NHS: End-of-life Care

Baroness Stowell of Beeston Excerpts

Thursday 8th September 2022 Lords Chamber

[Lord Kamall (Con)]

I think many noble Lords will echo the sentiments of the noble Lord on that. That is why we want the review to be as wide-ranging as possible. People have suggested mediation, but should that be mandated or voluntary? There is also a difference between commercial mediation and family mediation. Commercial mediation is usually binding, whereas family mediation is not always binding. A further question is: at what stage do we offer mediation? One thing we are being told is not to offer it when everything else has failed: we should offer it as soon as possible, to encourage a collaborative approach.

[Baroness Stowell of Beeston (Con)]

My Lords, clearly it is important that the professionals are involved in this review, but I think it is also important—as this review begins and my noble friend considers the terms of reference—that emphasis really is given to families, because these tragic cases are symptomatic of a wider problem that a lot of people face when they engage with officialdom and professionals, which is feeling that they are not being taken seriously. It is even more acute when the situation is the one that these families find themselves in, when they are parents and have important status as parents, and the issue at hand is the life and death of their own child. My noble friend has been very good at reassuring this House, but I ask if he could just give greater emphasis again to the importance of the families in this review.

[Lord Kamall (Con)]

Once again, I thank my noble friend for joining the meeting this week on this issue. It is quite clear that we want to hear from all voices. We encouraged the families to come forward. We have heard a number of cases, including some raised by noble Lords personally, who have been in contact with the families, and raised their concerns. Quite often they felt that their voices were not heard and they did not really understand the issues; they were in a very emotionally difficult time to take some of those issues in and understand the choices that were available. Sometimes they felt rushed into it by medical professionals. I think sometimes medical professionals have to show a bit of humility and not act like God.

Down Syndrome Bill

Baroness Stowell of Beeston Excerpts

2nd reading
Friday 18th March 2022 Lords Chamber

[Baroness Stowell of Beeston (Con)]

My Lords, I am sorry—my speakers’ list has me at the end, but I am happy to speak now. I am ready, if noble Lords are.

I say first how impressive the noble Baroness, Lady Hollins, was in introducing the Bill today. I cannot possibly do justice to this matter, particularly following her, but I will try because I support the Bill and I want to make just a short contribution. I have no direct experience of living with, or even being close friends with someone who has Down’s syndrome, but of course I have huge respect for the battles they encounter with officialdom—indeed, for all parents who have children with learning disabilities and how they have to navigate bureaucracy.

It is hard to explain, therefore, my particular admiration for people with Down’s syndrome. It may be something special about them that elicits a smile and fondness among all of us. Certainly my connection is very tangential, and it is this: my mum had a younger brother called Stuart, who was born in 1945 with Down’s syndrome. It was not called that then, but that is what he had. He also had lots of health complications and did not live much beyond a year or 18 months. Because he was born into a family of eight other children and they were desperately poor, my nana, who was a widow at the time, considered Stuart’s passing a blessing and she encouraged the rest of the family to accept that and move on, but my mum has never forgotten him, and she has always made sure that I know that he was one of her seven brothers.

Thankfully, the world is a different place. Not only can people in situations like that of my nana rely on support not available in the past, but people with Down’s syndrome live longer and we are now seeing their potential to achieve and succeed in lots of different arenas. That brings me back to this Private Member’s Bill. I am delighted to support my right honourable friend in the other place in this endeavour. I have known Dr Liam Fox for 30 years and I know that getting the Bill as far as this stage, with unanimous support in the other place, including that of the Government, is a result of him using all his professional and political skills—and probably a dose of impish charm along the way.

What is critical about the Bill for me is that it will inform a new strategic approach to supporting people with Down’s syndrome before we encounter the situation that my nana could not have conceived of 80 years ago: a person with Down’s syndrome can not only survive and thrive, but they are living longer and, as we have already heard from the noble Baroness, Lady Hollins, are now outliving their parents. It is vital that the future we anticipate now for people with Down’s syndrome is a positive one, so I commend the noble Baroness for all that she does in the field of health and support for people with disabilities. I support her in seeing this Bill through your Lordships’ House.

