Anti-depressants: Cost, Risks and Ramifications

Lord Alton of Liverpool Excerpts

Wednesday 11th December 2024 Lords Chamber

Asked by

[Lord Alton of Liverpool]

To ask His Majesty’s Government how many individuals have been prescribed anti-depressants by the NHS in England in the past 10 years, at what cost, and what assessment they have made of the risks and ramifications.

[Lord Kennedy of Southwark (Lab Co-op)]

My Lords, we are still waiting for the Minister, my noble friend Lady Merron, to arrive to answer the first Question, which I am very sorry about. I did tell people that we were not starting this afternoon with Prayers, so I am somewhat embarrassed to be standing here to tell the House that we shall have to wait a few moments for my noble friend to arrive. [Interruption.] Thankfully, I have no information, so I shall keep talking on the basis that at some point my noble friend Lady Merron will arrive and answer the Question before us.

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[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

I apologise to your Lordships’ House and am grateful to my noble friend the Chief Whip, as ever.

In 2023-24, 8.7 million identified patients were prescribed anti-depressants at a cost of £220 million, compared with 2015-16, when the cost was £270 million for prescriptions to 6.88 million people. The NHS Business Services Authority reports patient prescribing data on an annual basis rather than a running total. All licensed anti-depressants meet robust standards of safety, quality and efficacy, constantly reviewed by the MHRA.

[Lord Alton of Liverpool (CB)]

My Lords, I thank the noble Baroness, Lady Merron, for her reply and for facilitating and attending our meeting with the Medicines and Healthcare products Regulatory Agency. Has she had the chance to read the correspondence I shared with her from the bereaved family of Thomas Kingston, who, like Olivia Russell, committed suicide while using anti-depressants? Has she noted that the coroner intends to issue a prevention of future death report to the MHRA? In the light of this tragedy, what can the Minister do to create a more rigorous approval regime, including greater definition of risk? Given that hundreds of millions of these drugs are issued, at a cost of hundreds of millions of pounds, will the Government establish a longer-term inquiry to ask searching questions about root causes—what is leading to endless repeat prescriptions and driving such widespread reliance on anti-depressants?

[Baroness Merron (Lab)]

I extend my deepest sympathies to the family of Thomas Kingston after his very tragic death earlier this year. We await the findings of the inquest and will act on any recommendations by the coroner as appropriate. While there has been an increase in prescribing, as the noble Lord observes, anti-depressants, for example, are often prescribed for a wide range of reasons—not just for the treatment of depression but for migraine, chronic pain, and ME, among other conditions. The other possible reason for the increase is because of the stigma associated with seeking mental health treatment, but prescribing anti-depressants is never the first port of call—it is just one of the tools in the box to assist people. There are no current plans to conduct a review.

Foetal Sentience Committee Bill [HL]

Lord Alton of Liverpool Excerpts

2nd reading
Friday 22nd March 2024 Lords Chamber

[Lord Alton of Liverpool (CB)]

My Lords, in declaring non-financial interests as listed in the register, I express my gratitude to the noble Lord, Lord Moylan, for bringing in this Bill. I entirely endorse what my noble friend Lady Smith of Newnham has said to the House today. Being pro-life—for a woman and a child—and believing in the right to life as a human right does not make people misogynist bigots, and they should not be caricatured as such.

During the passage of the Animal Welfare (Sentience) Act 2022, I wrote that it left a gaping hole because of the lack of any comparable mechanism for the consideration of the human foetus, a point the noble Lord made earlier. I agree with what CS Lewis said in support of the National Anti-Vivisection Society: if you start by being cruel to animals, you will also end up being cruel to human beings. It is that incongruity, and how we treat the most vulnerable of our own species, that is close to my heart, and I make no apology for that.

In the 18th century, Jeremy Bentham argued that the relevance of pain was not dependent on the ability to think rationally, but rather to feel, as animals can do. In 1789 he wrote,

“the question is not, Can they reason? Nor, can they talk? But, can they suffer?”

There is an analogy here with foetal sentience, one which emerged in two ad hoc inquiries held in Parliament and in which I took part, one chaired by the late Lord Rawlinson of Ewell, a former Solicitor-General. We said that, like a newborn infant, a foetus may not be rational in the way an older child or adult is, but, if there are grounds to believe that a child in the womb may be able to suffer, we have a responsibility to do what we can to minimise such suffering. If we are uncertain about the exact point at which, and by how much, an unborn baby suffers, we should always err on the side of caution.

The noble Lord, Lord Moylan, referenced, by implication, Professor John Wyatt, who has three decades of experience treating extremely premature babies, including a large number born at 22 or 23 weeks, below the current abortion time limit. A few years ago, when addressing parliamentarians, in sobering evidence, Professor Wyatt told us that there was a link between what the foetus and premature babies experience. He said:

“I think from my observation of extremely premature babies that they are sentient, they are conscious, and they are responsive to their environment”.


Why should we care? First, this is a human rights issue. The preamble to the UN Convention on the Rights of the Child, to which the UK is a signatory, states that the child

“needs special safeguards and care, including appropriate legal protection, before”—

please note that word—

“as well as after birth”.

We have obligations that must be honoured, and how will we do that without expert research or guidance policy?

Secondly, as we have heard from the noble Lord, Lord Robathan, barbaric, discriminatory legislation permits abortion up to and even during birth in the cases of Down’s syndrome—it was World Down Syndrome Day yesterday—club foot and cleft lip and palate. As the noble Baroness told us, the NHS recommends the use of analgesics when performing foetal surgery on babies with spina bifida after 20 weeks, but pain relief is not mandatory for foeticide abortions.

