Health and Care Bill

Debate between Baroness Northover and Baroness Finlay of Llandaff

Lords Hansard - Part 2 & Report stage
Thursday 3rd March 2022 Lords Chamber

[Baroness Northover (LD)]

The noble Lord, Lord Hunt, has very effectively introduced the amendments to which I have put my name, Amendments 162 and 173, and I wish briefly to express the support of these Benches for those. We also support Amendment 108, to which my noble friend Lady Brinton has put her name.

As noble Lords know, we have been inching forward on these matters with Ministers, and I welcome that forward movement. I note, however, recent warnings from Ministers that, for example, there are “opportunity costs” in implementing these measures, as ensuring that proper standards are enforced requires effort and potential cost. I understand that. Nevertheless, we cannot allow ourselves to become complicit in any way in organ tourism where the source of those organs is forced or where selling the organ is to address appalling poverty.

Some say that this trade may be declining in and from China. If so, that is welcome and might reflect international pressure, not least on the Chinese medical profession. It is not clear that those involved in the China Tribunal and the Uyghur Tribunal would agree that it is declining.

Even if we were to accept that, and Ministers seemed to indicate that they thought that might be the case, we are also hearing now of an increase in the selling of organs in Afghanistan because of the dire situation there. There have been recent reports of journalists seeing the scars of those who have sold their kidneys. That is a terrible indictment of our walking away from Afghanistan and failing to address the appalling conditions that we have left there. How can we regard such potential “donors” as being anything other than the most extremely vulnerable? How can you put that up against the vulnerable who may need to have donations?

As for the bodies exhibitions, we have discussed before how distasteful they are—but then we realise with horror exactly where these bodies seem to have been sourced: among other things, from Chinese prisons. We should never have condoned that, turning a blind eye. I agree with the noble Baroness, Lady Thornton, who argued in Committee that they should simply be banned. There is no reason whatever to agree to their continuation.

I now hear that the Government may argue—and this is incredibly familiar—that these amendments are flawed. As the noble Earl knows, often Ministers are given briefs that say, “This is a flawed amendment, so turn it back.” I am very familiar with them. In those circumstances, the best thing is for your Lordships to pass these amendments, because Ministers know, or should know, that the essence is extremely clear, and with government lawyers we can work out how best to sort out any unintended consequences. I hope that I do not hear anything about these amendments being flawed—and I say that to the Box. I therefore commend them to your Lordships.

[Baroness Finlay of Llandaff (CB)]

My Lords, I support all the amendments in this group, and I shall speak specifically and briefly to Amendments 162 and 173.

These amendments are updates to the Human Tissue Act, which was born out of public outrage following the Alder Hey scandal, when over 100,000 organs, body parts and entire bodies of foetuses and stillborn babies were stored in NHS facilities. The body parts of dead patients, including children, were removed without consent. Today, the Human Tissue Authority’s guiding principles, as set out in its code of practice, are consent, dignity, quality, honesty and openness. These principles should not only reflect how human tissue sourced from within our own nation is treated, we must treat human tissue and organs with the same principles when sourced overseas.

In China, as has been said, there is substantial evidence of Falun Gong practitioners and Uighurs—as well as some evidence of Tibetans and house Christians—being killed on demand for their organs. Blood is taken off them for tissue-typing at the time when they were taken into custody, often with no idea why they were taken into custody at all, other than that they belong to one of those groups. There is no consent, no dignity and no transparency.

On 7 December last year, the British Medical Association released a statement on the abuse of Uighurs in China, expressing

“grave concern regarding the situation in China and the continuing abuse of the Uyghur population of the country as well as other minorities.”

It went on to state:

“We are particularly alarmed by the reports of organ harvesting, forced birth prevention, and the use of genomics data for racial profiling.”


It urged

“the UK government and international actors to exert pressure on the Chinese government to cease its inhumane actions towards the Uyghurs”.

If we do not pass amendments as laid before the House today, we will be complicit with these practices, because we will be looking at them with Nelson’s eye, with all the evidence that we have that they are going on.

On Amendment 173, on the exhibition of whole bodies using a plastinated technique, I suggest that there is no transparency whatever. Any attempt to claim that there has been consent is extremely suspect, because consent is very easily falsified. I went to one of these exhibitions because I thought you ought to go and see what you are criticising. This was not an anatomical, educational experience but a visual display of plastinated bodies in all kinds of different poses. But the one that horrified me the most was a pregnant woman, quite advanced in her pregnancy and with the foetus in her womb, which had been plastinated. I do not believe that that woman would have given consent for plastination. That raised real questions as to why such an advanced foetus was in the womb of a dead woman without something there explaining the nature of her death, the cause of death and the circumstances in which she had decided to consent to such a procedure.

Health and Care Bill

Debate between Baroness Northover and Baroness Finlay of Llandaff

Committee stage
Friday 4th February 2022 Lords Chamber

[Baroness Northover (LD)]

My Lords, I have put my name to Amendment 270, which requires the Government to consult on raising the age of sale for tobacco to 21, and which the noble Lord, Lord Faulkner, has just introduced. I also express my support and that of these Benches for all the anti-smoking amendments in this group. My noble friend Lord Rennard will speak on them shortly. Together, these amendments seek to close loopholes, strengthen regulation and provide a mechanism to reinstate vital funding for tobacco control and smoking cessation. Tackling tobacco and the tobacco industry has strong cross-party support, as the noble Earl well knows, having been very much part of that himself over the last 20 years. He will note the number of us speaking to support these amendments, even though only four can sign each one. He will also note the contribution made by his noble friend Lord Young, not only here but in his Private Member’s Bill, and he will no doubt note that there are very few voices—possibly one—who tend to speak against such measures.

I welcome the progress that the Department of Health has made in this area, and that of local government, but other parts of government are not always totally aligned. We found that with pavement licences—the noble Earl will remember this—in the now-termed Department for Levelling Up, even though the new White Paper on levelling up has, rightly, as the noble Lord, Lord Faulkner, pointed out, identified addressing health inequalities as vital, and addressing smoking as part of that. Two cities in the north have the highest smoking rates in the country: Kingston upon Hull, at over 22%, and Blackpool, at over 23%. The average in the south-east is just over 12%.

