Terminally Ill Adults (End of Life) Bill

Baroness Jay of Paddington Excerpts

Friday 16th January 2026 Lords Chamber

[Lord Deben (Con)]

It seems to me that this an opportunity for the noble and learned Lord to help the Committee and speed the Bill. Here are a whole series of amendments designed to deal with the genuine concerns of the experts who are going to have to actually carry this law into effect if we are to pass it. Some of us may have strong views about the principle, but we have a duty to do our best to make the Bill work.

One of the problems people have is that the noble and learned Lord has so far not been willing to tell the Committee that he will meet concerns by proposing amendments himself. In this particular group of amendments—which is why I tried to wait until the end of it, because it is not only on an individual amendment that I speak—there are a whole series of reflections of the concerns of those who will have to deal with the Bill when it is passed.

This is an occasion in which we can overcome a lot of the concerns—I might even say suspicions—that there is no intention of changing anything, and that it will just be pushed through, however long it takes, in order that there should not be a concern at the other end of the Corridor. I am sure that the noble and learned Lord does not really think that, but he needs to reassure the Committee. We will get much further, much faster if he can look at these amendments and say he is going to bring forward amendments that reflect the concerns here, which themselves reflect the concerns of the various medical bodies in particular, in order that the Bill will be a more effective Act.

If the noble and learned Lord does not do that, there is a very serious criticism of the Bill, that we are not reflecting in this House the concerns of those who, next to the people who make this choice, matter most: the people who have to implement it. All the medical bodies have reservations. Some few are opposed to it in principle. I am perhaps more interested in those who are not opposed to it in principle but who are concerned about it in practice. If we are not prepared to make the changes that make them happy—though perhaps “happy” is the wrong word—and able in good conscience to support the Bill and follow it through, then we will not have done our job as this reforming House. I say this because I have become rather weary with the fact that what appears to be true is that there are those for whom this is so important a doctrinal position that they are not prepared to consider that this particular formulation needs alteration.

Therefore, I ask the noble and learned Lord, when he comes to answer, to consider very seriously a willingness to say, “I will go through these amendments, talk to the people outside if necessary and bring forward the kinds of amendments that will meet the real concerns of those people upon whom I am going to depend for the efficacy of this legislation if it is passed”. If the noble and learned Lord is unable to do that, more and more of us will begin to wonder whether this is really a debate in which we are trying to improve the Bill and make it the best legislation possible, or merely one that will be prolonged for as long as possible in order to put through the exact same Bill to the House of Commons. Frankly, if it is that, all of us who have doubts about it should redouble our doubts. If it is not that, we have a duty to help the noble and learned Lord to get the best Bill possible. It is in his hands, and this may well be the moment for him to show his hand.

[Baroness Jay of Paddington (Lab)]

I wonder whether the noble Lord would accept the actual evidence of one member of the medical profession who gave evidence to the Select Committee. She reflected many of the concerns that people who support the Bill agree with. She said that, when the healthcare professions

“get it wrong … it is usually because we are being paternalistic”.

A great many of the amendments in this group are very well intentioned and meaning in their concern for patients, but we must allow for the fact that they rely on an assumption that the medical professions, in their doubts, may act paternalistically.

I have been married for a very long time to a doctor. He would certainly say that the practice of medicine has changed hugely in his lifetime, and that when he first qualified as a young doctor, the field was paternalistic. However, now there is a much greater assumption that the words, intentions and wishes of the patient should be the ones that carry force. That is obviously the philosophy behind so many of these amendments, which, in a sense, seek to reintroduce the paternalistic attitude of the medical profession. In contrast, those of us who support the Bill are much more concerned to support its underlying principle of the autonomy of the individual patient.

[Lord Deben (Con)]

I hope that it was an intervention, because, if so, I am able to comment on it. If we start talking about paternalism, we will go backwards in time. We are not really talking about that at all; we are talking about the legislation of this House and the House of Commons. We are talking about how we produce legislation that works. What worries me is that there are a lot of words being used, such as “paternalism”, “kindness” and others, that are making us less precise. Law has to be precise enough for it to be properly implemented.

