Health and Care Bill

Lord Bethell Excerpts

Lords Hansard _ Part 1 & Report stage
Wednesday 16th March 2022 Lords Chamber

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I support what has already been said and the amendment in the name of the noble Baroness, Lady Finlay. I also declare an interest in that I was a member of the commission she so ably chaired.

I have been on this, along with others, for a decade. Back in 2011 we had The Government’s Alcohol Strategy, which was very good but regrettably fell by the wayside. I was heartened back in 2019 when the Government, while they are prepared to give details about sugar and calorific effects on almost anything we eat or drink apart from alcohol, were given cause to think about consulting on extending it to alcohol too.

We had a short debate last autumn with the noble Lord, Lord Bethell, who was then the Minister responsible, on calorie and labelling regulations. I was persuaded not to divide the House on the basis of promises given of change coming. The Minister said:

“I give the noble Lord, Lord Brooke, the noble Baroness, Lady Finlay, and all those who have expressed concern about the issue this commitment: the Government will be consulting shortly on whether calorie information should be mandated on prepacked alcohol and alcohol served in pubs and restaurants. Covid-19 makes it more important than ever to support the nation to achieve a healthier weight, and the Government are taking action to help people to lead healthier lives.”—[Official Report, 22/7/21; col. 456.]


It is now 2022 and we still have not got the consultation, so the noble Baroness, Lady Finlay, has posed a fairly simple question.

I think in their heart of hearts the Government know they have to do something on this; it is quite ludicrous that alcohol is out of step with almost all other drinks and food. It is time we brought it into line. Can the Minister please tell us when we are going move on this issue? When are we going to have some definite dates and when will the consultation be concluded?

[Lord Bethell (Con)]

My Lords, I too support the amendment in the name of the noble Baroness, Lady Finlay. I declare my interest as my wife is a director of Diageo. There is no doubt that mandatory calorie labelling of alcohol is one of the most basic steps we need to take to make this country healthier. We have a moral obligation to give people the information they need to make an informed choice. We must take reasonable steps to prevent illness so that we can keep our spiralling health costs down. We must address the health inequalities the Minister has spoken about so thoughtfully on previous occasions. We should do all we can to nudge drinks companies to bring down the calorie levels of some drinks.

As the noble Lord, Lord Brooke, said, these measures have been promised for years. They were made in Tackling obesity: empowering adults and children to live healthier lives, published in July 2020. In October 2020, the then Minister responded to a Written Question, saying:

“we are committed to consult before the end of the year on our intention to make companies provide calorie labelling on all pre-packaged alcohol they sell. The consultation will also cover introducing calorie labelling on alcoholic drinks sold in the out of home sector, for example bought on draught or by the glass.”

The then Minister wrote on June 21 2021:

“We are committed to consult shortly on our intention to make companies provide calorie labelling on all pre-packaged alcohol they sell. The consultation will include further details about the proposed timescale for implementation of the policy.”


In the debate on calorie labelling regulation on 22 July 2021, when alcohol labelling was left off at the last minute by the then Minster, he said—well, the noble Lord, Lord Brooke, said what the Minister said and I will not repeat it, but it was pretty emphatic.

As the Minister who said and wrote all those words, I ask the current Minister to make the very specific time commitment the amendment seeks.

[Lord Vinson (Con)]

My Lords, there is a sheer impracticality to this suggestion. Whatever the need to get people to drink less, there is the actual practicality of getting millions of bottles of wine shipped from all over the world pre-packaged with this label stuck on them, quite apart from the number of drinks, as has been mentioned, served in carafes or over the counter freely. This is not the way to tackle the problem. It goes to the heart of people’s freedom of choice. They may be overdoing it, but labelling like this is expensive, impractical and it does not work.

Health and Care Bill

Lord Bethell Excerpts

Lords Hansard - Part 2 & Report stage
Monday 7th March 2022 Lords Chamber

These amendments are actually about making the Government’s own policy work, which it will not, as it stands. They are about fairness, the sustainability of the media and ensuring that platforms are responsible. I hope they will find support across the House from those who support the ban and those who do not— that point is actually now behind us—because they are designed to strengthen this important Bill and make the implementation of the policy more effective. I hope, therefore, that my noble friend will say that the Government will accept them, so that it is not necessary to divide the House.

