Women’s Health Strategy for England

Debate between Baroness Thornton and Baroness Barker

Thursday 21st July 2022 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for taking this Statement today, and I hope her noble friend is fully recovered from the bug that he acquired—goodness knows where. I declare an interest as a maternity safeguarding champion at a London trust hospital.

We must welcome this rather late and delayed strategy. For too long, women’s health has been an afterthought and the voices of women have been at best ignored and at worst silenced. I welcome the appointment of Professor Dame Lesley Regan as the first ever women’s health ambassador for England.

If this strategy is properly funded and actually delivered, it may not solve the crisis in women’s healthcare after 12 years of Conservative mismanagement but it would certainly help shift the policy and delivery of services. Four out of five women who responded to the Government’s survey could remember a time when they did not feel listened to by a healthcare professional.

The context for this strategy is that, in recent years, we have seen a string of healthcare scandals primarily affecting women: maternity services at Shrewsbury and Telford; more than 1,000 women operated on by rogue surgeon Ian Paterson; thousands given faulty PIP breast implants; many left with traumatic complications after vaginal mesh surgery; and the use of medication such as Valprol during pregnancy, as highlighted by the noble Baroness, Lady Cumberlege, in her report, First Do No Harm, which has helped to transform issues in this space

There is one issue I wish to raise with the Minister immediately, and of which I have given prior notice, which calls into question the Government’s commitment to sexual health rights for women. In the past few days, it has emerged that a statement on freedom of religion or belief and gender equality was issued by the UK as part of the intergovernmental conference it hosted in London on 5 and 6 July. Commitments to abortion and sexual health rights have been quietly removed. Is that true, and, if so, why has that happened?

I return to the Statement. The context of the strategy is that every woman who needs to use the NHS today faces record waiting times. The NHS is losing midwives faster than it can recruit them. Gynaecology waiting lists have grown faster than any other medical speciality. The number of women having cervical screening is falling, and black women are 40% more likely to experience a miscarriage than white women. We need to look at what is being proposed in this strategy.

The strategy promises new research, which is absolutely vital and very welcome. I draw the Minister’s attention to the report from the University of Birmingham commission into safe and effective, accessible medicines for use in pregnancy, Healthy Mum, Healthy Baby, Healthy Future. Chaired by the noble Baroness, Lady Manningham-Buller, it addresses the terrible lack of research into conception and pregnancy. The starting point is that virtually no drugs have been developed or trialled for pregnant women in the many decades since Thalidomide. This leaves women at the mercy of general diseases, the diseases of pregnancy and drugs that are usually unlicensed.

Pregnant women and babies throughout the world continue to get sick and die from largely preventable and treatable causes. Even in the UK, the way in which medicines are developed currently risks preventing pregnant women accessing the benefits of safe and effective medicines. Most recently, the exclusion of pregnant women from Covid vaccine trials has probably led to needless deaths among pregnant women and babies, which highlights this issue. The commission provides a blueprint for action. Will the Government make use of it?

Studies suggest that the gender bias in clinical trials is contributing to worse health outcomes for women. There is evidence that the impacts of female-specific health conditions, such as heavy menstrual bleeding, endometriosis, pregnancy-related issues and the menopause, are overlooked. Can the Minister set out how exactly the Government intend to make use of the new research to improve outcomes for women? How will they address widespread bad practice across clinical trials where women are not selected because their hormones might distort the results—which really means that they might reveal the side effects that treatments will have on them?

Moving on, we welcome improving the education and training of health professionals as absolutely vital. Almost one in 10 women have to see their GP 10 times before they get proper help and advice about the menopause. Why is it that almost half of medical schools do not teach doctors about the menopause, given that it affects every single woman? Those are two small consequences of not addressing gender in the training of our medical professionals.

I want to ask a question about what my honourable friend Carolyn Harris said in the Commons yesterday:

“I am delighted that my private Member’s Bill that I negotiated with the Government last October now appears as part of the strategy, but I am bitterly disappointed that the timeframe for that once annual charge is delayed until April 2023—18 months after it was promised”.—[Official Report, Commons, 20/7/22; col. 980-81.]

My honourable friend needs an answer on that. Why have the HRT costs been delayed until April 2023?

We can only welcome the extra £10 million for the breast screening programme. This screening can prevent avoidable deaths by identifying breast cancer early, but we must note that fewer women in the most deprived areas receive regular breast screening. Even before the pandemic, too many women with suspected breast cancer were waiting more than the recommended two weeks. Can the Minister tell the House how the programme announced today will make a difference to outcomes for patients if, once diagnosed, they end up on a waiting list that is far too long?

There are plans in the strategy to remove barriers to IVF for lesbian couples, which we welcome. For too long, they have faced unnecessary obstacles to accessing IVF for no other reason than the fact that they love another woman. It is encouraging to see the Government take action to set this right.

As well as the appalling figures on black maternity deaths, a quarter of black women surveyed by Five X More felt that they received a poor or very poor standard of care during pregnancy, labour and post-natally. Women who live in deprived areas are more likely to suffer a still-birth than their richer counterparts. Labour has pledged a new race equality Act to tackle the structural inequalities in our society, including in healthcare. Does the Minister acknowledge that those inequalities exist?

There is one final issue that I would particularly like to draw to the attention of the House. Support counselling for women victims of rape is absolutely vital but End Violence Against Women estimates that the Government need to provide a minimum of £195 million each year to rape crisis services to properly respond to that need, with a significant proportion ring-fenced for specialist BAME services. The problem, as a recent survey revealed, is that 60% of people believe that access to free counselling is readily available for rape survivors. That is not the case. The waiting lists are growing. Do the Government accept that this is not an acceptable situation?

[Baroness Barker (LD)]

My Lords, I agree with much of what the noble Baroness, Lady Thornton, has said. It is always interesting to see what is included and what is excluded in documents such as this. Like the noble Baroness, Lady Thornton, I would like straightaway to query the omission of rights to abortion and sexual healthcare. Is that now the policy of the Government and the Department of Health? If it is, that is a very significant change that will have a huge, detrimental effect on the health of women.

It is notable that this document lists its ambitions at the beginning, talking about the availability of RSHE in schools so that young people know and understand what good health is and what their rights to it are. Unfortunately, there is still a dearth of appropriate material getting to schools and there is equally no commitment to training staff in schools to deliver appropriate training. I therefore ask the Minister when that situation is going to be rectified.

Organisations such as the Faculty of Sexual and Reproductive Healthcare and RCOG have been telling the Government for years that there is an absolute crisis in reproductive health services. We have a completely fragmented system for access to basic contraception, which is having a huge impact. We now know that approximately 50% of pregnancies in this country are unplanned. That statistic in itself tells us how far reproductive health has slid backwards.

I am glad to see the appointment of Professor Dame Lesley Regan. Some of the work that she has done in this report says that investment in contraceptive and fully inclusive reproductive and sexual health services is a public health investment which has a massive return on investment. Every £1 spent on contraception is a saving of £9 in public health services. If you invest that £1 in maternity services, the return on investment increases to £33. It is a no-brainer, yet at the moment we fracture access to services so that women who want access to proper reproductive health services end up going multiple times to multiple places. Why? It is because funding streams are fractured. Can the Minister say when that is going to be rectified? The sooner it is, the swifter we get a proper impact on women’s health.

One of the things that I have noticed, having read the review, is that for the first time it tries to be inclusive in its definitions. I also welcome the statements made about access for lesbians to assisted reproduction. The review includes Roma women. It notes the disparities in the appalling health inequalities for black women and women of colour. It also completely ignores trans people. I have a simple question for the noble Baroness. Is that the policy of the Government and the Department of Health? Are these people going to be excluded from our health policy in future?

The final thing I wish to say is that one of the big things that has been noted all the way through our reviews of continuity of care and the great work by the noble Baroness, Lady Cumberlege, is that continuity of care is key to outcomes, in particular, continuity of care in primary care, which is where most women want to get their health services. Will the Minister say what will be done to do that?

One other thing we certainly know is that we have an impending crisis in the workforce. The skilled women and men—largely women—who have been delivering women’s health services for the past 30 to 40 years are, by and large, about to retire now. Young male and female doctors and nurses, particularly in primary care, have not been given access to training. What will be done to make sure that the looming skills deficit is dealt with? Unless we address that, this is just a load of pipe dreams that will never come to pass.

Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) Regulations 2021

Debate between Baroness Thornton and Baroness Barker

Tuesday 14th September 2021 Grand Committee

[Baroness Barker (LD)]

I thank the Minister for introducing the regulations as he did, but it does not alter the fact that the current rules around self-isolation and PCR and lateral flow testing are confusing. People who are not stupid and who genuinely want to know what to do and what they should be doing for the best find them difficult. I heard about someone who had contact with a positive case last week trying to work out from GOV.UK if it was okay that they had had a negative PCR test and had no symptoms—what were they then supposed to do? It is imperative that we continue to have very clear and sustained messaging around testing and isolating.

Ministers have made great play of the fact that the front line of defence is double vaccination. Okay, but that is only as strong as it is if you continue to have the second-line defences of testing and isolating in behind it; if you do not, that places a much greater strain on the vaccination process. We know that from other countries. I know that the Minister said that there were other mitigations, and he talked about investment in therapeutic treatments, but they are not yet with us. Therefore, we need to concentrate yet again, albeit with fewer restrictions than there were before, on who is being tested and who is having to isolate.

I go back to one point on which I have asked the Minister questions for more than 12 months. What about people who are not registered with GPs? There are still such people in the country, perhaps people whose first language is not English and who—surprisingly, perhaps—do not know about what to do about going to get vaccinated. I have come across a couple of examples recently. I do not think that there are vast numbers of such people, but there is a significant cohort in some communities who are hesitant not because they have any great ideological disposition against vaccination—they just simply do not know what to do, or they may have language problems, which means that they are concerned about going to vaccination centres.

I want to talk again about schools, because we have the data that has come through from Scotland. I point out to noble Lords that mask-wearing in schools in Scotland is still in place. From talking to epidemiologists, as we did earlier this year, about the whole process of the country coming out of tight restrictions, one thing that they said to my noble friend Lady Brinton and our team is that with enclosed spaces it is not just ventilation that you have to look at—you have to look at air purification as well. The big health risk is when you have stagnant air into which people who are positive are exhaling droplets of the virus. What has been done to enable schools to look at things like carbon dioxide monitors, as a proxy for measuring stagnant air? Again, I do not think that many schools have had the resources to enable them to deal with that.

I want to make one point that my noble friend Lady Brinton would have made had she been here. We are still talking about 1,000 deaths a week and 50,000 deaths per annum. By the Prime Minister’s reckoning, that is an acceptable but very high number of deaths. The reason why these regulations are not helping is that they seem to be part of a high-level message that says, “It’s over.” A lot of people think it is over, but it is not; it will not be for a considerable time and it will continue to be very dangerous if we chip away at the side mitigations that go beyond the vaccine.

Finally, we have always said that local authorities have a key role to play in identifying those people who are in the communities that are most vulnerable, and they are the communities that need the most help to self-isolate. When will the Government produce a comprehensive report on the funding of local authorities for local self-isolation schemes and their effectiveness?

[Baroness Thornton (Lab)]

My Lords, my noble friend Lord Hunt made the most pertinent point, which is that, as we have acknowledged, Covid has pointed to the gross inequalities in our society. That can be seen absolutely when we look at the self-isolation regulatory regime and the impossibility of those on low incomes self-isolating because they then have to choose between feeding or not feeding their children; they cannot afford to self-isolate. We still have not solved that problem sufficiently well.

As we move into the winter, as the noble Baroness, Lady Barker, said, this pandemic is not over. If you have 150 to 200 people a day dying, it is not over. If you have half the ICU beds in our hospitals still occupied by people with Covid, it is still not over and we will never catch up with all the NHS waiting lists that have fallen so abysmally behind in the past 18 months. So it is not over.

Self-isolation is part of the toolbox, to use the Prime Minister’s and Secretary of State’s word, that will help to control the spread of this virus. What the old regulations did—do—is amend the self-isolation regulations. With effect from 19 July, they allow a person to leave self-isolation and put an antibody test in the post, and from 16 August certain people were no longer required to self-isolate if they had come into contact with a person who had tested positive for Covid. The Minister listed who those different groups are, including children under 18. I completely agree with my noble friend about the need to include children under 18, but we have to address the issue of what that means for schools.

The Minister said before the summer, when we were hearing Statements about the easing of these regulations, that people were going to have to behave “in a responsible fashion”. I had a particular issue with that last week, when a friend I was supposed to be meeting called me to say that her husband had caught Covid. Both were double vaccinated, he was not very ill—I am pleased to say. They had been at a wedding, and there was a family there who were anti-vaxxers; they did not know and he caught it. She tested negative for the next four or five days.