These amendments are designed to help the Government and the Department of Health take forward their very welcome apparent intention for the country to be smoke free by 2030. The Government say they are committed to delivering a smoke-free country by 2030 but keep putting off what they have themselves declared to be the “bold action”, promised in 2019, needed to deliver what they said was an “extremely challenging” ambition. The tobacco control plan promised in July 2021 has been delayed again. When will it be published? No doubt “in due course”.

Meanwhile, instead of those bold actions, according to a recent leak to the Sunday Times, the Secretary of State “plots vaping revolution”, by providing e-cigarettes on the NHS. I agree that vaping has a role to play in a comprehensive strategy to end smoking. Vaping doubles people’s ability to quit smoking compared with existing nicotine replacement therapy. However, as we know, smoking is highly addictive, and even doubling success means that only a small proportion of smokers who were trying to quit would remain quit at the end of one year. Vaping is not a magic bullet and, although it will increase quitting, it will not prevent youth uptake, as raising the age of sale would, as the noble Lord, Lord Faulkner, has indicated. He set out extremely cogently the evidence for why this measure would be highly effective. I will briefly focus on why it would be proportionate and justified.

The age of 18 is often considered to be the age at which someone acquires all the rights and obligations associated with adulthood. However, this is not the case, and there are several examples of rights or obligations which are acquired earlier or later than the age of 18. Raising the tobacco age of sale to 21 would be consistent with the flexible approach that we apply to other age-restricted activities: those prohibited to under-21s in England include adopting a child, driving a large passenger vehicle, and supervising a learner driver, for example. Thresholds change over time, as demonstrated by the Government’s support for a Private Member’s Bill, which I welcome, to raise the age of marriage from 16 to 18.

It is now accepted that the late teens through to the early 20s—ages approximately 18 to 26—are a distinct period of life: young adulthood, when young people may still need support and protection. It was the period during which I hoped that my sons would develop what I thought of as a judgment gene—a gene that my daughter seemed to have had from at least the age of four, but they noticeably lacked. For care leavers it was excellent, for example, when in recent years social care was extended from 18 to 25. That had long been needed.

As we know, smoking is highly addictive and uniquely harmful, and an addiction which, if not begun by the age of 21, is very unlikely to happen at all. Tobacco is the only legal consumer product which kills when used as intended, causing the death of more than 200 people a day in the UK. This means that a unique response is required to minimise the burden of preventable death and disease that smoking inflicts. The evidence is surely sufficient to proceed with raising the age of sale, therefore this amendment is simply a modest proposal requiring the Government to consult. I commend this proposal and the other amendments in this group.

[Baroness Finlay of Llandaff (CB)]

My Lords, it is a great pleasure to follow the noble Baroness, Lady Northover, because I would like to pick up almost where she ended, on raising the age for the sale of tobacco. That measure has been successfully implemented in the United States, where smoking among 18 to 20 year-olds has been reduced by nearly a third as a result, so I support Amendment 270.

On Amendment 271, which affects the sale of nicotine products to children, it is rather horrifying to realise that it is not illegal for free samples of e-cigarettes to be given out to those under 18, even though it is illegal for them to be sold to those under 18. Amendment 271 would cover this. It would also cover the novel nicotine products, such as Japan Tobacco International’s widely advertised nicotine pouches—I do not particularly want to use their name because I do not want to advertise them. Unlike e-cigarettes, the marketing of these products is currently completely unregulated, despite the high levels of nicotine, which is an addictive substance. A quick search on the internet to look at the questions around them reveals that it is admitted that they are highly addictive, that they could affect the development of the brain and that they could result in mood changes in the user as well, possibly making them emotionally volatile. These are loopholes in the law, which can easily be fixed by our Amendment 271.

In Amendment 278, the noble Lord, Lord Rennard, seeks to ban all flavours in smoked tobacco. Again, this is another gaping legislative loophole which has allowed tobacco manufacturers to flout the current flavour ban.

I have led on Amendment 279, which relates to the packaging and labelling of nicotine products such as e-cigarettes. A cursory search online for these reveals that widely available electronic cigarette e-liquids feature cartoon characters in garish, appealing colours, with child-friendly descriptors, including sweet names such as gummy bears. Such branding is clearly unacceptable; it is targeted at the young. It is therefore deeply disappointing to discover that an amendment giving the Government powers by regulation to prohibit child-friendly packaging was voted down by them in the other place. The Minister said then that the Government

“are committed to ensuring that our regulatory framework continues to protect young people and non-smokers from using e-cigarettes.”—[Official Report, Commons, 22/11/21; col. 88.]

The Government can prove their commitment by supporting Amendment 279, which requires the Secretary of State to consult and report to Parliament on e-cigarette packaging, in particular the branding elements designed to be attractive to children.

European Union (Withdrawal) Bill

Debate between Baroness Northover and Baroness Finlay of Llandaff

Committee: 8th sitting (Hansard - continued): House of Lords
Monday 19th March 2018 Lords Chamber

[Baroness Finlay of Llandaff]

My Lords, as the noble Lord, Lord Deben, has pointed out, this is about moving into our law the regulations that currently protect us. That is why it seems appropriate in this Bill. I remind the Committee that the implications of Brexit for our health were published in the Lancet in a review in November last year, which detailed the areas that are in jeopardy. A fortnight ago, the Guardian reported a leaked document highlighting an unprecedented, co-ordinated effort by transatlantic right-wing think tanks to secure what they described as the “ideal” trade arrangement between Britain and the USA, which would involve the UK diluting its existing standards on food safety. I remind the House that the excessive use of antibiotics has resulted in superbugs, which is precisely why we have been worried about diluting any food safety standards. Working conditions in the farming areas that want to export to us are troubling. This would tear up the precautionary principle, whereby companies have to prove their product is safe before it can be sold, rather than waiting for it to be proven unsafe before it is recalled. That precautionary principle and the principle of safety run right through everything. As my noble friend Lord Patel outlined, and as previously discussed in Amendment 30, this relates to all of the infective areas, but it also covers toxic substances and the way that we handle those.