[Lord Bethell (Con)]

My Lords, I shall speak to Amendments 149, 151 and 153 in my name and those of the noble Lord, Lord Krebs, and the noble Baronesses, Lady Walmsley and Lady Boycott. The amendments refer specifically to a deadline for the implementation of the junk food advertising restrictions.

I completely applaud the Minister for the approach of bringing in government amendments to try to refine the terms of the Bill; it is a collaborative approach, which I think all of us have really appreciated. However, in this matter, a government amendment has, I think, overshot, by removing the previous deadline in the first draft of the Bill. These amendments seek to rectify that.

I will not speak at length, but many have said, both in Committee and at Second Reading, how urgent it is to address the issue of obesity in this country. We cannot have any delay or rolling procrastination around these measures, so it is entirely right, proper and suitable for there to be a deadline in place in a Bill such as this.

It is also right to have certainty. I have huge consideration for Grenade and its low-sugar, high-protein bar. I will certainly look out for its excellent product when I am next in the gym, and I think the uncertainty it faces, which my noble friend Lord Moylan has described, is heartbreaking. That is why it is important to start the mechanisms now for answering its quite reasonable questions and to put a deadline on when those answers should be delivered.

I am not blind to the fact that many in the industry have voiced concerns that the deadline is too tight. I have looked at it and I do not accept those concerns. I think the bans have been around and on the books for a very long time and preparations have been in place. I worked in publishing during the tobacco ban: the turnaround for that was quite tight, but it was quite transparent and it happened without too much trouble. I think that a deadline is entirely right and suitable and that the deadline proposed is reasonable. I would like to hear reassurance from the Minister that there will be clear scheduling for these measures.

I would also like very briefly to address Amendment 151A, from my noble friend Lord Black, and the related amendments. On this, I feel utterly conflicted. The harms caused by online advertising have been mounting over several years. They are currently far too damaging and they are set to grow, both in scale and sophistication, without any clear sight of regulatory control. That is of grave concern, and the points made by my noble friend were very persuasive: I think he was right about bringing in compliance by the platforms. On the other hand, I accept that government regulation in this area is so off the pace; the online harms Bill is so far behind and the online advertising review has taken so long that the Government are just not in a position to implement the measures in this amendment.

I shall not be supporting these amendments in any votes that might happen, but my sentiments are very much along those lines. I ask the Minister to say very clearly what the Department for Health and Social Care and the Government will do around these concerns, not just on junk food advertising but on the advertising of alcohol, betting and non-surgical cosmetics, which all face similar concerns around the explosion of complex and persuasive online advertising which is underregulated.

[Lord Krebs (CB)]

My Lords, I shall speak in support of the amendments in the name of the noble Lord, Lord Bethell, to which I have added my name. I do not really need to say anything more than has already been said. We know that this country, according to the World Obesity Atlas published last week and supported by the World Cancer Research Fund, is now top of the European league table for projected levels of female obesity by 2030 and joint top for projected levels of male obesity. Sadly, it is probably already too late to stem this trend, but by acting now on these measures we might be able to protect the next generation. That is why I support the idea of having a firm deadline by which time the measures will be introduced.

I actually wanted to speak in slightly more detail about Amendments 148, 150 and 152 in the name of the noble Lord, Lord Moylan. As he explained, they are really just one amendment.

I promise you that this was not set up, but I have in my hand the very Grenade bar to which the noble Lord, Lord Moylan, referred. I wish to explain why this Grenade bar should definitely not be excluded. I am grateful to Dr Emma Boyland, of the University of Liverpool’s Institute of Population Health, for giving me a briefing on the Grenade Carb Killa bar—this particular one is high-protein, low-sugar, white chocolate and salted peanut. I bought it at the weekend from Holland & Barrett, in its health food section; it is marketed and advertised as a healthy product. Is it a healthy product? The answer is no.

First of all, no age group in this country is short of protein. We simply do not need to eat more protein. So the fact that this bar is high-protein is completely irrelevant in terms of health benefits. Secondly, remember that HFSS is high fat, salt and sugar. The bar may be low-sugar, but what about fat? It contains two-thirds of the recommended daily limit of the intake of saturated fat; it is definitely high in fat. It also contains more salt than a bag of salted crisps. Is it right to exclude something that is fatty and salty from the definition of HFSS? I am convinced it is not right, and therefore I completely reject the argument of the noble Lord, Lord Moylan. These products should not be excluded from the measures proposed in Schedule 18 to the Bill.