I was personally quite torn about what to do: should we meet or not? The idea shocked me that somebody who is living with somebody who has Covid did not have to self-isolate. I worked my way through it; I read the regulations, which I must say are complex and not completely clear. She did not say, “I am allowed to go out”; she was being very responsible, but I thought that millions of people must be facing those issues all the time. Just saying that people have to behave “in a responsible fashion” may not be quite the point.

Medicines and Medical Devices Bill

Debate between Baroness Thornton and Baroness Barker

Committee stage & Committee: 3rd sitting (Hansard) & Committee: 3rd sitting (Hansard): House of Lords
Wednesday 28th October 2020 Grand Committee

[Baroness Barker (LD)]

I thank my noble friend Lady Sheehan for her introduction to this amendment and the noble Lord, Lord Alton, for the detail that he added to that.

My interest in this matter stems back to 2013, when I was part of the All-Party Parliamentary Group on HIV and AIDS, which produced a report called Access Denied. It was about barriers to access to antiretroviral drugs for HIV and AIDS in low and middle-income countries. In the course of our research work for that report, we held a number of hearings with all sorts of representatives from a number of international research groups based in the United Kingdom but which worked across Africa and Asia. We met user and patient groups and also included representatives from the pharmaceutical companies.

I vividly remember sitting in a room in Portcullis House during one of our question and answer sessions and putting a question to a representative of a pharmaceutical company that has cropped up in our discussions in the last couple of days. I asked him a simple question—whether there was a direct correlation between the R&D costs of a drug and the price. With disarming candour, he said, “No”. Once people’s jaws had ceased to drop, we had the revelation that actually there is no transparency about pricing in the pharmaceutical industry or about the extent to which public and private funding goes into the development of new medicines—and, in effect, an admission that the overstatement by pharmaceutical companies of the need to charge excessive prices in some markets to maintain their viability is not substantiated.

I am not an anti-pharma campaigner. I believe that human and animal welfare rests very much on the development of pharmaceutical knowledge and science, and I am all in favour of extension of research and development of new drugs. However, for far too long Governments of all sorts have been held over a barrel by pharmaceutical companies, and that should stop.

I say this as someone who has had a long-standing interest in HIV. To see some patient groups in some parts of the world continue to become infected and, perhaps, have threats to their lives that would not occur if they had simply been born in another country is devastating. For example, in the world of HIV, very little work is being done on development of antiretroviral drugs for paediatrics because there is very little call for that in western developed nations, whereas there is a very big need for it in sub-Saharan Africa. Our involvement in these matters has a direct bearing on the lives of people across the world and on our standing not only as one of the major governmental funders through the different international funds but as a country in which research into new and emerging transmissible diseases is second to none because of our long-standing history.

For all those reasons, I very much support my noble friend Lady Sheehan, and I await with interest the answer to the question that my noble friend Lord Stunell put, which was the one I was going to ask, about proposed new paragraph (d) in my noble friend’s amendment.

[Baroness Thornton (Lab)]

The Committee owes the noble Baroness, Lady Sheehan, a debt of gratitude for bringing forward this amendment. I very much enjoyed her opening speech—and, indeed, those of the noble Lords, Lord Alton and Lord Crisp, both of whom are so well qualified to speak about international health responsibilities.

What this debate does is to remind us of how privileged we are to live in a country with free access to new medicines and innovations. However, we are now entering choppier international waters. We have been sheltered, as it were, over 40-odd years or so by the European Union’s heft and regulatory framework. So we need to take notice of the need for greater co-operation, as has been outlined by the noble Lord, Lord Patel.

I was very struck by the mention of things like price gouging by the noble Baroness, Lady Sheehan, and their dangers for those less fortunate than ourselves. On the immediate responsibilities and dangers around the Covid vaccination, which we so desperately need, the World Health Organization says that it is working on a plan to ensure equitable distribution of vaccines, but how that would be enforced in practice is not clear. Professor Mariana Mazzucato, who heads the University College London’s Institute for Innovation and Public Purpose, says:

“In a pandemic, the last thing we want is for vaccines to be exclusively accessed by countries that make them and not be universally available.”


That is absolutely right.

However, as the noble Lord, Lord Crisp, said, we need to pay attention to what is happening in the UK and what the effect of Brexit might be—and, goodness me, we are all on tenterhooks as to whether we get a deal or not. Rick Greville, the director with responsibility for supply chain at the Association of the British Pharmaceutical Industry said, in the run-up to a no-deal Brexit—the last time this happened—that there could be currency fluctuations, including a fall in the value of the pound. He said:

“You can imagine in that situation that exporting medicines into Europe would become even more profitable. It may be that”


drugs

“that currently aren’t being exported suddenly become attractive to export, driven entirely by profit”.

The UK is not invulnerable to what might happen next, and I would like the Minister’s observations on that.

Launched earlier this year, COVAX wants wealthy nations to pool funds that together can be used to develop and scale up vaccine production. In return, rich countries would have a guaranteed supply for about 10% and 15% of their population. I would also like the Minister’s answer to that, because several noble Lords have raised that question.

This is one of those debates in which one feels that so many people are better qualified to speak than oneself. I finish by quoting the noble Lord, Lord Crisp, and what he said on Monday. He said:

“This amendment is absolutely right in asserting that the UK should reaffirm its position and its rights to protect the health of its population. We should adopt it. The future will be difficult, as will the negotiations on this issue, but no one should be in any doubt about the UK’s firm position. We should support not just the UK’s position for the population of the UK directly but a global effort to deal with these important matters.”—[Official Report, 26/10/2020; col. GC 71.]


I could not have put it better myself.

Medicines and Medical Devices Bill

Debate between Baroness Thornton and Baroness Barker

Committee stage & Committee: 1st sitting (Hansard) & Committee: 1st sitting (Hansard): House of Lords
Monday 19th October 2020 Grand Committee

[Baroness Barker (LD)]

My Lords, I just want to add to what my noble friend Lord Sharkey said. This is a matter of principle; from the two reports by the two committees that have been cited and from the Second Reading debate, the Government can be in no doubt about the strength of feeling on it. In the light of those, the Government’s response in the government amendments in this group is, frankly, rather pathetic and not at all acceptable.

The Bill represents an enormous upheaval for one of the critical areas of our industry. The pharmaceutical industry is of immense importance to this country. Apart from anything else, to add criminal offences created through delegated powers by means of a Bill that is so spare and lacking in detail does a huge disservice to people who want to continue to pursue not just high-quality but ethical production of badly needed medicines in this country and within international frameworks. If the best the Government can do is to table the amendments in this group, they do the industry a great disservice.

[Baroness Thornton (Lab)]

I do not think that I need to say much in response to the remarks that were, I think, unanimous in their support for my amendment and the other amendments in the group. The cap on the sentence is not a good enough response by the Government. Earlier in our debates, I made a remark about amendments designed to circumvent; I am afraid that the government amendments before us are exactly that kind of amendment. They will not serve, I am afraid.

Unless the Government are prepared, as I hope they are, to table amendments that actually solve the problems and address the issues raised by the Constitution Committee and the Delegated Powers and Regulatory Reform Committee—they could not have been clearer on this issue: in this country, we do not set up criminal offences and their sentences by delegated legislation—there is nothing more for me to say, other than that I hope the Government will think again.

Covid-19 Update

Debate between Baroness Thornton and Baroness Barker

Tuesday 6th October 2020 Lords Chamber

[Baroness Thornton (Lab) [V]]

I thank the Minister for this Statement, which was made yesterday in the Commons, and for the one made on Thursday in the Commons. It seems like a good idea to take them both together, since the news about the unreported and untracked positive tests needs urgent scrutiny, and the Minister does not have to suffer double the pain of explaining the very real problems we face with the winter and the second spike.

For example, today, we see another increase in positive tests—14,522 cases reported, with two-thirds of those in the north and north-west. To summarise, we have had people being told to travel hundreds of miles for a test; hundreds of children out of school unable to get a test; tracers sitting idle, watching Netflix; care home tests taking days to be processed; the Minister’s hyperbole, saying this could be a moment of national pride, like the Olympics; and a Prime Minister in a complete muddle over the rules. The Prime Minister seems to be able to learn large chunks of Greek by heart, so why, when he does regional media, could he not at least learn which lockdown rules apply where? It is not much to ask.

The questions from my honourable friends Jonathan Ashworth and Stella Creasy in the Commons yesterday were very pertinent. The reason why they needed to ask what the contractual teams were for the contracts supplying test and trace is that they are not working well and a large amount of public money is being spent on them. Is it not sensible to ask if there is a break clause if goods being purchased with public money are faulty or not working properly, given that they have been sold to us as world-class and planet-beating? What did the Secretary of State say to these questions? Unfortunately, he reverted to the government line of blaming Public Health England. Can we see the terms and conditions and profit margins on all these contracts? Is it true that there is no break clause addressing whether these contracts do what they are supposed to? As the former chair for a few years of the procurement committee of a local CCG, at a very lowly level in the NHS, I can tell the Minister that these are vital questions which have to be asked—questions for which I would expect to be held to account.

Does the Minister agree that transparency would ensure proper governance and accountability for those charged with the stewardship and responsibility of spending public money? Let us examine this for a moment. Is it true that Public Health England’s older version of Excel has a 65,536-row limit, meaning that, in the data transfer from the big CSV file, rows were chopped off? Can the Minister confirm that the data could not be handed over to Public Health England due to the size of the Excel spreadsheet files? Why are critical databases in a national pandemic being hosted on Excel spreadsheets? Is it true that the upgrade to a later version of Excel, which copes with just over 1,000,000 rows, costs about £100? Is this an issue with one particular lighthouse lab or across all the lighthouse labs? Public Health England’s sources say that they report the data when they get it from NHS Test and Trace, so if the information is coming in incomplete, they cannot do their job.

We know that the budget for test and trace is in the region of £10 billion to £12 billion, and it seems to me that an IT audit might have been a good place to start. Was there one? What did it say? We know it is true—so, presumably, does the Secretary of State, who is ultimately responsible for Public Health England—that Public Health England’s budgets were cut by 40%. So, is it the case that Public Health England had no IT upgrades of any kind recently? Given what we know, is it legitimate to ask where all that money has gone?

Why in October, after all the promises of the Prime Minister, the Secretary of State and the noble Baroness, Lady Harding, are we now facing the possibility of 60,000 people unknowingly spreading Covid in their homes and communities, which might account for some of the sudden increases seen today? Have all those people been contacted, traced and isolated?

These are not irrelevant, disloyal or silly questions: they are vital if these matters are to be remedied. They are vital if the Government are to dispel what communities are feeling, described on Sunday by the leader of the Labour Party, Keir Starmer, as

“This deep sense of despondence, anxiety. And actually, what they want is hope.”


We on these Benches want the Government to do that: to give hope. Assuring us that they have everything under control will, however, not work anymore, because it is clearly not true.

Surely, what is needed is transparency and a strategy, expressed with clarity, that everybody understands and supports. It is, furthermore, urgent. Tonight, a group of leaders of the largest councils in the north—Manchester, Leeds, Newcastle and Liverpool—has written to the Prime Minister asking for, among other things, significant local control and support. I beg the Minister not to chant the mantra that test and trace are working closely at local level, because clearly they do not believe that it is. Again, it does not seem to be true. I hope that the Government will respond positively to these councillors.

Yesterday, Jeremy Hunt asked whether responsibility for NHS and care home staff testing should be moved to hospitals and laboratories, and that idea was repeated by the Nobel laureate Paul Nurse, of the Crick Institute, on the radio this morning. The fundamental problem is that there is no strategy: there is a vacuum. That is because there is division in the Cabinet over which strategy should be followed. This needs to be remedied and a clear way forward explained.

Finally, with regard to the part of the Statement concerning treatment: will the Minister clarify whether the establishment of Orbis will be in co-operation and collaboration with EU medicine protocols or in competition with them? Will Parliament scrutinise Orbis, and when?

[Baroness Barker (LD)]

I thank the Minister for yet again turning up at the crease to defend what is becoming increasingly indefensible: the poor performance of the NHS Track and Trace system.

The noble Baroness, Lady Thornton, was right to note the admission in this Statement that 16,000 positive results had not been uploaded, and that by yesterday only 51% of those people had been contacted, despite the injection of resources into NHS Track and Trace over the weekend to try to make up the deficit. Given that we know that each person who tests positive is likely to report between four and five contacts, that is potentially 60,000 people who last week were walking around, not self-isolating and possibly infecting others. It is not their fault—they did not know. It is a really significant breach of trust.