Frankly, the intervention of the noble Baroness sums up something else. There is a paternalism among some in this Committee who feel that they are so right about the Bill and that they can therefore ignore the comments of people who are trying very hard to overcome their own prejudices—if that is the right word—to get the Bill right. I find it a bit discomfiting to be lectured to, from time to time, as if I should not be making any of these comments because I do not seem to understand the higher views that are being presented. After being a Member of Parliament for 40 years and knowing what goes on in families in terrible circumstances, all I am trying to do is protect people. That is my job; it has been my job all my life. In response to the noble Baroness shaking her head, I say: that is not paternalism; that is the role of leadership in any circumstances. It is what decent people do, and, above all, it is what kindness demands.

Terminally Ill Adults (End of Life) Bill

Baroness Jay of Paddington Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

[Lord Rook (Lab)]

With the greatest respect, that is not the conversation I am trying to have here. The conversation is about the necessity that someone who is going through the process has continuity of care and a relationship with that GP. We are suggesting that someone who is after a state-assisted end-of-life process should have the opportunity to see that GP on a number of occasions so that their judgment can be made in the context of continuity of care, not in one appointment.

To pick up the noble Lord’s questions, this amendment would not block access. It would not frustrate autonomy. It would simply ensure that assisted dying does not begin from nowhere. It grounds a grave decision in a minimal but essential relationship with the health service that is charged with safeguarding the person in question. Supporting autonomy requires a supportive context. It requires knowing whether a request reflects a settled conviction, a moment of despair, untreated depression or pressure that the patient feels unable to articulate. These things cannot be reliably assessed in isolation. Above all, care is relational. If Parliament is to contemplate legislation under which the state may participate in deliberately ending life, the very least we must insist on is that such decisions take place within the context of real and primary medical relationships, not on the periphery of the system.

This amendment would strengthen residency safeguards, improve the evidential foundation for clinicians, reduce the risk of doctor shopping and respect the seriousness of what the Bill proposes by rooting it in genuine and consistent care. I commend the amendment to the Committee.

[Baroness Jay of Paddington (Lab)]

Can I ask the noble Lord, having cited the doctor Michael Mulholland as a great authority in relation to his evidence to the Select Committee, whether he also accepts what Dr Mulholland said to the Select Committee? He said:

“As GPs, we are very used to providing holistic care and trying to understand where the patient is coming to us from in lots of situations”.

[Lord Rook (Lab)]

I absolutely agree with that. The reason why the doctor is able to do that is because he gives consistency and continuity of care. He does not see patients on one occasion on one big issue, but is able to travel with them in a longitudinal relationship, and that gives him the ability to make those decisions.

Terminally Ill Adults (End of Life) Bill

Baroness Jay of Paddington Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Baroness Butler-Sloss (CB)]

My Lords, I declare that I was a vice-president of Hospiscare in Exeter. I am probably the only person in this Committee who has tried cases of capacity, again and again, both as a High Court judge and in the Court of Appeal. One case was so difficult that the Court of Appeal, where I was presiding, sat until 1 am. Noble Lords may not have thought that the Court of Appeal did that very often. It is important for your Lordships to realise that some cases that I tried were extremely easy to try—one in particular involved a Miss B, who was obviously competent—but other cases were extraordinarily difficult. One case—the one that we did until 1 am—concerned somebody with a needle phobia who was expected to need a caesarean, and she objected because she could not bear the idea of a needle. At one in the morning, we took the view that she did not have the mental capacity to decide on her caesarean. She was hugely relieved and had the operation without any trouble. But that was not a unique case—the time was, but not the problem.

[Baroness Jay of Paddington (Lab)]

My Lords, I of course enormously respect the experience of the noble and learned Baroness and her ability to make these judgments. I am sorry that she had to sit until 1 am. But does she feel that those decisions would have been more or less complex and difficult if she had been judging them on the basis of ability?

[Baroness Butler-Sloss (CB)]

I have not the remotest idea. It is such an important point that I would have to go away and reflect. I am not commenting on ability or capacity; the point I am making to the Committee is about the difficulty of this for a doctor, or several doctors—probably GPs. The Royal College of Psychiatrists, of which I am an honorary fellow, has said firmly that it wants nothing whatever to do with the panel or with this, so doctors who are not psychiatrists will decide, with other people, whether somebody has or does not have capacity. That is what is currently in the Bill.

I warn your Lordships that this can be difficult, particularly when it involves depression. I had a friend, a solicitor, who suffered from depression. She said that she used to fall into a black pit and try to crawl up the sides, which were slippery. It was clear to me that, when she was in that depression, she certainly did not have the ability to make serious decisions. So I warn your Lordships about the potential problems of assessing capacity.

