Health and Care Bill

Debate between Lord Alton of Liverpool and Earl Howe

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

[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.

Health and Care Bill

Debate between Lord Alton of Liverpool and Earl Howe

Committee stage
Friday 4th February 2022 Lords Chamber

[Lord Alton of Liverpool (CB)]

I will follow the noble Lord’s point. Even though it may be impossible to collect credible data on people leaving who are not going to say they are going overseas to collect organs, when they return—as the noble Lord, Lord Hunt, pointed out—many of them will receive treatment and care inside the National Health Service as a result of having an organ that has not come from within the United Kingdom. That is data that could surely be collected.

[Earl Howe (Con)]

The noble Lord makes a very good point and, if I may, I will investigate the feasibility of doing that and what systems are in place to capture that kind of data.

I am grateful to the noble Baroness, Lady Finlay, for her Amendment 297H, which covers the retention and use of tissues after coroner post-mortem examinations. I of course share the commitment to promoting education and research. However, I am afraid I do not believe that this amendment represents the right approach to supporting this aim. I appreciate that the noble Baroness emphasised that she was referring to blocks, slides and urine samples; the amendment refers to tissue samples. The advice I have received is that it is important that we remain committed to the principle that consent is fundamental to how we treat the remains of the deceased. I remember the passage of the Human Tissue Act; the noble Lord, Lord Alton, was absolutely right in what he said earlier about that. All of us should have a choice about what happens to our bodies after we die, and if we cannot exercise that choice, those close to us should be able to.

Post-mortems can already be distressing to the families of the deceased. Denying them a say as to what happens to the remains of their loved ones will compound that distress—often unnecessarily, as many of the retained tissues will never be put to use.

There are three other defects, as I see them, in the amendment; I am concerned that it would allow tissues to be stored indefinitely; it would allow for an overly broad interpretation of what constitutes a tissue sample —that is, in fact, my main concern; and it does not address the considerable challenge of how to effectively catalogue, audit or access the large amount of new material that would have to be retained.

Having said that, I believe that under the current consent-based model we can and should do more to encourage the active identification of tissues that could serve an important purpose, and to communicate the significance of retaining this tissue to the deceased’s family when seeking their consent. I understand the force of what the noble Baroness is trying to achieve and there may be different ways of doing that.

While I am grateful to noble Lords for their amendments in this area, I respectfully ask them to withdraw or not press them at this stage.

Zimbabwe

Debate between Lord Alton of Liverpool and Earl Howe

Wednesday 11th March 2020 Lords Chamber

[Earl Howe]

We are not wholly in agreement with the EU on its approach to sanctions. During the EU’s annual review of its Zimbabwe sanctions regime, for example, it decided to suspend sanctions on Grace Mugabe. As I said, the UK remains aligned to the EU’s restrictive measures on Zimbabwe during the transition period. We did not agree with its decision to suspend sanctions on Grace Mugabe; we will review the whole sanctions regime at the end of the year, as I have mentioned. It is important to stress that our commitment to the people of Zimbabwe did not stem from being an EU member. We have long-standing, deep relations with that country, as noble Lords will know. We will continue to raise our concerns with a range of international partners and most recently did so at the UK-Africa Investment Summit.

[Lord Alton of Liverpool (CB)]

My Lords, will the noble Earl return to the question put to him by the noble Lord, Lord Collins, about the use of Magnitsky powers? With inflation in Zimbabwe running at 500% by the end of last year, extreme poverty rising to 34% and corruption remaining rampant—authoritarian and brutal individuals own properties in London and have salted away money and assets here—why are the Government considering excluding kleptocracy and the misuse of resources by political leaders from the Magnitsky powers? Will he give an undertaking that the Government will reconsider that?

[Earl Howe]

My Lords, I will certainly take that point away and bring it to the attention of colleagues; it is very important. We do our utmost to ensure that our bilateral aid, for example, does not go through the Government of Zimbabwe or their agencies directly. We work primarily through multilateral organisations, notably United Nations agencies. The noble Lord is absolutely right: the economic crisis in Zimbabwe is very serious indeed. We are disappointed that the staff-monitored programme agreed with the IMF has gone off-track. Our focus at the moment is on mitigating the worst impacts of the economic crisis and concentrating on the most vulnerable Zimbabweans.

Counter-Daesh Update

Debate between Lord Alton of Liverpool and Earl Howe

Tuesday 7th November 2017 Lords Chamber

[Earl Howe]

My Lords, I am sure that my noble friend’s comments will resonate with many noble Lords. Approximately 850 UK-linked individuals of national security concern have travelled to engage with the Syrian conflict. That flow of British citizens has diminished considerably, but clearly there is a risk that some will attempt to return to this country. Our position is that, wherever possible, anyone fighting for Daesh should be brought to justice and that a decision to prosecute an individual suspected of fighting for Daesh should be taken by the relevant competent authority. Our policy is that terrorist fighters should be held to account by the states on whose territories their crimes have been committed. We would offer support to any such prosecution, so far as we were able. I reassure my noble friend that all returnees to this country will be investigated where that is considered appropriate.

[Lord Alton of Liverpool (CB)]

My Lords, in welcoming the role that British officials played in the drafting of Resolution 2379 which, as the noble Earl told us, was passed on 21 September by the Security Council, may I press him on two or three details about that resolution? For instance, concern has been expressed about the absence in the resolution of explicit reference to the 120,000 Christians who were displaced from the plains of Nineveh, and to the Yazidis who were displaced from Sinjar. Will they come within the scope of the inquiry and will those particular displacements feature in it? The resolution also says that Daesh fighters will be prosecuted in Iraq’s national courts—but, as Iraqi law contains no provisions on genocide, crimes against humanity or war crimes, how will that be done? Does the investigative team have the necessary capacity to collect evidence that meets the required standards?

Have the Government given proper consideration to whether a specialised regional tribunal, such as that used in Cambodia, would be a better way of dealing with this, rather than going to a national court that clearly does not have the capacity, the powers or the proper jurisdiction? Given that a veto might well have been used against a referral to the International Criminal Court, would a regional tribunal not have been a better way to go about it?

