European Qualifications (Health and Social Care Professions) (Amendment etc.) (EU Exit) Regulations 2018

Baroness Hayman Excerpts

Thursday 7th March 2019 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, it is very tempting to follow the noble Lords, Lord Warner and Lord Deben, in their remarks. I do not know whether the noble Lord, Lord Deben, has studied the document issued by the US Government last week on their requirements for a trade deal, but there is a contrast between what Brexiteers told the public about how easy trade deals would be and the demands of the US Government, which this Government will have to accede to in their desperation to get a trade deal, and their implications for the National Health Service. Apart from anything else, they will mean that voluntary control on prices of branded drugs will go and the market which the Government now want to legislate to remove, amending the Health and Social Care Act 2012, would fall foul of the requirements of the US Government on public services, which are very explicit about the areas they want US corporations to bid for.

As the noble Lord, Lord Deben, said, I wonder how those on the Front Bench feel about being members of a Government which will be excoriated for decades to come, perhaps as was the pre-war Government in the 1930s, for the lack of preparations they made for the disaster into which they are now taking this country. Of course, this SI is a sort of backstop which, it is hoped, will never come into being. But do we really think the vote will take place next week or will it, as some people feel, be postponed yet again to a cliff edge, when there is no guarantee whatever that there will be an agreement to enter talks about an agreement? This order takes on considerable importance.

I should at this point declare my interests as a member of the General Medical Council and a trustee of the Royal College of Ophthalmologists, and say that the GMC welcomes the order on its narrow terms. I should say to the noble Lord, Lord Deben, that it is the GMC’s view that it can administer the new arrangements effectively without additional substantive burdens being placed on its day-to-day operations. I do not know whether that reassures him; I hope it may.

I should like the Minister to comment on one area which is relevant to what my noble friend and the noble Baroness, Lady Jolly, said. It relates to page 9 of the order, where new powers are afforded to regulators effectively to determine what should and should not be comparable clinical qualifications to those gained in the UK. This is clearly of great importance given the way we are going. Instead of the current automatic recognition given to qualifications gained by, for example, doctors, dentists and nurses in another EEA country, the powers allow them to be deemed non-comparable by a regulator if it felt that necessary for patient safety reasons. The order states that the Privy Council would have to approve any such decision by the regulator. On what basis would the Privy Council approve or not approve a request to do so? Without some idea of the criteria to be used, it will be difficult for regulators to adopt the powers in the order in this area with confidence. Do the Government expect to issue guidance to advise regulators on the basis of a Privy Council judgment? Can they do so as quickly as possible, and will they consult the regulators in so doing?

[Baroness Hayman (CB)]

I also declare an interest as having been a member of the General Medical Council until that post was taken up by the noble Lord, Lord Hunt of Kings Heath.

Many of the points I wanted to make have already been made by the noble Baroness, Lady Jolly, and the noble Lord, Lord Hunt. I follow up his point about the ability to remove a qualification from automatic acceptance. When she introduced the SI, the Minister said that the Government would not issue guidelines. If there are no guidelines, one regulator may decide to remove an automatic qualification. The Minister said that it is in the best position to do so, but the SI lays down that there must be approval by the Privy Council. How is the Privy Council to make its decisions and against which criteria? There must either be criteria for the regulators to abide by and the Privy Council to supervise, or you give power completely to the regulator. I do not see how that process has any power or heft without guidelines.

The issue of review after two years has also been raised. There is concern that that review should be wide-ranging, because the process for recognising the qualifications of non-EEA and Swiss medical professionals is not satisfactory at the moment. It can be very long, drawn-out, bureaucratic and take a lot of money and time, as opposed to the streamlined system that we have had with EEA and Swiss nationals, which we are throwing away if we go for a no-deal Brexit. It is really important that that review is wide-ranging and does not leave us at the end with another cliff edge, which is that these health professionals on whom we depend so much become translated into international medical graduates and subject to an extremely unsatisfactory process.