Noble Lords should study the recommendations of the UN Committee on the Rights of Persons with Disabilities and attempts in the other place, in one instance, to increase the opportunities of abortion right up to birth in all cases, and, in another, to lower the abortion time limit from 24 to 22 weeks, in line with the increase in survival rates of babies born at 22 and 23 weeks. I also gently point out that, as long ago as 1988, I succeeded in the House of Commons in persuading 296 MPs—a majority of 45—to vote for my Bill to reduce the upper time limit to 18 weeks, the Swedish upper time limit. It would have saved the lives of some of the 10 million babies who have been aborted in Britain, but it was talked out by opponents. The case today is even more compelling; please note that the EU average upper time limit is around 12 weeks, with many Parliaments greatly influenced by the questions of sentience and pain.

In other areas of medicine, the precautionary principle is often applied: the idea that, where there is uncertainty, we should err on the side of caution. So, it seems to me that we ought to be prudent when it comes to foetal sentience.

I end with Professor Wyatt’s words:

“I think we should play safe, we should give the foetus the benefit of the doubt. We should assume that it is capable of experiencing pain and unpleasant sensations, and we should then treat the foetus appropriately, which would if necessary be with strong pain relief medication or with anaesthesia”.


This is both sensible and humane. A foetal sentience committee, which is all that the noble Lord, Lord Moylan, is asking us to support today, would enable us to increase our understanding in this area. I therefore commend the Bill to the House, and I gently say to my friend, the noble Baroness, Lady Kennedy of The Shaws, that Article 3 of the Universal Declaration of Human Rights states:

“Everyone has the right to life”.


Supporting that does not make me right wing, a bigot or a misogynist.

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[Baroness Thornton (Lab)]

The noble Lord will note that my noble friend made all her remarks within the guidelines of the House on how we address each other. He may not enjoy what she had to say, and he may disagree with her—some of us do agree with her—however, she did it within the rules of the House.

First, I would like to congratulate—

[Lord Alton of Liverpool (CB)]

I am sorry to interrupt the noble Baroness. I do not think I have ever misused the procedures of the House and I do not intend to start now. I respect the noble Baroness and we have made common cause on my occasions. Does she think it is within the rules of the House to talk about other noble Lords as if they are dupes or as if they are in receipt of money from outside that has been undeclared?

[Baroness Thornton (Lab)]

If the noble Lord reads Hansard, I am not sure that that is actually what my noble friend said. However, she is perfectly capable of defending herself.

I want to start my remarks by congratulating the noble Lord, Lord Moylan, on introducing the Bill with such clarity. He called it “modest”, but I beg to differ: this is not a modest Bill. It is short, which definitely helps, but it is not modest. I also need to start by stating that Labour’s policy is that abortion is an essential part of healthcare. We support a woman’s right to choose and we believe that access to safe, legal abortion should be available throughout the UK.

We need to be clear about the true intentions of this proposal: it seeks to chip away at the Abortion Act and change how we govern abortion law. The noble Lord, Lord Moylan, may have said that this is not about abortion or the Abortion Act, but the fact that so many of his supporters have said exactly the opposite—that this is indeed about abortion—shows that that is what the Bill is actually about. We can be clear that that is the intention behind the Bill.

The topic of foetal sentience is under constant review by the Royal College of Obstetricians and Gynaecologists, and its last review found no evidence of a foetus experiencing pain before 24 weeks. It is best that we trust expert medical bodies and scientists, not a Government-appointed committee, to say what is the case and how we should proceed. We need to be clear that the Bill seeks to circumvent expert clinical guidance because it has an ideological disagreement with its conclusions. I was looking at the list of participants on the committee of the royal college, and I suggest that noble Lords do the same because it is a truly impressive medical and scientific body that takes its job very seriously. One noble Lord said they had changed their view between 2010 and 2022. In a way, that proves the point: the point of that committee is to do that review.

Has there ever been a time when a Bill has been brought to this House asking the Government to set up a committee to analyse the medical evidence for, for example, coronary heart disease or endometriosis? No, because we trust the relevant expert medical bodies to do that job for us. We believe the Bill represents a dangerous move to politicise the way that we make decisions about healthcare, and for that reason I will not be supporting it if it moves forward.

The review of foetal awareness of pain reception undertaken by the Royal College of Obstetricians and Gynaecologists found in 2010 that the cerebral cortex is necessary for pain perception, and that connections from the periphery to the cortex are not intact before 28 weeks. It was therefore concluded that a foetus cannot experience pain in any sense before that stage. In the light of that, I ask noble Lords to ask why we would vote to set up a committee on that issue, unless that evidence is not considered robust.

I note that, if the Bill were to pass, the remit of this government committee would not extend to the health and well-being of pregnant women, as the noble Baroness said. The comments about sentience in fish, animals and so on make one question where the supporters of the Bill place women’s health, well-being and reproductive rights on the scale of animals, fish and so on. One has to question where that is coming from.

No other area of healthcare is subjected to a dedicated government committee designed to limit access to its treatment. The Bill would leave a woman’s right to access to care at the whim of a committee focused solely on the foetus, with no remit to consider women’s experience, needs or rights. I will certainly not support the Bill as it progresses.

NHS Procurement: Palantir Contract

Lord Alton of Liverpool Excerpts

Thursday 22nd June 2023 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend. This is absolutely about enabling innovation: the data platform is there so that providers can use it to innovate. We all hear about AI, and AI depends on data. This puts in place a data platform that AI can use. It can also be used for scheduling appointments—currently done in 32 hospitals—and for the dynamic discharge of waiting lists. All those applications can work in place only if we have an open tender process, which is exactly what we are doing here, while making sure that transitions are in place so that no hospital is left in the lurch in the meantime.