In the part of the Statement that I find most curious, the Secretary of State said that the Chief Medical Officer’s analysis of the Government’s assessment of the disease as a result of the new data was that

“its impact has not substantially changed.”

Can the Minister give us further detail about that? The omission of 60,000 people not having any impact does not add up at all. The Secretary of State went on to say that the Joint Biosecurity Centre had confirmed that

“it has not impacted the basis on which decisions about local action were taken last week”.—[Official Report, Commons, 5/10/20; cols. 625-6.]

When will that data come through and when will we be able to see the impact on local areas? As these statements make clear, the virus is beginning to have different impacts in different places. Can the Minister say at what point directors of public health were informed about this breach? Six months in, it is clear that, when local authorities are properly resourced and given correct and timely information, the virus is managed and contained. The major problems come about when decisions are made centrally, poorly communicated and badly executed.

Time and again, it comes back to track and trace, whether it is about a lack of skills and capacity or a lack of foresight. Who could not have foreseen the impact that hundreds of housefuls of students moving around the country in September would have on transmission?

Yesterday when this Statement was debated in another place, speaker after speaker, mostly from the Conservative Benches, got up to complain about the effect of the 10 pm arbitrary cut-off. They explained how well-run businesses, especially in the hospitality sector, will be going to the wall because of continued use of blunt instruments designed nationally and applied over wide geographical areas. How long will it be before the Government realise that local people—local professionals, directors of public health and environmental health officers—have detailed knowledge about businesses in their area, their hygiene ratings, their previous breaches of licensing conditions and where crowds congregate? When we can get decision making to a more local and granular level, we will be better able to protect good businesses without jeopardising public health.

I welcome the announcement of hospital funding for upgrades to A&E departments. We need a greater capacity for A&E. However, could the Minister give the House the definition currently used by this Government of what constitutes a new hospital?

On the Orbis project, we go into this having left a safe and highly effective system of medicines regulation, one where patient safety is paramount. How does the Government propose to withstand the commercial imperatives of American pharmaceutical companies in these circumstances?

The public are getting very worried about the extent to which the Government continue to wing it. It is time for them to bear down on the fundamental flaw in their strategy—thinking that they know best in the centre, above people who are professionals at a local level.

Covid-19 Update

Debate between Baroness Thornton and Baroness Barker

Wednesday 23rd September 2020 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for taking questions on this Statement today. It was noticeable yesterday, and on Monday, that at no point was there any attempt to reveal any scientific basis or evidence for the impact on the spread of the virus of either a 10 pm curfew or going back to working from home if you can. A few weeks ago, we were all being urged to go to the office or workplace if we could. We have certainly not been told what SAGE’s modelling shows as the impact a ban on mixing households indoors would have.

The Government are lacking a clear Covid-management approach. We recognise that the pandemic, and its impact, are complex. The response can be no better than the best compromise, and that should be admitted. Timely policies to rejuvenate the economy will fail if policies to contain the infection fail; we recognise that. In the absence of a vaccine, testing, tracing and isolation is the only response that matters now. Covid infection data should be published, to make it clear to the public where the risks are. The Prime Minister said that more information would be made available. I would like to know that it will and when that might happen.

This leads back to testing, tracing and, importantly, isolating, as every conversation about the containment of Covid-19 does at the moment. Looking back over the last few weeks of growing disquiet, and then serious concern, about not being able to get tests, does the Minister agree that part of the problem—leaving aside the seeming failure of the noble Baroness, Lady Harding, and her operation—is the clear lack of communication about testing? I plead with the Minister not to treat the House to the mantra about the record number of tests and so on. It is completely clear, from MP’s postbags and the media, that “them out there” were under the impression that tests were more widely accessible than they in fact are. Lecturing us on how simple all this is both misses the point and is dangerous.

As far as schools are concerned, I asked a headmaster how things were going. He said: “If they ran a school the way they are running the country, what Ofsted grade would they put on their self-evaluation form?” I thought that was quite a good question. The tone of the Secretary of State and the Prime Minister in their Statements rather gave the impression that the Government were blaming people for breaking the rules and allowing the virus to grow. The reality is that people have done everything that they were asked to do. They have missed birthday celebrations, weddings and funerals; they have, quite rightly, sent their children back to school; they have gone back to their workplace. They have done what they were asked to do. In return, Ministers were supposed to fix test, trace and isolate so that we could return to something like normality.

The mayor of Tower Hamlets, John Biggs, said:

“With cases rising the government is right to bring in stricter restrictions to prevent the transmission of COVID-19. In Tower Hamlets we need to keep each other safe by following these new rules”.


He added:

“Government also needs to ensure adequate testing is available and that there’s continued support for those losing out financially due to these restrictions. The next few months will continue to be challenging—as a community we’ll remain resilient and together can get through this”.


He puts the case extremely well.

The Cabinet Office Minister, Michael Gove, said the 10 pm curfew on pubs in England has been brought in after evidence from places such as Bolton, where the curfew has already been in place for two weeks, suggested it will drive down coronavirus infection rates. However, according to the latest figures released by Public Health England, the infection rate in Bolton has risen again. Does the Minister share my concern that the new regulations may be based on poor evidence? Will the Government review this decision and immediately publish the evidence to allow it to be scrutinised in peer review?

Why is that 10 pm curfew not on all sales of alcohol? For example, you get thrown out of the pub at 10 pm with five of your mates; you go to the off-licence, buy whatever you want and go to somebody’s home. I cannot see the evidence that this will make any difference. I would really like to know.

Returning to tests, can the Minister confirm that only half of all tests have been received in less than 24 hours and will he publish the Pillar 2 data which breaks down how many people asking for those tests were symptomatic and how many were asymptomatic? Many parents report going to walk-in centres with their sick children, when they had no symptoms, and being given a test. Was that a national policy? Has it been abandoned? This is further evidence of confusion.

I welcome what the Minister said about prioritising NHS staff, care workers and teachers, but can he clarify why he has issued guidance to hospital trusts placing restrictions on the number of tests they can carry out? Also, how he will protect care homes? In a previous exchange this afternoon between the Leader of the House and the Leader of the Opposition, my noble friend asked the noble Baroness about domiciliary care. I think she maybe did not understand what was being said—it might have been after a question from the Back Benches. Will people in domiciliary care, going from one home to another doing social care, be given PPE and will the tests available in care homes be available to them? I am trying to put it as simply as I can because it is a very important question.

Will the Minister ensure that no one is discharged into a care home without a Covid test? Given where the virus is, what is his advice to the shielding community? What protections is he putting in place for those from black, Asian and minority-ethnic communities, given that there are disproportionate numbers from those communities in intensive care units even today?

None of us wants to see another lockdown or circuit-break. We will understand if one becomes necessary, but test, trace and isolate should be fixed. The failure of that has left us vulnerable and exposed. It seems to me we must now act with speed to save lives and minimise harm.

[Baroness Barker (LD)]

My Lords, three months ago the Secretary of State said that test and trace was the single most important thing that had to be done to conquer the virus. Yesterday the Prime Minister said it had “little or nothing” to do with the transmission of the virus. These two things cannot both be right. For six months, the problem has been that we have had confused messages, careless use of statistics and a persistent refusal to work with and listen to people who run local public services and know what needs to be communicated to whom and how.

All those are the fundamental reasons we find ourselves in this situation. We still lack an effective and timely track, test and isolate system. In its place and without any evidence base behind them, we have come up with messages which, quite frankly, do not make sense to the general public. The rule of six does not make any practical sense at all, as was very well evidenced today by my noble friend Lord Newby in an earlier interaction with the Leader of the House.

Yesterday, the Prime Minister said the Government now had granular data that enabled them to understand the transmission of the virus. When will that evidence be released? And when will it be released to Members of this House and the other place, who, next week, are going to be asked to renew emergency powers the like of which have never been seen before to this Government? If the Government cannot come up with that evidence—and, I have to say, over the last six months, they have persistently failed to answer any kind of detailed question from Opposition Benches in this House—why on earth should they be trusted to have those powers renewed? When are we going to get the evidence base?

It is helpful, looking at the Secretary of State’s Statement, to see that finally, after repeated questions from these Benches and the Labour Benches, we have got a clearer statement on who is being prioritised for testing and in which area. But, as the noble Baroness, Lady Thornton, said, it is remarkable that there is nothing about black and minority ethnic communities, which we know are at greater risk, and nothing about the important people who work, for example, in domiciliary care, or who work in hospitals but are not medics.

I would like to ask one final question. When will they start listening to local authorities, who are persistently asking, in helpful ways, what they can do to expand the capacity for testing and to make sure that testing is better tied into the rest of the services? We are about to have an app launched, and local authorities are already telling us that there is soft intelligence that people who think they have symptoms but are unable to get a test just give up, and that people whose children are ill give up. It is all well and good for the noble Lord to say, as he did the other day, that they are going to completely redo NHS 111 to make it a more streamlined portal into the NHS, but if people have given up looking for tests long before they should, we are never going to get the data we need to get on top of this.

So I ask, as I did the other day: when they are revamping NHS 111, will they talk to the Royal College of Paediatrics and Child Health about the NHS 111 protocols? I agree with the noble Baroness, Lady Thornton; I think the public are desperate to do the right thing. They have been extraordinarily patient and have listened throughout, giving the Government the benefit of the doubt. But they will not go on doing that indefinitely while the Government continually fail to come up with a decent evidence base for their actions.

Covid-19 Update

Debate between Baroness Thornton and Baroness Barker

Monday 21st September 2020 Lords Chamber

[Baroness Thornton (Lab)]

Like everyone here, I watched the briefing by the Chief Scientific Officer and the Chief Medical Officer today, and very sobering it was too. It was followed by a very informed discussion on the BBC. It feels that we are playing catch-up again, although I realise that that is almost inevitable. Today we have had another Statement since this one and I gather that the Prime Minister will make a further Statement tomorrow.

Last week, when we discussed the then Statement which was already three days old, I said that I thought that we had come to a critical moment when some very serious decisions would need to be taken, and clearly that was correct. The words “tipping point” and “perilous moment” were used in the Commons today during the debate on the Statement. As we have said all along, clarity of messaging is totally vital. The country has become increasingly confused about what people should do to protect themselves and those around them, so perhaps this break point is really important.

A few weeks ago, the Prime Minister was setting out his stall to review the outstanding restrictions and allow a more significant return to normality, possibly in time for Christmas. Now the Prime Minister has admitted that we face a further six months of very difficult lockdown restrictions while the CSO, Sir Patrick Vallance, said that the UK faces 50,000 Covid cases a day by mid-October if the current infection rate is not halted. My first question for the Minister is: are we now at level 4? I ask because the Joint Biosecurity Centre has recommended that the Covid-19 alert level for the UK should be increased to level 4, meaning that transmission of the virus is high or rising exponentially. It has been at level 3, meaning that the Covid-19 epidemic is in general circulation, for several months, but the Chief Medical Officers of England, Wales, Scotland and Northern Ireland said in a joint statement this evening:

“After a period of lower Covid cases and deaths, the numbers of cases are now rising rapidly and probably exponentially in significant parts of all four nations.”


Given that, are we going to move to level 4?

Can the Minister confirm that the Government intend to bring forward further restrictions in London? What are the next steps nationally? This morning, Chris Whitty, the CMO, said that people should

“break unnecessary links between households to stop coronavirus spreading out of control.”

Has the advice about return to work changed? Can the Minister confirm whether the reported two-week circuit-breaker lockdown is indeed going to happen?

It is deeply concerning that the Statement last Thursday contained scant reference to testing. As my right honourable friend the shadow health Secretary said, under this Government test and trace is actually trace a test. When will that be resolved? Giving evidence to the Science and Technology Committee on Thursday, the noble Baroness, Lady Harding, told MPs:

“I do not think anybody expected to see the really sizeable increase in demand that we have seen over the course of the last few weeks.”


This is simply not true. Can the Minister confirm that SAGE warned the Government that the UK faced an inevitable increase in community transmission and cases after the summer and needed a fully functional and trusted test and trace system put in place?

I feel that I need to talk about the “moonshot”, because it is an emerging story on the i that the moonshot test for Covid-19 that will allow people to resume normal life will not be available on the NHS—as the Government’s testing tsar, the noble Baroness, Lady Harding, suggested. She said that individuals and companies would have to pay to access the proposed test and that it would not be part of the normal NHS test and tracing scheme that she heads, which will continue to concentrate on swab tests. So the question I need to ask the Minister is: are we now looking at an A and a B test and trace system or an A and B test system where people who can afford to pay for a test can get one immediately and those who cannot—the majority of us—will not?