[Earl Howe]

My Lords, I will take advice on the noble Lord’s very constructive suggestion. I do not know the answer to his question but I will ensure that he gets one. Clearly, we want to see mechanisms that are fit for purpose in this context. We are all aware that there have been horrific cases of attacks on religious communities by Daesh. We are working with the Iraqi Government, the United Nations and the international community to support the protection of the rights of all minorities. That includes making sure that those who are responsible for these atrocities are brought to justice. We prioritise reaching the most vulnerable people across the region, including Christians, of course, and others who have suffered from such violence. I have already mentioned children, in particular, in that context.

It is probably right for me to leave it there. My understanding is that the United Nations Security Council is confident that the structures it has set up will deliver the necessary degree of justice and accountability —but I think the noble Lord is owed further and better particulars on that front.

Immigration Bill

Debate between Lord Alton of Liverpool and Earl Howe

Tuesday 26th April 2016 Lords Chamber

[Earl Howe]

My Lords, Amendment 59B, proposed in lieu of Amendment 59, while slightly less radical than the earlier amendment, would still mean fundamental changes to the government policy of restricting permission to work to those who have been awaiting a decision, through no fault of their own, for 12 months. As the noble Lord reminded us, those allowed to work are restricted to jobs on the shortage occupation list introduced in the last Parliament. As I indicated earlier, the Government believe that this is a fair and reasonable policy, and we believe that because of the need to ensure that access to jobs is prioritised for British citizens and those with leave to remain here—including, importantly, refugees.

The new amendment would not only allow asylum seekers to work after only nine months; it would also remove the important caveat that any delay must not be of the asylum seeker’s own making. This would benefit those who are responsible for delaying a decision on their claim and purposely frustrate the asylum process simply to gain permission to work or to avoid removal. It would also benefit individuals whose cases were complex for perfectly good reasons, such as those accused of serious criminal acts, including war crimes, where there is an inescapable imperative to investigate the facts before reaching a decision. It would also allow unrestricted access to the labour market—that is to say, not just to jobs on the shortage occupation list—regardless of the interests of British jobseekers. It is a recipe for a free pass into the UK employment pool and that really is not fair to British people competing for the same jobs. In making policy in this area, we have a duty to consider how such policy impacts on society as a whole, not just on asylum seekers.

The noble Lord, Lord Alton, rather dismissed the arguments rehearsed by my noble friends Lord Ashton and Lord Bates in earlier stages of the Bill. But there is a danger that the noble Lord’s amendment would serve to encourage unfounded claims from those who do not need protection at all but are simply seeking employment opportunities, knowing that if they play their cards right they can achieve that objective within nine months. These are opportunities for which they would not otherwise be eligible. That cannot be right or acceptable. The shorter the period allowed for in this context, the more we encourage spurious asylum claims of this kind.

Currently, the Immigration Rules allow non-EEA nationals to work here if there is no suitable resident worker available. This gives priority to those filling roles on the shortage occupation list and is subject to numerical limits. If non-EEA nationals could bypass these restrictions by lodging an unfounded asylum claim, this approach would be completely undermined. It could encourage illegal migrants to come here and make an unfounded asylum claim, which would prejudice the position of British people and recognised refugees in our labour market. I say that because if we were to experience an increase in unfounded claims, the knock-on effect would be to delay claims from genuine refugees and undermine our progress towards a fair and efficient asylum system.

There has been much debate about delays in decision-making in the Home Office, but this is no longer an issue. Delays have been brought under control and, in the great majority of cases, asylum seekers receive a decision within six months. Many of those who do not are the complex cases that I referred to earlier. The noble Lord’s amendment carries an increased risk that we will be obliged to give a free pass to people with a criminal record—or, shall I say, with a criminal past. The majority of refugees are granted asylum within six months and once that happens, they have unrestricted access to the labour market.

The noble Lord, Lord Alton, suggested that his amendment was a route out of poverty but this suggests that asylum seekers are penniless. While awaiting a decision, they receive free accommodation and a cash allowance to cover essential living needs if they would otherwise be destitute. While their claim is outstanding they can undertake volunteering activities that can benefit a community, giving them a sense of purpose, and we are exploring ways to support this.

The amendment proposed is unnecessary and I really do not think that the noble Lord has made his case. Asylum seekers do not need to work and what he proposes carries the risk of serious abuse. I firmly believe that the current policy strikes the right balance. As I said earlier, it is fair and reasonable towards genuine asylum seekers; it is consistent with our international obligations; and it takes into account the rights and needs of our society as a whole. On that basis, I ask noble Lords to resist Amendment 59B in lieu.

[Lord Alton of Liverpool]

My Lords, I am grateful to the noble Earl for his reply. However, I would beg the House to consider whether these are convincing arguments. If there were gangs of marauding criminals—or war criminals—seeking jobs in the 24 countries that use either a six-month or a nine-month limit, I think we would have heard about it by now. It is a slightly bizarre argument. If the Government were really concerned that this might be misused, then surely the answer is to engage with the amendment and for the Government to come forward and include exemptions, so that if someone is being prosecuted, they would not qualify for this entitlement. There are ways of dealing with this, if the noble Earl really is serious about it, rather than saying out of hand, “We are not prepared to do what 24 other countries are doing”.

The noble Earl also said that this will deprive British people of jobs. We are talking about a tiny number of people in reality: the 3,600 people I mentioned in my earlier remarks. If the Government are right and are able to deal with these matters in a six-month period, presumably those numbers will continue to reduce.

What is the view of the British public? A survey conducted by the IPPR found that 51% of people in the UK thought that asylum seekers should be allowed to work, with 29% saying they should not. It is not right for the Government to imply that there is hostility in the country. If you were to ask people whether it is right to leave people to survive on £5 a day, I have a pretty shrewd idea of how public opinion would react to that question. If you were to ask them whether it is better for people to scrape along in destitution on £5 a day or to be given support through their own efforts and labours, again I know where public opinion would stand. Of course people believe it is better for people to provide for themselves rather than the state making that provision for them. This is not about free passes; this is about human dignity. It really disturbs me that we are adopting a morality that seems closer to the Victorian approach to the workhouse than to one based on the humane and civilised needs of the 21st century.

