not drive a further wedge between the four nations, because the consequences really do not bear thinking about. I certainly agree with those who say that they create an additional threat to the cohesiveness of the union.

Agriculture Bill

Debate between Baroness Finlay of Llandaff and Baroness Bennett of Manor Castle

Report stage & Report stage (Hansard): House of Lords & Report: 1st sitting & Report: 1st sitting: House of Lords
Tuesday 15th September 2020 Lords Chamber

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

I call the noble and learned Lord, Lord Morris of Aberavon. No? Then we will move on to the noble Baroness, Lady Bennett of Manor Castle.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, during the dinner break, I went for a brief walk and reflected then on what feels like ancient history: my honours thesis in 1983, which was on abomasal bloat in goat kids. Your Lordships can be reassured that I am aware it is dinner time, so I will not venture further into that subject. However, one thing that emerged during that year, as I was completing that honours thesis, was that the work had received some modest support from a milk manufacturer. It had donated the supplies for the goat kids, and in return got an awful lot of free student labour and the imprimatur of a university using its product. Soon, however, we found that there was a conflict between the commercial interest of the manufacturer and that of the science. It was private profit versus public good.

My noble friend Lady Jones of Moulsecoomb and I have been reflecting on that again and again today. Relying on the market rather than public service’s guidance and rules has led us to the society and countryside we have today. The market will, and by law our commercial companies have to, maximise private profit. All too often, that is at the cost of public good.

A seed company, fertiliser or pesticide manufacturer, or tractor company will want to sell more of their products, but moving in the direction we are talking about—agroecology, agroforestry, looking after the land—often means reducing, and using fewer, inputs: for example, using a local tree nursery for hedges and fruits rather than a multinational seed company. Yet, so much of the advice and information that farmers have been forced to rely on over recent decades has come from those commercial sources, which do not want to head in the direction provided by this Bill. So, we have to provide an alternative source of advice.

If we look at the history of this—to where we went backwards and went wrong—we go back to 1996 and the debate in your Lordships’ House on the privatisation of ADAS. Lord Mackie of Benshie said then that charging for its services had led to less advice being requested, a shift towards commercial suppliers’ advice and a concern about how public opinion of farmers had declined. In Committee on this Bill, I put forward a modest little amendment, 234, suggesting that a service be established by means of which farmers could associate, lead research and work with the experts we have now.

I ask the Minister at some point to look back to that discussion. One interesting, original contribution came from the noble Lord, Lord Adonis, who developed this proposal into something like a NICE for farming. Where otherwise is the advice and support in this clause to come from? It is clear that we need a duty to provide that advice, as so many other noble Lords have said in this debate. Farmers cannot be left on their own in this fast-changing, uncertain situation. This is not just about the Agriculture Bill; so many other aspects of the world are changing—the climate emergency, for example, and different markets and economic situations. We need to develop the expertise; we need the Government to do this. I would argue that this amendment is a crucial step in that direction, and I commend it to your Lordships’ House.