Health and Care Bill

Baroness Stowell of Beeston Excerpts

Lords Hansard - Part 2 & Report stage
Wednesday 16th March 2022 Lords Chamber

[Baroness Masham of Ilton (CB) [V]]

My Lords, I have my name to Amendment 172, and I congratulate my noble friend Lady Finlay of Llandaff on her persistence on this important matter of mediation. It is a proven way of dismantling conflicts before they reach the courts.

Over the years, there have been some tragic cases when relationships have broken down between doctors and family members. When this happens in a hospital environment, parents can feel backed into a corner, with no alternatives. Mediation gives the opportunity for the parents to give their views and to hear the doctors’ views too at the earliest stage.

Ending up in the courts costs parents, hospitals and the Government hundreds of thousands in legal fees and causes avoidable distress and concern to all those involved. The only people who win are the lawyers. Parents have to live with grief and the decisions which have been made for their child for the rest of their lives if the results are not good. They want to know that they tried everything possible to give their child the best chance.

I feel that there should be adequate training for doctors, nurses and social workers in the values of mediation so that there is a team approach to treating a child in a life-and-death situation. I hope the Minister understands the need for this amendment and will accept it.

[Baroness Stowell of Beeston (Con)]

My Lords, it is always a great privilege to follow the noble Baroness, Lady Masham of Ilton. I too have added my name to Amendment 172 and commend the noble Baroness, Lady Finlay, for the way in which she introduced it. This debate could risk sounding technical and legalistic, but it is really about redressing an imbalance of power between doctors and parents when their child is desperately sick and at risk of dying and decisions are being made about how best to care for them.

I will not repeat all that I said in Committee, but my attention was drawn to this issue just over a year ago by listening to Connie Yates describe the ordeal that she and her partner Chris endured through the courts when the Great Ormond Street Hospital doctors disagreed with their decision as parents to seek alternative treatment for their baby. Theirs may be an extreme example of what it means not to be listened to or taken seriously by highly qualified professionals who, because they know more, believe they know best, but it is all the more profound because, as parents, what they experienced was not right, and it certainly was not what they deserved.

While this kind of ordeal might be rare, the wider principle—ensuring that we are all taken seriously when we deserve to be—needs promoting with vigour by those of us who enjoy great power and privilege. We need to go out of our way to redress imbalances where we see them, because the inequalities and unfairnesses that people feel, which have driven the political realignment we have seen in recent years, will not be fixed by infrastructure projects or economic decisions alone.

--- Later in debate ---

[Baroness Finlay of Llandaff (CB)]

My Lords, I find myself conflicted over this amendment. I am probably the only person in this Chamber who has consulted women over abortions, signed forms for abortions and performed abortions and I have been with women during late abortions for foetal abnormality. It is a complex area. I have also had women say to me, in the privacy of the consulting room, just before they go, “I have never told anybody else this before”—they have then told me about the serious abuse that they have suffered.

My worry with the first part of the amendment, on remote consultation, is that you do not know who is on the other side of camera or who is standing in the room with the woman. You do not know whether the man is using fertility and sex as a form of abuse and is standing there threatening the woman to proceed in one way or another. We know that men refusing to use condoms is a common form of coercive control of women.

The abortifacient tablets, to which my noble friend Baroness Watkins referred, are a separate step. It is inhumane to expect women to take those and then travel on a bus or even go in a taxi. Knowing what has happened before, I cannot help feeling that there is another step. Yes, let the women have their tablets and take them in the privacy of their own home. It is not pleasant to undergo an abortion—nobody should think that it is—but those women also need support and contraceptive advice as part of the package. I am concerned that I do not see that in this amendment and I have been concerned that during the pandemic the ability of women to access contraception may have become more difficult.