In his wonderful speech the noble Lord, Lord Deben, referred to how the Government say that we will have wonderful flexibility but never quite explain what that is. Actually, the Government have flexibility on international medical graduates, because those procedures are not governed by the European Communities Act or by our membership of the EU. For many years, regulators have wanted to make progress on the issue but have not been given the legislative time or space and policy commitment from the Government so to do.

Alongside this work on EEA graduates, can we make sure that we look at the wider issue of doctors and other medical professionals coming here from outside the EEA? If the overall immigration trends are mirrored in the people coming to this country as medical professionals, we will see fewer EEA medical professionals but more IMG medical professionals coming here. I believe that we are seeing that already. Therefore, how we recognise their qualifications will be even more important.

Health: Cancer Nurses

Baroness Hayman Excerpts

Wednesday 2nd May 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is quite right that the Macmillan report highlights some challenges around vacancy rates and the age profile of cancer nurse specialists. It was explicitly set out in the cancer workforce strategy that it would have a phase 2 of planning once the census had been published. This census has been published, so there is an absolute commitment by Health Education England to work with Macmillan and the cancer alliances to bottom out how many more staff are required to meet the standard that we have set out—for every patient to see a cancer nurse specialist by 2021—and how many extra people we would need to recruit for that, and therefore to deliver the funding that would enable that to happen.

[Baroness Hayman (CB)]

My Lords, I declare my interest as a member of the General Medical Council. What assessment have the Government made of the effect on cancer services of the repeated refusal of visas to overseas doctors qualified to work here, and who have been recruited by the NHS to work here, but not being allowed to enter the country because of Home Office policies? Given the severe shortages of doctors across the board in the NHS, not just in A&E, is it not time that the cap on tier 2 visas for doctors was lifted?

[Lord O'Shaughnessy]

The noble Baroness will know that the NHS benefits from many of those visas issued under tier 2, which obviously has great benefits for our workforce. It is in the long-term interests of this country that we recruit more of our staff, wherever possible, from the domestic workforce. On that basis, Health Education England has committed to increase the number of cancer consultants by more than 20% between 2016 and 2021, as well as increasing the number of radiographers and others.

Dental Care

Baroness Hayman Excerpts

Thursday 1st February 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is right. About 59% of children have seen a dentist in the last two years, but of course that leaves 41% who have not. I have to say that that is an improving picture. On her two particular issues, there is NHS England’s Starting Well programme, which is targeted on 13 local authorities that have the worst oral health outcomes for children. The range is really quite dramatic from one area to the next. It has also developed a core offer to help every local authority commission better dental health for children.

[Baroness Hayman (CB)]

My Lords, is not the issue of fluoridation of water just like the issue of adding folic acid to fortified flour, about which even more overpoweringly conclusive evidence was published this week? The Government need to take a more robust attitude towards public health.

[Lord O'Shaughnessy]

I return to the point that I have made: I do not think there is any doubt about the evidence on the benefits of fluoridation, but it is important to do it in a way that brings local people with you. I should also point out that a big programme of fluoride varnishing is going on for children’s teeth as well, so we are getting fluoride into children in other ways too.

NHS: Cancer Treatments

Baroness Hayman Excerpts

Thursday 25th January 2018 Lords Chamber

[Baroness Hayman (CB)]

My Lords, like the noble Lord, Lord Blunkett, I have known the noble Baroness, Lady Jowell, for over 40 years. We met as young women, trying to make our way in the Labour Party and change the world. I never dreamed that we would end up as ministerial colleagues at the Department of Health or, two decades later, as fellow Members of your Lordships’ House today. What does not surprise me is that my very dear friend has shown unfathomable fortitude and determination in her current illness, or that her enduring commitment to the public good has led her to scrutinise the care we provide to those who have various forms of cancer—particularly obdurate ones like her own—and to campaign for improvements in that care.