Given these issues, tests now seem to be rationed, with health and social care prioritised. Could the Minister reflect on reports that care homes worst hit in the first wave could be tested for coronavirus less often, as the Government believe there will be higher levels of immunity and that they are less likely to pass on the virus? This is deeply worrying, given the high percentage of staff turnover and the vulnerability of residents.

Can the Minister confirm reports that evidence shows that 20% of people who have been told to self-isolate are still leaving their homes, and will that information be published? That is presumably what is leading to the much more aggressive fines. The Government say that the £10,000 maximum fine will act as a deterrent to testing positive and not self-isolating. Does the Minister share my concern that this actually may deter people with symptoms from getting a test at all? For many people, ignorance may also be the only legitimate option, as they are unable to get a test and self-isolation is financially non-viable.

The Minister will be aware that the Joint Committee on Human Rights said it was unacceptable that many thousands of people were receiving fixed-penalty notices despite evidence that the police do not fully understand their powers. They highlight enforcement as having a disproportionate impact on young men from black, Asian and minority ethnic backgrounds. Currently there is no way for people to challenge the fixed-penalty notices easily, so does the Minister share my concern that this will invariably lead to injustice, as members of the public who have been unfairly treated with a fixed-penalty notice have no means of redress?

It ought to be straightforward for a member of the public to find out what the current law is, nationally and in their local area, without having to trawl—as the rest of us are doing—through countless confusingly named regulations. Will the Government publish a website where people can enter their postcode and be told in plain English what restrictions currently apply where they live?

[Baroness Barker (LD)]

My Lords, I thank the Minister for dealing with this Statement, which comes hot on the news that we are at level 4 as regards the pandemic. Therefore, I want to touch on two or three points in this Statement. The first is the Government’s intention to invest £24 million in increasing call-handling capacity through NHS 111, to make it into a gateway to emergency care, providing the first port of call for patients. I must say to the Minister that it is a bit late to be doing that, and most of us should be somewhat alarmed at the news in the Statement that the Government intend to conduct pilots and will roll out NHS 111 First to all trusts from December. I understand the need to run pilots, but does he not think that time is against us?

On 17 September, six council leaders, cross-party, from across Yorkshire and Humber, wrote to the Minister. It is worth paying attention to what they said in their letter. They said: “It would be worth exploring the protocols and policies that might increase demand for what might be considered lower-value testing in a time of capacity constraint. This would include working with NHS 111 and reviewing their protocols. It seems that any childhood illness may result in a Covid test—that is what GPs are constantly telling us—while the Royal College of Paediatrics and Child Health have produced helpful guidance around that.” I ask the Minister if his department has seen that guidance and whether it will pay any attention to it.

Secondly, back to care homes and the ring of steel that never was. It is very welcome that there is going to be further investment in PPE and coverage for staff who have to take time off. However, there is a real danger in this, and there always has been, because social care is much more than care homes. Only 15% of people aged 85 or over are in a care home—most people who receive care are not. It is not uncommon for domiciliary care workers to visit 10 to 15 different homes in a shift. This Statement is silent on this matter which, given that the advisers are telling us they now know more about the transmission rate, is somewhat surprising. I wonder whether the Minister could talk about that.

The big issue in the last few days is the increasing confusion among members of the public as to who should be tested. Even in areas that are on the watchlist, people do not know whether they should be tested only if they are symptomatic or if they are asymptomatic. Some authorities have been given the power to do asymptomatic testing. Going back to that letter of 17 September, I note that the local authority says that it would be happy to have discussions locally but accepts the need for a co-ordinated approach with the Government. There needs to be a public discussion that provides urgently needed clarification from the department on how long these capacity issues are going to be around and what contingencies are going to be in place to manage them, particularly in high-risk areas.

This is not endless carping but a genuine concern for public health, and I therefore look forward to some detailed answers from the Minister.

Covid-19 Update

Debate between Baroness Thornton and Baroness Barker

Thursday 10th September 2020 Lords Chamber

[Baroness Thornton (Lab)]

First, I place on record our thanks to the teachers, head teachers, school staff, university and FE college staff and others making it possible for our children and young people to return to their education. I hope this will remain a top priority for the Government as we move through and, we hope, out of this pandemic. It has been wonderful to see my great-nieces and nephews and granddaughter joyfully going back to school in the last week. As a non-executive director of one London’s hospitals, which is in my record, I can testify to the huge amount of work going on preparing for the winter stresses.

But here we go again. We need to start by reflecting on why we do not have before us the incredibly important new Covid restrictions announced yesterday by the Secretary of State and the Prime Minister, which aim to deal with the new surge in coronavirus infections. In fact, the Statement has been made in the Commons in the last hour or so, and I suspect we will see it in due course at the beginning of next week. I accept that the hybrid nature of the House means that we will not be able to take it today, which might have helped us all enormously. It is not the Minister’s fault; it is just one of the casualties of the situation we find ourselves in. Perhaps, the noble Lord could confirm when the new regulations will be laid.

Yesterday, Mr Speaker said quite rightly in the Commons:

“It is really not good enough for the Government to make decisions of this kind in a way that shows insufficient regard to the importance of major policy announcements being made first to this House and to Members of this House wherever possible.”—[Official Report, Commons, 9/9/20; col. 619.]


The Secretary of State made a Statement about current Covid-19 issues on Tuesday and failed to mention major policy proposals of which he must have had prior knowledge and which were already being discussed on social media. Thus, he did not allow a discussion of the current proposals, which the Prime Minister then announced in a Downing Street press conference and a letter which noble Lords will have received overnight. This suggests that the omission was deliberate and reveals yet again the disregard with which the Minister and his colleagues hold their duty to be accountable to Parliament, which is undermining our democracy. If Mr Speaker follows through on his threat to allow Covid-19 UQs at the beginning of every day to ensure that the Secretary of State can and will report new policy and be accountable to Parliament, I assure the House I will be arguing to take every single one in this House every day, so that the Minister can do his bit for accountability, too.

We have a Statement before us, press announcements made and a new law of six, but I need to return to the question I asked yesterday about what has gone wrong with the testing system. I would be grateful if the noble Lord would engage with what look like widespread problems some people are having accessing tests, rather than repeating the mantra about the high proportion of successful tests close to home, which is accurate, I am sure, but not the way to solve a clearly growing number of problems. I know the Minister will not shout at me, as his right honourable friend did to Keir Starmer yesterday, or accuse me of undermining the whole test and trace system when legitimate, evidenced problems are being articulated by many Members of Parliament and reasonable questions are being asked. The Minister needs to address the problem of the availability of tests.

Yesterday, I mentioned schools, where inevitably children will become ill. Parents are advised to keep them at home and get a test, and some are finding this impossible. Unsurprisingly, parents turn to teachers and head teachers for advice, placing even greater stress on our schools, which are working so hard to keep our children safe and educated. A reliable, rapid testing regime is vital, as we have said from the outset.

As for moonshot, which the Prime Minister mentioned in his letter, with his fondness for hyperbole, if the Government cannot even deliver testing for those ill with symptoms, how on earth are they going to deliver 10 million tests a day? I want to correct a statement the Secretary of State made in the Commons an hour or so ago, when he said to my honourable friend Jonathan Ashworth that the Labour Party was opposed to mass testing. That is absolutely not true. What we are against is incompetence. We are saying: how on earth will moonshots be delivered if basic testing is not working well?

The new regulations are meant to make it easier for people to understand. But does the noble Lord agree part of the confusion stems from the fact that some of these rules may be inconsistent with government messaging that people should return to work. Does he accept that, even where employers are taking necessary steps to facilitate social distancing, busy commuter trains, tubes and buses are not Covid-secure? On these Benches, we have said from the outset that one of the biggest barriers to self-quarantining would not be Covid fatigue but personal finances. Does the Minister accept that the Government need to go much further in helping people who need financial and housing support to self-isolate? Otherwise, how will we get on top of infections in areas characterised by low pay, child poverty and overcrowded housing?

Finally, to contact tracing: in Bolton, contacts were reached in only 57% of non-complex cases; in Oldham, 50%; in Blackburn 47%; and in Bradford, only 43%. Nationally, only 69.4% of contacts are reached and asked to self-isolate. These are Government’s latest statistics, and they make me wonder whether “world-beating” is yet another piece of hyperbole. On the effectiveness of testing, my colleague, the shadow Health Secretary, highlighted that only 69% of contacts were identified by the test and trace system, and I am afraid the noble Lord’s colleague Matt Hancock said he was wrong. He was right. I yet again have to ask the noble Lord—privately, if he wishes—to correct his boss’s record. More importantly, how can we improve on that record of testing and tracing?

[Baroness Barker (LD)]

My Lords, this is a Statement made two days ago in the other place, but it has been largely overshadowed by yesterday’s deluge of hyperbole and hokum. The Prime Minister said yesterday:

“We know, thanks to NHS Test and Trace, in granular detail, in a way that we did not earlier this year, about what is happening with this pandemic. We know the groups that are suffering, the extent of the infection rates, and we have been able, thanks to NHS Test and Trace, to do the local lockdowns that have been working.”—[Official Report, Commons, 9/9/20; col. 609.]


If that is true—and given the record of the Prime Minister and Health Secretary, one is always entitled to ask whether it is—how come local authorities and directors of public health are given only limited access to the test and trace case management system and not given full access to the contact system? Why are the Government sitting on data or passing it to companies run by their mates, instead of passing it to local authorities, which, for weeks, have been trying to predict and manage the inevitable spike in infections that follows people starting to travel and going to school and university. Why are they not getting that data in a timely manner?

From the start of this pandemic, experts advised the Secretary of State to invest in public health teams and NHS labs that are numerous and easily reached by many communities, including in rural areas. Instead, he gave the money to outsourcing firms such as Serco and G4S, which have no expertise and have not had to compete for the contracts. He could have invested in local public services; instead he has built a system on a foundation not fit for purpose. On Tuesday, in the Statement, the Secretary of State for Health said of care homes that

“we have met our target to provide testing kits to all the care homes for older people and people with dementia that have registered to get tests.”—[Official Report, Commons, 8/9/20; col. 517.]


But on Monday, the Government were forced to apologise for continuing delays to Covid-19 testing for care home bosses and GPs, who are threatening that these will lead to more infections among vulnerable people.

The Secretary of State’s own department, the Department of Health, admitted to breaking its promise to provide test outcomes within 72 hours. Care managers have described the Government’s centralised testing service as “chaotic” and “not coping”, amid reports that whole batches of tests are coming back not only late but also void. Testing officials told care homes by email on Monday morning that

“immediate action has been taken at the highest levels of the programme to bring results times back”

within 24 hours.

“We apologise unreservedly to … you … and your staff.”

The ring of steel that the Secretary of State claimed to have put around care homes never was. With upwards of 40,000 deaths, when will the Government sit down with care home providers, local authorities and CCGs to develop a comprehensive system of testing and supply of PPE? It does not have to be world beating; it just has to work.

The Prime Minister’s Statement yesterday would have been risible were the consequences not so serious. Most ludicrous of all was the announcement of a team of Covid-secure marshals to enforce the new laws on public gatherings. The Government could have done any number of things. They could have announced resources to enable the rehiring of retired public and environmental health professionals, since there is a shortage. They could have given funding to local community and voluntary groups to communicate ongoing health risks and the law to communities. They could have given additional funding for trained police officers to work with health officials and businesses to improve adherence to infection control. But, no, instead we got another vacuous attempt to steal the headlines. Maybe these marshals, with no training, no resources, no local management and no authority could join up with the 750,000 volunteers for the NHS and the trackers, and like them they could sit and twiddle their thumbs, waiting for the phone to ring.

One thing we can be sure of is that this is another stunt which will be an utter waste of time, money and resources. Local authorities, police forces, health authorities and schools are using their professional expertise and local knowledge to plan effective public health interventions. They are not only following the science but also using it to actively protect people in their authorities. In stark contrast, this Government ignore advice, misrepresent the science and carry on winging it, but the data on infections and the lack of reliable testing are evidence that the Prime Minister’s bumbling bombast and the Health Secretary’s growing litany of half-truths are indicators of world-beating incompetence and, sadly, people in black and minority ethnic communities and poor communities will suffer the consequences. It is time for the Government to change.