I am disappointed that the noble Lord, Lord Rosser, feels unable today to come into the Lobby with us. After all, he was a signatory to this very same amendment, when it provided for six months, when it was before your Lordships’ House on a previous occasion. However, I am extremely grateful to the noble Baronesses, Lady Lister and Lady Hamwee, and others of your Lordships who encouraged me to retable an amendment today. Having done that, I would like to see the opinion of the House. I hope the House will agree that this amendment should find favour here and go back to another place so that they can have a discussion about its merits, or otherwise, which it was unable to do yesterday. That is a reason, surely, for returning it back down the corridor.

--- Later in debate ---

[Lord Alton of Liverpool]

The noble Earl may remember, or may have been briefed on it, that a meeting was convened by his noble friend Lord Bates when he held ministerial responsibility. We were told during that meeting that to deal with the problem of an employer who might repeat the offence of bringing other people into the country in order to engage in the same level of abuse against them that they did with an earlier employee, some kind of register would be drawn up and there would be a licensing system to prevent that taking place in the future. Can the noble Earl say whether any further thought has been given to that? He is quite right that none of us would want to see the repetition of these offences, but surely a licensing system and register would be the way to prevent that occurring.

[Earl Howe]

My Lords, as I said in my earlier remarks, we have accepted in principle the need to bring employers into the net, if I can put it that way. They have to register when they arrive so that we know who they are and who they are employing. I think we have addressed that point. It is necessary, I agree with the noble Lord, to know who is bringing overseas domestic workers into the country. We will be working through the detail of the registration requirement over the coming weeks and will announce more details in due course. The key purpose will be to allow us to monitor those who bring overseas domestic workers into the UK in the first place.

Immigration Bill

Debate between Lord Alton of Liverpool and Earl Howe

Tuesday 12th April 2016 Lords Chamber

[Lord Alton of Liverpool]

My Lords, from the Cross Benches, perhaps I can briefly add a remark to those of the noble Baroness, Lady Hamwee, and the noble Lord, Lord Rosser, particularly in paying tribute to the noble Lord, Lord Bates, whose leave of absence was agreed by the House only yesterday. I was privileged to get to know the noble Lord, Lord Bates, when we served in another place and we remained friends after he left the House of Commons. I was delighted when he was appointed as a Member of your Lordships’ House; I was even more delighted when the Government had the good sense to appoint him as a Minister of the Crown. He has discharged his responsibilities in the House over the passage of time, particularly on the Modern Slavery Act and now on the Immigration Bill, with great distinction. We have huge admiration for the work that he is undertaking, which is to raise the peace pledge and the work of the Red Cross and Save the Children. It touches on many of the issues which we have debated in your Lordships’ House during the passage of the Bill so, before the Bill passes, I am sure that we all add our voices to those which have already been raised in thanking the noble Lord, Lord Bates, for all that he did.

[Earl Howe]

My Lords, I am sure that my noble friend Lord Bates, were he present today, would be touched and gratified by the comments that have been made about him. I am grateful to all noble Lords who have spoken but, more particularly, I am grateful to the Members on both Opposition Benches and the Cross Benches for their constructive role throughout the passage of this Bill which, as the noble Baroness, Lady Hamwee, has said, has not quite left our Chamber yet. We will be returning to it. Nevertheless, the whole tone of the debate has been extremely positive even when it has been questioning and, from the point of view of the Government’s Benches, I express my gratitude for that.

Syria

Debate between Lord Alton of Liverpool and Earl Howe

Tuesday 15th March 2016 Lords Chamber

[Earl Howe]

It may be possible for me to give a more substantive answer to my noble friend as the days proceed. But he is absolutely right in what he says about our experience of the Russians, which is why I made it clear earlier that we need to judge Russia by its actions and not by its words. President Putin has committed to a political resolution to the conflict through UN Security Council Resolution 2254. Russia’s co-chairmanship of the International Syria Support Group is further evidence of that. President Putin told European leaders on 4 March that he agreed that now was the time to focus on the political process. He backed the timetable agreed in Vienna of a political agreement within six months and a schedule for the preparation of a new constitution and elections within 18 months. We are saying to Russia that it must use its influence to end the conflict once and for all, rather than prolong it, and we hope it chooses to do so.

[Lord Alton of Liverpool (CB)]

My Lords, reverting to the question that was asked by the noble Baroness from the Opposition Front Bench a few moments ago, has the Minister had a chance to consider the unanimous resolution passed yesterday by the House of Representatives of the American Congress, declaring events to be a genocide, following in the footsteps of both the European Parliament and the Parliamentary Assembly of the Council of Europe? Does he not agree that the time now is right for this country to consider passing such a resolution, invoking whatever judicial procedures are necessary to bring that about, and to bring the matter up at the Security Council, pressing for a referral to the International Criminal Court, in the light of the monstrous acts of barbarism by ISIS and others that have taken place?

[Earl Howe]

My Lords, we have noted with deep concern and condemnation the actions to which the noble Lord refers. We have also noted the resolution that he mentioned. As he knows, however, it has been the consistent position of the Government, and that of Governments before us, that any resolution declaring genocide is a matter for the judicial system rather than the Government. But that does not alter the facts on the ground, which are truly dire. We are very concerned that these matters should be given the due weight and prominence that they undoubtedly deserve in the negotiations.

Armed Forces Bill

Debate between Lord Alton of Liverpool and Earl Howe

Thursday 3rd March 2016 Grand Committee

[Earl Howe]

My Lords, without wishing to preclude further debate on this amendment, it may be for the benefit of the Committee if I confirm the announcement made by my ministerial colleague in another place on 29 February. This was that the option of receiving a lump sum of £140,000 will be extended to veterans in receipt of a war pension for diffuse mesothelioma who were diagnosed before 16 December 2015 and also to those who have yet to have a claim accepted. We listened to the views of parliamentarians and ex-service organisations, particularly the Royal British Legion, which commented that the Government had “done the right thing” in announcing these changes to the compensation pay-out.

[Lord Alton of Liverpool (CB)]

My Lords, I support the amendment moved by the noble Lord today in Committee. I apologise to the Committee, as, although I attended some of the Second Reading debate, duties elsewhere in the House prevented me from being able to be present for the Minister’s reply. I therefore did not speak at that stage and I crave the indulgence of the Committee in speaking today.

Noble Lords might know that I currently have before the House a Private Member’s Bill which has received a Second Reading. It enjoyed all-party support and would provide funding for research—to which the noble and gallant Lord just referred—into the causes of mesothelioma, a disease which the Government themselves predict will take a further 60,000 British lives. We have the highest incidence of mesothelioma anywhere in the world. No effective treatment exists; there is no cure and once diagnosed, the average patient dies within a few months.