Following on from the words of the noble Lord, Lord Hunt of Kings Heath, I believe that the UK has tremendous opportunities to make progress, even given the formidable challenges that these cancers present in terms of timing, precision of diagnosis and the development and evaluation of effective treatments. If we are to make that progress across the spectrum of prevention, detection, treatment and cure, we have to collaborate internationally. I hope the Minister will have some words to say about the EU clinical trials regulation that we expect in 2019. We also have to exploit all the resources we have; that includes the NHS and its scientific goldmine of information, which my noble friend has already referred to. That is one resource. Another is the Cambridge Biomedical Campus; I declare my interest as a recent chair of Cambridge University Health Partners. At that campus, we have world-leading research institutes, such as the Laboratory of Molecular Biology, Cancer Research UK and the Wellcome Sanger Institute, just down the road. We have great NHS hospitals: Addenbrooke’s now, and Papworth to come. We have leading international pharmaceutical companies, including AstraZeneca and GSK; and, of course, we have the University of Cambridge itself. The opportunities are enormous if these players can collaborate effectively.

There are exciting plans, led by Professor Richard Gilbertson, a world-leading expert in brain cancers in children, to build on the already impressive results in, for example, breast cancer, by creating a ground-breaking institute for early detection and a new cancer research hospital, bringing patients speedy access to the latest research and treatments. I hope the Department of Health will see this not as another simple NHS building project but as a real opportunity within the context of the life sciences strategy.

The noble Baroness, Lady Jay, cannot be here today as she is abroad. She asked me to say how sad she was to miss this opportunity and to pay some words of tribute to the noble Baroness, Lady Jowell. I think she would feel that the House has perhaps done her proud in paying that tribute. I started off by saying that, 40 years ago, Tessa wanted to change the world. The debate today illustrates clearly that her determination to do so is undiminished.

Maternal Safety Strategy

Baroness Hayman Excerpts

Tuesday 28th November 2017 Lords Chamber

[Lord O’Shaughnessy]

The whole point of these reforms is that lessons should be learned, and they can be. The Francis inquiry, and other investigations that have taken place into poor practice, have led to dramatic improvements. The fact that there are over 10,000 more nurses on wards was a direct response to the Mid Staffordshire crisis and the finding that there were not enough staff on wards to look after patients and make sure that they were not vulnerable. It is possible to be optimistic about this. We are already seeing improvements through the learning from deaths programme and from the reduction in the number of stillbirths. The noble Baroness is shaking her head but that is rather a gloomy view, which does not reflect the support for these proposals in this House.

In answer to the point about staffing, there are more midwives in the service and more coming through training. We need to make sure that that continues so that the level of support that is needed is there.

[Baroness Hayman (CB)]

My Lords, like others, I welcome the Statement and the determination to deal with this issue. The Minister will recall that a few weeks ago I asked him about coroners’ inquests on stillbirths and I will address myself to that. Does he agree that, for many parents, the depth of their bereavement at a stillbirth means that they feel the weight and authority of a coronial investigation is absolutely warranted? I therefore welcome the discussions that are to take place. Can the Minister tell me a little about the timing of that and about the legislative vehicle? I understand that primary legislation will be necessary and a Private Member’s Bill that refers to this is currently in the Commons.

[Lord O’Shaughnessy]

I am glad to be able to return to the topic, which the noble Baroness has raised before. There was a powerful story on “Today” this morning, about parents who wanted precisely that for the level of authority it would bring. The hospital was not necessarily treating them as well as it could. These independent investigations will provide a degree of authority and independence that is perhaps sometimes lacking. We want to see how this pans out, but the Secretary of State is committed to looking at coroners investigating stillbirths. This is obviously a complex issue, so I hope the noble Baroness will forgive me if I am not in a position to provide more detail at this point. However, there is a desire and willingness to look into this in the months ahead. When we have some more details, I will certainly write to her.

Medical Examiners and Death Certification

Baroness Hayman Excerpts

Wednesday 18th October 2017 Lords Chamber

[Lord O'Shaughnessy]

I think that the difference here is between handling mass deaths, which would obviously be an emergency situation—so we are talking about contingency and resilience planning—and looking at all deaths. About half a million people die each year. At the moment, only those who go through coroners receive that additional level of investigation, except in those pilot sites and early adopter areas that I mentioned. The new arrangements are about making sure that there is a system of verifying deaths from normal causes.