Coronavirus Bill

Debate between Baroness Thornton and Baroness Barker

3rd reading & 3rd reading (Hansard) & 3rd reading (Hansard): House of Lords
Wednesday 25th March 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, on behalf of these Benches, I thank the Minister for the way he has conducted the Bill. It has been a perfect exercise in consultation and work across the House. I thank not just the parties but other noble Lords who have taken part in this Bill for co-operating and working together in a way that has allowed us to scrutinise it as best we possibly could. I think we raised every issue that we could during its passage. It is important to have those things on the record because, as we move forward, we will need to know that we have asked those questions, and the Government will need to address them.

I thank my team, particularly my noble and learned friend Lord Falconer, who got drawn into this about a week ago, and my noble friend Lady Wheeler. I also thank the people in the office, who of course do all the work. In our case, that is Rhian Copple, who has done a brilliant job in keeping us informed and on the go.

I thank all my noble friends and noble Lords who are not here, but who gave us their views and have been patient. I know that they would have wanted to be here.

[Baroness Barker (LD)]

My Lords, from these Benches I too thank the Minister, the Bill team and all the civil servants who have worked with them for the collaborative and inclusive way that they have conducted the Bill through this House. I thank Members on other Benches for their immense understanding and patience as at times we have had to rattle through some very difficult issues that normally, in other circumstances, we would not have dealt with in that way.

Human Tissue (Quality and Safety for Human Application) (Amendment) (EU Exit) Regulations 2019

Debate between Baroness Thornton and Baroness Barker

Wednesday 9th January 2019 Grand Committee

[Baroness Thornton (Lab)]

That is right. I intend to cover some of these issues when I speak tomorrow in the major debate.

[Baroness Barker (LD)]

My Lords, I will confine myself to considering the regulations. I accept the challenge thrown at us by the noble Lord, Lord Deben, about what we are doing. For my part, I believe that my job is to go through these SIs precisely to establish what is real and what is fictitious in them. There is a grave danger, not least on an important subject such as this, that the general public are being given completely false reassurances. I take the point that the regulations are for a no-deal situation and will last for six months only, but the world does not stop and research does not stop in those six months. I echo the point made by the noble Lord, Lord Winston, that the impact on medical research is tremendously important.

I will make two points. On the inspection of premises, the noble Baroness mentioned in the discussion of the previous regulations reciprocal inspection powers between countries. She said that countries in the EU will continue to inspect their premises and we will inspect ours. In a no-deal situation, why would the EU 27 continue to uphold our inspection processes? They are under no obligation to do so. That has huge consequences, not least for research. I make the observation that if we in the United Kingdom are sitting here content that the EU countries will continue to inspect their own facilities to their own standards, that is a very curious interpretation of taking back control.

Secondly, we are told that the regulations will be in force for six months in a no-deal situation. What if, down the line, it turns out that there has been an adverse incident either here or in the EU? What are the implications of that in a no-deal situation for the protection of patients? Yes, we are in fantasy land, but even in fantasy land we have to start asking real questions. Those are simply two of the many questions that noble Lords are entitled to ask and to which we are entitled to have strong answers.

Quality and Safety of Organs Intended for Transplantation (Amendment) (EU Exit) Regulations 2019

Debate between Baroness Thornton and Baroness Barker

Wednesday 9th January 2019 Grand Committee

[Baroness Thornton]

Along with the noble Lords, Lord Deben and Lord Tyler, and other noble Lords, my noble friend has done rather a good job of ensuring that these issues will be taken to where they belong: the Floor of the House.

[Baroness Barker (LD)]

My Lords, we have had a lengthy debate, but it has been extremely helpful and important, and that was best illustrated during the debate on the previous instrument, in the answer the noble Baroness, Lady Manzoor, gave to my question about the inspection of premises. I made the point that the noble Baroness has repeatedly said that this is about ensuring existing arrangements continue. When I challenged her, she was given instant advice that we were talking only about the question of importing organs and tissue, not exporting. That is brilliant; in effect we are not, in a no-deal scenario, going to continue with an existing arrangement for the EU 28, but will, from that point on, be a third country. Whatever we may wish or hope for, the EU will be under no obligation to treat us under continuing and existing laws. Therefore we will inevitably be at a disadvantage. That was extremely helpful.

Mental Capacity (Amendment) Bill [HL]

Debate between Baroness Thornton and Baroness Barker

3rd reading (Hansard): House of Lords
Tuesday 11th December 2018 Lords Chamber

[Baroness Barker (LD)]

My Lords, I too thank the Minister for bringing forward this amendment and for having taken the time and effort to discuss the thinking of the department with many of us. I pay tribute to him and to the noble Baroness, Lady Stedman-Scott. They were rookies—this was their first ever Bill—and they have done a tremendous job, not least because it is a fairly open secret that many of us think this is one of the worst pieces of legislation ever brought before this House. I seriously mean that; we have said it several times. Together, they have enabled all of us in this House to play a very responsible role in turning some very bad legislation into legislation that is still in many regards highly deficient, but not as bad as it was.

As the noble Baroness, Lady Murphy, said, inevitably we failed to see the wood for the trees. We were so busy dealing with big defects in what was presented to us that we did not really get the chance to stand back and look at what would be an efficient overall system. It is for people in the House of Commons to look at what remains to be done to improve the Bill as it comes to them.

Part of it is that we spent so much time looking at the role of care home managers, we did not get around to thinking about how AMCPs, IMCAs and appointed persons could work together more efficiently to ensure that the most vulnerable get the most attention. It is unfortunate that Sir Simon Wessely’s review came to us only last week, with, at its very heart, the important issue of objection, the implications of which we should have been able to discuss in this Bill. I am sure we will need to return to that.

On this amendment, I thank the Minister for widening the triggers to include the involvement of an AMCP. But I want to flag up to those who will look at this in future the change in the role of care home managers and the role they will continue to play in renewing deprivations of liberty for up to three years, which is a big concern.

I also want to return to an issue that has been raised before: why, in this Bill, do we continue to deploy the best interest argument when it comes to ensuring that somebody has an IMCA? Several times we have asked to see the evidence base for creating that hurdle to access an IMCA, and the Government have yet again not given us any. A lot of people, particularly older women with dementia, will not get an IMCA because they will not be deemed to be objecting.

Perhaps the Bill’s biggest deficiency, and one we have not discussed much, is that practically nothing is in regulation; large swathes of it will be left to a code of practice. If one goes back to the Mental Capacity Act, however, one finds regulations that relate primarily to those who will be enacting this legislation. Regulatory conditions are applied to those who can be an AMCP, and to what their training has to be, and to those who can act as an IMCA, and to their ongoing duties to maintain contact when people move and to step in when the appropriate person, for some reason or another, ceases to fulfil the obligations it was initially assumed they would.

I say to those who will look at this in the House of Commons: the Government must be required, apart from anything else, to come forward with a great deal more detail than we have been able to elicit from them. With that, I welcome what is before us today.

[Baroness Thornton (Lab)]

My Lords, I join other noble Lords in welcoming this amendment, which we will of course support. It is a little disappointing that we have not made all the progress that we wished around the AMCP. We are half way there with the pre-assessment regime in this amendment and have a commitment that the other part will be undertaken in the Commons. As the Minister and other noble Lords will be aware, the Bill has to end its passage here anyway, so we will be able to see whether those commitments have been fulfilled to ensure that the safeguards are in place.

As we discussed on Report, and in the helpful meeting with the Bill team, the amendments we were seeking—to ensure that the care home manager is not responsible for decisions about independent consultation —have been responded to. However, I am not sure we are quite there yet.

As the noble Baroness, Lady Watkins, pointed out, a question remains about independent hospitals employing their own AMCPs and whether that is a conflict of interest that needs to be dealt with by the Bill. As other noble Lords have said, we need to ensure that if the person who expresses concern is a member of staff, they will be protected under the whistleblowing regime. I accept that, as the noble Baroness, Lady Finlay, said, that would not necessarily be included in the Bill, but it simply has to be there, otherwise this will not work.

The noble Baroness said that we are going to congratulate each other, but I shall do that next.

Mental Capacity (Amendment) Bill [HL]

Debate between Baroness Thornton and Baroness Barker

Report: 2nd sitting (Hansard): House of Lords
Tuesday 27th November 2018 Lords Chamber

[Baroness Barker]

My Lords, I think the Minister deserves our congratulations on having met all the conditions that we around the House said we believed were important. I am sure that the Government always intended to have some of these matters as part of the legislation, but making them explicit in the context of the Bill is helpful. Not least, it will be helpful to care home managers themselves, who will welcome the protections from unjust accusations of undue influence in future. On behalf of these Benches—and, I should imagine, others—we welcome that.

[Baroness Thornton (Lab)]

My Lords, I agree with the noble Baroness, Lady Barker, and welcome these amendments. As the Minister said, they are very important and deal with the issues of conflicts of interest and the preauthorisation review. I congratulate the Minister on navigating us to this point, and certainly we will be supporting the amendments.

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[Baroness Barker]

My Lords, I will speak briefly to Amendment 77 in my name, which was drawn up because of the experience of many relatives. I make particular reference to the case of Stephen Neary, where relatives had to deal with local authorities which were telling them wrongfully what their position was in law. A great deal of responsibility was put on to the relatives to oversee the right interpretation of the law. This amendment seeks to ensure that, where they are acting in the best interests of someone who is cared for, relatives would be able to meet an AMCP and trigger their involvement. In our earlier discussions, there was an underlying sense on the Government Benches that the involvement of professionals can often be an unwelcome intrusion into families. In fact, many of them do not find that at all. Many find that the first occasion when they come into contact with a professional is the point at which all sorts of information and understanding becomes available to them in support of their loved ones.

Although I am not seeking to press this amendment today, I hope that the Minister might think about it and, if he is disposed to do so, make some supportive statements.

[Baroness Thornton]

My Lords, I will speak briefly to Amendment 46, which is in my name and supported by the noble Baroness, Lady Barker. It provides that the care home manager, or any person interested in the cared-for person’s welfare, is responsible for being satisfied that an AMCP should carry out a pre-authorisation review. The Committee has already discussed this and the important safeguards which we will be seeking come under Amendment 76A. Some of the important matters raised by the noble Baronesses, Lady Finlay and Lady Barker, have been addressed by the Minister in the Government’s amendments. I look forward to his reply.

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[Baroness Thornton]

My Lords, right from the beginning of this Bill—at Second Reading and in Committee—concerns have been expressed across the House about how the interests of the cared-for person can be ensured through the process of using the AMCP when that person is at their most vulnerable and may not be articulate at all. The noble Baroness, Lady Finlay, articulated exactly what we are saying. Amendment 76A, in my name and those of the noble Baroness, Lady Barker, and the right reverend Prelate the Bishop of Oxford, is an essential fail-safe that we believe needs to be in the Bill.

Like the Minister, we have sought across the House to prioritise the issues that we thought were most important for the cared-for person. I think we have come through rather well in improving this Bill together, and mostly without having to resort to Divisions. I hope that the Minister will accept Amendment 76A, because it is certainly in line with the aspirations that he has expressed to the House about safeguarding the cared-for person. If he is not prepared to do that, certainly on these Benches we hope that the noble Baroness, Lady Finlay, will seek the opinion and support of the House, because it is certainly there.

[Baroness Barker]

My Lords, it has been a concern of all noble Lords who have taken part in discussions on the Bill that a person could be deprived of their liberty without seeing an appropriate professional at any time. We have argued back and forth about the extent to which access to an appropriate professional should be universal, automatic or whatever.

With this amendment, the noble Baroness, Lady Finlay, and those of us who have attached our names to it are trying to ensure that where the people who are most closely associated with a person have a genuine and deep concern—I imagine it would be a shared concern—but not necessarily a formal role, they can alert a professional to come in and make an assessment. We are trying to close a loophole that we think is still there.

If we can do that, we will be well on the way to doing what the Minister has indicated the Government are trying to do: to make the most effective and efficient use of professional resources amid a level of demand which we know cannot currently be met. We have moved some way from what we would ideally like to see and this amendment represents something of a compromise. I hope we can reach agreement on this last part of the link.

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[Baroness Barker]

My Lords, like all other noble Lords, I welcome the Government’s change of heart on this matter and am glad that they have understood the very real concerns about conflict of interest in relation to care home managers. However, I would like to take this opportunity to raise one other potential conflict of interest to which we have not really had time to pay much attention, and that is within the responsible body. The responsible body may well be the local authority which is funding somebody’s care home place. During meetings, stakeholders have been very concerned that the person within the responsible body who makes these decisions should not be within the commissioning part of that body, as there is the potential there for another conflict of interest.

