Health and Care Bill

Debate between Baroness Finlay of Llandaff and Lord Cormack

Committee stage
Friday 4th February 2022 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my interest as an elected member of the BMA ethics committee, which looked at these issues and was involved in producing the statement quoted earlier by the noble Lord, Lord Ribeiro. I strongly support these amendments and cannot see any reason for anyone not to. They set a basic moral standard. As the noble Lords, Lord Hunt, Lord Alton and Lord Ribeiro, and the noble Baroness, Lady Northover, have laid out, the arguments they have given us are in many ways only the tip of the iceberg. There is so much more than could be said.

Our Human Tissue Authority’s guiding principles have a code of practice which has consent, dignity, quality, honesty, and openness as key pillars. These principles should reflect not only how human tissue is sourced from within our own nation but how we treat human tissue and organs from overseas. There is overwhelming evidence now that in China, Falun Gong practitioners and Uighurs, Tibetans and house Christians are being killed on demand for their organs. There is no consent, no dignity and no transparency. Only yesterday I received a letter from a woman whose mother had been a Falun Gong practitioner, and who has been in prison and effectively disappeared. She has no idea where her mother is; she has not heard from her. That is happening all over this population.

I will not repeat the statement that has already been read out, but I just hope that the Government can see that we have a moral obligation to accept these amendments. I hope that they will do so.

Amendment 297H, in my name, is supported by the Royal College of Pathologists. Post-mortem examinations here are subject to careful legislative control and we have the Coroners (Investigations) Regulations 2013, which oversee post-mortems. When a post-mortem happens, it happens without the consent of the next of kin, of course, because there are questions around the cause of death. The coroners’ statistics for England and Wales in 2020 show that 79,400 post-mortem examinations were ordered by coroners. A fifth included histology and a quarter included toxicology samples being taken.

When the coroner’s work is complete, the tissue samples and any fluids taken—the tissue being in the form of blocks and slides—must be destroyed unless specific consent has been provided by someone in a qualifying relationship. However, consent is logistically very difficult to obtain in practice. The McCracken review of the Human Tissue Act in 2013 recommended that:

“Consideration should be given (inter alia) to reducing the scope so that microscope slide and tissue block samples and bodily products such as saliva, urine, and faeces are excluded”.


The Government accepted this recommendation, but the issue has not subsequently progressed.

There are some real difficulties with post-mortems. A post-mortem is effectively a snapshot of the deceased at the point of death. It is only by going back into the clinical records that the pathologist gets some picture of what happened pre-mortem, and many of the other factors. But at the end of the day, it is often subjective in terms of determining the likely cause of death for the report that is then signed off. In Scotland, tissue blocks and slides are deemed to be part of the clinical record and therefore do not have to be destroyed after the procurator fiscal’s investigations are complete. However, no whole organs can be retained in Scotland without explicit consent. In the light of Alder Hey, it is important to stress that point.

Changing to a system that reflects Scottish law could be beneficial because it would provide information about the cause of death if new circumstances came to light months or years after an investigation was complete. Indeed, we have recently had the case of the Farquhar family, where the evidence of long-term poisoning probably came to light many years after the person had died. Crucially, forensic deaths can be masked by natural disease processes and storage of tissues and fluids as part of the medical record would help clarify these at a later date when new information came to light. In a way, that is essential for completion of justice.

In addition, genomics research is rapidly developing, so the family may want to access the tissue later on as disease processes become more clarified. Metabolic storage disorders such as Fabry or Gaucher disease have been examples of this.

The tissue blocks from post-mortems are usually larger than the small pieces of tissue in a biopsy from a living person. That is particularly relevant where you want a piece of the heart or the brain, because a large biopsy from a living person would be impossible. There is also a third use of these tissue blocks and slides, which is as teaching material for autopsy pathologists. There is now a real shortage of teaching material, not only for pathologists who are in training but for ongoing audit of pathology processes.

So this amendment would bring the Human Tissue Act in line with the position in the Human Tissue (Scotland) Act 2006, where tissue samples as blocks and slides, but not—I stress not—organs, automatically become part of the person’s medical record after a post mortem. Explicit consent to keep them does not have to be sought from a grieving family, but it would allow justice in the long term to be pursued if necessary, and it would allow better development of autopsy pathologists.

[Lord Cormack (Con)]

My Lords, I apologise for missing the first minute—but it was only the first minute—of the splendid speech of the noble Lord, Lord Hunt. I am delighted to add my support to his initiative, most splendidly supported by my noble friend Lord Ribeiro. We entered this House on the very same day and it was very good to hear what he had to say. Of course, the noble Baronesses, Lady Northover and Lady Finlay, and the noble Lord, Lord Alton, all have an impeccable record on these matters.

Children and Families Bill

Debate between Baroness Finlay of Llandaff and Lord Cormack

Wednesday 29th January 2014 Lords Chamber

[Lord Cormack]

Would this amendment apply to open-topped cars such as sports cars where children would presumably not be at risk?

[Baroness Finlay of Llandaff]

It is worth pointing out that the noble Lord, Lord Ribeiro, has already indicated that he will not press his amendment, which is quite specific, and the amendment in the name of the noble Lord, Lord Hunt, simply addresses the ability to bring forward regulation but does not specify what those regulations should be. I respectfully suggest to the noble Lord, Lord Cormack, that his question is an important one for us to have at a later stage, in the event that the House decides to support the amendment of the noble Lord, Lord Hunt.