I strongly support this amendment because it would build up the health protections that we have built up slowly since we entered the European Union. It would simply guarantee the continuity of the present conditions and ensure that Articles 9, 11 and 168(1) of the Lisbon treaty are actually respected. It would require European institutions to maintain high levels of human health in all their policies and activities and would mean that these are then mirrored in the UK. It would of course affect areas of shared competence, such as environmental law, health and safety law, and public health law, as well as trade law. By mainstreaming this, it would build on precedents in UK law such as in Section 75 of the Northern Ireland Act, Section 149 of the Equality Act and Section 3 of the Human Rights Act. It covers acts of all public authorities, as I understand it. Judicial acts taken in interpreting retained EU law would then be subject to the same standards that we are used to and have become accustomed to. It covers the whole of the UK, irrespective of whether legislation is made or adopted in Westminster, Belfast, Cardiff or Edinburgh. I cannot see a reason not to accept it. It would maintain the standard to which we have become used. We are all aware of the dangers of dropping that standard.

[Baroness Northover (LD)]

My Lords, I support this amendment on public health. I feel very strongly on this issue, having played my part as a member of the health team on the government Benches that took the then Health and Social Care Bill through the Lords. My responsibility was to take through the measures on public health; I had an academic background in a related area. We placed public health back with local authorities. We said that public health would be safe there, in its appropriate place. As we have heard, the 19th-century development of public health in Britain led the way in extending life for those living in cities globally, and it did so in a local authority setting. It was not antibiotics that transformed life expectancy, it was public health measures.

So has public health been safe? Not recently, I submit. With local authorities and social care in crisis, what chance for public health? So when the Faculty of Public Health flags to me its worries about public health if we leave the EU, I listen. Yet another threat from Brexit, it seems, as the noble Baroness, Lady Blackstone, pointed out. The Minister will be aware of the concerns from the Faculty of Public Health and others working in this most important field. I am sure he will assure us that there will be no reduction in standards if we leave the EU—in which case, enshrine that in the Bill.

The public health community is concerned that, without the safety net of EU law, we may see our existing high level of vital public health legislation, policy and practice eroded. This year we celebrate the 70th anniversary of the NHS, as the noble Lord, Lord Warner, pointed out. Public health is a critical part of that NHS, not a side issue. We know that diseases such as cardiovascular disease, cancers, chronic respiratory disease and diabetes account for around 40% of premature mortality in the UK, and they continue to place a significant burden on patients and the health service. These conditions are to a large extent preventable and their costs in human, social and economic terms largely avoidable. We also know that effective public health strategies to tackle these and other challenges deliver an extensive range of benefits. As the noble Baroness, Lady Chalker, and the noble Lord, Lord Deben, have referred to, we have been able to bring benefits and improvements worldwide by the promotion of public health, from sanitation onwards.

That is why safeguarding public health is vital. The Government have said they will continue to co-operate with the EU on disease prevention and public health and that the UK will continue to play a leading role in promoting public health globally, so the amendment would simply put that commitment in the Bill. I have heard those promises on public health. When I was in government, I was worried that public health in local authorities was not ring-fenced as we were ring-fencing the NHS. I was assured by our coalition partners that all would be well. I was particularly worried about the position of reproductive health, given how essential yet controversial that might be. The reason why I am supporting the amendment today is that those promises proved rather hollow, so no promises that the Minister gives tonight will ring true to me. Whatever he may genuinely feel or whatever may be in his brief, they could be out of the window should the UK decide that standards are to be lowered or costs cut in an effort to increase the UK’s competitiveness. That is why the amendment is so important.

Legal Aid, Sentencing and Punishment of Offenders Bill

Debate between Baroness Northover and Baroness Finlay of Llandaff

Tuesday 20th March 2012 Lords Chamber

[Baroness Northover]

My Lords, this is a very important social issue. I do not think that anyone in the House disputes the fact that alcohol-related crime is a scourge blighting too many of our city and town centres and one we must address. I pay tribute to many noble Lords, especially the noble Baronesses, Lady Finlay and Lady Jenkin, and the noble Lord, Lord Avebury, for ensuring that we have reached this point. Through their amendments in Committee for an alcohol-monitoring requirement, this issue was flagged up in the way that it was last year in the Police Reform and Social Responsibility Bill.

In that regard, I also thank the noble Baroness, Lady Browning, who brought her knowledge, experience and wisdom to this area, including when dealing with the previous incarnation of this issue during the debates on the Police Reform and Social Responsibility Bill. The noble Baroness, Lady Newlove, has given an insight into the terrible harm that alcohol-fuelled violence can cause to victims and their families. I applaud the work that she has undertaken to help the Government establish a more effective approach to building active and safer communities, and in particular the work that she is leading to develop community-led, partnership-based approaches to tackling alcohol-fuelled crime and anti-social behaviour.

As noble Lords have demonstrated through their persuasive and informed words, it is vital that we look at new innovative ways of tackling the causes of alcohol-fuelled crime. That is why the Government have committed, as I set out in Committee, to undertake pilots to trial sobriety requirements as part of conditional cautions and community orders. Since then, we have considered the noble Baroness’s amendments. I was also fortunate to listen to the presentation from the United States based around experience in both South Dakota and Hawaii.

We have attempted to capture the essential elements of the amendments of the noble Baroness, Lady Finlay, in order to provide a practical power for the court to impose sober behaviour on offenders who commit alcohol-related crime. Through these means we will send a clear message that if you abuse your right to drink and damage those around you, that right can be taken away from you. That is why the Government are bringing forward their own amendment which provides courts with a new power to impose an alcohol abstinence and monitoring requirement as part of a community order or suspended sentence order on an offender who has committed an alcohol-related offence.

The amendment forms an important part of our wider response to these problems, introducing a new and innovative way of tackling the causes of alcohol-fuelled crime through enforced sobriety schemes. I pay tribute at this stage to the work of the London mayor, Boris Johnson, and the deputy mayor, Kit Malthouse, and to their commitment in this area. Their work on the alcohol abstinence and monitoring requirements is a testament to their determination to make a stand against alcohol-fuelled crime in the capital and we will continue to work with them in the development of this initiative.