[Lord Alton of Liverpool (CB)]

My Lords, one of the issues raised during the passage of the Procurement Bill and, certainly, in the context of transparency, efficiency and getting value for money, was the keeping of some 118 million items of PPE in storage in the People’s Republic of China, at a cost of millions of pounds to British taxpayers. I have also raised this directly with the Minister. Can he give us an update as to what has happened to those items? Will they stay in storage? Are we continuing to pay and, if so, at what cost, or are we going to dispose of them? What lessons have we learned from that?

[Lord Markham (Con)]

As I said in a previous Answer, we are in the process of disposing of those contracts. On many occasions, it is easy to look with hindsight. Noble Lords may remember that, at the time, there was a massive rush and countries were gazumping each other to get hold of PPE. It was very much the feeling of this House, and all the people in the UK, that we had to desperately contract suppliers to do it. Did we make mistakes? Yes. Were we right on more than 90% of occasions? Absolutely. To keep the front line going, we needed to order more than 9 billion essential items, and we did so using the very system that we are talking about here in respect of Palantir. There are circumstances—Covid is a prime example—where it is appropriate to do those sorts of direct awards. That notwithstanding, I think we all fundamentally agree that an open, transparent and competitive tendering process will always be preferable.

Covid-19: PPE Procurement

Lord Alton of Liverpool Excerpts

Wednesday 30th November 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord. As I am sure we are all aware, this is subject to a criminal investigation at the moment, so in terms of paperwork we need to let that take its due course. What I can talk about is what we are doing as a department on that, particularly in terms of the contracts for gowns which were defective, and it is in that area that we are in dispute with them. We have made a claim and put in place a process so that we will take it to court, and we will pursue that if we do not come to a negotiated settlement which is satisfactory.

[Lord Alton of Liverpool (CB)]

Can I take the Minister to the present rather than the past, and to two Written Answers which he gave to me yesterday on the 120 million items of PPE which are currently still stored in the People’s Republic of China and costing taxpayers £770,000 every single day—three-quarters of a million pounds, daily? I asked the Minister how much this has cost to date, but in telling me that the cost has been £16.3 million, he simply took the period of April to September. I would be grateful if he could produce a more complete set of figures and say how much longer we are going to go on paying £770,000 every day to companies linked to the People’s Republic of China, to the Chinese Communist Party, and to goods that have been made by slave labour in the Xinjiang region.

[Lord Markham (Con)]

I will happily provide those updated figures in writing; I thank the noble Lord for his question because it sparked a number of inquiries on my front. As he will be aware, I am only two months into this job. But one of those very questions—a hard question for us to think about—is the cost of storage versus, dare I say, scrapping it, because we have tried to donate all we can from it, and, God forbid, having to buy it again if there is another pandemic. In many cases it is cheaper right now to scrap it and buy it again at current prices. Of course, you cannot be certain whether prices could then get inflated again, but I hope your Lordships can tell from this answer that I am very much looking into the cost-benefit of the best approach.

NHS: End-of-life Care

Lord Alton of Liverpool Excerpts

Thursday 8th September 2022 Lords Chamber

[Lord Kamall (Con)]

One thing that often happens at reviews is that we realise how complicated these issues are. One often cannot pinpoint one key issue, or one silver bullet, as it were. Therefore, quite often—and I was on a call on a different issue yesterday—we thought we had to tackle certain issues but realised there were wider systemic issues. Clearly, that is going to be the case here. NHS England’s palliative and end-of-life care programme is an all-age programme, but there are specific pieces of work focused on children and young people. We have also been working very sympathetically with charities such as Together for Short Lives. It has been commissioned to produce written guidance to provide ICBs and ICSs more detail, as the noble Baroness asked for, but also to make sure we make it a better environment and learn.

[Lord Alton of Liverpool (CB)]

My Lords, in my conversation with the family of Charlie Gard, they were emphatic that adding to the tragedy of the loss of a child, the thing they found hardest was having to go to court and go through an adversarial system. Anything the review can do to prevent the necessity of court action, notwithstanding wonderful judges such as my noble and learned friend, would be welcomed by such families.

[Lord Kamall (Con)]

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

Health and Care Bill

Lord Alton of Liverpool Excerpts

Consideration of Commons amendments
Tuesday 26th April 2022 Lords Chamber

[Lord Alton of Liverpool (CB)]

My Lords, it is a great pleasure to welcome government Amendment 48C. To see an amendment committing the National Health Service to the eradication—that word “eradication” is amazing in itself—of slavery and human trafficking in NHS supply chains is as welcome as it is remarkable. This becomes like a mutual admiration society, but I take this chance to thank my noble friend Lord Blencathra and pay tribute to him for the work he has undertaken to secure this amendment; we have become good friends in the course of this amendment and other fights on these issues as the years have gone by.

I also want to reference the work of the Bill team, who my noble friend and I met yesterday along with the Minister. I pay tribute to them for the work that they have done; they have gone an extra mile. I also thank the Minister himself and the noble Earl, for helping us with his advice in earlier stages; it was candid but helpful, and I appreciate that. I thank the Secretary of State, who has been referred to. There is no doubt that this is not just another issue as far as he is concerned; he is deeply committed to it. He does not want to be the Secretary of State presiding over a National Health Service accused of purchasing goods made by slave labour in places such as Xinjiang.