My last point relates to my home country of Wales, where I am delighted that the problem of tobacco consumption has been taken seriously. The results of the Welsh campaign will be published fairly soon. But it is with regret that I have to note that at the end of the first year of the campaign, 22% of smokers still pointed out that smoking was allowed in their car at any time. There is a perception that if it is allowed it is okay. I am concerned over the results that will come forward from the education campaign, although I fully support the campaign itself.

I remind the House that we had a parallel debate over seat belts in cars. Yet the seat-belt wearing rate increased in the UK from 25% before legislation to 91% after legislation. That was introduced alongside awareness campaigns. We cannot have legislation without a large education and awareness-raising campaign. The efficacy relates to the education and awareness-raising campaign rather than to any kind of punitive measures that go alongside it.

Legal Aid, Sentencing and Punishment of Offenders Bill

Debate between Baroness Finlay of Llandaff and Lord Cormack

Monday 23rd April 2012 Lords Chamber

[Lord Cormack]

My Lords, I will not detain your Lordships long. This is a simple, precise amendment. It does not cover the ground of Amendment 170, but it does repeat, almost exactly, the amendment which your Lordships’ House approved just before we rose for the Easter Recess. When I moved the amendment at that stage, I made it quite plain that I felt that it was very wrong to single out a specific group of children who had suffered as a result of clinical negligence, and to leave the others. I have heard, of course, what my noble friend has said, and I do not for a moment question his personal commitment to these issues. But we have not had any adequate response in the very brief debate in the House of Commons, and my noble friend merely repeated this evening the amendment that the Government introduced at an earlier stage, which of course we welcome, but which creates an anomaly and an unfairness.

When we debated this last time, my noble friend Lady Eaton—who signed the earlier amendment along with the late Lord Newton of Braintree—made a very moving speech in which she talked about a child who had not suffered from brain damage, but who had been paralysed. She talked about the needs of a child who would grow up to be able to walk, in spite of the brain damage, and a child that would remain paralysed for the rest of his life. It was a movingly made speech, which illustrated what this amendment is all about.

I have heard what my noble friend has said about other means of getting support. I would just repeat a point that I made in my last speech: the National Health Service—of which we are all proud, and which we have spent many months discussing in your Lordships’ House during the course of this parliamentary Session—is an agency of the state. If anyone suffers as a result of the negligence of an agency of the state, then the state should, automatically and properly, provide a means of redress. This amendment does not go so far as that, because it concerns itself wholly and exclusively with children. I believe that, in all fairness, it is an amendment that even at this late hour should commend itself once again to your Lordships’ House. I believe that it would be appropriate for us to ask the other place to think again. It did not think very much about this one, and it really should. In his brief intervention this afternoon, my noble friend Lord Higgins referred to the inadequacy of time given in another place to your Lordships’ considered amendments. As we look to the future of your Lordships’ House, we ought to consider, in the imbalance between the two Houses, whether it might not be appropriate to do a little more insisting, if what we have deliberated on is so summarily dismissed.

Given the present conventions, and the relationship between the two Houses as they exist, I do not believe that one should go on and on playing a game of ping-pong. However, in this instance we have every right to say to another place, “Please think about this. Think about the children who suffer as a result of clinical negligence. This is your opportunity to redress an imbalance”, because welcome as it is, and I repeat that it is welcome, what the Government have done does not go far enough. Let us send this back. Let the other place think, and because there are no large sums of public money involved in this—indeed it could be argued that we are probably in the long term saving public money—let them in their charity look to those who are most deserving of that charity. I beg to move.

[Baroness Finlay of Llandaff]

My Lords, I very strongly support the amendment. There is a very strong reason for looking at children separately from adults. Indeed the age of 16, as outlined in this amendment, makes sense because in the General Medical Council guidance 16 is the age at which a child can be assumed to have capacity to consent. When treating a child who is actively withholding consent to treatment and who is aged between 16 and 18, the doctor should and must think again. Those under 16, however, go into treatment at the consent of their parent or guardian, not of themselves. If they are then subject to error, whether that is unfortunate or negligent or almost wilfully neglectful, they have done so not with their own informed consent but with that of others.

The amendment that the Government have brought forward, which relates to neonates and birth-related trauma, is, I suggest, fraught with difficulties over the problem of premature babies and accurate estimation of the date on which they would had been born. Even in the very best of hands, estimates of their expected date of delivery have to have a plus or minus of four days around them. That would impose an eight-day error. I fear that there will be endless arguments. Should there be a small, very premature baby in a neonatal unit, and should somebody inadvertently inject the wrong drug or should their ventilator inadvertently be set incorrectly—switched off from oxygen levels, or whatever—I fear that there will be arguments around whether the expected date of delivery was really the one that had been written on the notes. Was it actually two days forward from that or two days back, depending on the date of the error?

This amendment avoids that kind of deeply traumatic argument and recognises the fact that a child undergoing treatment has not given their informed consent to it. That treatment has been at the consent of others acting on that child’s behalf. They must therefore be treated differently from adults because they are vulnerable on two counts: first, their age, and, secondly, because there was of course something wrong in the first place for them to be entrusted to the care of the service which then failed them.