This is a complex issue. It is about a pathway with many steps in it. I wonder whether we should return to it at Third Reading, rather than trying to take a yes or no decision tonight on something that has some merits but also some problems. We are not adequately going into them by having a short debate now.

[Baroness Stowell of Beeston (Con)]

My Lords, it gives me great pleasure to follow the noble Baroness, Lady Finlay, whose contribution reflects her extensive wisdom and knowledge in this area. I just want to say that I commend my noble friend Lady Sugg for her leadership in bringing forward the amendment. I, too, will listen to what the Minister says in reply this evening, but instinctively I support what my noble friend is seeking to achieve.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I rise briefly to support Amendment 183. My background in this goes back to March 2020, in those difficult, scary, early days of the pandemic, when your Lordships’ House was operating on a skeleton crew. That led to me, as very new Peer, moving the amendment to the coronavirus regulations that would have allowed for telemedicine. I thank the noble Baroness, Lady Barker, who I note has signed this amendment, for supporting me through that process, because I had little idea about what I was doing in terms of your Lordships’ House. It is worth noting that we were doing that in part in acknowledgement that women would not otherwise have access to the necessary medical service of an abortion, but also because we knew that NHS resources were going to be enormously stretched. We are still in a situation where NHS resources are enormously stretched. Earlier we were talking about the Ukrainian refugees whom we will be welcoming here and the medical services that they will need.

Of course, we want to say that, in this area of medicine, we should be putting resources into all the NHS services that women need, but the evidence is overwhelming that telemedicine abortion is giving women a better service. I pick up the point made by the right reverend Prelate that there may be safeguarding concerns. There is evidence, particularly from MSI Reproductive Choices, reporting a major uplift in safeguarding disclosures, including from survivors of domestic and sexual abuse, with telemedicine.

On the medical side of this is a simple clear fact: since telemedicine has been introduced, complication rates from abortion have fallen by 20%. You do not have to listen to just me on this; permanent provision of abortion telemedicine is supported by eight royal colleges and medical societies, including the Royal College of General Practitioners, the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives and the British Medical Association. I also point out that abortion telemedicine is going to continue in Wales and Scotland, based on the evidence. The arguments are simply overwhelming: this is the best option.

Health and Care Bill

Baroness Stowell of Beeston Excerpts

Lords Hansard - Part 1 & Committee stage
Wednesday 9th February 2022 Lords Chamber

[Lord Moylan (Con)]

My Lords, I have also put my name to this amendment. I congratulate the noble Baroness, Lady Finlay of Llandaff, on bringing it forward.

We need a broad debate on the balance of responsibility for children as between parents and the various arms of the state. Sadly, these have come to include the medical profession. Today is not the day for that debate, but this amendment does something to give a voice to parents who find themselves in dispute with doctors, often unaided, unsupported and dependent on voluntary contributions, so that they have at least a voice and a status in decisions about their sick child. I very much hope that the Government will be able to support this.

[Baroness Stowell of Beeston (Con)]

My Lords, I do not very often become involved in health matters, so I hope that your Lordships will indulge me on this occasion.

Five years ago, when Charlie Gard’s parents were doing everything they could to fight for his life, I, like everyone else, was moved by their determination. Even so, my instincts were to accept what the Great Ormond Street hospital doctors were advising and what the judge decided was in Charlie’s best interests. I fall into the camp which believes that, in such an unimaginable, heartbreaking situation, the objective and dispassionate professionals are best placed to make a decision that no parent would ever want to have to make for themselves. When Charlie sadly died, I was moved by his parents’ dignity in coping with their heartbreak in the midst of a legal battle and in the full glare of publicity. Probably like many others who felt so sorry for their loss, I soon moved on and thought little more about this tragic case.