[Baroness Hayman (CB)]

My Lords, when considering these issues will the Minister look at the proposal made by bereaved parents and raised by the chief coroner in his report in 2016 that there should be coroners’ investigations of cases of stillbirth, so that the causes of stillbirths could be better understood and such tragedies could be averted in the future?

[Lord O'Shaughnessy]

The noble Baroness is quite right to highlight this point. Medical examiners are not involved in stillbirths, because the cause of death is before the point of birth. However, there is clearly a need for the involvement of coroners. I will look into the detail of that. I can tell the noble Baroness that the Government are taking the issue of stillbirths seriously. A new perinatal mortality review tool is looking at that and it is integrated into the learning from deaths scheme now going on in the NHS.

Gene Editing: Agriculture and Medicine

Baroness Hayman Excerpts

Monday 27th March 2017 Lords Chamber

[Lord O’Shaughnessy]

As we have discussed, there is huge potential regarding illnesses such as HIV. Clinical trials of gene therapies involving gene editing are still at an early stage, and are receiving support from the National Institute for Health Research. Any applications that go beyond the experimental and research stage would inevitably have to go through the Medicines and Healthcare products Regulatory Agency regarding safety and clinical potential. So the right system exists, investment is taking place at the early stage of research and before anything is done to any scale, it must be subject to the proper discussion and scrutiny.

[Baroness Hayman (CB)]

My Lords, as the Minister said, we have an enormously strong agriculture and genetic technology science base in this country. While this is not a magic bullet for food production, it could be a very important weapon in our armoury for meeting the world population’s future food needs. Given that, will he undertake that centres like the John Innes Centre in Norwich will continue to receive government support to develop genetic technology in agriculture, within a strong and ethical regulatory framework?

Nursing and Midwifery: Student Applications

Baroness Hayman Excerpts

Tuesday 7th February 2017 Lords Chamber

[Lord O'Shaughnessy]

The Government took the decision to change to a fee-based system precisely because a bursary-based system involves caps and only so many places can be commissioned. A fee-based system allows the cap to be removed, with the intention of increasing the places available by up to 10,000 people a year, which will increase the flow into the profession to address precisely the issue that the noble Lord raises.

[Baroness Hayman (CB)]

My Lords, can the Minister tell the House whether his department undertook a risk analysis of changing the basis of the funding for nursing education at a time when the age profile was as has been described, and when the security of the EU nurses on whom the NHS depends at the moment—and will do so for the continuing future—is so damaged by the uncertainty of their immigration status? If such risk analysis was not undertaken, might it be done now?

[Lord O'Shaughnessy]

As the noble Baroness will know, Health Education England is responsible for commissioning medical training places, and I am sure that all necessary impact and risk assessments would have been carried out at the time. As the noble Lord opposite recognised, I was not in post at that point, but I will certainly look at it. I would be surprised if that was not the case.

Drug-Resistant Infections

Baroness Hayman Excerpts

Thursday 15th September 2016 Lords Chamber

[Baroness Hayman (CB)]

My Lords, like others, I congratulate the noble Lord, Lord Lansley, both on securing this debate and on his very cogent introduction today.

My contribution will concentrate on the global health aspects of the report, particularly in relation to malaria and artemisinin resistance. I draw attention to my interests in this area, as set out in the register. Much of what I will say draws on the recent report of the All-Party Group on Malaria and Neglected Tropical Diseases, and the Malaria Consortium, entitled, Racing Against Time: Protecting the Gains Achieved in Malaria Control Against Drug Resistance. It was dedicated to the memory of Dr Sylvia Meek of the Malaria Consortium—its co-author—who died tragically young very soon after completing the report. Sylvia dedicated her life to the fight against malaria with both passion and intellectual rigour. I pay tribute today to the enormous contribution she made, and the example of service she gave in international health.