The requirement as part of community orders and suspended sentence orders will therefore focus on serious offences, in particular violent offences, where alcohol is often a contributing factor, such as common assault, actual bodily harm, affray and violent disorder. Under the Government’s proposed alcohol abstinence and monitoring requirements, offenders will be required by the court to abstain from drinking for a period specified by the court up to 120 days. They will be required either to attend a police station or test centre to be monitored by breathalyser equipment or to wear an alcohol tag around their ankle. This innovative new electronic monitoring technology will test sobriety at half-hourly intervals during the day.

Before imposing a requirement, the court will have to establish a link between alcohol consumption and the offending behaviour. In a case where the offender does not comply with the conditions of the requirement, existing breach proceedings will ensue and the courts will have robust powers to penalise the non-compliance.

I wish to make clear that this requirement does not amount to treatment. That is not to say that supporting programmes such as alcohol awareness and education courses do not have a use here, alongside the abstinence requirement, to help ensure that offenders seek to change their alcohol-fuelled offending behaviour. However, it is distinct from the alcohol treatment requirement and the alcohol specified activity requirement, which seek to treat dependent drinkers and provide advice and support to offenders with other alcohol-related needs. For alcohol-dependent offenders and others needing treatment these options will continue to be the best avenue for addressing these issues.

These new provisions enable the Government to carry out initial trials which will test the processes and practicalities of enforced sobriety schemes and help build the confidence of the probation officials and sentencers who will operate them. We will make use of the lessons learnt to inform further work in this area. We are carrying out an additional pilot to test sobriety schemes as part of conditional cautions. The conditional caution is an out-of-court disposal which aims to tackle low-level crime. The pilot scheme will therefore be targeted at offences such as drunk and disorderly, criminal damage and public disorder, which account for a considerable volume of alcohol-related offences overall. The condition requires an offender to abstain from drinking on the days they are most likely to offend as a result of alcohol and to attend a police station to be tested, using a breathalyser, on those days—for example, Friday, Saturday or Sunday.

We have already had interest from a number of police areas in piloting the conditional caution scheme, particularly from cities where alcohol-fuelled crime is a severe problem. We heard quite a lot about that in Committee. We will announce the pilot areas in the forthcoming government alcohol strategy. The first conditional cautions enforcing sobriety should be administered from April/May. We believe that this is a considered and effective amendment to test out the important concept of reducing alcohol-fuelled crime.

Amendments 152ZC and 152ZD seek to remove provisions under Section 223 of the Criminal Justice Act 2003 to amend the minimum period of time specified for a drug rehabilitation requirement or alcohol treatment requirement under Sections 209 and 212 of the same Act. The Government are taking forward provisions in the Bill to remove the statutory minimum period for drug rehabilitation requirements and alcohol treatment requirements in order to increase the use and effectiveness of these requirements, allowing for greater flexibility in tailoring and delivering treatment and recovery options to individual needs. Provisions under Section 223 for these requirements are therefore no longer necessary.

The alcohol abstinence and monitoring requirement, introduced by our amendments, is to be available to the courts in England and Wales but not, of course, to the courts of Scotland or Northern Ireland. It is our intention that the requirement should not be capable of being imposed by a court in England and Wales on a person who is resident in Scotland or Northern Ireland. We undertake to bring forward and table amendments at Third Reading to make that clear. I beg to move.

[Baroness Finlay of Llandaff]

My Lords, I have some amendments in this group, but of course I am absolutely delighted that the Government have decided to bring forward their own amendments. If the House approves those amendments, I will withdraw the amendments in my name. I would like to add my thanks to all Peers from all sides of the House who have worked tirelessly to try to ensure that this localism response for local communities to deal with alcohol-fuelled offences can actually proceed and that this new sentencing ability will be available to the courts. I would also like to single out the noble Baronesses, Lady Browning and Lady Northover, both of whom have gone to great lengths to listen to all sides of the argument and to take those representations away. I know that they really have worked very hard behind the scenes to get to the point that we have reached today.

The government amendments do not include the “offender pay” content set out in my amendments. I understand that this is a complex issue and, depending on the outcome of the pilots, could be revisited at a later stage, but it has wider implications. The advantage of now being able to proceed with breathalyser pilots as well as tags is that, for those who have to present daily or twice daily for breathalysing, they will encounter staff who will be able to see how they are coping and offer them support to cope with all the other aspects of their lives that they have not been managing well and that have been contributing to their alcohol abuse. There is that support element and I know from the United States that the failure rate with tags is about nine times that with breathalysers. That is partly because the offenders tend to think that the electronics will fail and do not believe in the efficacy of the tags. They sometimes try to tamper with them and so on. It will be very important to see how it works here and compare the different systems.

This week there was a motion to seek international endorsement for these types of programmes from the 180-signatory nations to the UN Commission on Narcotic Drugs. These kinds of schemes are being debated there as well. I have had meetings with police officers from different parts of the UK and a consistent story that comes through is that after 10 pm at night alcohol-related problems are between 80 and 100 per cent of their workload, depending in part on the night of the week. Evidence of decreased reoffending has come from the USA and in the pilots we will be able to see whether that is replicated here. There, they are reporting a more than 50 per cent drop in reoffending at three years; a more than 50 per cent drop in drink-driving offences; and a more than 10 per cent drop in domestic violence. There has also been a fall in incarceration rates. Alcohol use appears to be interrupted before the person who has been abusing the alcohol can actually kill somebody, so they have decreased the very serious end of crime as well. We know that in London the Metropolitan Police recorded 18,500 offences flagged for alcohol. Offences involving violence against the person accounted for 64 per cent of those.

