Access to Palliative Care and Treatment of Children Bill [HL]

Baroness Stroud Excerpts

2nd reading & 2nd reading (Hansard): House of Lords & 2nd reading (Hansard)
Friday 7th February 2020 Lords Chamber

[Baroness Stroud (Con)]

My Lords, it is a pleasure and a privilege to be able to congratulate the noble Lord, Lord Brownlow, on his excellent and deeply thoughtful maiden speech. The compassion and care with which he has approached this debate are testament to the wisdom and experience that he will bring to this Chamber. His professional success and entrepreneurial track record are matched, as we have heard, by his compassion and philanthropy. His personal charity has been an important driver in addressing disadvantage across the UK, including support for the Alexander Devine Children’s Hospice and the Prince of Wales Hospice, showing his deep, long-term commitment to the issues raised in today’s debate. It is a pleasure to be able to welcome someone with such experience to this Chamber, and I look forward to his continued contribution to this House.

I support this important Bill. As we have heard, Marie Curie estimates that one in four people in the UK does not get the care and support that they need at end of life. It is estimated that over the next year 118,000 people will die not having received adequate care. If their voices and those of their families could be heard in this place today, it would be declared a national crisis. So I thank the noble Baroness, Lady Finlay, for introducing the Bill and for her tireless work fighting for the dignity and respect of all who are dying.

The Bill does two things: it addresses the concerning gap in our healthcare system around end-of-life care; and it would ensure mediation in instances of conflict between parents and health professionals over the withdrawal or the giving of treatment. Following on from the NHS’s 10-year plan, published in January last year, the Bill addresses the failure to include palliative care as a core service of the NHS. This omission has created an unequal system whereby the standard of treatment at end of life is influenced far more by geographic postcode than a commitment to manage suffering and dignity in someone’s final days. The Bill addresses this issue by ensuring access to specialist palliative care in hospital, in the community and in places of usual residence.

Without the Bill, the crisis of care will become only more acute. Over the next 25 years, demographic changes will increase the need for end-of-life palliative care, as more people pass away each year with more complex needs. A recent analysis published in BMJ Supportive & Palliative Care found that clinical commissioning groups had significantly varying budgets for palliative care services, from approximately £51 to £2,300 per patient per annum. This is largely the result of a consistent failure to build a broad institutional approach to palliative care, as individual founders and local organisations have historically been the dominant forces in creating and funding hospices, for example. This issue is compounded by the fact that, as we have just heard, many hospices do not receive pharmaceuticals from the NHS, meaning that hospice budgets are consumed largely by the provision of essential medicines—a further inequality skilfully addressed by the Bill.

The Bill also addresses the issues raised by the tragic incidents involving the families of Charlie Gard and Alfie Evans. To lose a child is a tragedy that I believe every parent dreads, but I cannot imagine what it is like to lose a child under the glare of intense media scrutiny, with the public and professionals debating your intentions as a parent for your child. I offer those families my sincerest condolences.

For Chris Gard and Connie Yates, the pain and anguish they experienced with Charlie’s illness was exacerbated by the feeling that they simply were not being listened to. When they requested mediation and it was refused, and Charlie’s treatment was escalated to the courts, they not only felt powerless but were legally unable to access Charlie’s medical records to obtain a second opinion.

If mediation was the expected conflict-resolution pathway, the suffering of all families involved in these types of cases could be greatly eased. A recent Dutch study published in the official journal of the American Academy of Pediatrics found that, when there were conflicts regarding end-of-life decisions, by postponing these decisions until the 4% of conflicts within the administering team and 12% of conflicts between medical practitioners and parents were resolved, a consensus was ultimately met in all cases.

When our court system is so strained by parents who are failing their children, surely we want to support as much as possible those who seek to do everything right. Mediation is a crucial instrument in aligning the love and empathy of a parent and the practical medical reasoning of a practitioner. The goal of medicine is to heal and relieve suffering. As Eric Cassell warns in The Nature of Suffering and the Goals of Medicine,

“failure to understand the nature of suffering can result in medical intervention that (although technically adequate) not only fails to relieve suffering but becomes a source of suffering itself.”

Our adversarial court system is not conducive to the relief of suffering. Charlie Gard received months of intensive care that health professionals felt was contrary to his interests, all the while without receiving the nucleoside treatment that his parents desired. This treatment, I might add, did not involve any invasive surgery but was a simple powder that was to be added to his milk formula. Nobody got the outcome they wanted, and it is evident that the suffering of Charlie and his family was greatly prolonged. The mental anguish in these situations is of a traumatic nature. For Charlie’s parents, not a day goes by when they do not wonder whether, if the circumstances around decision-making had been different, they could have done more for their son. This situation could have been avoided with a focus on mediation and by ensuring that consensus was reached before any decisions were made. The Bill will stop this happening again.