Health and Care Bill

Lord Bethell Excerpts

Committee stage
Friday 4th February 2022 Lords Chamber

Can my noble friend say a little more about the views of those who represent the workforce, the relevant trade unions, those who run care homes—some of those whom I have met favour registration—and those currently responsible for registering the health professions, many of whose employees do exactly the same work as the social care workforce and do not seem to have been deterred by registration? Finally, what is the timescale for any decision on this important matter?

[Lord Bethell (Con)]

I will also speak briefly in support of the register for social care workers, and I very much echo the words of my noble friend Lord Young. During the pandemic, we faced a huge challenge in identifying who social workers were. That meant that we struggled to distribute PPE, to get testing to the right people, to allocate and reallocate responsibilities when we tried to move away from itinerant service, and to create the vaccine prioritisation list. In the longer term, the question of the education of social care workers is absolutely essential, and a register is imperative to do that. In contrast with the NHS, the lack of a register of social care workers is a real impairment to the modernisation of social care working. For that reason, I ask the Minister to say a little more about his consultation and think very carefully about a mandatory register.

[Baroness Walmsley (LD)]

My Lords, last week, when we debated the call for a separate list of properly qualified cosmetic surgeons, I received a briefing from the GMC about the forthcoming new system of professional regulation. I asked the Minister when this would be forthcoming, but I fear that he was not able to give me a clear answer. This matter has been hanging around for a very long time, but, when I scrutinised Clause 142, I saw that there was another problem: in future, the regulation of healthcare professionals can be made through secondary legislation—and whether this would be agreed by the negative or affirmative procedure is not clear.

The Explanatory Notes make clear that subsection (2)(e) —the powers to remove certain professions from regulation—

“includes the currently unenacted provisions concerning social care workers”.

Like the noble Lord, Lord Young of Cookham, I want to ask the Minister about this, because many noble Lords, including me, have been asking that social care workers have the opportunity to obtain qualifications that would provide them with registration and a career path to better pay and conditions—but this sounds like the opposite to me. Perhaps the Minister can explain this and tell the House when the new regulatory system will be ready. The 2017 report of your Lordships’ House’s Select Committee on the long-term sustainability of the NHS said:

“The current regulatory landscape is not fit for purpose. In the short term, we urge the Government to bring forward legislation in this Parliament to modernise the system of regulation of health and social care professionals”—


I emphasise “social care professionals”—

“and place them under a single legal framework as envisaged by the 2014 draft Law Commission Bill.”

That was five years ago.

I have also received a briefing from the Health and Care Professions Council. It appears from this that the HCPC has a rather different view from the GMC: it wants the new professional regulation of health and care professionals to be collaborative and innovation focused. It believes that the current system is “siloed”, and it is looking for multiprofessional regulation, which, it believes, better reflects current working practices in the NHS. I am not an expert in this matter, so I express no opinion on that, but I am looking for some clarity from the Minister on which direction the new regulation system will take and the evidence that this will be better than before and contribute to better quality and safety of care for patients. I would also like to know when it will happen, because Clause 142 appears to me to open the door to a fight between different regulators, which would not be helpful.

--- Later in debate ---

Thousands of hours of consultation have gone into introducing these restrictions, but, if the Government really want to reduce childhood obesity, they need to address the media that children are viewing: the video-sharing platforms. Unless the Government act now to bring responsibility and regulation to how children access these ads online, all this good work will be in vain.

[Lord Bethell (Con)]

My Lords, I will speak to Schedule 17 generally and in support of Amendment 244 in the name of the noble Baroness, Lady Finlay. In doing so, I declare my wife’s interest as a board director of Tesco and Diageo.

I will focus my comments on the amendments supported by my noble friends Lord Vaizey and Lord Moylan. In doing so, I seek to address all the amendments they have put forward, which seek to: extend the implementation period for the new restrictions; introduce brand advertising exemptions; and bring in effectiveness reviews and sunset clauses, and all the other clauses that seek to water down the really important measures in the Bill on junk food advertising. I recognise that the noble Baroness, Lady Boycott, has already gone through some of these amendments in detail, so I do not want to go through that again. However, I am aware that my noble friend Lord Vaizey and other noble Lords have brushed off the Government’s obesity strategy as wrong-headed and doomed; indeed, the noble Lord, Lord Clement-Jones, has shared his view that the measures in the Bill are disproportionate.