Then, just over a year ago, during the Christmas lockdown, when I was out on my daily walk, I heard an interview that Charlie’s mother, Connie Yates, gave to Andy Coulson on his podcast, “Crisis What Crisis?” For well over an hour, I listened to Connie tell her story. She spoke clearly, intelligently and reasonably about their experience as a family during the year in which Charlie lived, and about all that she and her partner, Chris, went through in their fight to be heard and taken seriously by doctors and lawyers. From listening to Connie, I learned that their expectations were well-informed and reasonable but that as the dispute continued, the situation became increasingly fraught and distressing —to the point where their efforts to be heard as parents made them feel that others believed they were guilty of not wanting the best for their baby. Even so, she was at pains to praise all the medical staff who had cared for Charlie at Great Ormond Street.

Towards the end of the interview, Connie told Andy Coulson that a Private Member’s Bill was being sponsored by the noble Baroness, Lady Finlay, that would bring to life what she called “Charlie’s law”. The noble Baroness has described this law. When Connie talked about it, I was struck by how modest and reasonable it is to create a legal framework to allow for resolution, without the added stress and trauma that they had faced during the time when they were fighting for Charlie. It also struck me very powerfully that, in developing this framework, Connie had taken the time to contact and listen to the doctors who had opposed her, so that she could better understand them and their position. That is worth emphasising again: this young woman is so reasonable that she wanted to create a law that would work for the benefit of the medical profession, not just parents.

As I finished listening to Connie, I vowed that I would support that Bill whenever it appeared. But as we know, Amendment 287 is here in lieu of that Private Member’s Bill, and arguably is a better way to introduce this measure, rather than having to battle with the usual procedural risks that are associated with private Members’ legislation. I am delighted to lend my support to this amendment. I am sure there are technical matters within the amendment which might require discussion between the noble Baroness and the Minister, but I urge my noble friend to take this seriously.

Given the ordeal that Charlie’s family faced a few years ago, when no one in authority listened to them, I am sure it would bring them a huge amount of comfort to know that they are being heard now. That is my main point and motivation today. Of all the things we must do if we are to level up this country, listening and taking seriously people who feel ignored or misunderstood is the most important aspect of that agenda, and in this context it costs us nothing.

I also say to Connie Yates, should she be listening today or read the record subsequently, that she is one impressive woman. When I heard her speak, and listened to what she had to say, she changed my mind and made me realise I had been wrong not to listen more carefully a few years ago.

[Lord Balfe (Con)]

My Lords, I welcome the amendment put forward by the noble Baroness, Lady Finlay, and will make what have been described as technical points. While I think this is a very good base, there are some things that I think need looking at.

I trained as a commercial mediator some years ago, and practiced for a couple of years, before I was signed up by David Cameron to do a different job. The first point I make is that there is a difference between commercial and family mediation. It is important to realise that. I notice that the amendment says

“where the authorities consider that the difference of opinion is unlikely to be resolved entirely informally”.

I suggest that it cannot be the authorities that decide; it has to be offered equally to both sides. That is why it will not be appropriate for the authorities to provide the mediation service. There are a couple of good, independent mediation services, including the Centre for Effective Dispute Resolution and the Alternative Dispute Resolution Services, but if it is to be a system which has the confidence of both sides, it must be independent of the authorities.

The next point I would like to make is this. There is a big difference between family and commercial mediation, and the difference is fundamental. Commercial mediation produces a legal, enforceable result; family mediation produces an agreement which has no legal force. One of the points which must be addressed if this is to be brought to fruition is what is to be the status of the mediation agreement. That is fundamental.

I was a commercial meditator and in East Anglia, where I was, we had a practice of commercial mediators going out also with family mediators to get an experience of the full area. One of the most distressing points about family mediation was the way in which families would bicker, eventually reach some sort of compromise, and, before you were through the door, decide they were not going through with it. If mediation is to work, it will have to have some sort of resolution at the end where the medical profession and the family can say, “This is settled”—not where one side can say, “Well, I don’t really like the outcome”. This could be the case, particularly in a complex medical situation, where you have a number of doctors involved and maybe two or three of them are part of the mediation but there is then someone further up the line who says, “No, I just don’t accept this”. There has to be a dispute resolution which has a legality about it.