Some further work will have to be done—I suspect either in regulations or in a code of practice—to make sure that we do not enable another conflict of interest to take place which is probably more important than a conflict of interest relating to a care home manager. It is just a case of being sure that all the decisions—although principally these decisions—are taken by a person within the responsible body but not within the financial decision-making parts of it.

[Baroness Thornton]

I have an amendment in this group which covers the same ground that we have been talking about for the last 20 or so minutes. It is probably not essential to pursue this amendment because the government amendments on this matter seem very comprehensive.

Mental Capacity (Amendment) Bill [HL]

Debate between Baroness Thornton and Baroness Barker

Committee: 3rd sitting - (Hansard): House of Lords
Monday 22nd October 2018 Lords Chamber

[Baroness Barker]

I have to disagree with the noble Baroness, Lady Finlay. Mark Neary had to resort to the law, not to a code of practice, to get his son out of a place where he should never have been detained. We need to have further discussions about what needs to be in the Bill and the role of regulation and the code of practice. I think she has a fundamentally wrong take on this. This is about legal protection for very vulnerable people. That sometimes has to be in a brief outline in law. It has to be stated in the Bill that a person has to be spoken to face to face. We can then go on to put a load of stuff in the code of practice about how we do that.

To pick up the point made by the noble Baroness, Lady Murphy, I think this is a terrible Bill containing huge holes and some real problems. If the Government take the tack they took last time, we may be able to improve it substantially, but we are in danger of putting one bureaucracy in place of another bureaucracy, and the only difference between the two is that there are far fewer protections for the most vulnerable people. We would be somewhat negligent to go ahead on that basis. I cannot approach the Bill in that way.

[Baroness Thornton (Lab)]

I thank the noble Baronesses, Lady Barker and Lady Tyler, for tabling this amendment. I agree with the remarks of the noble Baroness, Lady Barker, about the state of the Bill. I am rather—“disappointed” may not be quite the right word—surprised that the noble Baroness, Lady Murphy, who has brought discipline to the House to focus on good legislation and how it should work, is suggesting that we have to have something, so this is it. I really hope that that is not the case and that this Committee will have revealed to the Minister, and particularly to the Bill team, that many elements in the Bill need clarification, need to be changed and can be improved. That is our job, and the noble Baroness, Lady Barker, is highlighting but one of those elements. In fact, the amendment that I am due to talk about next refers to the difficulties that the Bill has brought and the differences between the Mental Health Act and the Mental Capacity Act.

The last month or so has been very revealing. The Bill was sold to us as something really quite simple that was going to streamline things, get rid of the backlog, save some money and so on, and it really needed only one day in Committee. That is certainly how it was sold to me on these Benches and, I am sure, to other people in the House. In fact, what has happened over the last couple of months is that all the stakeholders and people who are writing to us are saying, “No, this will not do. This Bill does not work. It is dangerous and difficult”. It needs clarification, and these amendments highlight the areas that need it. We are going to move on to other areas that need clarification and which will certainly need amendment. This is an important and legitimate question to ask about the Bill.

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[Baroness Barker]

My Lords, this is again a rather fundamental indicator of some of the things that are badly wrong with the Bill. The words “best interests” appear in it three times, and twice they are used in relation to a care home manager being able to restrict access to advocacy. As the Bill stands, referral to advocacy is controlled by a relevant person, either the responsible body or the care home manager, and an advocate must be appointed if a person has capacity and requests an advocate—that is quite rare, and I have to say that under the Bill it would be something of a miracle, because they do not have the right to information about not only their current circumstances but about other less restrictive options. The Minister’s statements on information last week, when he referred to GDPR, were so strange that it has taken me a considerable time to work out that he had completely misunderstood that under the current system people have a right to information. They have the right not to request information but to be provided with information, which this amending Bill severely restricts.

However, the second condition is by far the most worrying. Somebody can request an advocate if the person lacks capacity and the relevant person is,

“satisfied that being represented and supported by an IMCA would be in the … person’s best interests”.

I invite noble Lords to think what would have happened if those words had been in law during Winterbourne View. That is why I am quite happy to use the word “shocking” about the Bill, as this is unacceptable. My amendments would try to get rid of the abuse of the term “best interests” to limit vulnerable people’s access to support. The Minister knows that under the DoLS system, by and large, if somebody requests an advocate, it is up to the relevant body to try to do their best to find one, or that they find an appropriate person. I refer to the point made by the noble Baroness, Lady Finlay, that under case law at the moment, local authorities have the right to override if an appropriate person is not doing their job properly on behalf of the person. That too will be undermined by the Bill.

The Minister will also know that if somebody has no relatives and nobody else in the world—they are “undefended”, to use that rather archaic but useful and clear term—they have an automatic right to advocacy. I know that much will be made of advocacy being expensive, advocates being a resource that is not readily available, and that people who do not need advocacy will be unnecessarily interviewed. I am quite happy to talk at length to the Government about ways in which advocates or advocacy resources could be better used and better targeted—but absolutely not by drawing it like this, putting this sort of hurdle not even in a code of practice but in a Bill.

[Baroness Thornton]

My Lords, we on these Benches very much agree with the purport of these amendments, which again bring to light some of the ambiguities in the Bill and some of the rights that are not properly respected by it. Over the next period the Minister will not only need to give us a theoretical answer but have to answer things such as the question about Winterbourne View, and look at the hard examples of real experience which some of us have been receiving in our postbags over the last month. We will need to return to this over the next few weeks, and possibly even at the next stage.

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[Baroness Thornton]

This is the last amendment, and I will be very brief. It is quite appropriate that the last amendment we consider is about Article 5 of the ECHR, which is about the core of the Bill: people’s liberty and the deprivation of it. I have four things to say. The reason this amendment is so important is because it addresses the things that we have found lacking in the Bill which we feel need to be addressed. They are: the availability of information; advocacy and the fact that people need to have access to champions; representation; and the conflict of interest that arises when a detainer is required to assess a detainee. Particularly where a financial interest is in play, it is obvious that it has to be addressed if the proposals in the Bill are to be Article 5 compliant, which they need to be. That is the test that we need to apply to the Bill all the way through. I beg to move.

[Baroness Barker]

My Lords, I am glad that the noble Baroness has given us this opportunity to discuss a really important matter, albeit that it is late at night. I noted what the Minister said at various times throughout the debate about reliance on the code of practice. He will know that, as we have been trying to make clear all the way through the debate on the Bill, if some rights are not statutory rights in the Bill, then compliance is inn question. I rather suspect that the Bill that was presented to us was not compliant. I do not see how a Bill which, on the face of it, would enable somebody to be detained without being met and assessed by a professional person could be compliant.

There are a number of key matters which the Government are, at the moment, talking about putting into the code of practice—perhaps, possibly on a good day, into regulations—but which need to go back into the Bill. If they do not, the responsible body will not have the statutory responsibility to see that they are carried out. They are: the basis for the detention and the necessary and proportionate test and when that test applies; the role of IMCAs and access to appropriate persons; professional qualifications and training for people undertaking those pre-authorisation reviews; where an AMCP referral should be made; and the obligation to provide information to the person and their family about authorisation. All those things are important.

I say from these Benches that if we do not have considerable movement towards putting those things into the Bill, however briefly, the Bill will still be in trouble when we come to Report.

Mental Capacity (Amendment) Bill [HL]

Debate between Baroness Thornton and Baroness Barker

Committee: 2nd sitting (Hansard): House of Lords
Monday 15th October 2018 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, it is our job to look at how things will and will not work and what the alternatives are. The noble Baroness takes a perfectly legitimate position that says, “If this won’t work, what will?” In a way, that underlines a lot of the discussions we have been having in this House: we need some time to discuss this Bill and we have not been able to have that.

My name is to the amendments tabled by my noble friend Lord Hunt. We are questioning the ability of the care home manager to be able to do this at all. The words that have been used to us by the stakeholders—we have now talked to dozens of stakeholders in the last month or so—are “capability” and “capacity” of care home managers. Professionals question the capability and local government and other institutions question the capacity. Those words are being used constantly while we discuss this issue.

It is also worth mentioning the voice of the care home managers themselves, which is starting to emerge. We recently had a briefing from a large group of care home managers who feel that they are not qualified to take on this role or to carry out assessments and that the administrative burden they could carry could mean that they will not have the capacity to take on the extra work to carry out liberty protection safeguard assessments.

There is some confusion here with what the Minister said during the first day in Committee and in the letter he wrote to us all following Second Reading. I admit that I am confused as to whether we are talking about initiating and carrying out assessments and what the powers of the care home managers are. It seems that the Bill team and the Minister have given us several different descriptions of what those roles might be. That has not helped our consideration of our concerns.

Mencap has stated that it believes that the views of the cared-for person have to be at the heart of this part of the Bill and that it should be refocused accordingly. The comments made by my noble friend and the noble Baroness, Lady Finlay, suggest that that has not yet been achieved, and that the role of the care home manager makes it less rather than more likely. That has been said to us not just by Mencap but by many stakeholders. They are concerned that the cared-for person is not at the heart of the Bill. It is therefore legitimate to ask whether the Government have got this aspect of the Bill right and whether they need to find a different way of delivering it.

[Baroness Barker (LD)]

My Lords, I wanted to respond in part to the points made by the noble Baroness, Lady Murphy. The original legislation was brought in on the basis of agreement across all parties in the House; so, too, was the report which reviewed the workings of the Mental Capacity Act. There was a unanimous view that DoLS need to be revised; they are not working.

It is interesting that many of the criticisms that have come to light in recent months have been from people who do not defend the current system but who have grave concerns not just about capacity but about some basic assumptions being made—not just about the role of care managers but about how the arrangements will work in practice. There is a quite legitimate view that the legislation will not solve the problem nor necessarily deal with a backlog; it will just shove it somewhere else. We need to think our way carefully through that because, as I will go on to say in debates on later amendments, there is no doubt that there is a watering down in the legal protections proposed by the Government. The noble Baroness and the noble Lord, Lord Hunt, are therefore right that we should examine in some detail exactly what the Government are proposing, because up until this point it has been quite difficult to understand it.

I thank the Minister for sending his letter of 4 October —he did so in the characteristically open and respectful way in which he treats this House. However, I want to ask a question which is germane to what the noble Baroness, Lady Finlay, is trying to achieve in her amendment. The letter states:

“Care home managers will be responsible for arranging the assessments that are needed for the authorisation. In most cases, they will use assessments that have been completed by a social worker or a medical professional or others as part of the care planning process. This means we will reduce the duplication that exists in the current DoLS system and ensure that people access the safeguards they need”.


Exactly what assessments is the Minister talking about? DoLS assessments are different from assessments under the Care Act. It would be very helpful if he could say that, because it is one of the fundamental assumptions that we are all working to and which may turn out to be incorrect.

Mental Capacity (Amendment) Bill [HL]

Debate between Baroness Thornton and Baroness Barker

Monday 15th October 2018 Lords Chamber

[Baroness Barker]

Following on from the observation made by the noble Baroness, Lady Murphy, one of the most common restrictions of liberty is medication and medication reviews. We often think of it as being physical but it is not. New medicines often come online and create change. I take her point and hope we will be able to work towards a definition.

[Baroness Thornton (Lab)]

I will not add much more because the noble Baroness, Lady Finlay, has done us all a favour by putting forward great questions exploring the Cheshire West ruling. The Joint Committee on Human Rights agrees that a definition needs to be found, otherwise—the noble Baroness is right—we will be back in a situation where things have not gone right and we end up in court again. We all need to put our minds to this. We should be able to find a definition and I look forward to the Minister leading that particular discursive discussion across the Committee.

Mental Capacity (Amendment) Bill [HL]

Debate between Baroness Thornton and Baroness Barker

Committee: 2nd sitting (Hansard - continued): House of Lords
Monday 15th October 2018 Lords Chamber

[Baroness Barker]

There are two amendments in my name in this group. Amendment 44 is designed to probe an issue that is clearly worrying lots of noble Lords: that the condition that triggers an AMCP is that the person is objecting to their care in a particular place. The noble Baroness, Lady Hollins, is always very good at helping us to understand legislation from the point of view of people with learning disabilities. My background and my chief concern is with older people with dementia who are probably disproportionately likely to be overlooked by this provision because they will not necessarily be vocal.

I return to the questions raised by the noble Baroness, Lady Thornton: why would you object if you do not know what you are objecting to? What will happen if you do object? Will you receive any help? Currently, best interests assessments are required for DoLS detentions but, as I understand this, where a person does not object they do not get to see an AMCP. If they are in a care home, it is the care home staff, but in hospital and community settings the responsible body can use evidence from other assessments to make a determination for somebody. What is the evidence base for this? Do we know how many people currently object to their care and treatment? Why is that considered a sufficiently robust basis on which to make this a criterion in law? There is something deeply flawed and deeply wrong about this.