--- Later in debate ---

[Baroness Jay of Paddington (Lab)]

My Lords, I am grateful to my noble friend Lady Thornton for raising the question of other countries. Some of us here have sat on Select Committees on this subject over a large number of years; for example, I did so 20 years ago. I would not suggest that that evidence is necessarily completely relevant, but the fact is that we have taken evidence. We have not simply taken written evidence; we have been to countries where this has been in practice for many years. If, for example, noble Lords were to look at parts of the United States such as Oregon—one of the states that introduced assisted dying many years ago—they would see that the improvements in palliative care have been enormous and coincident with the application of assisted dying. It has never been the case, for those of us who support the Bill or support the general principle of assisted dying, that there is a choice between palliative care and assisted dying: both should be available.

[Baroness Scotland of Asthal (Lab)]

I never suggested that they should be alternatives. The truth is that palliative care is not available in all parts of our country, so this has to be a real choice. That is the only element I made.

Also, I hope that all of us would look at the evidence, from wherever it came. We know that we have to make evidence-based decisions, and the best evidence will help us to make the best decisions.

King’s Speech

Baroness Jay of Paddington Excerpts

Thursday 9th November 2023 Lords Chamber

[Baroness Jay of Paddington (Lab)]

My Lords, I follow other noble Lords, in welcoming and supporting the measures to reduce smoking, but like the right reverend Prelate, I am most concerned this afternoon about the lack of any broad-based public health programmes in the gracious Speech. Public health, after all, is central to successful healthcare in this country and, indeed, to the overall health of the nation, yet it has been neglected for many years and is neglected again. I repeat my welcome for the tobacco products Bill, but one Bill does not create a strategy. In every area we look at, the need for a broad-based programme to meet the public health crisis we are facing is urgent. In every problem you look at—from obesity to sexual health, from children’s dentistry to disease caused by damp housing—the situation is getting worse and worse. At the same time, we have seen the capacity of the NHS fall. Sadly, it has become a struggling health sickness service, rather than a positive health service. If we want the NHS to be renewed and restored to its proper role, we must primarily focus on avoiding preventable disease and promoting healthy living through cross-government programmes.

At the Labour conference last month, the shadow Health Secretary, Wes Streeting, promised that a Labour Government would deliver a prevention-led revolution. He insisted that a broad revolution, putting prevention first, could be delivered through social, economic and environmental change. This, he said, must lead to less illness and therefore less pressure on the NHS. Now there is no doubt that achieving this type of change is complex, difficult, expensive and long term. But under the Conservative Government, many prevention initiatives have been greeted with the cliched expression, “a nanny state” calling for intervention in our private lives. I understand that even the new anti-smoking Bill, which has the Prime Minister's personal endorsement, has already been criticised by his own MPs on this basis.

In the last 13 years, many of the specialised institutions that focused on promoting good health have disappeared or been marginalised. The Government abolished Public Health England, which had a global reputation for its expertise and research. The grandly titled Office for Health Improvement and Disparities has been recently set up, but so far no grand practical statement of environmental activity has been announced. Today, many of the responsibilities for public health have been devolved to local authorities; at first sight that seems a good idea as so many services that can affect people’s general health are provided at a local level. However, the Treasury’s public health grant to local authorities has been reduced by a staggering 26% in the last years; not surprisingly, basic services have suffered badly or completely collapsed. Apart from the financial cutbacks, the connections between organisations commissioned by individual councils and the health service can be weak and can reduce vital capacity. Services have sometimes been outsourced to independent bodies, which do not have the necessary expertise to deliver them. This has been recently drawn to my attention in relation to HIV and other sexually transmitted infections. There has recently been an alarming increase in many of these infections, some of which are growing by as much as 50%. These must require medical care, which is often lacking in an outsourced clinic. For example, only half the clinics can now offer face-to-face appointments for individual advice and treatment—they simply cannot deliver good practice.