I want to reflect for a moment on what we are trying to do here. As a country, we have got into a situation where, by every measure, we are seriously overweight. The worst affected are our children. We have heard, both in this debate and many times in this Chamber, that two in five children are overweight. The worst-affected children are the poorest children, who are twice as likely to be overweight. In thinking about the environment our children are being brought up in—this question of environment is absolutely critical—what are our values as a nation if we knowingly create an environment that encourages children to develop addictions to foods that we know will hurt them, adversely affect their moods, hold back their learning, reduce their self-worth and damage their health for years to come?

Through the pandemic, we have seen that now is the time to lean into this ongoing national disaster. The measures in this Bill are necessary because they are an essential condition for an overall change in the direction of travel of childhood obesity prevalence. The challenge is going from an increase in the weight of our children of around 1% per year to a decrease of 4.2% per year. That is an astonishing mission and a massive challenge. No country has ever undertaken such a thing.

However, I am not convinced that we can just hope that our primary schools will do all the heavy lifting to achieve this. Somehow, as a country, we have to change the way in which we run our lives. This will require a change in the environment in which our children learn about, engage with and buy food—and that includes the media they consume. If we fail, for every year that this is not achieved, the rate of change needed in future years will grow, and thousands more children will be exposed to the physical and mental health impacts of obesity.

The noble Lord, Lord Krebs, talked eloquently about how, 20 years ago, the Hastings report had this research nailed. There is now a sense of urgency, which is why these measures are needed. It is why we cannot seek to extend the implementation periods for new restrictions; this will just drag them out indefinitely and undermine the seriousness of the programme. It is why we cannot give brand advertising an exemption that clearly leaves the door wide open for the same old advertising in different ways. It is why we should not commit to effectiveness reviews that will become a rear-guard action to unpick these regulations, nor commit to sunset clauses that will give industry false hope that somehow the Government will just give up on these measures or the problem will go away.

To reach the 2030 target, it is absolutely crucial that the Government continue with these plans to restrict junk food advertising on TV and—as the noble Viscount rightly said—online, and do not waste any more time. It is also crucial that we introduce fiscal measures to speed up reformulation at the same time, making healthy eating more accessible to everyone. It is absolutely clear from our data that any delay in action or the implementation of proposals to address childhood obesity will have a significant impact on the ability of the Government to achieve their ambition. More children will grow ill and live shorter lives.

I hear—loudly and clearly—the concerns of my noble friends Lord Vaizey and Lord Moylan, and the noble Lord, Lord Clement-Jones. I hear their concerns about the science, the research and the public health epidemiology that underpin these measures. I do not agree with their scepticism but I do hear their concerns, so let me pick off a couple of them.

My noble friend Lord Vaizey expressed scepticism about the effectiveness of these measures. He is right that these advertising restrictions will not work on their own. Obesity is a complex issue and no one single policy can solve it. However, small steps matter. It can take as little as 46 extra calories a day for children to gain excess weight, and seeing just one minute of HFSS adverts leads to children eating an extra 14 calories a day on average.

As I said earlier, this question of environment is absolutely critical. I accept that we need population-level structural policies to address the social and economic drivers of obesity, to then address the growing inequalities between the most and the least-deprived children. That is why the levelling-up White Paper earlier this week that tackles housing, education, deprivation and many other aspects of British life was critical to this debate and forms the context in which we should discuss these measures. It is also why my noble friend should not feel that the broadcast and food industries are in some way being uniquely scapegoated. This is a national programme that will touch on many lives.

My noble friends are right to express concerns about the fortune of the broadcast and internet industries, two jewels in Britain’s creative industries and employers that drive local economies. I want to reassure them. I once worked in the media industry and have not forgotten the intense competition for advertising and the existential battle with big tech, but my noble friend Lord Vaizey spoke as if many of these companies would find that all communication by these companies on all their products to all their target markets would somehow be terminated forthwith and that the British public service broadcast industry would be thrown into destitution. That is just not quite right. Cancer Research UK found that ITV, Channel 4, Channel 5 and Sky One derive a small proportion—just 8% of their total ad revenue—from adverts for HFSS foods.

It is true that almost two-thirds of HFSS product adverts aired between 6 and 9 pm fall within the category that UKHSA has identified as the highest contributors of sugar calories in people’s diets, a fact that I found quite alarming, but under a 9 pm watershed broadcasters would have lost only 5% of their total advertising revenue if all HFSS adverts were removed completely, without anything in their place. Noble Lords should know that over three-quarters—79%—of potential revenue loss from removing HFSS adverts could be mitigated against by companies advertising their existing non-HFSS products instead of promoting their HFSS products. Healthy foods can still be advertising.

