Palliative and End-of-life Care: Funding

Baroness Hayter of Kentish Town Excerpts

Wednesday 4th September 2024 Lords Chamber

[Baroness Merron (Lab)]

As the noble Lord will be aware, statutory guidance and service specifications are provided to support commissioners in ICBs to meet their duty. As I am sure the noble Lord is also aware, NHS England has developed a palliative and end-of-life care dashboard that brings all the relevant local data together and helps commissioners to understand the situation so that they can provide for their local populations. This is part of ongoing work for this new Government to see how we meet requirements to provide dignity, compassion and service at the end of life and just prior to the end of life.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, although I pay enormous tribute to the hospice movement, there will be some people for whom end-of-life care means assisted dying. We will have the Second Reading of the Bill in November. I hope that my noble friend will be able to give strong government time, if not government support, to enable that Bill to make good progress.

[Baroness Merron (Lab)]

The Prime Minister has already reiterated his commitment to allow time for a Private Member’s Bill and a free vote. I recognise that this is an extremely sensitive issue with deeply held views on the various sides of the debate. Our commitment is to ensure that any debate on assisted dying in Parliament will take place in a broader context of access to high-quality palliative and end-of-life care and that we will have robust safeguards to protect vulnerable groups, if the will of Parliament is that the law should change.

NHS England: Ovarian Cancer

Baroness Hayter of Kentish Town Excerpts

Thursday 2nd May 2024 Lords Chamber

Asked by

[Baroness Hayter of Kentish Town]

To ask His Majesty’s Government what assessment they have made of NHS England London stating that “anyone with ovaries can get ovarian cancer” in a social media post rather than referring to “women”, whereas at other times NHS England refers to “men” in relation to prostate cancer; and whether this wording has been market tested with women, including those for whom English is a second language, to ensure that it is fully understood.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

We are writing to NHS England about NHS London’s social media post, to reiterate the expectation that biological sex should be front and centre of all health-related information. Removing language around biological sex has the potential for unintended health consequences. The Government are committed to upholding the rights of women and girls, which is why we are consulting on updates to the NHS constitution, including the use of clear language based on biological sex.

[Baroness Hayter of Kentish Town (Lab)]

I warmly welcome the Minister’s response, which is probably welcomed across the House. Given the Government’s welcome assurance that “single-sex wards” means “biologically single-sex wards”, will he also discuss with the GMC the video on its website that advises doctors to ask trans patients which wards they would prefer to go in? Perhaps he could also talk to the GMC about its practice of allowing doctors to change their gender on the register without any advice that they should inform patients of their biological sex. Although I approve of the Government saying so, it is very hard for patients to ask for a doctor of a particular sex for intimate care if they do not know the sex of their doctor.

[Lord Markham (Con)]

First, I thank the noble Baroness for all her work in this space. I will continue to work closely with her, including by writing to and meeting the GMC as necessary on all these matters. On her second point, while I respect that many clinicians may wish to keep their information private, we have to understand that, for many people, it is the patient’s right to be treated by someone of a particular biological sex and to know what that is. We have to make sure that those feelings and understandable sensitivities—which are sometimes religious—are catered for.

Cass Review

Baroness Hayter of Kentish Town Excerpts

Wednesday 17th April 2024 Lords Chamber

[Lord Markham (Con)]

Yes, absolutely, and I thank my noble friend for correcting me and giving me the opportunity to correct that. Again being very honest, this shows that part of the challenge in setting up the new services is that this has become such a difficult, toxic space, and finding and recruiting staff who want to work in this area is a real challenge as well.

[Baroness Hayter of Kentish Town (Lab)]

I thank the Government, the Minister and indeed the Opposition for their very robust response and welcome to the report. I am really sorry that the Lib Dems have chosen to use Stonewall’s briefing in what we have heard tonight; I hope that is not the whole of the Lib Dem position.

I note that the Government have already met with the GMC over the weekend, and they have been in contact with the CQC. However, just last month, the Royal College of General Practitioners tried to cancel a conference posing exactly the questions covered by Dr Cass in her excellent report. It allowed this conference—it was called “First Do No Harm” and I had the privilege to open it—only after an enormous amount of persuasion; it did it under duress, with bad grace and some hostility. That was the Royal College of General Practitioners.

Will the Government also meet the Royal College of General Practitioners and indeed the Royal College of Psychiatrists, the Royal College of Nursing, the Professional Standards Authority and all the other regulators, many of which seem to have been blind when all this was going on, and ensure that they all engage with the conclusions and the recommendations of Cass, whether those professionals over which they have oversight are working in the NHS or in the private health sector? These puberty blockers were being prescribed years after we knew they were irreversible, when Stonewall still said they were reversible, and when the doctors should have known but still prescribed them. Will the Government therefore engage with all those regulators to ensure that Cass is implemented in full?