I also pay tribute to the charities and NGOs that have campaigned for this—not least the charity Arise, of which I am a trustee, and its chief executive Luke de Pulford. Serendipitously, it held a reception here attended by some noble Lords who are in the Chamber tonight, including government Ministers, a former Minister and other Members from all sides. The reception included speeches from Sir Iain Duncan Smith, Sarah Champion and Danny Kruger, underlining the bicameral, cross-party and no-party support for this amendment.

The Minister knows that I have two short questions for him about the amendment. One concerns a point raised by my noble friend Lord Blencathra about the timetable for laying the regulations and seeks his assurance that nothing is being done—such as further reviews or consultations—to kick this down the road. I do not believe that that is the case but I would love to hear it from the Dispatch Box. Secondly, the amendment gives power to the Secretary of State to assess the circumstances in which the amendment will be implemented. As the Minister knows, I would like an assurance that the reference to the word “appropriate” in the amendment could never be used to frustrate the decision of Parliament to achieve the central objective of the amendment; that is, to eradicate slavery from the supply chains.

May I also press the Minister on two other related issues? They relate to the purchase of goods from a state that was, after all, described by the Foreign Secretary herself, Elizabeth Truss, as one committing genocide. The Minister knows that the Government continue to use, in his words, commercial sensitivity in answering questions about the loss of UK taxpayers’ money on faulty PPE and addressing legitimate questions involving transparency and accountability. The Minister has confirmed to me—I quote him—that

“the Department’s Anti-Fraud Unit received referrals from varying sources on 37 contracts.”

As recently as 7 April, the Minister told me:

“The Department is committed to transparency and a total of funds recovered may be published in future.”


I wonder whether the Minister can tell us when we will get to a point when publication will be allowed.

Health and Care Bill

Lord Alton of Liverpool Excerpts

Consideration of Commons amendments
Tuesday 5th April 2022 Lords Chamber

[Lord Alton of Liverpool (CB)]

My Lords, at earlier stages of this Bill, with my noble friend Lady Finlay, the noble Baroness, Lady Northover, and the noble Lord, Lord Ribeiro, it was a great pleasure to be able to support the noble Lord, Lord Hunt of Kings Heath, in moving his amendments on organ transplantation. It is a crucial issue and I congratulate the Minister on responding so constructively and positively with that amendment. I think that we all wish it a fair wind as it goes on to the statute book.

No one was more relieved than me to see my noble friend—if I may call him that—Lord Blencathra back in his place today, because it fell to me on Report, when he was afflicted by Covid, to move his amendment. It is a pleasure to follow the speech he made earlier and the remarks of the noble Baroness, Lady Brinton, committing her Front Bench—I think the Opposition are of a similar mind—to support this amendment if the noble Lord takes it to a vote. I have only a couple of additional points to make to your Lordships.

One is about the sheer volume of items of personal protective equipment for which China is recorded as the country of origin—I raised this during Oral Questions earlier today. Since Report, the Minister has confirmed that 24.1 billion items have been bought from the People’s Republic of China, where of course the Chinese Communist Party exercises control over all companies. The cost to the British taxpayer has been £10.9 billion.

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[Baroness Sugg (Con)]

My Lords, I rise to speak to Motions N and N1. I fully support the Government’s Motion N; it delivers the same outcome as the cross-party amendment supported by your Lordships’ House and received cross-party support from the other place last week. I am grateful to the Health Secretary and my noble friend the Minister for their engagement on this issue, and to the officials and lawyers in the department for their assistance in drafting.

Motion N makes the provision of access to telemedical early medical abortion permanent. It is supported by the vast majority of medical professionals, vulnerable women’s groups and by women themselves. Following the largest ever abortion study, the service was shown to be safe, effective and compassionate.

I cannot support my noble friend’s Motion N1 for two reasons. First, it was debated in full in the other place, including substantive discussions on whether under-18s should be included. MPs voted in support of this service in its entirety, without requiring any changes. Your Lordships’ House also supported making this service permanent. Both Houses are in agreement, and I do not believe we should reopen an already considered and agreed position.

Secondly, I cannot support it for safeguarding reasons. It is absolutely crucial that we protect young people—I am sure all noble Lords agree on that—which is why the Royal College of Paediatrics and Child Health, the Royal College of Obstetricians and Gynaecologists, the DHSC and abortion providers have already agreed to produce a set of best practice standards on safeguarding and abortion care for young people. I appreciate the Minister reassuring us on this; it is how clinical guidelines should be developed. It is standard professional activity for medical royal colleges and does not warrant any additional legislation.

If Motion N1 is agreed, as a result of the inequitable provision, young women will be more likely to have poorer access to and experience of abortion care. It would mean that young women who are physically unable to make it to a clinic, as a result of a health condition, or who live in a very rural area, have no access to transport or are at risk of violence and abuse, will have no legal way to access abortion services in England and Wales. They would be forced either to access illegal pills online or to continue with their unwanted pregnancies.

I will address a couple of the points that have been raised. I also have anecdotes about how this has helped women and girls, but I do not believe it is helpful to share individual cases—we should listen to the experts on this—but the poor girl in the terrible case raised by my noble friend Lady Eaton was actually seen in a clinic, so my noble friend’s amendment would not have helped. On the point raised by my noble friend Lady Verma, of course we want to avoid sex-selective abortions, but this goes up to only nine weeks and six days, and it is not possible to find out the sex of your baby until after then. That would not be possible in early telemedical abortion.

Children must be protected. I appreciate and agree with my noble friend Lady Eaton’s desire to do this. However, as my noble friend the Minister has set out, this should be done through clinical guidelines and safeguarding best practice. I am pleased there will not be a vote on this, as I could not support it.