Malaria control is one of the great global health success stories of this century. Deaths have declined by 60% across the world since 2000, which equates to 6.2 million fewer deaths than would have occurred. The incidence of new cases is down by 37%. The UK has played a major part in this achievement: at government level, through NGOs like Malaria Consortium, and through the enormous scientific contribution of our centres of excellence, particularly the Liverpool School of Tropical Medicine and the London School of Hygiene and Tropical Medicine. Progress has been achieved through collaborative action and the development of new tools—treatments, diagnostics, vector control, prevention strategies—and their effective deployment in endemic countries. The research continues, not least on the development of an effective vaccine against malaria.

But all this progress and all the investments we have made are threatened—and the history of malaria teaches us that progress has been threatened and lost in decades past—by the declining effectiveness of vector control because of the growth in resistance to insecticides and, in particular, to artemisinin combination therapies, which are the most effective treatment we now have for malaria. Resistance to ACTs is already a significant threat to health in south-east Asia and it will be a global threat if it spreads. Drug resistance has been detected in five countries in the Greater Mekong Subregion: Cambodia, Myanmar, Thailand, Vietnam and the Lao People’s Democratic Republic. If it spreads to other parts of south Asia, and worst of all to Africa, a global public health crisis will occur.

Drug-resistant malaria parasites have not yet been detected in Africa, but, following the pattern of the spread of previous resistant strains—as I said, we have been here before—drug-resistant malaria is a distinct and worrying possibility. At the moment, despite ongoing work to develop replacement drugs and a vaccine, no new treatment for malaria is in the pipeline if ACTs were to become ineffective. If resistance were to reach Africa, where the malaria burden is greatest, the impact could be devastating, leading not only to a massive increase in deaths but to massive costs—both medical costs and productivity losses.

I welcome the publication of this report and the opportunities it gives us to tackle the threat and existence of antimicrobial resistance. There are certain areas to which I wish to draw attention. One is recommendation 4, on improving global surveillance of drug resistance. The noble Lord, Lord Lansley, rightly drew attention to this, and I would like to endorse what he said. Strong disease surveillance systems are critical to monitoring and responding to the spread of disease resistance, as well as to the management and elimination of diseases such as pneumonia and malaria. Effective surveillance systems allow resources to be directed to the most affected populations, enabling us to identify gaps in programme coverage, detect outbreaks and assess the impact of interventions. The Ebola crisis provided a stark warning of the need to strengthen surveillance, particularly at community level, as I saw for myself when I visited Sierra Leone 18 months ago at the height of the epidemic. However, countries like Sierra Leone need support to substantially strengthen disease surveillance so that it becomes a core intervention and part of their public health systems. I encourage the Government to prioritise surveillance and would be grateful if the Minister, either in summing up today or separately in writing, told me what plans there are to help countries strengthen their surveillance.

The other recommendation to which I would like to draw attention is promoting new, rapid diagnostics as one of the ways of cutting the unnecessary use of antibiotics. Universal access to accurate diagnosis prior to treatment is a critical element of decreasing the irrational use of drugs, which is one of the causes of their reducing efficacy. The increase in availability of malaria rapid diagnostic tests over recent years has improved the rational use of artemisinin combination therapies. In 2014, for the first time, more RDTs were distributed through the public sector globally than ACT treatments. The availability of RDTs was also crucial in extending the accurate diagnosis and treatment of malaria at community level through trained volunteer community health workers, allowing for the differential diagnosis and treatment of febrile illness and reducing the common blanket prescribing of antibiotics for almost every sick child.

In Uganda, I had the privilege of seeing community health workers, some of whom were barely literate, doing an amazing job of differential diagnosis and effective treatment in the middle of the night with a two year-old with a high temperature. It is extraordinary what can be achieved. Developing new, accurate and easy-to-use diagnostic tools for other diseases, such as neglected tropical diseases like dengue and Zika, would support efforts to eliminate them and deserves priority.