Health and Social Care Bill

Debate between Baroness Northover and Baroness Finlay of Llandaff

Thursday 8th March 2012 Lords Chamber

[Baroness Finlay of Llandaff]

Before the noble Baroness sits down, does she recognise that the legal status of children differs from that of adults? That is why they do not fall into the same category as many other vulnerable groups. Children do not reach the age of majority until they are 18, although they can consent to some things at 16. Therefore, they are always dependent on a responsible adult to speak for them or to open the door for them, as it were. They cannot form a group in the way that others in the population can to speak up for their rights and what they need. Will the noble Baroness reassure us that the Government recognise that the legal status of children differs from that of adults, and that if these amendments are not to be accepted, careful consideration will be given as to how that can be made explicit in the Bill before it completes its passage?

[Baroness Northover]

The noble Baroness made a poignant case for why children need to be listened to. I hope I can reassure her that HealthWatch England and local healthwatch have a responsibility to hear the voices of everyone, whatever their age. I accept what she says about the legal status of children. However, as she made very obvious, that does not mean to say that we cannot hear their voices and take very seriously their perception of how they can best be treated.

Health and Social Care Bill

Debate between Baroness Northover and Baroness Finlay of Llandaff

Wednesday 29th February 2012 Lords Chamber

[Baroness Finlay of Llandaff]

My Lords, I also did not put my name on this amendment because there was not enough space for more than four names.

I have a concern that the Health Protection Agency itself may have been a bit like a prophet in its own land and that it was not recognised fully until now, when we see its disappearance, just how important the work is that it has been doing, both nationally and internationally. Apart from already earning money for the UK, its potential to carry on doing so in the emerging large economies in other parts of the world and expanding its scientific input is enormous. It has the role not only of public health but of anticipating what threats may emerge in the future, particularly in the range of toxins that it looks at and studies.

These amendments seem to solve a problem that we have all heard about. We have all been at meetings; we have all met with the relevant people. I really hope that we will not just get told that this cannot happen for a variety of reasons. The amendments seem to be solving a problem that has only been created as a result of these changes. I cannot see that there is anything to lose, except that if the amendments are not accepted we might lose the capacity to earn international research funds in the future.

[Baroness Northover]

My Lords, noble Lords have raised a number of issues regarding Public Health England, many of which we discussed in Committee. Both then and today, we heard serious points very cogently argued, which we greatly appreciate. We have considered all these issues very carefully. Since Committee stage, the department has published more detail on the new public health system, including its operating model for Public Health England. The views expressed in Committee influenced the tone of those documents, and I hope that I can now reassure noble Lords that our proposals will give the agency the operational independence that it needs to become the leading organisation of its kind in the world.

The first point I want to stress is that Public Health England will function openly and transparently. Its operational freedom will be formalised in a clear and published framework agreement between it and the department. My noble friend’s amendment proposes that the PHE board must have a non-executive chair and a majority of non-executive members. We have considered this at length and understand what the amendment aims to achieve, but we do not agree that this is the best option.

The Public Body Review was clear that Ministers should take more responsibility for arm’s-length bodies. Cabinet Office guidance is also clear that nothing should undermine the direct accountability of an agency chief executive to the relevant Minister. We believe that there are sound and pragmatic reasons underlying that position, which could be put at risk by a governance structure dominated by non-executive representatives.

The public will look to the Secretary of State for leadership and accountability in protecting the nation from threats to health and they will be right to do so. The buck must be seen to stop with him. In the past, public health has too often been pushed to the fringe, which has been recognised by noble Lords. This arrangement brings public health centre stage. Instead of the NHS simply being a treatment service, public health in its widest sense will be central to the new arrangements.

Health and Social Care Bill

Debate between Baroness Northover and Baroness Finlay of Llandaff

Monday 13th February 2012 Lords Chamber

[Baroness Finlay of Llandaff]

Will the Minister clarify what the sanctions are when there is a failure to co-operate? Examples of failure to co-operate are emerging already. While there is an outline duty in the Bill, what are the sanctions when that is not happening?

[Baroness Northover]

Local authorities have a statutory responsibility for public health. If the noble Baroness looks at the outcomes framework, she will see where different authorities have different responsibilities. In order to discharge those responsibilities, those authorities will have to work together, otherwise they will not be able to deliver those outcomes.

In response to Amendment 25, we entirely share the view that we must make use of the best scientific and other evidence available. However, we do not think that an amendment to the Bill is necessary to do this. If the Secretary of State is to carry out his duty effectively, he must necessarily obtain and use such advice.

I heard how the noble Lord, Lord Beecham, read out the amendment. It is clear that evidence must be sought without it being skewed in any way by any special interests. However, the way in which the amendment is drafted implies that the Secretary of State might not be able to consult legitimate professional organisations or stakeholder groups that may have relevant expertise and experience. I made that point in Committee. We agree, clearly, that the inappropriate influence of special interests would not be right, but that is not quite how the amendment is drafted.

The Government’s Chief Medical Officer will continue to provide independent advice to the Secretary of State on the population’s health. She will be supported in this role by a public health advisory forum that will bring together expert professionals and leading partners to assist her in providing advice and challenge on public health policy and implementation. I hope the noble Lord will be reassured about that. The use of evidence underpins all this and there is no intention whatever that it should be skewed in any way. I trust that that reassures noble Lords and that they will not press their amendments.

Legal Aid, Sentencing and Punishment of Offenders Bill

Debate between Baroness Northover and Baroness Finlay of Llandaff

Tuesday 7th February 2012 Lords Chamber

[Baroness Finlay of Llandaff]

I will be grateful if the Minister will tell the Committee under exactly which parts of current legislation these pilots can be conducted. The legal advice that I have had is that it is only low-level offences. I have also been advised that breathalysers cannot be used under current legislation, so it would be helpful if she could specify which legislation they would be used under. Will she tell the Committee whether devices that detect alcohol in sweat are Home Office-approved and, if they are not, when she anticipates that approval will come through so that the pilots can start? Where will these pilots be conducted? When will they start? For how long will they be conducted? Who is funding them? Without that information, it is very difficult to accept at face value what sounds like a great idea, but we have heard it before, last summer, and I am afraid that no action has been seen since then.