[Lord Markham (Con)]

Yes, and that is an excellent point. Again, I thank the noble Baroness in this area. The questions that she raised earlier in the year in terms of some of the language from the GMC really added to the debate and represented a step forward. Therefore, although I am sure it is happening already, I will doubly check that it is.

General Medical Council: Internal Guidance

Baroness Hayter of Kentish Town Excerpts

Tuesday 17th October 2023 Lords Chamber

Asked by

[Baroness Hayter of Kentish Town]

To ask His Majesty’s Government what discussion they have held with the General Medical Council on its removal of the words “mother” and “women” from its internal guidance for pregnant or menopausal staff, and whether this reflects advice to doctors as to how to treat and describe patients.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The Government have not had any discussions with the General Medical Council on its internal guidance for pregnant or menopausal staff. The GMC is independent from the Government and its internal guidance is produced for its staff. It is not for doctors registered with the GMC. The Government are clear that biological sex matters and that there are different health needs between the sexes. Removing language around biological sex has the potential for unintended and adverse health consequences.

[Baroness Hayter of Kentish Town (Lab)]

I do not think that Answer is quite satisfactory and I am sorry that the Minister used the words “pregnant staff” rather than “pregnant women”. Maybe the GMC lost out on medical lessons, where they would have learned that men produce sperm. We produce eggs and when they are fertilised in our wombs, we give birth and become mothers. When that is over, it is us who go through the menopause. The GMC has a statutory duty; it is the register of all the doctors who work in the NHS and it has a duty to maintain public confidence. I wonder how many mothers would have confidence in a doctor who thinks that men can have babies. The Minister should engage with the GMC and I ask him to do so, because although its internal guidance may have upset some of us, it regulates doctors and the language it uses matters in how it oversees, trains and interviews them. I hope the Government will take this a little more seriously.

[Lord Markham (Con)]

I can definitely confirm that we are taking it very seriously. The Secretary of State was clear in his speech at the recent party conference that it is vital that we recognise the importance of the different biological health needs. That means being clear about describing a woman as a woman. I apologise: the noble Baroness was quite right to pick me up on that point, but we are very clear that biological sex is absolutely vital in addressing people’s health needs. It is clear that we are addressing women as women and men as men.

Mental Health Services for Rough Sleepers

Baroness Hayter of Kentish Town Excerpts

Monday 21st March 2022 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for her Question and for her continued conversations with me on a number of different health-related issues; I am learning quite a lot from those. I understand that the data will be collected at some point, and I hope that that will be done regularly. If the noble Baroness will allow me, I write to her with more details, but I know that the top-level answer to that question is that we are about to get the data.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, about two-thirds of people who are homeless cite alcohol misuse as one of the reasons that first made them homeless, and for about one in 10 people who die homeless, alcohol is the main cause of death. Can the Minister assure us that all this work will include a proper alcohol treatment programme, so that the underlying problems are dealt with in addition to the other mental health problems?

[Lord Kamall (Con)]

The noble Baroness makes the very important point that a number of people who are homeless suffer from alcoholism and alcohol abuse—and indeed drug abuse. For some of these people, the issues they are suffering from are often interrelated. Therefore, in the joined-up thinking we are looking at, charities, civil society organisations and the NHS are making sure that we treat the various symptoms in an integrated way.

Health and Care Bill

Baroness Hayter of Kentish Town Excerpts

Lords Hansard - Part 3 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, the Green group is operating on the lark and owl system —appropriately enough, you might say. My noble friend Lady Jones of Moulsecoomb attached her name to Amendment 203 in the name of the noble Baroness, Lady Meacher. I am going to be brief, as I am aware of the pressures. I find it very hard to see why anyone would resist Amendment 203. It is about providing appropriate structures and law to ensure that people’s views are heard and respected.

When I looked at this, I thought of the very old feminist slogan, “the personal is political”. What could be more personal or political than a person having control over the nature of their own death, being able to express their wishes and ensuring that they are heard and recorded.

It is worth saying that I was not able to take part in an earlier debate about the funding for palliative care. We should see much better investment in palliative care in the UK; we should not see volunteers rattling fundraising buckets for hospices to meet their basic needs. But that goes along with the right of individuals to be in control, knowing that they will be heard and listened to, and their wishes acted on. That would allow them to be in a situation of much less fear.

I also want, very briefly, to offer the Green group’s support for Amendment 297. Support for assisted dying is Green Party policy. I want to reflect back to October last year, when the Private Member’s Bill was being debated. There was a very respectful, silent crowd outside, holding up signs saying “Choice, Compassion, Dignity”. I ask people considering this to make sure that those people can be heard in this House and this can be debated.