Over the course of this Parliament, more than 3 million people will die in the UK. Of these, around three-quarters will have an expected death. They have the right to know that they will get the care they need when they need it and, where there is conflict over that care between parents and physicians, that mediation will be available to them. I commend the noble Baroness, Lady Finlay, for introducing this Bill, which has the power to ensure that children and adults alike receive the dignified and respectful care they deserve.

Queen’s Speech

Baroness Stroud Excerpts

Thursday 9th January 2020 Lords Chamber

[Baroness Stroud (Con)]

My Lords, I rise to support Her Majesty’s gracious Speech. It is a huge pleasure to be able to add my congratulations to Her Majesty’s Government on their remarkable election victory. With this victory the voice of the British people has unequivocally been heard and their will made crystal clear, not just to get Brexit done or to build one nation but to tackle the key social challenges of our generation.

One of the main findings of the Legatum Institute’s 48:52—Healing a Divided Britain report, and here I declare an interest, was that voters were concerned that public services and the social fabric of the nation were no longer working for them. In particular, people wanted more from their health and education services and had concerns over housing and employment stability.

These were their top four issues. The test for me of Her Majesty’s gracious Speech was to look at how these issues would be addressed: the four tests. To take health first, the UK prosperity index has charted a marked decrease in our satisfaction with the quality of our healthcare, down 21 places in recent years to 34th globally. The commitment, therefore, to level up our NHS is an important first step in addressing this felt public service gap. Forty new hospitals, 50 million more GP appointments, 50,000 more new and retained nurses and an extra £650 million in NHS funding weekly will help ensure that our healthcare is far more equitable across our most vulnerable communities. This commitment represents a renewed focus and a commitment to drive change.

The second test is education. Educational ability, as we have heard, is spread across our great nation, but opportunity is not. We should be proud of the gains that we have made over the last three years in education, but we need to ensure that we are focused on giving all students equal opportunity to reach their full potential. So the pledge in the Queen’s Speech

“To ensure every child has access to a high-quality education”


by increasing levels of funding per pupil in every school is welcome, as is the announcement of the national skills fund of £3 billion over the course of the Parliament.

Yet although the outcomes and investments are results that our teachers and students should be proud of, some worrying signs arose from the PISA report. On student well-being, only 53% of 15 year-olds across the UK reported that they were satisfied with their lives. Nearly 50% of our young people feel a severe lack of identity and purpose. For a Government who are committed to building one nation, I would welcome hearing from my noble friend the Minister what action they will expect from parents and teachers to ensure that our young people are confident in their identity and future, as the current approach is obviously not working and more of the same will not do.

The third test concerns housing. We are currently facing a housing crisis nationwide, but, as we all know, there is no silver bullet for this issue. However, I welcome the Government’s energy, vision and focus expressed through the commitment to shared ownership, supporting local families on to the housing ladder, improving the rental market, and housebuilding. I welcome the building of a million new homes, but can my noble friend comment on what change of pace, policy and impetus will be deployed? The “million new homes” figure seems familiar now and we really need delivery.

The last test is for job security. Out of the 48:52 report, a clear link emerged between stagnant, low wages and a vote to leave the EU. However, we have an extraordinary record as a nation: on average, 1,000 new jobs have been created each day since 2010, with levels of employment at a remarkable 76%. The election saw a resounding roar from those in tough circumstances and a clear message that they do not want handouts but want to be able to work hard and support their families. The Queen’s Speech lays the foundations for the development of an economy where prosperity can grow through the creation of jobs that are stable, full time and in every corner of our nation.

I welcome Her Majesty’s gracious Speech, the energy and vision with which this Government are setting about the task of building prosperity and levelling up, and their commitment to the creation of opportunity and quality of life. If this becomes reality, we will indeed take great strides towards meeting the four tests of a stronger health and education system, access to housing, and stable, full-time employment, while building the longed-for one nation.

Abortion (Disability Equality) Bill [HL]

Baroness Stroud Excerpts

Report stage (Hansard): House of Lords
Friday 24th February 2017 Lords Chamber

[Lord Swinfen (Con)]

My Lords, I am a complete layman in these matters. When the noble Lord, Lord Winston, responds, can he tell the Committee what in his view is a “high probability”? What does he mean by that? Also how long is “shortly after” a birth? Would that be hours, days, weeks or years?