It is just not right to call these measures appalling and crude or ridiculous and blunt. To change the environment in which our children make decisions about food is critical for this national mission, and to contribute to a campaign to improve the health of children is a commendable aspiration for these government measures.

[Lord Stevens of Birmingham (CB)]

My Lords, perhaps channelling the noble Baroness, Lady Deech, from this morning, I congratulate the Government on including in the Bill these measures to tackle childhood obesity. As we have heard, with one in four children not just overweight but clinically obese, we are storing up huge problems for the future because we know that what starts in childhood continues into adulthood. In that sense, diet is destiny. Unfortunately, obesity is the new smoking. We know that it is the cause of avoidable heart attacks, strokes, 13 different types of cancer, and respiratory disease, and causes a far higher risk of dying from Covid. Clearly action is needed, and the Bill makes a start.

If anything, these measures, which are certainly proportionate, may be overly targeted. Some of the criticisms levelled at the Bill should have given rise to amendments to extend its scope to deal with some of the loopholes or to level the playing field into other digital aspects that people are concerned about. That would have been a constructive response to legitimate concerns. Instead, I cannot help feeling that this morning we have heard from opponents who are simultaneously arguing that the measures in the Bill go too far and at the same time will not be effective enough, and to ensure that this becomes a self-fulfilling prophecy they have included amendments which would essentially fillet the Bill of its active ingredients.

These are familiar tactics. This is the tactic of deny, dilute and delay. The first is denying, claiming to us as parents that ads and marketing make little meaningful difference to kids’ consumption; but on the other hand we have companies—presumably rational economic actors—spending maybe hundreds of millions of pounds every year on the basis that exactly the opposite is true. Like Schrödinger’s cat, which is simultaneously dead and alive, it seems that junk food advertising and marketing simultaneously does and does not work. What is at stake here is not quantum physics but the physical and mental health of millions of children.

Health and Care Bill

Lord Bethell Excerpts

Lords Hansard - Part 2 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Lord Lansley (Con)]

My Lords, can I just take us back to Amendment 266, to which I have added my name, before we lose sight of it? It was helpfully introduced by the noble Baroness, Lady Wheeler, and its purposes were explained very well by the noble Baroness, Lady Brinton.

I just want to add a bit of context, which I hope will commend itself in particular to my noble friend Lord Howe on the Front Bench, in that he and I tackled together the PIP breast implant problems that emerged in December 2010 and which led directly, subsequently, to us asking the distinguished first medical director of NHS England, Bruce Keogh, to undertake an inquiry. Since the report of that inquiry, we have made considerable progress. Most recently, noble Lords will recall that the noble Baroness, Lady Wyld, took through the Private Member’s Bill from Laura Trott in the other place to assist in the regulation of Botox treatment for under-18s.

The point is that there is still unfinished business. Amendment 266 relates to giving the Secretary of State the power to set up a licensing process for non-surgical cosmetic procedures—not through the CQC in this case, because the CQC regulates healthcare professionals, but almost certainly through the mechanism of asking local authorities to undertake a licensing process. It gives the Secretary of State all the flexibility that we have grown accustomed to legislation having to give them, but it does so in a way that enables the regulation that would be brought in using this power to be proportionate, being very clear that it should apply only to those activities that present a significant risk. It makes sure that it takes advantage, for example, of the national standards that have been put in place by the Joint Council for Cosmetic Practitioners. It would be very helpful in trying to mitigate the risks associated with non-surgical cosmetic procedures.

Amendment 293 in my name is a follow-up to a Private Member’s Bill that made no progress. It again follows Bruce Keogh’s report and looks to give the General Medical Council the legislative opportunity and requirement to bring forward a scheme to put surgeons who have a specialty relating to cosmetic surgery on to its specialist registers. With Amendment 293, we have the benefit of being able to do this by virtue of the recommendations in recent years from the Cosmetic Surgery Interspecialty Committee of the Royal College of Surgeons. It gives us an opportunity to give those who wish to undertake surgical treatments for cosmetic purposes the opportunity to see who is on the specialist register. All this relates to the safety of those undertaking cosmetic treatments, which is a large number of people; there is a large amount of activity and a significant need for the consumers of these services to have a degree of protection. I think we can make progress on that.