On introducing that Bill, and in relation to our Armed Forces, I said that,

“the failure of the 2014 Act to include provision for compensation for our servicemen who die of mesothelioma is a glaring anomaly. The British Legion, the Royal Navy & Royal Marines Charity, the Royal Navy Royal Marines Widows’ Association, the Royal Naval Association and others all support calls for change”.—[Official Report, 20/11/15; col. 385.]

I contrasted at the time the position of a 63 year-old civilian, who might expect to receive around £180,000 in compensation, compared with a veteran’s entitlement to a year’s worth of war pension which, paid at the maximum rate for a non-married naval veteran, amounts to just £31,000. I argued then that veterans should be offered compensation at least equal to that which the courts and the Government have decided that civilians deserve. The unequal treatment of our servicemen and servicewomen amounts to a serious breach of the Armed Forces covenant, which is supposed to ensure that veterans are not disadvantaged because of their service.

I am particularly grateful, therefore, that the department has recognised that this is an anomaly that needs to be rectified, and I strongly welcome what the noble Earl, Lord Howe, said to the Committee a few moments ago. Of course, this echoes what his honourable friend in another place, the Parliamentary Undersecretary, recently told the House of Commons. He will also know that there was not just that anomaly: there was an anomaly within the anomaly in that a very small group of people—some 60—had been excluded from the scheme because of the way in which the timeline in the announcement fell. It is particularly good that the noble Earl has been able to say today that that will be removed—that the effect of the amendment that the noble Lord, Lord West, has put before the Committee will be realised.

The noble Earl will also know, especially given his previous duties at the Department of Health, that this is a disease that does not have a cure and needs much more basic research. He will also know that until the mid-1960s, blue asbestos—crocidolite—was widely used in the insulation of Royal Navy vessels. In consequence, many Royal Navy personnel have died of mesothelioma, particularly those working in boiler rooms and in engineering trades but also those on board ships during refits.

Professor Julian Peto, in an analysis for the Royal British Legion, estimates that a further 2,500 Royal Navy personnel will die of mesothelioma between now and 2047. On 8 December 2015 I asked the noble Earl in a Parliamentary Question how the Government intend,

“to assist members of the armed forces who are diagnosed with mesothelioma in the future; and what assessment they have made of whether those individuals should receive financial support at least equivalent to that of civilians diagnosed with the disease”.

The noble Earl replied that this was “a complex matter” and that:

“The Department commissioned advice from the Independent Medical Expert Group to look at mesothelioma and the awards paid through the WPS”.

The noble Earl promised an announcement and we have now received that.

However, if I may say so, there were also written into this and other Questions tabled at the time questions about the levels of research and indeed the data collection by the Government. I refer particularly to the comments of Commodore Rhod Palmer, who is a third-generation Royal Navy sailor diagnosed with mesothelioma in April 2015. Incidentally, he is one of those who would have been excluded from the new compensation scheme—the anomaly within the anomaly. He said:

“No amount of money will ever compensate sufferers and their families for a preventable death. However, it is a real breakthrough that the Government will treat all current and future sufferers of mesothelioma exposed to asbestos during their Service under comparable terms as civilians. This payment allows patients with mesothelioma to make arrangements to maximise their quality of life during this terminal illness and to support the family that they leave behind”.

He went on to say:

“Looking to the future, I strongly encourage further funding of research into advancing the treatment of this devastating condition”.

The noble Earl will recall that when he was at the Department of Health I moved an amendment to the Mesothelioma Act to provide financial support from the levy on the insurance industry, which was defeated by a handful of votes. At the time four insurance companies were voluntarily supporting research and the noble Earl believed that many of the other 120 insurance companies covered by the levy would voluntarily join the other four in supporting research into this killer disease. Sadly, I have to inform the noble Earl and the Committee that the opposite has happened, with only two companies now voluntarily supporting research. In supporting this amendment and welcoming this week’s announcement, I ask the noble Earl to study the correspondence that I have sent him today, which includes a letter sent on 18 February to Mr George Osborne, the Chancellor, by Professor Sir Anthony Newman Taylor CBE of Imperial College, urging him to release LIBOR funds—referred to by the noble Lord, Lord West—to help fund a national mesothelioma research centre, which Imperial wishes to create with the National Heart and Lung Institute, the Royal Brompton Hospital, the Institute of Cancer Research and the Royal Marsden Hospital. Incidentally, in that letter Sir Anthony says that the current rate of death is around 3,000 a year. He says:

“There is an urgent need to find curative treatment for this awful disease”.

He says that modern genetics hold great promise but that,

“sadly, to date, mesothelioma has not been the focus to achieve this at any research centre in the UK, or, as far as I am aware, at any centre worldwide”.

The Committee will recall the decision of the Chancellor to transfer some £35 million from the fines levied on the banks for attempting to manipulate the LIBOR interest rate. That money was transferred to the MoD for use in supporting the Armed Forces community. The proposal from Imperial College would be an imaginative use of some of those funds to help to find cures for a disease which has claimed too many lives among members of our Armed Forces. Following our debate today, therefore, I would be grateful if the noble Earl would write to me with a considered response to Sir Anthony’s initiative.

I shall conclude with a word about data collection within the Armed Forces. In February 2014, I asked the Government,

“how many of the annual fatalities caused by mesothelioma involve former members of the armed forces; what data are kept on the cause of death of former servicemen; and what research they plan to commission into the incidence of mesothelioma amongst former servicemen”.

The then Parliamentary Under-Secretary, the noble Lord, Lord Astor of Hever, replied:

“Data on the number of annual fatalities caused by mesothelioma does not identify those who were former members of the Armed Forces … The MOD has no plans to commission research into the incidence of mesothelioma amongst former Service Personnel”.—[Official Report, 11/2/14; col. WA 125-6.]

It is the duty of the department to do that, and it should have such plans. I encourage the noble Earl to revisit this issue. This should not be a case of don’t ask, don’t say. This is about people’s lives and our duty of care towards them. Anecdotes and speculative figures are no substitute for hard-edged data and empirical research, and today I again ask that data collection be instigated.