[Lord Alton of Liverpool (CB)]

My Lords, I made my substantive points when we debated this on Report, so I will not be tedious in repeating all those arguments about the nature of abortion, why I feel there should be a more thorough consideration of the way the law works in Britain today and why there have been 9 million abortions—one every three minutes. That does not suggest a lack of access to abortion in this country. But I support what the noble Baroness, Lady Eaton, said to us about the lack of safeguards in the amendment that we passed, against the wishes of Health Ministers, during the tail end of the Report stage consideration of the Bill.

If the noble Baroness, Lady Sugg, was right that there had been substantive discussion, I would feel easier about this, but she will agree that there was no discussion of this at Second Reading or in Committee here, and there was no discussion of it in another place. When this was voted on in another place, there was a relatively close majority at the end of a very short debate—215 votes to 188. This demonstrates that this question is not settled.

If one winds back the clock to 1967, only 29 Members of the House of Commons voted against the Abortion Act 1967. That demonstrates that not only is this not settled but there are deep concerns about the way that this public policy has been enacted. That is why I pleaded, on Report, that rather than making policy on the hoof, it would be far better if—despite our differences of opinion, some of them fundamental, on the substantive issue—at some point, there is a review of the legislation, in which we can at least talk to one another, in a civilised way, about the best approach.

That brings me to this amendment, which was introduced with such sensitivity and compassion by the noble Baroness, Lady Eaton, and which deals with safeguarding issues. I will not repeat the quotation that was just given to us by the noble Lord, Lord Morrow, but it comes from a royal college. The royal colleges may be divided about this too—I do not dispute that—but that is exactly the sort of thing that should be laid before a commission of inquiry or a Select Committee of this House to examine the workings of the legislation.

We have heard the quotation about the safeguarding, well-being and physical needs of children from the Royal College of Paediatrics and Child Health, but I was also struck by what a designated doctor for child safeguarding said in a briefing which many of us have been sent by the National Network of Designated Healthcare Professionals for Safeguarding Children. Dr Helen Daley says:

“The considered expert position of the NNDHP is that all children (i.e. those under 18) and looked after individuals under the age of 25, should be seen face-to-face when applying to take both sets of abortion pills at home so as to prevent coercion, child sexual exploitation and abuse, and so that clinical assessments can be made to check the risk of an inadvertent mid- or late-trimester abortion.”


I note what the noble Baroness, Lady Barker, said about specific individual cases. I do not know about the individual cases, other than that one was cited, and one is enough. It struck me, as a parent and someone who has worked with children with special needs, some of whom had significant emotional problems, to think how it would be if, in a home abortion, someone was to abort a late-trimester baby and the children in that household saw what happened. I think that would remain with them for the rest of their lives and it could have a deeply distressing and traumatic effect on them. That is why we should listen to Dr Helen Daley when she says

“We have very real concerns about the harm”


that this amendment to the Bill

“(which would allow girls to take abortion pills at home without a prior face-to-face consultation for any early abortion) will do to children.”

There is one other point, which was not referred to in our early debates. There is evidence about the physical effects on women. For me, this is not a choice between the unborn child and the woman—both lives matter. One in 17 women, or 20 a day, who had taken at least one abortion pill at home in 2020 needed hospital treatment for side-effects. This evidence was provided through a freedom of information request by the previous global director of clinics development at Marie Stopes International. There are significant risks.

I plead with your Lordships: when we make laws on issues such as this, let us always be respectful of each other’s opinions, attitudes, beliefs and principles, and listen to each other carefully, which we are doing in this House tonight; bluntly, I think we are a very good example to others about how this debate should be conducted. When the noble Baroness, Lady Verma, talks about the risks of, for instance, sex-selection abortions, we must take that seriously, because there have been examples of it and we know to what it can lead; we have seen that in other jurisdictions and countries. When the noble Baroness, Lady Eaton, tells us there could be risks to children over safeguarding, we must take that seriously. I promised to be brief and will now sit down.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I rise very briefly, having contributed quite significantly to the debate on Report. I support the Government’s amendment, which is not a position I find myself in very often. I respectfully disagree with the noble Lord, Lord Alton of Liverpool, who said this was not settled. As the noble Baroness, Lady Sugg—who has been such a leader, working on this issue in the House with great tenacity and determination to defend the well-being of patients—said, it has been settled in both Houses of Parliament and has been debated extensively.

The point the noble Lord, Lord Alton, just made about the sex-selection question was comprehensively answered. The dates do not work; we are talking about early medical abortion and you do not know by that stage. We have to come back to the evidence. We had an unintended experiment as a result of Covid, which showed us that telemedicine not only reduced the rate of abortion complication but increased the level of safeguarding disclosures. It is really important that we think about an equalities issue here. Access to telemedicine is medically preferable and results in more safeguarding disclosures. We do not want to deny that to young women where it is judged that it is medically appropriate.

I note that the National Network of Designated Healthcare Professionals for Safeguarding Children is working with the Royal College of Obstetricians and Gynaecologists to develop standards. It says that this should not be subject to discrimination in the law, as the safeguarding standards and guidelines are adequate. If we think about this as an access issue, this minimises the risks of young people going to provision outside the healthcare system. This is a crucial equalities issue.

Health and Care Bill

Lord Alton of Liverpool Excerpts

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

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I did not contribute to the debate on this amendment in Committee, but I did sit and listen to the contributions from around the House. What struck me was that in his characteristically sympathetic response, the Minister had not quite understood the purpose of the amendment and the problems it would solve. He stated that the amendment would place the views of parents and guardians above those of clinicians. I do not see that this is the case, especially with the revised amendment that we have before us. Unfortunately, it is a reality that parent-doctor conflict happens. I declare an interest as chief executive of Cerebral Palsy Scotland, and I have seen far too often the views of parents dismissed by clinicians. No matter how qualified parents may be, or what their role in life outside the hospital may be, they are consistently referred to only as “mum” or “dad”. Too often there is an imbalance of power with doctors, and too often parents are labelled as “difficult” or “sharp-elbowed”, as if wanting to do the best for your child is an irritant, and such parents should be grateful for what they get.

