Health and Care Bill

Baroness Neuberger Excerpts

Committee stage
Friday 4th February 2022 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I was—it is fair to say—flattered when the noble Baroness, Lady Cumberlege, asked me to co-sign her amendment, because I have admired all the work she has done, and I think her report, First Do No Harm, has had influence way beyond the group of patients she was looking at. Indeed, I was vice-chair of a NICE review, and we referred to it in terms of helping to empower the voice of the patients we had in that review process, which was, first, very important and, secondly, particularly helpful because they were very clear in their thinking, and they worked extremely hard.

I am also grateful to the noble Baroness, Lady Brinton, for referring to the General Medical Council’s briefing, because the GMC agrees that a solution to this needs to be

“Accurate, up-to-date, accessible and presented in a way that is useful for patients, so that they can have confidence in it”.

It also said that it must be “Enforceable”, and the GMC also wants it to be “Multi-professional”. However, I agree that we have to start somewhere. Your Lordships may think that the advantage of a local register is that it is more accessible, but the disadvantage is that doctors move around in different jobs, particularly trainees—but even consultants’ time in one post is now relatively short; it used to be a lifetime appointment.

It is important that, as a doctor, I am prompted to be completely open so that there can be no subliminal influence on my decision-making. The most dangerous influences are the subliminal ones—not the ones where you are completely open about what is going on. There has been a great clamp-down over recent decades on the pharmaceutical industry because of sponsorship and so on, and that has decreased influences on prescribing. But when it comes to using other products in medicine, the same can apply. I think that a register would help the profession itself in making clinical decisions. I do not see this in any way as inhibiting research; on the contrary, it would display who is research active and who is achieving results through their research.

A register would support the development of innovative healthcare and support novel thinking because it would be declared and open. It would also support the move that people should always publish their results, whatever they are.

[Baroness Neuberger (CB)]

My Lords, I support Amendment 283 in the names of the noble Baroness, Lady Cumberlege, and my noble friend Lady Finlay. Like my noble friend Lady Finlay, I want to say how grateful I am and how touched I was that the noble Baroness, Lady Cumberlege, asked me to add my support to this amendment. I also need to beg your Lordships’ indulgence: if we do go beyond 7 pm, which I sincerely hope we will not, it is actually the beginning of the Jewish Sabbath. I should not be here now, and I certainly cannot be here after 7 pm. I will pretend that I am just slipping out briefly, but I am vanishing at 7 pm whatever happens. Your Lordships will be very glad to hear that I am not going to talk until then.

When the noble Baroness, Lady Cumberlege, asked me to support the amendment, I said that I would consult with the medical directors at the two NHS trusts that I chair, the University College London Hospitals Foundation Trust and Whittington Health NHS Trust. I did exactly that, and I have never had emails back so quickly from the medical directors—there are four of them between the two trusts. The amendment was welcomed unreservedly; they really want this to happen. The medical directors had no doubt that this was both an ethical requirement and indeed something to be encouraged in how doctors think about their own practice. That is the point that my noble friend Lady Finlay made. It is something about the subliminal; it makes you start thinking differently and your reactions become different.

One of the medical directors pointed me to Patrick Radden Keefe’s superb book about Purdue in the United States, Empire of Pain, and said that in a way that is exactly the issue here. Some of the people clearly knew that what they were doing was totally wrong, but some did not realise that what they were doing was wrong, because they had not got the subliminal way of judging, because this was accepted practice. That is the really strong argument for this: we need to be able to encourage people to think differently. There are lots of doctors who desperately want it, as the medical directors at my two hospitals have made entirely clear.

I pay huge tribute to the noble Baroness, Lady Cumberlege, for her report First Do No Harm—as well as for the many other things she has done, but in particular for that report. It has changed the way that quite a lot of people think; it is quite hard to achieve that with a report and it is a very remarkable thing to have done. This is a national and international issue. We are concerned here only with the national, but we could—and should—set an international example of good practice.

After the Paterson review and First Do No Harm, this is now urgent. The GMC is obviously the right body to hold such a register, and I say so as a former member of the GMC. I was rather sad to see its somewhat lukewarm reaction in its briefing and I think that it has got this wrong. They are the right people to hold the register and to make it available to patients. The public must be able to access it. The employers, individual doctors, the Medical Royal Colleges and others must all play their part and, of course, other health professions must follow suit.