The noble Lord pursued this argument in June last year when he asked Her Majesty’s Government:

“What data is collected about the incidence of mesothelioma among members of the armed forces; what studies of this issue have been conducted; what estimates they have made of the future incidence of mesothelioma among service men and women and of connected fatalities”.

Those questions still have to be answered, and I hope today’s debate will help us to attend to that. In reply the Minister said:

“The MOD has not conducted studies or research about mesothelioma”.

Surely it is high time it did.

The London School of Hygiene & Tropical Medicine produced an estimate in 2009 that about 2,500 Royal Navy veterans will die from mesothelioma between 2013 and 2047. Surely, we should be commissioning research across the services to establish what the likely incidence will be and, more importantly, what we can do to avert this suffering and these deaths. Surely we should be supporting the work of our scientific community and offering hope to those who have been diagnosed with this horrible disease.

--- Later in debate ---

[Lord Alton of Liverpool]

Perhaps I can help the noble Earl because his noble friend Lord Prior of Brampton has been extraordinarily helpful on this subject and, as recently as two weeks ago, convened a meeting at the Department of Health which I attended. Many of the people involved in current research into mesothelioma were present. The big issue they all raised was sustained funding. The noble Earl, Lord Howe, knows far more about this than me so I am sure he will deal with it in his reply. The noble Earl, Lord Attlee, can be reassured that there is a lot of interest within the research community but it comes down to funding.

[Earl Howe]

My Lords, I thank the noble Lord, Lord West of Spithead, for raising this critical issue. Mesothelioma—as the noble Lord, Lord Alton, outlined—is a devastating disease that changes the lives of not only the people diagnosed with it but also those who care about them: their families and loved ones. The fact that life expectancy after diagnosis can be so tragically short is why it is so important to ensure that we get the support right for those affected by the disease.

The arrangements we announced will give veterans and their families greater control over their finances and choices to suit their individual needs. So, subject to finalising the necessary legislative changes, lump sums of £140,000 will be able to be paid from 11 April 2016. The lump sum will be provided through the well-established war pensions scheme, administered by Defence Business Services Veterans UK. Veterans UK currently prioritises claims for mesothelioma and will continue to do so. Claimants will be given a choice of either the new lump sum or the existing war pension payments. The noble Lord, Lord Empey, spoke about the need to raise awareness and I fully understand that concern. Defence Business Services Veterans UK will write to existing and new war pensions scheme claimants diagnosed with diffuse mesothelioma to explain that they have the option of the current payment arrangements or the new lump sum. The Veterans Welfare Service will be on hand to help claimants understand the lump sum option.

Defence Business Services cannot offer independent financial advice, so claimants will be advised to seek independent financial advice and to discuss their decision with their families. In addition to the announcements we made and to raise awareness of the lump sum option, details were given on the same day to ex-service organisations for them to publicise to their members.

On detection and treatment of mesothelioma, when individuals leave the Armed Forces their healthcare needs become the responsibility of the National Health Service. Most people with mesothelioma will therefore see their GP first if they are worried about symptoms. Regrettably, there is no reliable screening test for mesothelioma. The aim of screening is to pick up cancers at an early stage of the disease before symptoms develop. At the moment it can be difficult to diagnose mesothelioma since the usual tests for lung diseases often appear to be negative. Additional monitoring—as proposed in Amendment 22—outside of encouraging those worried about symptoms to contact their GP as early as possible would therefore not help detect cases any earlier.

We are, however, engaging with NHS bodies on disseminating information to GPs, respiratory clinics and other healthcare professionals so that when they treat a veteran with mesothelioma caused by military service they can also direct them to the GOV.UK website and the Veterans UK helpline. They have details of how to make a claim under the war pensions scheme and the new lump sum option. I hope that the Committee will agree that this shows that we are absolutely committed to supporting veterans with mesothelioma, and the wider Armed Forces community.

Abortion (Sex-Selection) Bill

Debate between Lord Alton of Liverpool and Earl Howe

Tuesday 16th December 2014 Lords Chamber

[Earl Howe]

My Lords, we issued guidance in May of this year. It sets out the expectations around the procedure to be adopted by the two doctors involved: certifying that an abortion meets the criteria set out in the Act by considering the individual circumstances of the woman and how they reached their decision. The guidance also reaffirms our position that abortion on the grounds of gender alone is illegal.

[Lord Alton of Liverpool (CB)]

My Lords, is the noble Earl aware that in China there have been 34 million abortions on the grounds of the one-child policy and that that has led to a distortion in the population of 34 million more males than females? Similar policies in India using ultrasound scanning tests have also led to the targeting of little girls. Given that some of these policies have been financed directly or indirectly through development funds from our own Department for International Development, will the noble Earl undertake to speak to his colleagues in that department to ensure that no British taxpayers’ money is used for these purposes?

[Earl Howe]

I am sure that noble Lords around the House will form their own conclusions on the information provided by the noble Lord, Lord Alton, but I do give that undertaking.

Ebola

Debate between Lord Alton of Liverpool and Earl Howe

Monday 13th October 2014 Lords Chamber

[Lord Alton of Liverpool (CB)]

My Lords, does not the handful of cases to which the noble Earl has just referred contrast very sharply with the prediction that 1 million people may die in West Africa? Given the fetid conditions and grinding poverty in places such as Monrovia and Freetown, does he not agree that this public health epidemic has been brought about because of the conditions that we have allowed to fester for so long?

Would the noble Earl not agree that the WHO was very slow in responding when this was first identified? Does he not also agree that an immediate problem is the disposal of corpses, which carry the risks of contagion? Furthermore, when will the 700 beds in Sierra Leone to which he alluded actually come on line?

[Earl Howe]

My Lords, I believe that the WHO itself has acknowledged that its response could have been swifter. It is easy to say this in hindsight, but I am sure that the noble Lord’s view on that is shared by others. Nevertheless, the WHO has not been slow in rallying support for efforts in the three countries affected. It is now working energetically with many developed countries to provide support, and I would not wish to criticise the WHO in those respects.

On the disposal of corpses, the noble Lord makes an important point. We know that many cases of Ebola in the three countries have arisen as a result of people being in contact with the corpses of people who have died from the disease. That has been as a consequence of the cultural traditions in those countries, which are very hard to displace or persuade people not to follow. It is nevertheless part of our effort in Sierra Leone that we should inform people there that their burial customs need to be set to one side for the duration of the epidemic. This is a very difficult thing to do, for understandable reasons, but that is the effort we are making and it is bearing fruit.