By the time a family is faced with palliative care, they will undoubtedly have been through the care of many clinicians: specialist, community, hospital and, potentially, hospice teams. The parents are therefore often the one consistent factor, and they are especially important when the child is too young or too ill, or unable to voice their own views. It is when parents feel they have not been listened to by clinicians that they resort to formal complaints or litigation. It is a last resort, but too often it is the only resort that is open to them. This amendment seeks to address this by giving them space for a formal coming together of all interested parties at an earlier stage, and so preventing costly and lengthy legal disputes. It does not place one party’s views above others; it does not, as outlined in proposed subsection (3), require the provision of resources for any treatment or require a doctor to provide treatment not in the best interests of the child. It simply ensures that there is a clear framework in these tragic, difficult cases to guide what happens next.

This amendment is designed to solve a problem currently faced by families and clinicians at moments of crisis. I urge the Government to consider it, and I will listen carefully to the response of the Minister tonight.

[Lord Alton of Liverpool (CB)]

My Lords, the House will want to move on quickly, so I will not make the speech that I intended to make on this issue, but I would very much like to endorse what the noble Baronesses, Lady Fraser and Lady Stowell, the noble Lord, Lord Balfe, and my noble friend said in their earlier speeches. I know Connie Yates and Chris Gard, who are the parents of Charlie Gard, who died in 2017 of mitochondrial DNA depletion syndrome. Indeed, I have entertained them here in the House, arranged meetings for them and travelled with them. I entirely agree with what my noble friend is trying to do. This will make mediation work; it will create a proper balance and equality of arms. No parents should have to face litigation in these often tragic and troubling circumstances, so this is a good amendment and I hope the Minister will feel he can accept it.

[Lord Sentamu (CB)]

My Lords, I was patron of Martin House in York, which is one of the amazing hospices that care for children and their parents. I was invited by the parents of a nine year-old, who was having a very difficult and trying time, to talk to clinicians, because they did not think that they were being heard. As we talked, it became clear that that was not true: the clinicians were on the side of the parents, but their language was not helpful. We had this amazing conversation, and as a result the needs of the child and the aspirations of both the parents and the clinicians matched, and we were able to get very careful care. What the noble Baroness, Lady Finlay, is trying to do is recognise that in most cases parents have good desires, and clinicians probably know more than they are willing to say but hold back because of the sheer pain and difficulty that they see on the faces of everybody, and another voice can help in these situations.

--- Later in debate ---

[Baroness Eaton (Con)]

My Lords, health and safety have arguably never been more front and centre in our nation’s thinking and approach to healthcare. The Government prioritising healthcare in one of their flagship Bills is therefore expected. I am proud of our Government.

As proud as I am, I feel equally perplexed as to why the amendment tabled by the noble Baroness, Lady Sugg, seeking to override the Government’s decision to end the temporary policy on at-home abortion would garner any serious consideration, given that it would contradict the aims of the Health and Care Bill by placing the health and safety of women and girls at risk. It also distracts from important matters in the Bill, for which the Bill was intended.

The provision allowing at-home abortion made alongside a host of other Covid regulations during an unprecedented global crisis was only ever meant to be temporary alongside almost all other temporary provisions of the Coronavirus Act that the Government are expiring or have already expired. The Prime Minister said that the Covid restrictions

“take a heavy toll on our economy, our society, our mental wellbeing and the life chances of our children”.—[Official Report, Commons, 21/2/22; col. 45.]


The health toll could not, in the specific case of the temporary provision allowing at-home abortion, be more apparent; it is a toll being taken on vulnerable women and girls. As highlighted by a submission to the government consultation on this matter, the lack of in-person consultation increases risks of potentially life-threatening conditions being missed, pills being prescribed beyond the 10-week limit, more women being coerced into a home abortion against their wishes and pills being obtained fraudulently.

These are not unwarranted concerns. Soon after the temporary policy was implemented, story after story emerged of the tragically painful experiences women underwent as a result of this policy. For example, a Telegraph article reported on a nurse whose at-home abortion led to extreme complications needing surgery. Indeed, there have been several cases of women taking these abortion pills outside the legal and safe time limit. For example, in May 2020 police investigated the death of an unborn baby after a woman took pills received by post at 28 weeks pregnant. Such cases are unsurprising given that abortion providers cannot ensure that at-home abortion pills are taken by the intended person in the intended circumstances and time. According to the American College of Obstetricians and Gynecologists, only half of women accurately recall their last menstrual period, again reaffirming that medical confirmation of gestational period is critical.

Given the vast evidence base highlighting how this policy has placed women’s health and safety at risk, an evidence base thoroughly reviewed by the Government in an extensive three-month consultation, I urge the noble Baroness, Lady Sugg, to withdraw her amendment but if she does not, I urge noble Lords to vote against it.

[Lord Alton of Liverpool (CB)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Eaton, and I rather agree with the points that she has just made. But the noble Baroness, Lady Sugg, also knows that I have considerable admiration for her, especially over issues around the stand she took about cuts to our overseas aid programmes; we had the privilege of serving together on the Select Committee of your Lordships’ House that deals with international relations and defence. She will not be surprised to know that I find myself in disagreement with her and I urge your Lordships to think seriously about Amendment 183.