Amendment 59 may seem a bit strange on the face of it. It inserts a requirement to keep a record of refusals of authorisations. One of the things that the Select Committee of your Lordships’ House found was that the evidence base for DoLS is very sketchy. I have to make it clear that the Select Committee’s report was put together and came out just around the time of the Cheshire West ruling. In the light of that ruling, the number of applications shot up. We have never had a robust evidence base for the way DoLS work. I agree with the noble Baroness, Lady Hollins, that this is not going to close the Bournewood gap, but we should at least try to cover up some of the deficiencies there have been in the past. Therefore, trying to get together some basic stats and information, including how many times things like DoLS have been refused, is important.

I know, as will other noble Lords, that among professionals, or rather among stakeholders, there was a big discussion prior to Cheshire West about whether having lots of DoLS applications was an indication that in fact you were a good provider or whether that would somehow be indicated by the fact that you had none. That is not the right calculation; you can argue it either way.

We still need to get to the bottom of the transparency of the decision-making around this. That was my reason for tabling what might seem to be a rather strange amendment.

[Baroness Thornton]

My Lords—

Mental Capacity (Amendment) Bill [HL]

Debate between Baroness Thornton and Baroness Barker

Committee: 1st sitting (Hansard): House of Lords
Wednesday 5th September 2018 Lords Chamber

[Baroness Barker]

My Lords, I hope that it is permissible for me to rise again. For the avoidance of doubt, will the Minister confirm that I understood him correctly? Is he saying that the role of the care home manager has not changed? I understand that, under the existing law, a care home manager may request that somebody’s capacity be assessed, but that assessment is not usually done by them. That assessment is done by somebody else. Is he saying that that is not going to change? I am sorry, but I think it very important that noble Lords understand what the Minister says.

[Baroness Thornton]

I understood that the Minister said “escalate”, which means that something changes. Perhaps when he is answering the question of the noble Baroness, Lady Barker, he could also explain the word “escalate”.

The Government may need to think about carrying out some form of assessment of the appropriateness and suitability of care home managers to undertake this task. If that has not been done, perhaps it needs to be done in the next month or so.

--- Later in debate ---

[Baroness Barker]

My Lords, I shall not detain the Committee for long but it is important to recap on a bit of history. The original legislation that came before your Lordships’ House on this issue—the Mental Incapacity Bill—was subject to the first ever pre-legislative scrutiny. In going through that then very innovative procedure, Members of this House and another place did a couple of things which at that time were game-changing. One was that we invited people who lacked capacity to come and give evidence to us. But we went further than that. When we produced our report, we invited them back to discuss with them what we had listened to and what we had changed. One of the first and most important things that we did was to change the title from the Mental Incapacity Bill to the Mental Capacity Bill. We also, for the first time ever, produced an easy-read version of a Bill.

I strongly support my noble friend Lady Tyler because this feels like a real regression in thinking. I understand that the term is there because somebody somewhere believes that it has a legal meaning. We came up against those same arguments all those years ago and this House led the way in getting lawyers and counsel to change their minds. I do not see a reason for us not to do the same again.

I wish to add one point. I vividly remember listening to the people whom we invited back to talk to us after we had produced our report. At this point, there were only Members of your Lordships’ House in the room—the Commons were busy and had not turned up. I remember one particular gentleman who said, “When I first saw this, I thought it was really rubbish, but actually you’ve done quite a good job”. I have to say that in all my years in your Lordships’ House I do not think that I have ever received a more sincere accolade. That is not to belittle anybody’s contribution to this, but I think that my noble friend has made a very strong point.

[Baroness Thornton]

These Benches support the amendment. As the noble Baroness, Lady Tyler, and others have said, the reference to unsoundness of mind is offensive to those with learning disabilities, dementia and brain injuries and their families. The noble Baroness, Lady Barker, has just demolished all the legal arguments for including the phrase in the Bill, and indeed a lot of organisations, including the Royal College of Psychiatrists, say that it out of place in today’s society. The GMC argues that it is not clear what added protection or benefit is achieved by using the term. VoiceAbility says that “unsound mind” is not used in modern psychiatry and that it could lead to debate in disputes. Therefore, I hope that the Minister will be as agreeable about this amendment as he was about the last one.

Conscientious Objection (Medical Activities) Bill [HL]

Debate between Baroness Thornton and Baroness Barker

Committee: 1st sitting (Hansard): House of Lords
Friday 23rd March 2018 Lords Chamber

[Baroness Barker (LD)]

My Lords, time is against us. For me, that is deeply frustrating because I have listened with great care to a number of very important points as well as a number of somewhat contentious allegations and assertions being made throughout the debate, each and every one of which should be subject to a great deal of scrutiny in your Lordships’ House.

In the short time available to me, I wish simply to say this. The noble and learned Lord, Lord Mackay, as ever, gave one of the most interesting and thought-provoking speeches. He talked about the nature of conscientious objection, and I think that issue needs further examination. It is important to look not only at the nature of conscientious objection—some such objections are absolute, others are not—but at the context in which it is exercised. If there has been a fundamental flaw in this debate, it is that we have not debated those two things together. That has enabled claims to be made on either side that I believe are not fully justified.

From where I am sitting and from the briefings I have had, I would say that conscientious objection must seek to balance the rights of healthcare professionals to act within their own ethical principles with the rights of patients to access medical care. The noble Baroness, Lady O’Loan, was half-right when she said her Bill as drafted would not remove the necessity for the NHS to provide access to abortion care. No, it would not; it would simply frustrate it. In practice, that would mean the denial of service to a woman. The exercise of conscience is not without effect.

The noble and learned Lord, Lord Mackay, said he is relieved that he is not a medical professional. So am I, but I do pay great attention to those who are. In this case, notwithstanding the point rightly drawn to our attention by the noble Lord, Lord Winston—that there is not total agreement among members of the professional bodies—those bodies have considered this issue over the last 60 years. They were involved in the discussions before my noble friend came forward with his landmark legislation, and over time came to conclusions that their members in the NHS—all 1 million of them—have to accept. They are the people for whom this is not a theoretical debating point; it is the exercise of life-and-death judgment.

Medical ethics are not the preserve only of those who have conscientious objection. Healthcare professionals who provide these services do so for the good of their patients, and this Bill, as currently drafted, threatens that. Therefore, at this late stage, I have to say to the noble Baroness, Lady O’Loan, that I welcome her invitation to talk, although I do not hold out much prospect of agreement because I think that we come from fundamentally different places.

The House should think long and hard about the words of the noble Lord, Lord Turnberg, regarding what the Bill might mean. In doing so, it is incumbent on all of us to consider whether this is an improvement on the point that my noble friend Lord Steel reached 50 years ago in anticipation of the problems that we now seek to address. I support the amendment.

[Baroness Thornton]

I just want to add two words to that. The noble Baroness, Lady Barker, is completely correct. The noble and learned Lord, Lord Brown, and my noble friends Lord Turnberg and Lord Cashman have summarised the situation. I think that the noble Baroness, Lady Barker, is right: the Bill does not improve the position that the noble Lord, Lord Steel, came to all those years ago.

I say to the noble Baroness, Lady O’Loan, that assertion is not evidence. I read her speech at Second Reading in which she used the word “evidence” but did not give us any evidence. Assertion is not evidence. In this Chamber, when you want to make a case and prove it to noble Lords under the scrutiny system, the evidence has to be evidence and not assertion.

Criminal Justice and Courts Bill

Debate between Baroness Thornton and Baroness Barker

Monday 21st July 2014 Lords Chamber

[Baroness Barker]

My Lords, I will address the point made by the noble Baroness, Lady Kennedy of The Shaws, that the way in which this amendment is worded is of the utmost importance. Our amendment tries to focus not on the definition of what is pornographic but on the act of revenge. That is why, in our amendment, we have concentrated on the initial posting of an image rather than the reproduction or the recommunication of it, because the act of revenge happens in the initial posting.

To respond to the noble Baroness, Lady Berridge, we have no problem with making this a sexual offence. Quite clearly it is. We do have a number of problems with the way in which her amendment is drafted. For example, it requires that the image be of the two people involved, but you can make a very good attempt at ruining somebody’s life by producing pictures of them with somebody else. I did not think that we would get to the headless man today, but we have—the point there was precisely that it was not the two people in the relationship.

The noble Baroness, Lady Kennedy, is right to make us focus on consent. There are a lot of people out there who one would best call amateur pornographers and who actually want to share the lives on the web. I do not know why, and do not ever want to see it or have anything to do with it, but they do. It should therefore be a defence that they had reason to believe that there was consent on the part of the other person. However, if we are going to make this sufficiently robust and—what we really want it to be above all else—a deterrent that makes it absolutely clear to people who are thinking of committing such an act that they may go to prison, she is right that we need to focus on that. Our amendments are not perfect but they take us quite a long way to where we want to go.

[Baroness Thornton]

My Lords, this has been a very good and interesting debate. We on these Benches support the principle of bringing forward legislation, probably along the lines that my noble friend Lady Kennedy suggested. We do not think that either of these amendments get us to the point where we want to be, as I think those who tabled them would admit, but they take us along that road and I hope we will see something emerge that does get us there.

Images described as “revenge pornography” are indeed a form of harassment and abuse. They constitute stalking and are humiliating. However, as well as a specific offence, what is also needed is the strong political will to tackle the underlying culture that creates and legitimises sexual violence, abuse and harassment in all its forms. That requires not only a government commitment to headline-making legislative reform but to ensuring effective implementation of any new offence and bringing forward compulsory sex and relationship education in our schools. The noble Baroness, Lady Brinton, referred to what goes in our schools. It is not good enough that this is done by voluntary organisations; it should be part of our curriculum. For the protection of our children, it really needs to be mandatory in our schools.

We on these Benches have problems with both these amendments, for different reasons, some of which have already been mentioned. For example, the amendment in the names of the noble Baronesses, Lady Berridge and Lady Morris, says that to commit the offence, the defendant must distribute the images,

“with the intention that he or a third person will”,

gain “sexual gratification” from doing so. That provision is problematic. As it is framed, no offence will be committed if the defendant discloses the image with a view purely to humiliate and embarrass the person in it. The motivation behind revenge porn is not typically to distribute pornography but to humiliate, embarrass and harass the victim. We need legislation that emphasises that, not the pornography aspect.

Likewise, with the amendment in the name of the noble Lord, Lord Marks, and his colleagues, we do not see why the offence should be limited to the circumstances where the individual is identifiable. As noble Lords have said, the motivation for this offence is to harass and abuse victims, and the harm will be done whether or not he or she is identifiable to others. There is some work to be done and, because we will have a long summer break before Report, I hope that we have time to undertake it. We on these Benches would be very happy to help to do that.

Marriage (Same Sex Couples) Bill

Debate between Baroness Thornton and Baroness Barker

Monday 15th July 2013 Lords Chamber

[Baroness Barker]

My Lords, the passage of the Bill has been a remarkable thing. Having sat through every bit of it, I have to say that the discussions in your Lordships’ House have been not just of the highest calibre but deeply thoughtful about the nature of the society that we wish to pass on to future generations; none more so than the contributions from the Bishops’ Benches. The Bill represents a real sea change for gay people and for our society—a good one that heralds the start of a new relationship between minority groups and faith groups. All those groups have an important part to play in building strong communities for the future and that is why we on these Benches have supported this Bill at every stage.

We have been helped enormously by the Front Bench team in dealing with some quite difficult, tricky and intricate issues. I say to the noble Lord, Lord Cormack, that, no, there is no room for triumphalism. However, he will perhaps allow some of us today to celebrate what for us is a really important step towards equality and equal treatment. There is no room for intolerance but this House should be very proud.

[Baroness Thornton]

My Lords, the custom at this stage of the Bill is for all of us to look at each other and congratulate ourselves on the piece of legislation that we are just about to sign off. Of course, I realise that not all noble Lords feel the same sense of satisfaction at a job well done that the Minister, other noble Lords who have supported the Bill and I feel at this moment. I regret that they are not sharing the sense of joy and happiness that some of us are experiencing. Certainly, if the London Gay Men’s Chorus’s tuneful offerings outside the House are anything to go by, very many others feel the same. Some of us, indeed, could not resist wearing pink carnations. However, I note that even the noble Lord, Lord Cormack, is somewhat resplendent in pink himself.

To noble Lords who opposed the Bill I say that you have tested the Bill to within an inch of its life, and for that I congratulate you. No one expected that getting the Bill through your Lordships’ House would be a walk in the park, and I think that noble Lords have done their job as they see it with dedication and commitment.