In the rest of this group, we have another opportunity to take action. My noble friend was right when she spoke about a more general approach. She will recall that, in April 2014, the Law Commission produced its recommendations on the regulation of healthcare professionals, so there is an opportunity to do something here. If we do not do it in this Bill, it would not hurt for the Government to tell us more about how they might make progress on the broader regulation, in addition to what is being proposed here.

I want to mention two other things. First, we had an earlier debate about access to innovative medicines. This is another opportunity for my noble friend to tell the Committee that NHS England is proceeding with its consultation on the implementation of the innovative medicines fund. Secondly, we do not need to repeat the short debate we had in Grand Committee not so very long ago under the auspices of my noble and learned friend Lord Mackay of Clashfern, who enabled us to present a lot of arguments about the future of NHS Resolution and clinical negligence within the NHS. We do not need to repeat that, but Amendments 178 and 297E would of course help us in that direction, not least by repealing the redundant NHS Redress Act 2006, which has never been implemented. With that thought, I pass the ball to the noble Lord, Lord Storey.

[Lord Bethell (Con)]

My Lords, I support Amendment 266 in the name of the noble Baroness, Lady Merron, and Amendment 293 in the name of my noble friend Lord Lansley for all the reasons that my noble friend just articulated. I will not repeat them as he put them so very well. However, I would say to the Minister that, coming from the innovation space, I can see that the technologies for both cosmetic surgery and non-surgical cosmetic interventions are improving all the time. There is an incredibly rapid pace of change. They are set to continue to get better and better, so the marketplace is getting more sophisticated and their popularity is also exploding. We have been briefed on evidence about the role of social media in promoting non-surgical cosmetic interventions in particular. This is exciting, because it is great that people have access to these interesting products, but also extremely worrying, because not all the surgeries and non-surgical interventions are successful. It is the right time for the Government to intervene, so that we have a register of cosmetic surgical practitioners and a much clearer regulatory regime for non-surgical interventions.

I am pro cosmetic surgery. As a young boy, I had an inherited condition of having very big, sticking-out ears, which my father had and my cousins and aunts have, and it was miserable. I had them pinned back and I am very grateful that that happened. It meant that I could be a much more confident person as I grew up. I am pro cosmetic interventions; if people want to use the benefits of medicine to improve their confidence in the way they look, I applaud that. However, standing next to my noble friend Lady Cumberlege, I am also aware of Bruce Keogh’s extremely good report and the very large number of interventions that have not gone well. I know that the Minister’s instincts are not to intervene unless absolutely required and my suggestion to him is that we have hit that moment. The marketplace is exploding and now is the right time to intervene.

[Baroness Finlay of Llandaff (CB)]

My Lords, as I address Amendment 266, I should declare that I am a vice-president of the Chartered Institute of Environmental Health. I stress that this amendment has been supported by the Beauty Industry Group, which represents 10 industry organisations—two voluntary registers for cosmetic practitioners, the Mental Health Foundation and others.

There are currently significant gaps in our regulatory system. Environmental health and licensing professionals work at a local authority level. They inspect, register and license premises for a very limited set of procedures, such as acupuncture, tattoos and piercing. Even for these procedures, however, there are no nationally set training programmes or qualification requirements for somebody to practise. For the riskier beauty procedures, such as the injectables, there are only voluntary registers of accredited practitioners. They have some approved education and training but that is not mandatory.

That means that there are many unaccredited practitioners on the high street providing services to people directly with no checks. A licensing scheme, as outlined in the amendment, would provide appropriate qualification and competency standards for practitioners wishing to practise, which is key to improving safety. The amendment as drafted is an open power for the Secretary of State, so it is easily amended as new procedures come online and on to the marketplace. The weakness of existing legislation in the area is that it fails to cover many of the newer treatments that are now popular.

When things go wrong, it is the NHS that has to pick up the pieces. Infections, injuries, scarring, burns and allergic reactions from a range of procedures often all end up in the NHS, sometimes with people being hospitalised and disfigured. Injection of fillers—or botulinum toxins—into blood vessels can cause dying back of tissues as well as blindness when administered by people who really are not adequately trained and certainly not registered. That means that there is no recompense for people damaged by these practitioners, who have no medical insurance or qualifications. In addition, there are unauthorised advertisements that breach advertising standards. There are strict laws around prescription-only medicines such as botulinum toxin, but these advertisements seem to bypass those.