I will give the House two reasons for this, if I may. One is procedural and the other is more substantive. I suppose on the substantive point, I will cite, as the noble Baroness, Lady Eaton, has done, some of the contradictory evidence that we have before us. Your Lordships may not be able to work out whether you believe one side of the argument or the other, and that brings me straight to the point about procedure.

Here we are at almost midnight. This issue has never been debated at any stage in another place in the elected House. Rather like Amendment 170 that we discussed earlier, we have to consider how we resolve sensitive and controversial ethical issues of this kind. There was no consideration of this question in the elected House, and it has come to us without being considered in Committee but at the fag end of Report stage. Surely all of us can agree, wherever we come from on the more substantive point, that this is not the way to go about parliamentary business.

We should bear in mind that since 1967, when the original legislation was passed in another place and then approved here, there have been 10 million abortions, which is around 200,000 every single year. Put another way, there is one abortion every three minutes. You do not have to come from the position that I think noble Lords will be aware that I come from, of believing in the sanctity of every human life, to think that this cannot be right. Indeed, my good friend Lord Steel, who was the mover of the original legislation, has often said that he never intended abortion to be as widespread or repeated as often as it has become.

This all points to the question of procedure. Should there not be a joint committee of both Houses to consider this extraordinarily complex ethical question? Should we not at least have a Select Committee that considers these matters? Should there not be pre-legislative scrutiny before a Bill or an amendment of this kind comes before Parliament? It is passing strange that since 1967, no Select Committee of either House has looked at this legislation, the original Abortion Act 1967. I say to the noble Baroness, Lady Fox, who always makes valuable contributions to your Lordships’ House, that we are changing the law. That is why this amendment is before your Lordships’ House this evening. We would not need the amendment if we were not changing the law.

I also ask those who have rightly emphasised the importance of conscience, and particularly some of my friends and noble friends on the Lib Dem Benches, why this is not a conscience vote. Why is there a Whip on an issue of this kind?

[Noble Lords]

It is!

[Lord Alton of Liverpool (CB)]

I am glad to hear that, because I was sent a document earlier on saying that there would be a Whip and that people should vote “Content” for this amendment.

[Noble Lords]

No.

[Lord Alton of Liverpool (CB)]

If that is so, I am glad to hear it. Noble Lords will know that, for me, this issue led to my leaving the Liberal Democrats when it became a party policy, so I would love to hear clarity on that question as the evening goes by. I passionately believe that this should be a conscience question for every Member but also at every vote. This should never be a party policy; people should be free to make up their own minds on a serious ethical issue—one of such magnitude and order that it should not be dealt with in such a perfunctory manner.

It was the noble Lord, Lord Kamall, who said that this

“was always intended to be a temporary measure.”—[Official Report, 10/2/22; col. 1820.]

In February, in announcing its end, the Government gave the results of a public consultation. Some 70% of those who responded said that it should end immediately. The consultation highlighted increasing safeguarding risks and “concerns about coercion”. Reinforcing that point, last weekend, BBC “Newsbeat” reported that 15% of women in a Savanta ComRes survey said that they had experienced pressure to terminate a pregnancy. Some women reported being given substances to cause an abortion without their consent.

I would be very happy to share with the noble Baroness, Lady Sugg, some of the contradictory evidence from GPs and doctors. She cited the RCOG and others, but I point out that, again in that ComRes poll, 86% of GPs surveyed across the UK were concerned about women having a medical abortion past the legal limit of 10 weeks gestation. Concern was highest among female doctors, at 91%. Six in seven GPs were concerned that the policy could see more women being coerced into abortion. Some 86% were concerned that women were at risk of being coerced into an abortion by a family member or partner, and 87% were concerned that women were at risk of unwanted abortion arising from domestic abuse by partners controlling or monitoring their actions. Some 94% agreed that staff at abortion providers need to ensure that they are collecting correct medical and personal information to certify a woman for a home abortion, and that it is important that checks are put in place to ensure that women being certified for abortion meet legal criteria. So, there is contradictory evidence, and surely that should be properly evaluated before we proceed in further liberalising our abortion laws.

A study released in November 2021 suggested that more than 10,000 women had to receive hospital treatment following the use of medical abortion pills in England between April 2020 and September 2021. Previous polling showed that 92% of women in Britain agreed that a woman receiving an abortion should always be seen by a qualified doctor. There are many statements from women that, again, I could provide to the noble Baroness, should she wish to see them.

Health and Care Bill

Lord Alton of Liverpool Excerpts

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

Moved by

[Lord Alton of Liverpool]

108: After Clause 71, insert the following new Clause—
“Health service procurement and supply chains: genocide convention obligations
(1) The Secretary of State must by regulations make provision for the purposes of ensuring that procurement of all goods and services for the purposes of the health service in England is consistent with the United Kingdom's obligations under the Convention on the Prevention and Punishment of the Crime of Genocide.(2) For the purposes of subsection (1), procurement is not consistent if a Minister of the Crown has assessed that there is a serious risk of genocide in the sourcing region.(3) A Minister of the Crown must make an assessment as to whether there is serious risk if the chair of a relevant select committee of either House of Parliament requests one, and must complete such assessment within two months.”

[The Deputy Speaker (Lord Duncan of Springbank) (Con)]

I should note, for the convenience of the House, that the noble Baroness, Lady Brinton, will be taking part in this debate remotely.