There were moments at midnight when we were again discussing adultery when I thought we were never going to reach this point. Those moments were made all the more memorable by the description by the noble Baroness, Lady Stowell of Beeston, of what is adultery and what is not. I refer noble Lords to col. 146, 8 July 2013, if they are in any doubt. I wish her well with George Clooney, and I myself do not think that he is anything like worthy of the noble Baroness.

I very sincerely hope that time will change the views of noble Lords who are still concerned about the Bill. I hope that the happiness the Bill will bring to thousands of same-sex couples will persuade everyone that, after all, Parliament was right in its huge majorities on free votes, which led us to where we are today. I hope that your own marriages will indeed come through this change unscathed and as whole as ever, and that marriage itself will actually be strengthened and deepened by the Bill.

We must recognise that when the Prime Minister, to whom I pay tribute for his steadfast support, my right honourable friend the leader of the Opposition, Ed Miliband, and the leader of the Liberal Democrats all speak in unity, then the issue has powerful friends. However, even with those powerful friends, free votes ran through the Bill on all the major votes, and were won all the way through with huge majorities.

I pay tribute to the Minister, the noble Baroness, Lady Stowell of Beeston, for the way in which she steered the Bill through the House. Patient, energetic and always ready to listen, she never lost her sense of humour or proportion. Ditto her helpmates, the noble and learned Lord, Lord Wallace, and the noble Baroness, Lady Northover. Indeed, we worked together on this Bill, and I am glad of it. The Bill team were always helpful and friendly, and are to be congratulated on their very hard work. I know that the demands that were made on humanism, pensions and a host of other issues meant that they and the Ministers had to go back and persuade their colleagues in government that they needed to revisit or revise matters they thought already settled. I know how hard that is.

Across the House there has been remarkable work by groups of Back-Bench Peers, co-operating to win the free votes on the Bill. My noble friend Lord Alli has been remarkable; not only did all of us on the Labour side receive bulletins and information about what was going to happen and when votes were taking place, but he also organised some light entertainment for Labour colleagues. On Monday the actor Richard Wilson and last Wednesday evening Paul O’Grady, aka Lily Savage, joined us in Committee Room G. I thank them for their support and generosity. My noble friend Lord Alli has talked to everyone all the time, which I think helped the good humour and tolerance which characterised the debates even when we fiercely disagreed.

There are other Members one should thank. The noble Lord, Lord Harrison, and the noble Baroness, Lady Massey, fought the corner for humanist weddings. The noble Lady, Baroness Meacher, and the noble Lord, Lord Lester, helped to find a way through on humanist weddings. My noble friend Lady Gould explained with great clarity the issues faced by transsexual people, matters not yet resolved and to which we may return some time in the future, but not on this Bill. Many of my colleagues have been here all the way through. I thank you all.

I personally have been blessed with support and equal sharing, as it should be, by my noble friend Lady Royall, who fitted the Bill in with her many other duties. I thank her. My noble friend Lord Tunnicliffe sat next to me all through the Bill, and kept us to time and calm while under duress. I also thank the back room: Bethany Gardiner-Smith from the Opposition Whips’ Office, whose research, political management and inspired amendment-drafting made many things possible.

Marriage (Same Sex Couples) Bill

Debate between Baroness Thornton and Baroness Barker

Wednesday 19th June 2013 Lords Chamber

[Baroness Barker]

My Lords, I want to thank the right reverend Prelate for the speech that he just gave. I thought that he addressed some very difficult issues in the most sensitive way. I also think that it is important that we hold this debate, however late it is, not least to put on record the fact that very many gay couples think very seriously about parenthood. It is not something into which they enter lightly at all. Perhaps some of the most distressing of the accusations which have flown around this Bill are that people who are in support of it take the issues of children’s stability and parental responsibility less seriously than those who oppose it. That is absolutely not true. I happen to believe very strongly in marriage and one of the reasons is that I believe that it provides stability for children. That is why I want to see it extended to gay people because I believe that the children of those relationships deserve that stability.

I want to take the opportunity to flag up one thing. I am a veteran of the Human Fertilisation and Embryology Act and the question of registration of birth is one which is becoming increasingly complex. It has been very complex ever since we had planned donor-assisted conception. There is a small group of people who will never be able to find out what their identity is because they were born prior to the legislative changes that require there to be a registration of their biological parentage, and that has done enormous damage to those individuals.

There is a small group of people working in this area who have thought long and hard for some considerable time about the way in which the birth registration system of this country needs to be updated and changed. I do not want to go into it in great detail now, but the right reverend Prelate has flagged up an issue that is not for this Bill or indeed just for gay people. It goes much more widely than that, and it is something that the Government will need to return to. There was a report on this a couple of months ago which I thought might be from the Joseph Rowntree Foundation but was actually by the Nuffield Trust. It is one part of the issue that the right reverend Prelate has raised, and it is one that the Government should return to at some length and in more detail than will be possible within the scope of this Bill.

[Baroness Thornton]

My Lords, my noble friend Lady Royall and I came to the same conclusion as the right reverend Prelate the Bishop of Guildford that we needed to probe this issue, and for exactly the same reasons. It is not clear from reading the Bill exactly what is meant, whether it is satisfactory, whether it covers the point about those children and whether it is adequate in giving those children the stability that they deserve and require. The only way to do that was to put down an amendment to delete this provision, but we have no intention of doing so and merely wish to know that there is no legal uncertainty around the parentage of children of a married couple of the same sex.

All the other points that I was going to make about IVF and the embryology Act have been made. All that remains is for the Minister to reassure us that this point is covered or needs further consideration.

Funding of Care and Support

Debate between Baroness Thornton and Baroness Barker

Thursday 24th November 2011 Lords Chamber

[Baroness Thornton]

My Lords, I thank my noble friend Lady Pitkeathley for initiating this debate and pay tribute to Andrew Dilnot and his colleagues, including my noble friend Lord Warner, for the report which they produced in July this year. I am sorry that no Conservative Members on the Benches opposite are present to take part in this debate because the band of “usual suspects” to which reference has been made includes members of the Conservative Party. Their voices have been missed in this debate.

I am grateful to all noble Lords who have taken part in the debate for their insights. We felt that it was important that those on these Benches should initiate this debate as we seem to be at a standstill, or making slow progress, on many social care fronts, and in some areas are possibly moving backwards. That is a matter of grave concern. I echo the final words of my noble friend Lord Warner that we cannot afford not to do anything.

We can all agree that the need to secure a sustainable funding settlement for social care has never been more urgent, with local government and NHS finances under significant pressure and demand for services increasing as the population ages. We all agree that the NHS will never work properly without a sustainable approach to social care funding. The Dilnot report therefore offers a credible and costed way forward. We believe that the Government must move quickly to undertake detailed work on the report’s recommendations and honour their pledge to publish a White Paper, followed by legislation in 2012.

The adoption of the capped cost framework recommended by Dilnot offers a fairer and more transparent way of sharing the costs of care between the individual and the state. This will make it easier to tackle the deeper problem of underfunding that has led to the tighter rationing of services and escalating levels of unmet need, which have also been mentioned by several noble Lords, including my noble friends Lord Lipsey and Lord Warner, and the noble Lord, Lord Sutherland.

The much mentioned budget deficit is no reason for delay. The questions of affordability go beyond the current economic situation, and the additional public spending needed to fund the proposals, as we have noted, is less than 0.25 per cent of GDP. The social care system is widely regarded as inadequate, unfair and unsustainable. Under the current means-testing arrangements, anyone with assets of more than £23,250 must pay the full cost of their care. This leaves one in 10 people over 65 facing costs of more than £100,000. Eligibility criteria for council-funded services have been tightened whereby in most areas only those with very high needs now qualify for help.

The squeeze on local authority budgets over the next four years will widen the gap between needs and resources, despite the additional £2 billion announced in the spending review and the best intentions of all local authorities to protect social care. As my noble friend Lord Warner mentioned, the King’s Fund estimates that a funding gap of at least £1.2 billion could open up by 2014 unless all councils can achieve unlikely and unprecedented efficiency savings.

In addition, only this week, the report of the EHRC, led by the noble Baroness, Lady Greengross, shone a light on the too often invisible experiences of older people receiving care at home. It reveals a service stretched to the limit and older people denied the dignity and respect they deserve. It is shameful and unacceptable for elderly people to be left for hours without food and drink and not properly cleaned.

We know that the Dilnot report called for the improved integration of health and social care. Evidence suggests that this can improve outcomes for individuals and deliver cost savings. We know all this, and we have been talking about it not only for the past 40 years but in the past few days during the proceedings on the Health and Social Care Bill. However, despite notable successes, the progress has been limited, with less than 5 per cent of NHS and social care budgets being subject to joint arrangements and wide variations across different parts of the country in the quality and achievement of joint working. Indeed, part of our scrutiny and testing of the Health and Social Care Bill is whether it will make that situation better or worse.

Nor should we forget that Dilnot did not claim to have the whole answer to the challenges that we face. He claimed that his report was part of the process and addresses very importantly, among other things than those I have mentioned, the injustices of portability of care assessments. The Government’s response to the Law Commission report is most important and was mentioned by my noble friend Lady Wilkins and the noble Lord, Lord Pearson of Rannoch. The Minister should be able to respond that progress is being made on this and other matters.

The proposals for carers are also important in the Dilnot report, as is the establishment of a national source of advice. The commission recommends that better advice should be complemented with a national awareness campaign on the cost of care and a new funding system. I look for that to be part of the Government’s response to this report. Indeed, the assessment and provision of services will be available using the same system as for older people, but the funding cap will work differently for younger adults and the report sets out how this might be achieved.

We must not forget that the need for timely, effective social care not only involves the long-term disabled, those in old age and people with long-term conditions. I thank Macmillan for its briefing and for reminding us that integration across health and social care is also vital in helping to meet the practical, emotional and financial needs of people living with cancer and those reaching the end of their lives. Macmillan welcomes the findings of the Dilnot commission, as it believes that the report also represents the foundation for a fairer funding system for social care.

I have mentioned all the things on which we agree, and I have done so quite deliberately. We all agree that we urgently need a long-term solution for the funding of social care, and that is why Labour offered cross-party talks on this issue from the outset. I urge the Government to get round the table so that we can tackle the care crisis and find a fair and sustainable solution for the future.

I hope that what I have to say now may help the scepticism of the noble Baroness, Lady Barker. Indeed, when I explain how we would like to proceed, I hope that she will nudge her own Government into conceding on this and making faster progress than they have done so far.

As the Minister will recall, when the Dilnot report was launched in early July, my right honourable friend the leader of the Labour Party welcomed it and offered cross-party talks on the future of social care, using the report of the Commission on Funding of Care and Support as a stepping stone to secure a better, fairer system of care for older people and the disabled. I understand that there was an exchange of letters in September and October, and most recently a letter to the Secretary of State dated 8 November.

There are some outstanding questions that the Government need to address in their commitment to this process, and I should be grateful if the Minister would indicate to the House whether progress on them has been made. There are four points. First, securing agreement on funding and implementing the Dilnot proposals clearly goes beyond the remit of the Department of Health and the Secretary of State for Health—it should involve all the departments affected. Given the public spending implications of both the Dilnot proposals and the rising costs and needs, the engagement of the Treasury in this process is crucial. Does the Minister agree with that, and is there agreement that that is how we need to proceed?

Secondly, the Government should nominate an independent person to chair the talks. Again, does the Minister agree with that, and when might it happen? Thirdly, we would like to see established an independent secretariat with the specialist expertise to provide equal access to the negotiations as required. Fourthly, there should be a party leaders’ meeting to agree a clear timetable to demonstrate that we are all equally and seriously committed to talks at the highest level.

Those commitments do not stand in the way of the process: rather, they will facilitate it. I put them on the record now, as they have been put to the Secretary of State for Health, and say that I think it would help the House and the process if the Minister would take the opportunity to respond on this matter. Finally, I thank all noble Lords for taking part in the debate.

[Baroness Barker]

I thank the noble Baroness very much—I did not know about the correspondence. However, can she explain why an independent chair is necessary for the process? I understand the other three points but I do not understand that one. What is the reason?

[Baroness Thornton]

We think that having an independent chair is a sensible way to move forward. We have not suggested that we should appoint the chair; we have asked the Government to suggest the name of the person who might chair those talks. I do not think that any of those things is a barrier to progress in this matter.

Finally, we on these Benches think that this is one of the most important issues facing our society today. It is one that we cannot neglect or leave in the long grass, and it is one that we are determined to resolve.