As the noble Lord, Lord Forsyth, said, it is not about a change in the law; it is about a guarantee of parliamentary consideration, as the courts have requested. It might surprise the noble Lord to know that I preceded him on this. I am trying to remember the details—I was not aware that any fuss had been made about this procedure, but it was either in the Agriculture Bill or the Environment Bill that I put down an amendment in this form. I would not consider myself a procedural innovator, so this is something that has been done many times before.

I want to make one final point. It is perhaps not of legal significance, but, in a way, it is a legal issue. Assisted dying is already available to people in our society—to people who have the funds, the knowledge and the remaining health to get to Dignitas, in Switzerland. This is very much an equalities issue around a right that some people have and some people do not. There is also the fact that, to be guaranteed to be fit to travel, some people are now dying before they need to because we have that inequality.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, I have added my name to Amendment 297 from the noble Lord, Lord Forsyth. He has made the case, so there is not much more to say. At the core of that amendment, in proposed new subsection (2)(b), all we are asking is

“to enable Parliament to consider the issue.”

That is really all we ask.

We know, as has been said, that the public want change. I believe that the House, at its full strength, wants change. The courts have said that it is not for them, judges, the Crown Prosecution Service, the Law Commission or anyone else to decide. It is the role of Parliament to take a decision of this importance.

By failing to allow a full debate and a decision in Parliament, as the noble Lord, Lord Forsyth, has just said, the Government are effectively siding with those who want no change. That is not a neutral position: it is allowing no change by forbidding those who want to put the issue to Parliament from being able to do that. That is done partly through the number of wrecking amendments that we have seen. I know that the Chief Whip has lots of other demands on his time, but my judgment is that, even if he did not, he would not give time for this—for what would be necessary, given the number of wrecking amendments.

All the Government are doing is accepting, as the noble Baroness, Lady Bennett, has just said, that people with money can go to Switzerland. More importantly, there are no safeguards. Those who oppose assisted dying say that it exposes people to pressure from their families. The whole point of having safeguards is that you will have to go and get permission before it happens, and someone has to test that. At the moment, you can go to Switzerland and there is no check—there is not even a check for whether you are dying. There is no check on whether you are of fit mind; there is no check on whether you are under pressure from a family member. You can just go, if you have the money, but there are no checks. The Government are allowing that to continue: our citizens are able, if they have the money, without any safeguards, to go quite legally to that country and end their lives when they are facing the end of life anyway. That really is not how this country ought to be.

What is important is that we allow Parliament to decide. I can only think that those who have turned up wanting to oppose this are actually afraid that Parliament will decide that it wants change. I often do not like things that Parliament does—unsurprisingly, sitting where I do, on this side of the House—but we are a democratic country and we should let Parliament take the decision on this.

Covid-19: UK Arrivals

Baroness Hayter of Kentish Town Excerpts

Tuesday 16th November 2021 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

The noble Lord, Lord Flight, is not present so I call the noble Baroness, Lady Hayter of Kentish Town.

[Baroness Hayter of Kentish Town (Lab)]

As the Minister has said, our universities have long been a welcoming and inspiring academic hub for international students but stories such as the ones that we have heard—along with, I am afraid, the attack on freedom of speech at the LSE and the shameful treatment of Professor Stock, which we will come to shortly—added to Covid and online teaching, to say nothing of the Brexit fallout, which means that EU schools can no longer use group passports, all question our ability to attract youngsters from across the globe. What are the Government doing to re-establish our reputation in this sector?

[Lord Kamall (Con)]

The noble Baroness makes an important point about us being a global hub and welcoming the whole world. For centuries the UK has been open to a number of different nationalities from across the world. Indeed, my own family came to the UK in the Windrush generation. I have always been clear that we should be a global Britain, not just focused on one small part of the world.

I want to take the opportunity to answer the question that I forgot to answer about international students. Anyone in England is eligible for the vaccine if they fall within the current eligibility criteria, and international students are encouraged to register with a GP.

On free speech, it is critical that our universities remain places where you can have free expression without fear. The essence of free speech is being able to tolerate views that you may not agree with but it is important that they are expressed. Universities should remain hubs of free speech.

Alcohol Duties

Baroness Hayter of Kentish Town Excerpts

Tuesday 2nd November 2021 Lords Chamber

[Lord Kamall (Con)]

Many public health officials, for many years, have criticised the system of alcohol taxation, particularly the EU’s system of taxation. Now that we have left the EU, we are free to set our own law in this area. Given the criticisms from the World Health Organization and many other think tanks, we can now set taxation based on the volume of alcohol.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, I welcome that the duty will be related to the strength of alcohol. However, the Budget included a dozen references to wine, just as the Government were boasting that the biggest benefit of the New Zealand trade deal was cheaper New Zealand wine. This duty freeze, as we have heard, will cost £3 billion to the Exchequer over five years—money that could have been used for treatment services and for public health, since we know that deaths and illnesses will go up. It seems to me that the Government have an alcohol problem. They are scared to increase prices for the sake of all our health and are uncaring about the problems that this measure brings in its wake. Can this Health Minister go to his colleagues in the Treasury and try to educate them as to what they should be doing?