As to the programme for building 700 beds, I do not have a precise date to give the noble Lord but if I receive advice before the end of this debate, I shall tell him.

NHS: NICE-appraised Medicines

Debate between Lord Alton of Liverpool and Earl Howe

Thursday 27th February 2014 Lords Chamber

[Earl Howe]

My Lords, patients have a right under the NHS constitution to access clinically appropriate drugs and treatments recommended by NICE technology appraisals. That is a legal right. If a prescriber has failed to adhere to that, a clinical commissioning group is bound to find in the patient’s favour. However, there are clearly individual circumstances for each case that need to be looked at. The key is that the patient is entitled to expect a transparent and fair process where the reasons for a decision are published.

[Lord Alton of Liverpool (CB)]

Given that the noble Earl has just referred to the Question of the noble Lord, Lord Hunt, about access to new, innovative medicines, will he undertake to look at material which I have sent to him today from the Toronto-based mesothelioma research institute, which has developed new, innovative treatments for mesothelioma victims and may hold hope for some of the 2,200 who die of that horrific disease in this country every year?

[Earl Howe]

Mesothelioma is a devastating disease, and I certainly undertake to look at the material that the noble Lord has sent me.

Mesothelioma: Research Funding

Debate between Lord Alton of Liverpool and Earl Howe

Thursday 16th January 2014 Grand Committee

[Earl Howe]

My Lords, I note my noble friend’s question. My best answer to him at this stage is “one step at a time”. However, I can assure him that we will use our best endeavours to see a successful outcome from our discussions with the insurance industry. It is perhaps premature for me to go further at this stage.

[Lord Alton of Liverpool]

My Lords, I am grateful to the Minister, and I promise not to interrupt again, but can he provide further clarity about this £250,000? Is it drawn only from the four companies that have been referred to? How many of the 150 companies are contributing to it? What does it represent in terms of what is currently available from the industry?

[Earl Howe]

My Lords, as this is a time-limited debate, perhaps the noble Lord would accept my undertaking to write to him with those details. I am not sure, in fact, that I have them, because the letter, although extremely welcome, is quite brief in the detail it gives on the source of the funding.

Mesothelioma

Debate between Lord Alton of Liverpool and Earl Howe

Thursday 5th December 2013 Lords Chamber

[Lord Alton of Liverpool]

To ask Her Majesty’s Government what funding has been secured for research into the causes of and potential cures of mesothelioma.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, the Government are fully committed to research into the causes of this dreadful disease and into potential treatments. The usual practice of the main public funders of health research is not to ring-fence funds for expenditure on particular diseases, and funding is available for high-quality research proposals. With its partners, the Department of Health is actively pursuing a package of measures that we believe will stimulate an increase in the level of research on mesothelioma.

[Lord Alton of Liverpool (CB)]

While thanking the noble Earl for his reply, does he recall the assurance he gave to the House, when an all-party amendment—which would have created a small, statutory levy to support mesothelioma funding—was defeated by 199 votes to 192, that insurance companies would voluntarily step up to the plate? Given that there have been 2,400 deaths from mesothelioma this year, with 60,000 anticipated over the next 25 years, and with the imminent ending of even the existing insurance industry funding, would it not be shameful to leave unfunded research that could save lives and prevent vast expenditure on compensation? The Mesothelioma Bill is now before another place, with an amendment supported by both Conservative and Labour Members of the House of Commons. Surely Ministers should be looking again at this practical way of finding a cure for this deadly disease.

[Earl Howe]

My Lords, I understand that the British Lung Foundation has had discussions with representatives of the insurance industry about extending the funding for research, but that no commitment has been made by the industry so far as to future funding. As I made clear during the debate, the issue holding back progress is not the lack of available funding—there is plenty of that—but the lack of sufficient high-quality research applications. The money previously donated by insurers is supporting valuable research, as the noble Lord, Lord Alton, has said. At the moment, a greater volume of mesothelioma research is supported by the Government, and we believe that the package of measures that I mentioned will stimulate an increase in that volume.

Mesothelioma Bill [HL]

Debate between Lord Alton of Liverpool and Earl Howe

Wednesday 17th July 2013 Lords Chamber

[Earl Howe]

A very great deal of the research conducted in this country is funded by different sources. It is funded by the Government, charities, universities, and industry. Nothing in the arrangements that I have outlined precludes a joint arrangement for funding mesothelioma research, which is why I welcomed the indication that the noble Lord, Lord McKenzie, gave about the ABI and the possibility of augmenting whatever funds are forthcoming from the MRC or the NIHR. That is an important point to make. I think I have said enough. The ball is in the noble Lord’s court.

[Lord Alton of Liverpool]

My Lords, I am always grateful to the noble Earl and I know that the House will appreciate what he has said about the four steps that he intends to take. I think he would agree, though, that there is nothing incompatible in taking those very welcome steps and supporting the spirit of this amendment. I made it clear when I spoke at Second Reading, in Committee and again today that if the Government—during the many discussions that the noble Lord, Lord Freud, and I have had about this—had been willing to accept the principle and come forward with their own amendment, I would have been happy to withdraw my own. The principle that I have been trying to underline is the need for a statutory requirement to step up to the plate to deal with this killer disease, which we all agree will take any number of lives—an estimated 56,000 before the disease completes its first wave. We heard in the quotations I presented to the House earlier today that there is a possibility that, in the BRIC countries and with new forms of asbestos being used worldwide, it will not be 56,000 who die, but many more.

The noble Earl has suggested that if such a levy were imposed, it would be swallowed up into Treasury funds and there would be no guarantee that it would then be used for its intended purpose. I do not think that any of us really believe that that would be possible. If Parliament has legislated that a levy of up to 1% should be imposed—that is all; it is a levy inside a levy and what this entire Bill is about—there is no reason why that money should not then be used for this specific purpose. The noble Lord has already said that this should be a priority area.

The noble Earl has said that there should be competitive research proposals; very good research proposals have been put forward but, unfortunately, have not gained traction because the funding has not been available for them. It has been a Catch-22 situation. It was also said that it would be unethical to support second-rate work. Nobody in your Lordships’ House would suggest otherwise—of course we accept that there should be no second-rate work and, through the Medical Research Council and specified outside bodies, an evaluation would be made of the quality of that work and of the proposals that have been put forward.