[Lord Alton of Liverpool (CB)]

My Lords, as we move to Amendment 108, I should declare my interests as set out in the register: my involvement in a number of all-party parliamentary groups, and the fact that I am patron of the Coalition for Genocide Response. I should also declare my support for the other two amendments in the group, Amendments 162 and 173, which will be spoken to by the noble Lord, Lord Hunt, who has trenchantly and consistently pursued the arguments around forced organ harvesting and the public exhibition of anonymous cadavers from Chinese jails. I have spoken in favour of those amendments previously and will not repeat my arguments today.

Like those two amendments, Amendment 108 is an all-party amendment, which was tabled in Committee by the noble Lord, Lord Blencathra, by the noble Baronesses, Lady Hodgson of Abinger and Lady Kennedy of The Shaws, and by myself, and supported by the noble Baroness, Lady Brinton, who is a sponsor today. It would have been moved by the noble Lord, Lord Blencathra, but he has had to self-isolate in Cumbria with Covid, and we all wish him a speedy return to his place.

Yesterday the noble Lord, Lord Blencathra, was able to attend an online meeting with the noble Earl, Lord Howe, and the noble Lord, Lord Kamall, and he asked me to move the amendment in his place. I thank both Ministers for their constructive engagement, and perhaps I might pursue further with them some of the arguments and issues raised yesterday. During our discussion the department told me that it had found no evidence of child labour, forced labour or unethical behaviour. Indeed, that was a repeat of a statement made to me in a parliamentary reply by the noble Lord, Lord Bethell, when he was a Minister.

--- Later in debate ---

[Earl Howe (Con)]

My Lords, that is a perfectly valid question from the noble Baroness, and I would be happy to take that back to those in the Department of Health and Social Care who have direct responsibility in this area.

[Lord Alton of Liverpool (CB)]

My Lords, I know that this is a complex and long Bill, and that the House will want to move quite quickly to the next business. I will end by simply thanking every noble Lord who has participated in today’s debate, especially the noble Baronesses, Lady Walmsley and Lady Merron, from the opposition Front Benches, and the noble Lords on the Government Benches who have supported the noble Lord, Lord Blencathra, and the noble Baroness, Lady Hodgson, at every stage of the progress of this amendment.

I know that when the noble Earl, Lord Howe, said that he was instinctively drawn to these amendments, and that he found many of these practices abhorrent, he was speaking as he feels. I am grateful to him, not only for the meeting that we had yesterday with the noble Lord, Lord Kamall, but for his promise to look at this further. Among those to whom I would like to introduce him is a Uighur surgeon I have met, who has given evidence here in the House about being forced to remove organs and to kill the patient in the course of that. This is the ethical issue here. If people profit from that in any way whatever, even if inadvertently, we must not be complicit.

A year ago, we were promised that there would be an urgent review of exports to Xinjiang and fines for businesses which failed to comply with the Modern Slavery Act, when parliamentary time allowed. Those things have not happened. The urgent review has just been completed, but it ended up dealing only with military exports and there have been no fines applied one year later. It is never the right Bill or the right time. The noble Lord, Lord Forsyth, and I were told this on the telecommunications Bill, we were told it again on the then Trade Bill. We are told it on every Bill. That is why it is inevitable that we come back with amendments like this until the comprehensive plan, to which the noble Earl referred, actually happens.

The House really needs to send this amendment further. We have had between Committee and now for the Government to help us redraw it, if there are any defects or flaws. I am unaware of what they may be; they have never been pointed out to us. The noble Earl also knows that the Government could say to us, “Bring this back at Third Reading and we will help to draw up such an amendment.” However, I am told that this is not possible either. Therefore, the only way for us to ensure that this amendment can proceed and be perfected is to send it to another place. I am glad to be able to tell the House that a former leader of the Conservative Party, Sir Iain Duncan Smith, has agreed that he will personally promote this amendment if it is passed in your Lordships’ House today and take it further there. He says that he is with us 100%. I would like to seek the opinion of the House.

Personal Protective Equipment: Accounting

Lord Alton of Liverpool Excerpts

Wednesday 2nd February 2022 Lords Chamber

[Lord Kamall (Con)]

The Department of Health and Social Care’s anti-fraud unit has acted quickly to investigate allegations of fraud. Indeed, this question came up when I was on a call with the unit earlier today; I was told that it saved £157 million in prevention and recovery by identifying and preventing high-risk contracts in the early days of the pandemic. There is a single company that is a potential source of loss, where we paid it and then terminated the contract as a preventive measure. I commit to write to the noble Baroness with a fuller answer.

[Lord Alton of Liverpool (CB)]

My Lords, on Monday, at col. 650 in Hansard, the noble Earl, Lord Howe, promised to write to me and answer my specific questions about the origins of and deficiencies in PPE, some of which originated at the hands of slave labour in the genocide state of Xinjiang—where the Foreign Secretary herself has said a genocide is taking place. Can the Minister confirm that the reply will be with us before Report stage of the Health and Care Bill, and will he ensure that a copy is placed in the Library of the House? Will the Minister reconsider his statement made to me in reply to a Parliamentary Question that no organisation or individuals will be censured—especially bearing in mind what he has just told the House about the continuing inquiry by the fraud squad into allegations of fraud? If such allegations were found to be true, how can that rule out the possibility that anyone will be censured?

[Lord Kamall (Con)]

I thank the noble Lord, Lord Alton, for his persistence in asking a number of questions. I think all noble Lords appreciate that we want to recognise the huge suffering of the Uighurs in China, and that we should not do anything that can be seen to support it. I would also like to correct the noble Lord, Lord Alton: it was not the fraud squad; it was the Department of Health and Social Care’s anti-fraud unit, which has been investigating these contracts throughout the pandemic. But I will speak to my noble friend Earl Howe and check when the answer will be available. The normal process is to make sure it is available before the next session of Committee.