[Lord Kamall (Con)]

The noble Baroness is being a little unfair in her comments. These reforms were based on the advice of many public health officials, including the World Health Organization as well as a number of think tanks, which said that it was about time that we linked taxation to the volume of alcohol in drinks in the hope that we can encourage and incentivise manufacturers to lower alcohol content and to produce more low-alcohol and alcohol-free drinks. I am not sure whether noble Lords would accept such reformulated drinks, but it is important that we push this from a public health perspective.

Personal Protective Equipment: Procurement

Baroness Hayter of Kentish Town Excerpts

Thursday 19th November 2020 Lords Chamber

Asked by

[Baroness Hayter of Kentish Town]

To ask Her Majesty’s Government whether they will (1) outline the transparency and reporting requirements of the procurement of personal protective equipment, (2) detail the steps taken to register any potential conflicts of interest in that process, and (3) publish all information about any such contracts awarded, including payments for intermediaries; and if not, why not.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, the National Audit Office report on Covid-19 procurement activity, published yesterday, recognised how we needed to procure new PPE contracts with extreme urgency in order to save lives. We are committed to publishing all the information about these contracts. Robust due diligence processes were in place. The report makes clear that there were no conflict-of-interest issues in procurement decisions. We will respond to the report’s recommendations in due course.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, I am surprised by the Minister’s reply. The NAO report revealed numerous issues of concern, from lobbying by an adviser to Liz Truss for a transaction in which he had an interest to the creation of a VIP fast track which happened to assist those with connections to senior Conservatives. Some awards were made without tender; some had no written contracts. There was no documented proof of urgency, nor of how to handle conflicts of interest. Awards were made to a pest control firm and £250,000 went to a jewellery company with no PPE experience. Today, we learn of a cannabis research firm with just £6,000 in assets being handed PPE contracts of £33 million.

The Minister has helpfully tweeted that he is going to respond by saying how well people did in responding to the Covid crisis. That is no excuse for improper dealing. Will the Minister say not only that these details will be published but that I and other Members of this House will get that list soon, as the information should have been published within 30 days of the contracts being signed?

[Lord Bethell (Con)]

I am grateful to the noble Baroness for this opportunity. We take transparency extremely seriously. We share the same values about doing things in the proper way. I stress “the proper way”. The NAO report does not say that the way in which the pandemic was responded to was “improper”, as she suggested. In many ways, the report is supportive of the point that we were facing an unprecedented global pandemic that posed a massive challenge to the entire country. We needed to procure contracts with extreme urgency in order to secure vital supplies. The shadow Health Secretary called on the Government to “move heaven and earth” to get needed PPE to staff. The leader of the Opposition quite rightly called on the Government to get rid of blockages in the system, saying:

“The Government must act to ensure supplies are delivered.”


We did everything we could to do that and I am proud of the achievement of those involved.

Covid-19: Adult Social Care Complaints

Baroness Hayter of Kentish Town Excerpts

Monday 5th October 2020 Lords Chamber

[Lord Bethell (Con)]

No one should be under any pressure, financial or otherwise, to move unless they are absolutely determined to. I emphasise that anyone who has a complaint should complain either to the ombudsman or through the CQC and Healthwatch system. To encourage knowledge of and access to that complaints procedure, we have launched the “Because we all care” campaign, which is encouraging people to use the NHS and social care feedback systems in a way that captures the learnings from Covid during this difficult time.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, given the close relationship between social care and the health service, the Government initially agreed that they would combine the two ombudsmen—the PHSO and the one for local government and social care. That is desired by both ombudsmen. We have had a consultation and we have had the Bill, but we heard, on 9 September, that there are no plans in government to proceed with that merger. Will the Minister explain how on earth that can be in the interests of consumers, be they patients or clients?

[Lord Bethell (Con)]

The noble Baroness is entirely right. There are very good arguments for combining the two ombudsmen and that is recognised by both of them. However, the framework and structure for that kind of reform is best conducted when there is an overall reform of social care. The Government made it crystal clear during the election that they are committed to a major and significant overhaul of the social care system. That has been reiterated by the Prime Minister and the Secretary of State for Health and Social Care. When it happens, we will review the combination of those two ombudsmen, as the noble Baroness described.