The noble Earl said that around £2 million will now be made available, and that is welcome. However, the House should just bear in mind, for example, the £22 million being made available this year for bowel cancer, the £41 million for breast cancer, the £11.5 million for lung cancer and the £32 million for leukaemia. Those comparisons show the position in which mesothelioma still appears in this terrible league table.

The noble Earl also said, quite rightly—and the noble Lord, Lord Howarth, touched on this, too—that we should protect the purity of the system, but my noble friend Lord Kerr of Kinlochard dealt admirably with that argument and I can add nothing more to what he said. No one wishes to pollute the process but the Bill before the House is about one specific disease, and that is why this amendment is before your Lordships. It is not that we are being asked to set a precedent for any number of other things. Mesothelioma has a unique characteristic. The reason that the noble Lord has been able to negotiate with the ABI and the industry is that, for instance, smoking cigarettes cannot lead to mesothelioma. This disease is specific and that is why the industry has accepted its responsibilities in this regard. Therefore, it is different from other diseases, and that is why we were able not only to have this Bill but to exclude from it even other asbestos-related diseases, which cannot be said to be specific, as mesothelioma is. I think that that is a perfectly good reason for attaching to the Bill an amendment that deals specifically with this disease.

I am extremely grateful to everyone who has participated in this debate. I am sure that we listened with great care to my noble friend Lord Walton of Detchant, who said that this could make a massive contribution and that it could pave the way for a cure. The noble Lord, Lord Selsdon, was right when he asked why it was not done a long time ago. As long ago as 1965, the Sunday Times reported on work that had been done by the London School of Hygiene and Tropical Medicine. In cities such as Belfast, Liverpool, Glasgow and other epicentres of the disease, it had identified the nature of mesothelioma, as well as its very long hibernation period, alluded to by the right reverend Prelate the Bishop of Norwich, before it had its terrible impact.

I doubt that there are many of your Lordships who have not come across people who have contracted this disease and died within the two years—that is all it takes—from the time that it is diagnosed until death. The right reverend Prelate referred to the late Bishop of Peterborough. When we dealt with the LASPO legislation last year, the noble Lord, Lord McNally, told a deeply moving story at the Dispatch Box about his sister, who had died as a result of washing the dungarees and overalls of her husband, who had worked in the industry. This is something that can affect us all and we need to do something about it urgently.

The noble Lord, Lord Pannick, said that it might be claimed that the amendment is not viable. That has not been said in the debate today, yet it was said in the letter that was distributed on Monday. The amendment deliberately mimics Clause 13 of the Bill so that it does nothing that the Bill itself is not doing. It cannot possibly be challenged under the Human Rights Act, but perhaps we could be challenged under that Act by victims of mesothelioma if we fail to do enough or take the opportunity to provide for proper research to deal with this disease.

The noble Lord, Lord Wigley, said that the mechanisms that we have at the moment are not generating the research but he said that this vehicle is at hand. There is no reason at all why this should delay the legislation. As I told your Lordships in my opening remarks, I met with the ABI. The industry had expressed no opposition; indeed, it has been generous in providing what funds there have been in the past towards dealing with this disease. Therefore, there is already a precedent here. I am certain that if the Government were to say that they would make available matching money, even more funds would be made available by the industry. The noble Lord, Lord Howarth, touched on that point, and rightly so. Yes, there is a moral obligation. Because of the privileges issue, it would not be appropriate to include that here, but there is no reason why it could not be attended to in another place and there is no reason at all why this should become a matter for ping-pong.

The mortality rate for most cancers is falling while it continues to rise for mesothelioma. There are humane and altruistic reasons for supporting funding for mesothelioma research, but for the Government and the insurance industry there are straightforward financial considerations, too. It would be impossible to eradicate all asbestos from our homes, schools, hospitals, factories and offices.

The Bill represents a genuine desire to act justly to those who have been afflicted with mesothelioma, which is why I have supported the noble Lord, Lord Freud, throughout in placing the Bill before the House. However, the one certain way to prevent deaths from mesothelioma will be to find a cure. That will not happen without adequate resources and that in turn requires political will. That is why I thank all those who have spoken today in the debate and who have supported the amendment. I would like to test the will of the House.

[Earl Howe]

Before the noble Lord finally decides what to do with his amendment, may I just explain why the Government have not brought forward their own amendment, which was one of his criticisms? We do not believe that a legislative route is necessary. We believe—as the noble Lord, Lord Empey, indicated—that we can do this in other ways. We can give the process exactly the kind of kick-start that was referred to in the debate much more effectively than can this amendment. Funders for research build areas for research by bringing researchers and clinicians together, not by throwing money at a problem, which is, I am afraid, what this amendment would do.

[Lord Alton of Liverpool]

My Lords, this is not about throwing money at problems. That is certainly something that I have always eschewed throughout the whole of my time in politics. You have to demonstrate the case and there is a case here. If 56,000 of our countrymen are going to die of this disease over the next 30 years or so, we have to find adequate resources to tackle mesothelioma. That is not being done by this Bill. We have a rare opportunity to do something about it.

Abortion

Debate between Lord Alton of Liverpool and Earl Howe

Thursday 6th June 2013 Lords Chamber

[Earl Howe]

My Lords, the Care Quality Commission has put in place procedures to identify pre-signing or other instances of non-compliance, and they are confident that these would now be picked up during inspections. However, my noble friend is right; there was a concern early last year that this pre-signing was happening. Since then, however, the CQC has been working directly with providers who are registered to provide termination of pregnancy services to ensure that they are complying with the requirements of the Act. It is beginning to explore how it can strengthen the registration process alongside its regular inspection activities. I therefore suggest to my noble friend that it is not a case of nothing having happened.

On sex selection, we have no evidence at all of gender-related abortions in the UK. Again, concerns were expressed about this in the press, but analysis has been done that shows that the UK birth ratio is within normal limits.