However, even if the Government have somewhat neglected the needs of good public health, it is encouraging to see the current level of parliamentary interest and engagement with these issues. The well-established All-Party Group on Health in all Policies has been able to broaden the discussion about reducing health inequalities and promoting healthy lives in ways that go way beyond traditional concerns about, for example, working conditions and safety. The Levelling-up and Regeneration Act 2023 could have been an opportunity to put some of these policies into legislation, specifically in the area of poor housing. There were several attempts to amend the Act in this way but all failed, although it must be remembered that the health effects of inadequate housing already cost the NHS about £1.4 billion a year. In this House, the noble Lord, Lord Crisp, with his vast experience in public health, pursued his amendment on healthy new homes to the point of ping-pong proceedings and still he did not succeed. In final exasperation he said:

“I have taken the key message that the Government do not want to … ensure that new homes and neighbourhoods promote health, safety and well-being. I think this is extraordinary.”—[Official Report, 23/10/23; col. 437.]


I must say that I agree with him.

Meanwhile, our very active Peers for the Planet organisation is urging an even broader approach to public health, which I support. It argues that the crises of climate change and threats to nature have a profound impact, and there are calls for the WHO to declare this a global health emergency. As far as the UK is concerned, the effects of higher temperatures have already been observed. In 2022, heat-related mortality in this country was up by as much as 42%, which is well over the five-year average. The very respected journal the Lancet has suggested that we should act immediately in this country on cleaner energy, improved air quality and access to green space. It is a vast agenda, but it should not be overwhelming. It needs a new clear strategic approach by the Government and resources to match. Given their record, I do not expect the present Government to give priority to this in the last months before a general election. On the other hand, the Labour Party has already published ambitious plans for its prevention and revolution in health. I am confident that there will be manifesto commitments on public health in all social policy. We can then have a programme that both improves health and renews the NHS. I look forward to discussing a new approach in the debate on the next gracious Speech.

Covid-19 Regulations: Assisted Deaths Abroad

Baroness Jay of Paddington Excerpts

Tuesday 10th November 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Baroness is entirely right; Covid has, in a very sad way, thrown a spotlight on the circumstances of those dying alone. That is one of the harshest and most heart-breaking dimensions of this awful pandemic. It throws a spotlight in particular on the way in which the law is applied in this country. The collection of data is a very important component of our review of this important area and I will definitely ensure that the indication given by my right honourable friend in the other place is picked up back at the department.

[Baroness Jay of Paddington (Lab) [V]]

My Lords, I am generally encouraged and relieved by the Government’s responses on this Statement, particularly the point made in the Commons by the Secretary of State that assisted dying must be considered in the general discussion of good end of life care. I hear the Minister say that a formal review is not planned, but when the Government come to look at the concerns about death and dying that have been thrown up by the pandemic, will they ensure that the questions of proper personal choice at the end of life will be both included and emphasised?

[Lord Bethell (Con)]

Well, this is an extremely complex issue. As the noble Baroness alluded to, there is a wide variety of issues at stake, including values issues, questions of faith and, as she rightly said, questions of personal choice. There are the components here for an important national debate. I acknowledge the comments of several noble Lords already that we are approaching the moment when that debate seems more relevant than it has ever done. When that debate takes place, certainly personal choice will be an important part of it.

Hospitals and Nursing Homes: Do Not Resuscitate Notices

Baroness Jay of Paddington Excerpts

Thursday 1st October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, it is completely unacceptable for any group of people to have blanket DNACPR provisions apply to them. The adult social care winter plan published on 18 September reiterates that and makes the position crystal clear. The General Medical Council is providing additional support and guidance to clinicians on how to meet the needs of patients and relatives, and the Resuscitation Council UK is creating a large amount of resources to provide training. The CQC is monitoring the situation extremely carefully.

[Baroness Jay of Paddington (Lab) [V]]

My Lords, the distressing circumstances of the pandemic have once again highlighted the difficult and sometimes controversial issues about end-of-life treatment in general and individual choices. Will the Government set up a long-proposed review to examine all these issues, particularly to improve real patient choice?

[Lord Bethell (Con)]

The noble Baroness is entirely right. The Covid epidemic has shone a spotlight on the awful arrangements around end of life at a time when contagious disease presents a threat to all those present in a nursing home or hospital. Our thoughts and prayers go out to all those who have lived through such an experience or will face one in the near future. I note the noble Baroness’s call for a review. There is no current plan for one but I will carry the idea back to the department.

Covid-19: Rise of Positive Tests

Baroness Jay of Paddington Excerpts

Wednesday 9th September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, we are deeply concerned about the BAME incidence of this horrible disease. We have put in place extensive new marketing arrangements targeted at BAME audiences. We have targeted our testing arrangements through mobile testing and door-to-door availability at that communities that have been hardest hit, and there are guidelines to NHS trusts to put in place the necessary safety arrangements for those with a BAME background.