[Baroness Stroud (Con)]

My Lords, I thank the noble Lord, Lord Winston, for the time he has given me to understand fully his amendment, and I put on the record my deep admiration and respect for so much of the work he has done.

Of all people, the noble Lord, Lord Winston, will be only too aware of the extraordinary medical progress that is being made in perinatal and neonatal care. In this Bill we should be advocating for the best treatment of children with disabilities. The provision of holistic care, including perinatal and neonatal hospice care at the end of life, can help to ensure that these babies are treated with dignity, care and love. While the life expectancy of these babies may well be brief, they do have a life and are significant family members who will be valued, remembered and treasured.

The Northern Ireland Executive have recently set out a commitment to provide such hospice care in the Department of Health’s 10-year plan on palliative care for children. I hope that we will see such care being provided elsewhere in the UK. Perhaps the Minister can comment on that.

Amendment 1, aside from being antithetical to the spirit of the Bill, is fraught with difficulties, as we have heard in the debate. Taking the amendment in the order of its wording, what would be judged to be a “high probability?”. We have heard that question repeatedly in the debate. Is that more than 90%, more than 50%, or 65%? How would the decision about likely death be made? Would that be with or without treatment, since conditions may be classified as the same but manifest varying symptoms, from those which may be lethal to those which may in fact be treatable or not immediately lethal? In my meeting earlier with the noble Lord, Lord Winston, we discussed cleft palate, which can be very severe or quite minor and correctable. How long would “shortly after” need to be to qualify? Would it be a matter of hours or days or months? What would count as a “serious fetal anomaly”, since that is not even a medical term? Amendment 1 does not bring any certainty; rather, it raises more questions than answers.

These questions demonstrate how the law would treat these children differently from those without disabilities. It would again enshrine the discrimination that my noble friend Lord Shinkwin is seeking to eliminate, and I encourage noble Lords not to support the amendment.

[Lord Elton (Con)]

My Lords, after that intervention I need say very little indeed. I share with everyone else my admiration for the noble Lord, Lord Winston, as I have for my noble friend Lord Shinkwin. However, while it would be helpful to have the noble Lord’s assurance as to what is meant by these terms, that is not sufficient. It has to be on the face of the Bill because that is what the law will be. Otherwise it will be decided by the courts, which would mean there is no certainty. The purpose of good legislation is bring certainty, not doubt.

Abortion (Disability Equality) Bill [HL]

Baroness Stroud Excerpts

Committee: 1st sitting (Hansard): House of Lords
Friday 27th January 2017 Lords Chamber

[Baroness Stroud (Con)]

My Lords, I welcome and support the amendment. At Second Reading I made two points. First, the Bill removes discrimination from our legislation, as set out in Section l(l)(d) of the Abortion Act 1967. Secondly, the Bill’s crucial objective is to address what takes place in the consulting room. A significant number of parents say that they feel very real pressure to have an abortion when what they want is support. The noble Baroness’s amendment addresses that issue. I thank her and congratulate her on her amendment.

In 2015, 929 abortions [see Official Report, 30/1/17; col. 967.] were undertaken in England and Wales after 24 weeks under ground E. There may well be a need for additional support for parents should any of these children be carried to term in the future, rather than terminated within the 24-week timeframe, so this is a welcome addition to a very important Bill. But welcome though it is, it should not be argued that this causes a financial exposure for the Government. The Government are already required to provide for all these families, regardless of the choice they make. Having worked with the Treasury over a number of years, I know the danger is that it could view this as a financial exposure, which is not appropriate for a Private Member’s Bill. My point is that we already have responsibility for these families in caring for them and supporting them in any way and with any choice they make. I welcome the amendment, with that caveat.

[The Lord Bishop of Durham]

My Lords, I was unable to be present at Second Reading but my noble friend the right reverend Prelate the Bishop of Bristol spoke on this matter, welcoming the Bill, and I add my support. I also welcome the amendment because I believe that, as others have already said, such a review would be very helpful.

One reason has just been demonstrated, although the noble Baroness would not have known this at the time; that is, the figure she quoted for the number of abortions that took place in this category after 24 weeks is different from the one that I have been supplied with. That said, the number is not hugely different. The point is that a relatively small number of abortions take place in category E after 24 weeks. If I understand it correctly, the noble Baroness’s amendment would apply not just after the 24-week period but to the Act as a whole. That review would be very welcome because we do not know exactly what is going on.

The Bill is primarily about the rights of the disabled. It is really important that we move to recognising that if we believe viability is at 24 weeks, it is 24 weeks for all foetuses and none should be excluded from that. That is why I support the Bill as a whole.