[Lord Alton of Liverpool]

My Lords, does the noble Earl accept that some cases were referred to the police last year where gender abortions were identified? Will he welcome the decision of Ranjit Bilkhu and a group of Asian women in this country to set up an organisation to challenge the attitude that it is permissible to take the life of an unborn child merely because of its gender? Has he noted the Private Member’s Bill of the Member of Parliament for Congleton, Mrs Fiona Bruce, and the Early Day Motion, signed by more than 50 Members of another place, drawing attention to the need at least to collect the data where the gender of a child is known so that we can truly know whether or not this phenomenon is occurring in this country as it does in many other parts of the world, where the three most dangerous words are, “It’s a girl.”?

[Earl Howe]

My Lords, I am aware of all the initiatives mentioned by the noble Lord. The issue of the sex selection of foetuses is, of course, extremely serious. However, as I mentioned in my earlier Answer, following extensive investigation and analysis we do not believe that there is any evidence that this is happening in the UK. That is the prime reason why we do not agree with the noble Lord that measures should be put in place to collect data regularly on the sex of the aborted foetus. Were we to do that it would require changes to legislation. It would also require changes to clinical practice, and it has ethical implications. I hope the noble Lord will understand that we have thought about this very carefully.

Abortion

Debate between Lord Alton of Liverpool and Earl Howe

Tuesday 4th December 2012 Lords Chamber

[Earl Howe]

My Lords, my noble friend raises some extremely important questions. The House will remember that reports came to light in February of pre-signing of the HSA1 forms—the approval forms that have to be signed by two doctors—and the CQC carried out a serious of unannounced inspections of all abortion providers in the light of that story to uncover any evidence of pre-signing. As a result, 14 NHS trusts were found to be non-compliant and clear evidence of pre-signing was identified. We await the outcome of investigations by the Metropolitan Police on that issue. Of course, as a department, we take it very seriously indeed.

On the issue of sex selection, my noble friend is absolutely right. The Act stipulates specific circumstances in which termination of pregnancy is permitted. Gender selection is not one of those circumstances. It is illegal for a practitioner to carry out an abortion for that reason alone, unless the certifying practitioners consider that an abortion is justified in relation to at least one of the Section 1(1) grounds in the 1967 Act. My noble friend will also be pleased to know that the Chief Medical Officer for England has written to all clinics and hospitals undertaking abortions to remind them of the provisions of the Abortion Act.

[Lord Alton of Liverpool]

My Lords, is the Minister familiar with a report that recently appeared in the Economist, which said that around 100 million abortions have taken place throughout the world on the basis of gender, which it calls “gendercide”? Does he not agree that in a country where routinely, every working day, there are some 600 legal abortions there is a real danger that, culturally, people imagine that it is simply a right to choose to take a life on whatever basis they believe it reasonable to do so? Can he therefore spell out again the illegality of taking the life of a child on the basis of its gender? Can he tell the House what penalties there will be when such actions occur and how long it will be before the police inquiries complete their course?

[Earl Howe]

In answer to the last question I have no firm information about when the police inquiries will complete their course. They have been ongoing for some months. The noble Lord, Lord Alton of Liverpool, is right to raise his concern, but I can again state emphatically that under the law of this country it is illegal to perform an abortion on grounds of sex selection alone. If evidence of such practices comes to light, the penalties are that the doctor or doctors concerned may be referred to the GMC. The Care Quality Commission will be called in and there will be the possibility of police investigation and prosecution resulting. This is not something that any provider of NHS-funded abortions should ever consider doing.

NHS: Liverpool Care Pathway Inquiry

Debate between Lord Alton of Liverpool and Earl Howe

Monday 5th November 2012 Lords Chamber

[Earl Howe]

My Lords, there is never any cause for complacency in a matter of this kind, and I can reassure my noble friend that the Government will keep this issue under review. At the same time, I hope she will allow me to respond in slightly more forthright terms than I normally do, because there has been an enormous amount of misreporting and misinformation around the Liverpool Care Pathway, which has been endorsed publicly in a consensus document by 22 of the leading professional organisations and patient organisations in this area, including Marie Curie. We cannot ignore that. As I mentioned in my Answer, some of those organisations are looking carefully at the reports to which my noble friend alluded. It is notable that not a single complaint has reached the regulators in this area, which I suggest indicates that there may be less substance to some of these stories than may first reach the eye. However, I emphasise that there is no complacency.

[Lord Alton of Liverpool]

My Lords, as the noble Earl comes to look at the consultation on the National Health Service constitution over the coming months, will he take the opportunity to look at the care pathway in Liverpool itself, where last week I was able to meet Professor John Ellershaw and those who devised the pathway? Given that 80,000 patients a year are treated on the pathway, does the Minister accept that it works very well for many of them; that while the philosophy is not the problem, the procedures used in some places have been; and that one of the principal concerns is dehydration? Does he agree that that is something to be looked at, as well as the level of training of those doctors who are responsible for the palliative care of people at the end of their lives?

[Earl Howe]

My Lords, I fully agree with the noble Lord. Training is integral to the care pathway, as is the need to consult the families of patients and, if possible, the patients themselves before a decision is taken to put them on the Liverpool Care Pathway. On the NHS constitution, I completely take the noble Lord’s point. The proposed change to the NHS constitution makes it absolutely clear that patients and their families and carers have the right to be fully involved in discussions and decisions about their care, including that at the end of life. We are clear that that should already be happening, but we understand from reports that that is not always the case. As regards end-of-life care, I think there is sometimes a taboo on discussing death and dying and press reports show how damaging that can be. I shall indeed take all the noble Lord’s points on board, particularly as regards nutrition and hydration.

Diabetes

Debate between Lord Alton of Liverpool and Earl Howe

Tuesday 10th July 2012 Lords Chamber

[Earl Howe]

My Lords, we keep the question of taxation under review in the light of emerging international evidence on its impact. That will include looking at the experience of the recently introduced tax on saturated fat in Denmark and what effect it has had on diet and health. With any fiscal measure, there is always a risk of unintended consequences, so we would have to look at this particularly carefully.

[Lord Alton of Liverpool]

My Lords, did the Minister have a chance to see the report from the London School of Tropical Medicine and Hygiene, published earlier this month, which suggested that if obesity levels could be reduced, there would be sufficient food for 1 billion people worldwide. The report pointed particularly to the United States of America and at western Europe. Does this not both justify the Government’s campaign to reduce obesity and illustrate the truth of Gandhi’s remark that there is sufficient in this world for people’s needs but not for their greeds?