[Baroness Jay of Paddington (Lab) [V]]

My Lords, following the Government’s statement that the rise in infection rates is due largely to increased spread of the virus among young people, what strategies do the Government propose to adopt to ensure that returning students, for example, and others, comply more stringently with public health regulations?

Tessa Jowell Brain Cancer Mission

Baroness Jay of Paddington Excerpts

Monday 13th May 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank my noble friend for his question. He is absolutely right that we want to focus on outcomes. That begins with earlier diagnosis, shorter waiting times and access to treatment. However, when it comes down to it, we want to know that we have better survival rates. Cancer is a priority for the Government so that we can improve that, and the quality of care for patients. I am pleased to report to the House that survival rates are at a record high: since 2010, rates of survival from cancers have increased year on year. However, we know that there is more to do, and we will never have any measure of complacency about this. That is why in 2018 the Prime Minister rolled out a package of measures to see three-quarters of cancers detected at an early stage by 2028—the current figure is just over half. The plan is to radically overhaul screening programmes to provide new investments in state-of-the-art technologies to transform the process of diagnosis and boost R&D. My noble friend is absolutely right that one of the areas that we must focus on is ensuring that treatment has the lowest burden of side-effects possible. The proportion of cancer survivors living with long-term disabilities as a result of treatment is high, so having more targeted treatment is absolutely a priority within our cancer strategy. I will be delighted to write to my noble friend with a specific update on where we have got to with PET scanners.

[Baroness Jay of Paddington (Lab)]

My Lords, I echo noble Lords who have said what a fitting and appropriate tribute it is to Tessa that, on this anniversary of her death, we have heard this encouraging update from the Minister. It was a great sadness to me that I missed her final speech in your Lordships’ House because I was abroad, but having worked with Tessa for more than 20 years in many different roles, I found it unsurprising that she showed her characteristic determination, courage and campaigning skills, which she carried on with absolutely to her final days. It is extraordinarily good to know that her daughter, Jess Mills, carries on this work today, as my noble friend Lady Thornton said.

I make two points that I know that Tessa would have emphasised. The first is the importance of what one might call translational research, as the Minister said. I know that one problem that Tessa had as an individual was that she could not find out, except by exercising her characteristic energy and skill with the computer, what was going on. It is very important that in developing both treatment and research in these difficult areas of cancer—the glioblastoma from which she suffered being one of the most intractable—individual patients have the opportunity to know more broadly what is available.

That is why it is particularly important that the announcement today reveals not only new treatment but emphasises that it will be available in all cancer centres across the NHS, because not all of us are blessed with Tessa’s energy and ability to find things out. Particularly when people are feeling very vulnerable when they are diagnosed, their need for clear available information is paramount. It is very good to hear that that will be more available in future.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her comments and think that she has hit the nail on the head. I think I can say that Tessa’s characteristic verve is being carried on and honoured by those involved in the mission: I have been in post for a relatively short time, but I have already met the mission and Jess twice, and they have nailed me down on commitments and ensured that I follow through on commitments that my predecessor, my noble friend Lord O’Shaughnessy, had made. It helps that he is still involved in pushing them forward.

One of the key principles of the mission is that it provides a convening function, bringing together government, the NHS, charities, industry and patients in working together to identify and drive through progress on areas that need improvement. One key area that has been identified is patient care, support and communication. As the noble Baroness said, Tessa was passionate about ensuring that patients can get rapid access to new treatments and know where they may be. That is one of the principles behind the brain cancer matrix. Separately, we have introduced the accelerated access collaborative programme to try to bring in other treatments that might be complementary to patients as quickly as possible through the NHS system, recognising that the NHS, while incredibly innovative, can be low and slow at times in adopting those innovations across the system in a consistent way. We want to make that better.

Health: HIV

Baroness Jay of Paddington Excerpts

Monday 4th July 2016 Lords Chamber

[Lord Prior of Brampton]

I can confirm that all the people who are receiving PrEP as part of the PROUD trial will continue to receive it going forward, which I think answers the main point made by the noble Baroness. In terms of the conduct of the trials that I referred to earlier, they will largely be organised and shaped by Public Health England.