Finally, the announcement of the Ross Fund is much to be welcomed, particularly the £350 million that has been committed to fight antimicrobial resistance. We hope that surveillance will be at the centre of the Ross Fund’s strategy. I would be grateful if the Minister provided an update, either today or in a letter, on the progress of the fund, along with details of how and when funding is likely to be allocated.

The UK Government, through DfID programmes and support for the Global Fund—HIV and TB being other areas, like malaria, threatened by antimicrobial resistance—have made a huge contribution to the fight against those three diseases, particularly in leadership on malaria. I hope the Minister will commit not only to the robust and speedy implementation of the recommendations in this report, but also to continuing the British Government’s commitment to their leadership role in the fight against malaria.

Bread and Flour Regulations (Folic Acid) Bill [HL]

Baroness Hayman Excerpts

Friday 8th July 2016 Lords Chamber

[Baroness Hayman (CB)]

My Lords, the House owes a debt of gratitude to the noble Lord, Lord Rooker, for his persistence in pursuing this case. I should tell the Minister at the Dispatch Box that I was a colleague of the noble Lord, Lord Rooker, in the days when we were both young MPs in a hurry, and he is a formidable opponent. We are, in our later years, perhaps old Peers in a hurry, but that does not mean that we are any less determined on this issue. Today, the noble Lord has provided the House with irrefutable evidence of the case for supporting his Private Member’s Bill, and in fact I think he has done more than that. A Private Member’s Bill is not the way to implement a measure that is so self-evidently important for public health. He argued for a change in government policy, and I hope that the Minister will not be put in what I know to be the profoundly uncomfortable position on the Front Bench of once more defending the indefensible on this issue.

Last night I was telephoned by my son, who told me of his frustration over the length of time it was taking to get the Government to respond on a completely different, although equally important, issue. It is an issue supported by five Select Committee chairs and committees and over 90% of parents—that of making PSHE a statutory subject in the national curriculum so that all our young people are given the means to protect themselves in today’s world. I fear that, when I explained to him that today I would be talking about an issue on which I had been campaigning for 25 years, that did not add to his optimism or enthusiasm. However, I also told him that one thing I had learned in politics was never to take no for an answer, and that applies to this issue and to his.

As I said, I first became aware of this matter in 1991. I was involved then, as I am now, in the ethics of medical research. The MRC trial, to which the noble Lord, Lord Rooker, referred, was the first trial I had ever known to end early. That was because the results were so clear that it was considered to be unethical to continue to allow one half of the group—the control group—not to receive the folic acid supplement which the other half was getting. The evidence that has had such a profound effect in the rest of the world, but not in the UK, is based on that trial.

A second reason for my concern was that in the preceding years I had helped to found an organisation called the Maternity Alliance. It was particularly involved in pre-conception care—in the health of mothers and babies. It was absolutely clear that the fortification of flour with folic acid was the most effective mechanism for delivering pre-conception and early pregnancy care, as has been demonstrated by the ineffectiveness of the supplement route, as the noble Lord, Lord Rooker, has demonstrated.

However, the main reason for my interest was that I had been having babies myself. I knew the intense anxiety of waiting for antenatal checks and then the birth, worrying about whether the baby was healthy, and thinking through what I would do in the case of an in utero diagnosis of an abnormality and having to face up to the question of whether to undergo a late termination.

A generation has gone by; I am no longer having babies, but I am having grandchildren and I see my sons, their wives and partners going through exactly the same anxieties. It is no wonder that the British Pregnancy Advisory Service says that this one measure would ensure that some of the saddest cases it sees would not need to come through its doors, and women in the devastating situation of ending a wanted pregnancy because of foetal abnormality would no longer have to do so. Beyond that, many families would not have to deal with the devastating and heart-breaking situation described by the noble Lord, Lord Rooker, of one of our colleagues and of having to support children who endure short and painful lives because of the burden of preventable disease.

In those 25 years, we have had the opportunity in this country to see not just pilot schemes of fortification of flour with folic acid but mass implementation of it. We have had the opportunity to see the effect—an up-to-50% reduction in the incidence of the neural tube defects—and to see that the theoretical risks of the policy have been investigated and not come to fruition.