I agree that alcohol does not cause domestic violence but I would be grateful if the Minister could tell us why alcohol-fuelled domestic violence is fundamentally different from other forms of domestic violence. Perhaps it is because it is witnessed by children in the family, who will bear those scars for their whole lives; at least if there is a drunken brawl out in the streets at midnight, it is not witnessed by children where their parent is being seriously injured. Therefore, I also ask for an explanation of why the Government have decided to downgrade the importance of domestic violence, which has extremely long-term effects.

[Baroness Northover]

I have to dispute what the noble Baroness says about downgrading the importance of domestic violence—we have not. It is because we recognise that it is a very complex and dangerous form of violence that we are separating it out from the assessment of the practicalities of this scheme in these pilots. It is something that has to be addressed across the board and in a much more complex way than whether or not you breathalyse or tag somebody and decide whether or not they have breached various conditions.

The noble Baroness has made her case extremely clear. We absolutely accept the principles. We are taking this forward in the pilots that I have mentioned. I realise there is another debate coming on. I am very happy to engage with her, as is my noble friend Lord McNally, and give her the answers to all the questions she has raised. I will not detain everybody at this point, and I hope that she will be prepared to work with us to take this further forward. As my noble friend Lord Carlile said, this is a very intractable, long-standing problem, but anything we can do to try to resolve the elements that we can, we should do; that comes overwhelmingly from people in this debate. We are taking forward these pilots—I give her that commitment—and let us discuss the details after the sitting.

[Baroness Finlay of Llandaff]

I am grateful to the Minister for having responded in that way, for offering to meet me and work through all the details. I am also extremely grateful for the support that I have had from all sides of the House, unequivocally. I make it clear that I am not against the tagging process; I am not against anything that deals with this problem effectively. What I am worried about is that if these schemes are not approved this problem will be kicked into touch for yet longer, as the noble Lord, Lord Carlile, said, and we just cannot do that. Like others, I also pay particular tribute to the noble Baroness, Lady Newlove, who has spoken movingly and has committed her life to trying to bring some good out of the tragedy that she personally suffered.

With that, I will not press my amendment tonight, but I look forward to further discussions, and I must warn the Government that if I do not get satisfactory answers I intend to bring this back on Report.

Health and Social Care Bill

Debate between Baroness Northover and Baroness Finlay of Llandaff

Monday 19th December 2011 Lords Chamber

[Baroness Northover]

I have already mentioned to the noble Baroness—she is probably totally familiar with this—that the Department of Health does not have evidence of there being a risk in this regard. Clearly, as I mentioned on the earlier group, these issues will always be kept under review. If the concerns that she has flagged up and if the association, which is particularly encouraging the regulation of clinical physiologists—that is fine; it is all part of professionalisation—flags up particular concerns that emerge from other evidence, then of course the department will take that very seriously. However, things need to be proportionate.

[Baroness Finlay of Llandaff]

I have listened very carefully to what has been said about the assistants relating to anaesthesia, but I also used the more catch-all phrase about the clinical perfusion scientists. I would be grateful if, after this debate, the noble Baroness would write to me and explain why coroner recommendations in relation to clinical perfusion scientists are not considered to be enough of a risk to take action. If one is trying to assess this on a risk spectrum, it would be helpful to understand why a coroner's decision to recommend that this small, contained group of clinical perfusion scientists should be regulated does not constitute enough of a risk to go down that route to regulate them and to have them on a statutory register.

[Baroness Northover]

I am very happy to take away what the noble Baroness has said and to discuss the situation further with her.

We expect the assured voluntary registration to be up and running by 2012. Therefore, afterwards that would need to be assessed to see whether anything further is required, as noble Lords have figured might be the case. We are hoping to see how it all works.

The noble Lord, Lord Walton, flagged up various groups which were regulated and he could not quite see why others were not. Given that I used to bump into the noble Lord, Lord Walton, in the Wellcome Library for the History and Understanding of Medicine, I think he will fully understand that the way in which regulation has grown up has not necessarily been logical or consistent. Therefore, I flag up the 2005 Hampton review on regulation which says that it should be proportionate to the risks that it seeks to mitigate and various other provisions. That is what we are seeking to do. Of course, we shall keep under review what we are doing to see whether it is adequate. In the mean time, I hope that the noble Baroness will be willing to withdraw the amendment.

Health and Social Care Bill

Debate between Baroness Northover and Baroness Finlay of Llandaff

Monday 19th December 2011 Lords Chamber

[Baroness Northover]

My Lords, the amendment links to an important point of principle which we wholeheartedly support: that any patient or person who receives NHS-funded treatment or care, whether the treatment or care was provided by an NHS or private provider, should have recourse to the Health Service Ombudsman, should their complaint not be resolved through the NHS complaints arrangements at a local level. I assure my noble friend Lady Williams that that is the first stage.

I reassure noble Lords that these types of situation are already provided for in law. I wish to address directly what the noble Baroness, Lady Finlay, has raised, which is the situation in Wales. The Public Services Ombudsman for Wales recently called for his office to be given more power to independently investigate hospices. This follows complaints from the family of a teenage girl who died of leukaemia, about the way their concerns over her care were handled. The ombudsman pointed out that he had no power to investigate the family’s complaints against the hospice, although it received public funds, as it did not fall into the same category as a hospital or a council-run service.

In response to a report published by the Public Services Ombudsman for Wales in 2011, we understand the Welsh Government are looking into extending the ombudsman’s remit, to enable him to investigate complaints about hospices and hospice services, as well as extending the existing complaints advocacy arrangements to cover complaints about hospices.

I therefore hope that the noble Baroness will be reassured by what I have been able to say, in that regard.

[Baroness Finlay of Llandaff]

I seek a little clarification. If I have understood right, the noble Baroness said that any provider is covered by the Health Service Ombudsman in England, and any cross-border provision would also be covered by the Public Services Ombudsman for Wales, irrespective of who that provider is. Therefore, the only change needed in primary legislation is to the remit of the Public Services Ombudsman for Wales, to make sure that the remit for non-NHS providers is extended within Wales; but that otherwise all patients, wherever they are in England, wherever they have come from and irrespective of the provider, have recourse to the NHS ombudsman. I suppose the same should apply to Scotland as well, though there is not the same cross-border flow.