[Baroness Jay of Paddington (Lab)]

My Lords, I have to declare an interest because my husband chaired the Medical Research Council committee that oversaw the original trial on this. The trial was suspended because it was so successful. It was suspended on ethical grounds because it was thought that the people in the control group must receive the drug. Do the Government agree that it is unethical, whatever the legal or financial situation, not to make the drug more available now, particularly given the alarming rise in new cases of HIV in gay men?

[Lord Prior of Brampton]

I am not an expert in this area, but having thought and read about this issue a lot over the past few days, it seems to me that the number of people who have not been diagnosed with HIV is a critical issue. As those people are not aware that they have HIV, their behaviour is not adjusted and because they are not taking treatment, they have a greater amount of the HIV virus. It is estimated that 18,000 people have not been diagnosed so, if one had to make a choice, increasing our rate of diagnosis must be crucial. However, I do not disagree with the noble Baroness that the evidence around PrEP as a prophylaxis is strong.

Health

Baroness Jay of Paddington Excerpts

Thursday 26th November 2015 Lords Chamber

[Baroness Jay of Paddington (Lab)]

My Lords, I thank the noble Lord, Lord Crisp, for introducing this debate in such an informative and authoritative way. It is obviously a very important issue. I wholeheartedly agree with the terms of the noble Lord’s Motion and support his points about the way in which the determinants of health in today’s society are often driven by matters such as alcoholism, obesity and other concerns, which are obviously not the sole responsibility of the NHS, however much we support it.

I think that the way that the noble Lord has proposed is the only way to improve the stark health inequalities in this country. As he reminded us, we are all familiar with the really disgraceful record of discrepancies in morbidity and mortality between different social and economic groups in this country. It has become almost a truism of health economics that low income and low social status are major contributors to ill health, and probably the determining factor in more rapid ageing.

The proposal of the noble Lord, Lord Crisp, for working towards a “health-creating society”—I am still finding it a little difficult to put those three words together—must be the right approach, but my concern this afternoon is: if the ideas and the vision he describes gain general support, how are they to be delivered? How will we make it happen? As noble Lords are aware, there is enormous emphasis nowadays on localism and finding solutions and organising action as near as possible to the communities involved. I worry that there are difficulties in relying primarily on the local approach to tackle some of the somewhat intractable problems of public health.

Of course, community-based alliances of public service, private enterprise and the voluntary sector can often unleash especially effective energy, and there have been some interesting and radical ideas put forward recently on this ground. I was intrigued, for example, by an article by the chief executive of the Royal Society for Public Health, who wrote about the local high street as “an untapped resource” for promoting health. She picked up on the WHO statement that modern society is actively marketing very unhealthy lifestyles, which the noble Lord, Lord Crisp, has already referred to, and argued that stricter local planning laws and differential business rates could drive businesses such as fast-food outlets, betting shops and payday loan shops out of the high street and reduce the tempting opportunities for unhealthy lifestyle choices. I can see the attraction of this proposal, but in the broader picture I fear that the huge reductions in the budgets of local authorities, combined with a lack of local expertise in specialist problems such as sexual health, may make local projects inadequate and sometimes even increase inequalities.

I hope I will not be labelled a centralist dinosaur for saying that national government and a senior Minister must take the lead responsibility for promoting change in this area and achieving the necessary collaboration to build a health-creating society. I was proud to be a Health Minister when the very first Minister for Public Health, my noble friend Lady Jowell, was appointed to that post. She was a senior Minister of State with a wide remit and, although the post has continued in successive Governments, it has not always had the authority of the original appointment and, very importantly from my point of view, it has always been based in the Department of Health. In my view, a Cabinet post should be created—we will have to think of a good title—to take forward the cross-cutting policies we are discussing. This Minister should be based in the Cabinet Office, with co-ordinating powers across government.

My enthusiasm for this approach is partly based on my experience as Minister for Women, when I was based in the Cabinet Office and worked with several departments across Whitehall and with outside agencies. It was a largely successful arrangement. My Cabinet Office team acted as a kind of internal pressure group within the Government; we legitimately raised issues of women’s employment, education, health and pensions across Whitehall and had the authority to do so. I think that the interesting and imaginative proposals for a health-creating society can only be delivered by an imaginative approach from the machinery of government, and I would like to see a Cabinet Minister leading the initiative towards this vision.