Let us start here. This needs to happen, and it needs to happen fast.

[Baroness Thornton (Lab)]

My Lords, I can only add to the last remark of the noble Baroness that this does need to happen. I can see why the GMC is so unenthusiastic, as it was in its briefing note, because it looks like it is probably about 300,000 people and that is a big job. However, the question that I ask myself is, if a large pharma or large manufacturer of medical products is having a national campaign that involves hundreds of clinicians across the country, how will we know that is happening if all the registers are local? It seems to me that that is absolutely the point. It has to be a national register and the GMC probably has to be persuaded. If it is not the GMC, we would have to set up something different, and that would probably be a ridiculous thing to do. So the noble Baronesses, Lady Cumberlege and Lady Finlay, are quite right: we have to make progress on this.

Tributes: Baroness Williams of Crosby

Baroness Neuberger Excerpts

Wednesday 14th April 2021 Lords Chamber

[Baroness Neuberger (CB)]

My Lords, I too rise to pay tribute to Baroness Williams, whom I always knew as Shirley. Others have focused on her political career and I can certainly echo that, but I will pay particular tribute to her for two very distinct but sometimes closely interrelated qualities and achievements.

For me and many women of my generation, Shirley was a profound influence. She encouraged us in the 300 Group, formed to get 300 women into the House of Commons, and encouraged us as individuals. She did that by acknowledging the real problems that women often face in political life, particularly parliamentary life and particularly those trying to combine small children and a parliamentary career. She was very kind to lots of us. Indeed, my noble friend Lady Hayman has just asked me to record her kindness to her. She was kind to us all.

She was unfailingly supportive of women who wanted to make a difference, as she always described it, and she was unflinchingly honest about how hard it would be. I have particular reason to be grateful to her. I had known her slightly as a child, but she was particularly kind to me as a student at Cambridge, as her marriage to Bernard Williams was coming apart. I was then membership secretary of the Labour Club. There was one of the usual internal scandals, and my college room was broken into to collect the membership records for said Labour Club. I was terribly upset by this, but Shirley was immensely comforting. She assured me I was right to make a real fuss about it and egged me on in doing so. I have been making a fuss about things ever since, thanks to Shirley.

Shirley would ask many of us younger women thinking about political interests and careers to work out what we really minded about. She would also always argue that party politics was not the only way we could influence things—though for her it was the main route—and that we should think about academia, as of course she herself did so successfully as a professor at Harvard for 12 years when married to the wonderful Dick Neustadt. She said that we should also think about NGOs.

She influenced many of us. Talking to a group of much younger women yesterday, I heard that many of them, in their 30s, also traced their willingness to enter politics, both local and national, to her straightforward way of talking with them, to her popularity with women voters—“Shirl the Pearl”, if people remember that—and to her immense personal kindness.

Of course, you could not go anywhere with Shirley without lots of people, often women, coming up to her and paying tribute. It was somewhat inconvenient. A group of us would go walking regularly in the Chilterns, and quite often people coming in the other direction would go past us, then realise they had just walked past Shirley Williams, turn back and come and pay tribute. It was wonderful, but slow.

Her obituaries have focused to a considerable extent on her encouragement of women, but they have not really focused on her immense personal kindness. Members of staff in this House have been telling me how kind she was to them, but we as a family have one particular, unforgettable example among many. A friend, Ralph Skilbeck, the former diplomat who became a headhunter, was dying of a very aggressive cancer in his early 40s. He told us how he desperately wanted to meet Shirley but never had. I rang Shirley, and immediately—without hesitation and without knowing him at all—she agreed to come and meet him, which she did a few days later. He was over the moon. He died a few weeks later, talking to the end about how amazing she had been.

I could give this House many other examples of her immense kindness; she was a profoundly good person. I believe her legacy will be memories of her immense strength of character; her inspirational qualities, particularly for younger women; the fact that she became a national treasure; and her legacy of kindness and goodness to so many people. She was a wonderful mother, and particularly grandmother, to her family, and I know they have been amazing to her in these past few years. I officiated with a blessing at her marriage to Dick Neustadt and said a blessing at Dick Neustadt’s funeral. I do feel that I can now say, “May she rest in peace”.