Carers over 80: Support

Baroness Stowell of Beeston Excerpts

Monday 13th June 2016 Lords Chamber

[Baroness Manzoor (LD)]

My Lords—

[The Lord Privy Seal (Baroness Stowell of Beeston) (Con)]

My Lords, I am so sorry to get up but we have not yet heard from the Conservative Benches. Although I recognise that there has been a series of Labour Peers it is the turn of the noble Lord, Lord Flight.

Obesity

Baroness Stowell of Beeston Excerpts

Thursday 26th May 2016 Lords Chamber

[The Lord Privy Seal (Baroness Stowell of Beeston) (Con)]

We definitely have time for two more questions. If we are going round in turns, it is the turn of my noble friend Lord Lang—and then, I am sure, we can come to the noble Baroness.

[Lord Lang of Monkton]

My Lords, I wonder whether my noble friend can help me. We used to be told that we should not eat salt; now we are told we should. We used to be told that we should not eat fatty foods; now we are told we should. We used to be told that one glass of red wine a day was good for us; then we were told we should have none. Now we are being told we should have two. Will my noble friend tell us which of these items should exit our diet and which should remain?

Health: Alcohol

Baroness Stowell of Beeston Excerpts

Thursday 12th May 2016 Lords Chamber

[Baroness Massey of Darwen (Lab)]

My Lords, does the Minister agree that attempts to alert the general public are often too little, too late?

[The Lord Privy Seal (Baroness Stowell of Beeston) (Con)]

My Lords, it is the turn of the Cross Benches.

[Baroness Finlay of Llandaff]

In the review to which the Minister referred, is the cost of accidents through alcohol-related driving and road accidents being costed? Is consideration being given to lowering the drink-driving limit, perhaps even to almost zero, as in some countries?

NHS: Hospital Overcrowding

Baroness Stowell of Beeston Excerpts

Tuesday 15th March 2016 Lords Chamber

[The Lord Privy Seal (Baroness Stowell of Beeston) (Con)]

My Lords, it is the turn of the Labour Benches. While I am on my feet, I remind noble Lords that we should not be reading out questions at Question Time.

[Baroness Pitkeathley]

My Lords, will the Minister agree that there is bound to be overcrowding in hospitals if we have a point of entry without any guaranteed point of exit? Therefore, unless social care is adequately funded and organised, we will always have this problem of overcrowding, particularly where old people are concerned. I would be very glad if he did not refer me to the better care fund as the answer to this, because it is already oversubscribed many times.

Pharmacies: Funding

Baroness Stowell of Beeston Excerpts

Wednesday 2nd March 2016 Lords Chamber

[Noble Lords]

This side!

[The Lord Privy Seal (Baroness Stowell of Beeston) (Con)]

My Lords, we should get out of the habit of shouting “This side” when we are on our feet. I suggest that the Cross Benches would like to go next.

[Baroness Greengross]

My Lords, has the Minister considered the relationship between hospital pharmacies and local community pharmacies? At a hospital I know well 56 people are discharged every day. However, they cannot be discharged until their prescriptions are ready from the hospital pharmacy. As people wait up to four hours, beds are blocked 56 times for four hours while they wait. A closer link—which exists in one or two areas—between the two types of pharmacy might remedy that situation. Has the Minister any plans to look at that issue?

NHS: Junior Doctors’ Pay

Baroness Stowell of Beeston Excerpts

Wednesday 27th January 2016 Lords Chamber

[Lord Winston (Lab)]

My Lords—

[The Lord Privy Seal (Baroness Stowell of Beeston) (Con)]

My Lords, I am sorry to intervene, but I know that the noble Lord cannot see that the noble Baroness, Lady Brinton, is trying to get in.