[Baroness Northover]

To clarify, I say that all care paid for by the NHS in England is covered—that is the crucial thing. My noble friend Lady Williams also mentioned other care that might be covered. Whoever provides the care, the crucial thing is who pays for the care. Even if there is a private provider or a voluntary provider as well as an NHS provider, if the NHS is funding that care it comes under the ombudsman’s responsibility.

[Baroness Finlay of Llandaff]

I do not want to detain the House much further, but I think this is something we need to discuss, and probably away from the Floor of the House. One of the issues about hospices is that their care is not fully funded by the NHS: it is only partly funded. Some providers receive grants to provide care because they are mostly charitably funded, partly NHS-subsidised and helped—but it is not that the NHS is paying for that complete package of care. That is where the confusion and the difficulty lie. It would be helpful if we could unpick this later and see whether we need to return on Report with a very small amendment, so that we can make quite sure that the system is watertight for all patients.

[Baroness Northover]

I am very happy to take up the noble Baroness’s suggestion that we discuss this further. I hope she will be reassured by what I can say about Wales. However, if there is a company, for example, that is providing care partly within the NHS funding, the ombudsman would not cover the rest of what they are doing. It could lead to confusion if that were the case. I mean the NHS-funded part of care. However, I am very happy that we should discuss this concern further. I hope that on that basis the noble Baroness will be willing to withdraw her amendment.

[Baroness Finlay of Llandaff]

I am grateful to the Minister for that reply. On the basis of that and of further discussions, I beg leave to withdraw the amendment.

Health and Social Care Bill

Debate between Baroness Northover and Baroness Finlay of Llandaff

Thursday 15th December 2011 Lords Chamber

[Baroness Finlay of Llandaff]

If we come back later with an amendment which specifies people of all ages—I accept what she said about the elderly also not having an adequate voice at times to meet their needs—will the noble Baroness consider it? This is one occasion when the legislation can give a lead and set a moral code. I also seek an assurance that there will be specific mention of children in the official guidance that goes with the Bill so that they are incorporated at every stage and do not remain left out, as they have been until now.

[Baroness Northover]

I hear what the noble Baroness says. It is interesting that she said “people of all ages”. The purpose of healthwatch and the NHS is to help and try to assist people of all ages, whether they are patients, their families and so on. We need to make it more person-centred—we all agree that that is what we are seeking to do—and I hear what she says in regard to the regulations.

Health and Social Care Bill

Debate between Baroness Northover and Baroness Finlay of Llandaff

Tuesday 13th December 2011 Lords Chamber

[Baroness Finlay of Llandaff]

My Lords, the noble Lord, Lord Warner, was most helpful in setting out the criteria with which one would want to look at competition, and emphasising the importance of competition. But there is another area of competition, which is the one that really drives up quality of care: the inherent competitiveness of different clinicians and different clinical services, their desire to have better clinical outcomes than others, and the pressure that they will put on themselves within their own team to achieve better clinical outcomes.

I apologise to the House if I contributed in any way to the confusion over the numbering of the amendments as they have arisen. I would like to address the ones that come after Amendment 266, which will be Amendments 268B and 267C. Amendment 267C was tabled because of the large number of patients with complex clinical conditions.

It is very easy, when we are thinking about tariffs and services, to look almost at discrete nuggets of care, diagnosis and so on. Indeed, Monitor has a requirement in the Bill to seek appropriate advice to effectively discharge its functions in,

“the prevention, diagnosis or treatment of illness, or … the protection or improvement of public health”.

The amendment related to the management of a wide range of complex conditions has been tabled because in complex conditions many situations overlap and cannot be discretely targeted together, nor can they necessarily be unpacked one from another because of their impact on each other. That requires integration of clinical services.

[Baroness Northover]

The noble Baroness might be aware that Amendment 267C has leapfrogged from the group with Amendment 264 to the group after this. She may wish to address that amendment when we come to that group.

[Baroness Finlay of Llandaff]

I thank the noble Baroness. I am most grateful. That message had not reached me, although I may be a little deaf. I shall simply confine my remarks to the amendment in this group about Monitor reporting annually to the Secretary of State on how it discharges its duty to promote integration. I do not think that the comments that I made previously are annulled. They are relevant because, unless we have integrated services—however much they may be seen to be in competition with each other over different aspects—and attempt to have a seamless provision of care, at the end of the day it will be the patients who fall through the gaps.

Earlier today, we heard a lot about Monitor being light touch, not having a series of minimum criteria and being able to use its discretion in how it grants licences of all sorts. But I have a concern that there has to be a means by which the way in which Monitor functions is transparent and available to public scrutiny. That is why I have suggested that an annual report to the Secretary of State would allow such scrutiny to occur, particularly as regards promoting integration.

Health and Social Care Bill

Debate between Baroness Northover and Baroness Finlay of Llandaff

Wednesday 7th December 2011 Lords Chamber

[Lord Warner]

I do not wish to have any commercial-in-confidence information and I am sure my friends do not either. We want to know what is at risk out of the £150 million the Health Protection Agency is getting now under the new arrangements. If you can guarantee, in writing, that Public Health England is not at risk of losing any of that money I think we will be much more confident. We do not want the details of the commercially sensitive stuff we just want the global figure and the assurances of what it is at risk of losing.

[Baroness Finlay of Llandaff]

Can we also have the assurance that it will be eligible in the future to apply for a broad range of funding even if currently it does not hold a grant from a particular grant-giving body? I think that that applies to the MRC.

[Baroness Northover]

I hope the cameras are not shining down on this piece of paper of mine so I can try to give you some of the information that may be less commercially sensitive: there are organisations such as the Wellcome Trust and Research Councils UK. Noble Lords should be very reassured as to how this will work, but as a very junior Minister I have to be extremely careful.

The noble Lord, Lord Turnberg, flagged this up, I took it back and asked for a breakdown of the funding the Health Protection Agency gets. I asked in every instance what would happen in the future and I have a comprehensive answer because I thought it was extremely important. I hope noble Lords will be reassured both by my probing and these answers, even if I dare not reveal them all. I hope we can therefore write and reassure noble Lords that those working for Public Health England will indeed have access to the same kind of grants that they have at the moment.