The question for the Government now is how they can in all conscience continue to ignore the evidence before them and not accept what their own Chief Medical Officer, the Scientific Advisory Committee on Nutrition, the other Administrations of the United Kingdom and the rest of the world accept. I cannot believe that they maintain their position given the conclusions of every piece of research—ending with that which found in December last year:

“Failure to implement folic acid fortification in the UK has caused, and continues to cause, avoidable terminations of pregnancy, stillbirths”—

and permits “serious disability in … children”. That situation should not be allowed to continue. This Bill would not solve every instance of it, but it would do a great deal. Not to do what we can do is a dereliction of duty.

[Lord Hughes of Woodside (Lab)]

My Lords, I join the noble Baroness, Lady Hayman, in paying tribute to our mutual friend, the noble Lord, Lord Rooker, for bringing forward this Bill and I certainly hope he succeeds. The three of us, the noble Baroness, Lady Hayman, the noble Lord, Lord Rooker and I, were in the other place for some years together. I can testify to the noble Lord’s capacity for identifying a public policy that needs to be taken up and his tenacity in seeing it through. He is perhaps best known, at least among the three of us, for the so-called Rooker-Wise amendment—an unlikely duo—which was successfully introduced to a Finance Bill to make national allowances subject to the rate of inflation. He annoyed the then Chancellor of the Exchequer, Denis Healey, no end. Such tenacity is worth having and it certainly makes us in your Lordships’ House proud.

The issue of adding folic acid to flour has been around for a long time, because we share knowledge of the suffering of families who have had children aborted, who have lost children early or who have had children born with defects that last for years of their lifetime. The question must be asked: why are the Government so reluctant to move in the face of such indisputable evidence about the efficacy of adding folic acid to bread when there are certainly no signs at all of any detrimental effects in doing so? I do not know and I hope the Minister can answer that question.

At Question Time in the House—I say this without malice—the Answers given by the Minister for not doing so have been rather flimsy. He has cited the fact that health problems are improving in women, and there is no doubt about that. But beyond that, there is no reason why the Government cannot move. As my noble friend Lord Rooker said, many countries in the world already do this. The Scottish Government are considering moving on their own and have the power to do so as health is a devolved matter. It would be a great shame if that were to be the case.

Why is there such opposition? I know from personal experience how difficult it is to argue against those who, possibly for genuine reasons, are opposed to vaccination or fluoridisation of the water. I still have the scars on my back from trying to persuade Aberdeen Town Council to adopt that when I was the convener on the welfare committee there. I do not know whether it is a matter of prejudice. It cannot be ignorance because the facts are very well known. But the fact is there is huge opposition to any move to what is called public health medicine. The worst example of that is adding fluoride to the water. I emphasise absolutely what my noble friend said. Adding folic acid is not mass medication. That argument might be made in the case of putting fluoride in the water but this is a different matter altogether. This is a simple and straightforward measure that has been well documented as being successful and safe and for making people’s lives much better.

As my noble friend said, this is not a panacea. It will not eradicate NTDs, but the fact that 50% of women may be beneficially affected by this is a prize that makes it worth doing. The only slight disagreement I might have, although I may have misheard what my noble friend Lady Hayman said, is whether this is the right way to go about getting the legislation. I may have misunderstood what she was saying. But in the face of a Government unwilling to move on their own account through lack of time—and goodness knows what the Government will face in terms of time in the coming months and years—it is absolutely essential that those who have the opportunity to bring forward a Private Member’s Bill should do so.

[Baroness Hayman]

I would be more than content were the Minister to say today that the Bill in the name of the noble Lord, Lord Rooker, be taken forward with all speed and support by the Government in another place.

[Lord Hughes of Woodside]

Hear, hear to that. But in the event of that not being the case, it is the duty of this House to pass this legislation through all its stages and send it to the other place to deal with. That is imperative and essential and I am pleased to give my support to my noble friend Lord Rooker.