Amendments 257A and 257B are minor and technical government amendments to Clause 54. These amendments would allow the Secretary of State or the Northern Ireland department acting alone to exercise functions in relation to biological substances for the whole of the United Kingdom. I was asked about sub-national structures. Indeed, Public Health England will have hubs. The precise details of these arrangements will be published shortly. As stated in Healthy Lives, Healthy People, we will provide further detail on the operating model for Public Health England.

I was also asked about emergencies. As I mentioned on the previous occasion when we debated public health, Public Health England will act on behalf of the Secretary of State as a category 1 responder. It will also be able to offer support or leadership in dealing with local incidents short of a full-blown emergency.

Reference was made to one or two other areas. If noble Lords will forgive me, I will write to them to sweep up what needs to be covered. I hope that noble Lords are reassured by what I have said. It is extremely important to the Government and to both Ministers in the Lords concerned with this matter that Public Health England is very strong and has the necessary independence. As the noble Lord, Lord Turnberg, put it, it should not be the mouthpiece of the Government. It needs to be able to conduct expert research. I hope that I have reassured noble Lords who have raised these very important points that all this is built into the Bill, and that the noble Lord will withdraw the amendment.

Health and Social Care Bill

Debate between Baroness Northover and Baroness Finlay of Llandaff

Wednesday 16th November 2011 Lords Chamber

[Baroness Finlay of Llandaff]

I am grateful for the reassurance that the noble Baroness does not see any way of uncoupling diagnosis from treatment. I am not terribly comfortable with the furniture analogy. Pieces of furniture are not as complex and integrated as human bodies.

[Baroness Northover]

I have a feeling that carpenters might disagree. Nevertheless, I take on board what the noble Baroness says, and I hope that I have reassured her.

Where was I? I think that I have covered the points spelled out by various noble Lords on research and evidence. Research and evidence would rightly run right the way through these arrangements, and I would have expected noble Lords to flag this up. It is absolutely crucial that evidence underpins the work that is done. I heard what was said about nudging, and so on. The Select Committee itself said that it welcomed the exploration of new ways of doing things, provided that they do not dislodge other ways of assessing things. It is extremely important that, in all these areas, you assess what the impact of something is. I hope that noble Lords will be reassured. We will come on to this in a minute.

--- Later in debate ---

[Baroness Northover]

I can see the temptation. The list in the Bill is indicative. These lists are always subject to much debate about what goes in and what stays out. I fully understand why the noble Baroness wishes to add her list. However, we would resist adding to the list in the Bill, which is, as she knows, indicative. We appreciate people's contributions to what needs to be covered in these areas. I point out to her that the list—no doubt we will spend many hours debating the regulations—includes all sorts of things, such as mental health services and dental public health services. I will not read out the whole list. If noble Lords think that something is on it that should not be there, or that other things that are not on it should be, I am sure that we will consider those points as we debate the regulations.

I noted a response to the noble Baroness, Lady Hollins, but I think that I may be referring to a previous debate. She is absolutely right to emphasise that we have to make sure that everything we do is patient-centred. All the changes must focus on that. It is a challenge for everybody. Perhaps people have tried to do it before. No doubt we will have problems trying to do it ourselves, now and in the future, but that has to be the focus. Therefore, we have to remember the diversity of the patients that we are talking about. I am sorry; that answer belonged in an earlier debate.

I know that we will return later to debate alcohol. I hope that noble Lords will not press the amendments in this group.

[Baroness Finlay of Llandaff]

I beg leave to withdraw the amendment.

Coroners’ Inquests

Debate between Baroness Northover and Baroness Finlay of Llandaff

Tuesday 12th July 2011 Lords Chamber

[Baroness Northover]

If you look around Europe at the moment you can understand why it is important that the Government take our economic situation seriously. We have transferred all the key responsibilities here to the Lord Chancellor and the Lord Chief Justice. I am sure that noble Lords will all hold us to account if that does not work.

[Baroness Finlay of Llandaff]

Could the Government explain why the Statement, which I did not see before it went out and I did not know the contents of, did not contain a transparent costing to justify the abolition of the chief coroner? Why does the Statement contain the line,

“neither the judge nor any other individual will be responsible for the leadership, culture or behaviour of coroners”,—[Official Report, 14/6/11; col. WS 62.]

which makes it clear that the key recommendations of reviews by Dame Janet Smith, Luce and others that highlighted the reforms essential to the coroners system have effectively been abandoned?

[Baroness Northover]

I dispute what the noble Baroness says. The costings were done in 2009 and they stand. The problem about the proposals that came forward afterwards was that they talked about deferred costs, and we could not go down that route. I remind the noble Baroness, who would know this only too well, that the chief coroner was not going to be a panacea. The chief coroner could do what he or she could to persuade; they did not have statutory rights to interfere with coroners, who are independent judicial officers. They did not have that right any more than is currently the case. We all wish to improve the coroners’ system. There is a lot to be said for turning the spotlight on practices in different areas, as has happened with military inquests, and seeking to drive up standards that way.

Health: Hydrotherapy

Debate between Baroness Northover and Baroness Finlay of Llandaff

Tuesday 23rd November 2010 Lords Chamber

[Baroness Finlay of Llandaff]

My Lords, as the Government are establishing an outcomes framework for the delivery of treatments, are they looking specifically to have a very flexible and alternative model for those with long-term conditions which takes account of the benefits in terms of both quality of life and welfare, and which also takes account of the avoidance of problems such as the earlier onset of contractures in those with neuromuscular disorders or neurological damage?

[Baroness Northover]

I thank the noble Baroness for that question as it enables me to point out, as she will know, that one element of the proposed NHS outcomes framework is enhancing the quality of life of people with long-term conditions. That is relevant here—it is not just a matter of seeing whether someone’s leg mends after it has been broken. I heard from my noble friend about the experience of the noble Baroness, Lady Campbell, and about the psychological benefit to her of having hydrotherapy. It is not simply a matter of physical benefit; there is also a psychological benefit.