Among members of the public who have had cosmetic procedures, alarmingly, three-quarters were given no information about the product, volume, brand or batch number of whatever was being used and just under three-quarters were not asked anything at all about their psychosocial or mental health or any body image issues. It is a vast and complex area and there are gaps in regulations. We need a national framework of standards with qualifications that can be recognised, so that there is a clear badge for members of the public.

To briefly address Amendment 297, I suggest that it is not needed because dermatological surgery and plastic surgery are subsections of medical practice and already registered with the General Medical Council. This gets nearer to credentialling than to requiring a separate qualification. These are doctors. They are highly trained, they have gone through a recognised training programme and they have been often examined as part of their exit from their training in whatever procedure they are undertaking.

I remind the Committee that, in a recent letter from the right honourable Michael Gove, he said that he is considering a licensing scheme. I hope the Government will see that this amendment would allow such a scheme without tying the Government down, and I hope that they will accept it, as well as Amendment 264 from the noble Lord, Lord Hunt, for which I should declare that I am an honorary fellow of the of the Royal College of Physicians of Edinburgh and the Royal College of Emergency Medicine. I think the contents of the amendment would go wider than simply surgical procedures. The Royal College of Emergency Medicine was established as a separate medical college in 2008, but the guidance and regulations were written prior to that, so they are completely out of date for what is now emerging as a major specialty across medicine. That amendment would rectify a lacuna.

Health and Care Bill

Lord Bethell Excerpts

Lords Hansard - Part 2 & Committee stage
Tuesday 18th January 2022 Lords Chamber

[Lord Mawson (CB)]

My Lords, my colleagues and I built the first online facility for the voluntary and social enterprise sector in this country in 1997, called CAN Online. We learned rather a lot from doing that, and I actually came to many of the conclusions that the noble Baroness, Lady Harding, is telling us about. When we started this, we naively thought that this online environment was going to solve all our problems, as if it sat “out there” somewhere. We bought 12 computers: they came in very big boxes at that point, as noble Lords might remember. We put them in a room in a conference centre—we were in the Cotswolds—and I invited 12 entrepreneurial people working in the social sector to come and share a few days with them. We connected them all up. We thought it was about technology, but we actually we discovered that it was all about people and relationships; that this technology was simply a tool—an enabler—to facilitate a marketplace that we needed to build between us.

We began to understand that this was not about large systems up there that you plonk in the middle of things in some separate way. It is actually organic: they are very connected, and you need to co-create it and invent it together around the real needs and opportunities that are presenting themselves. I think this technology is telling us something about what needs to happen to the health service. It is organic; it is entrepreneurial; it is about creating a learning-by-doing culture. My colleagues and I have seen examples in the NHS and other parts of the public sector where millions of pounds have been spent on systems that have landed from Mars and have not worked.

First, we must understand the detail of this technology, and the opportunity that it brings. Later on, as we go through the amendments, I will share with noble Lords some technology platforms that we are working with across the country that have absolutely understood this. When they are engaged with the NHS, instead of the system getting behind them and building on their success and knowledge, it never follows up on the conversation with them. They never heard from the NHS again. There is a disconnect going on, and a fatal misunderstanding of how this new world now needs to work.

I welcome these amendments and this conversation, but we must understand—from those of us who built some of this stuff, even in the clunky old days of 1997 —that it is all about the relationship between people and technology and a learning-by-doing entrepreneurial environment.

[Lord Bethell (Con)]

My Lords, I, too, praise the noble Lord, Lord Clement-Jones, for his analysis and for rightly identifying the important connection between trust and confidentiality, and the noble Lord, Lord Hunt, for his diagnosis. In particular, I double up on the praise for Laura Wade-Gery and her report, which provides a huge amount of insight for this debate, and praise also my noble friend Lady Cumberlege, who has been a pioneer and remorseless champion of safety. She is entirely right that we are talking here not just about productivity but safety. Data saves lives, and her report made that point extremely well.

Basically, I just want to repeat absolutely everything that my noble friend Lady Harding said about ambition. My concern about this debate is not the analysis, which I think is spot-on; it is the level of ambition. I have lived through digital transformations. I lived through one in the music industry, and it did not just come from digital transformation officers—although I know that that is not the point of these amendments—but required the commitment of everyone from the superstars down to the roadies. Everyone in the industry was affected; it was a massive revolution; it led to an incredible improvement in the industry; but it was hard fought and a difficult thing to go through.

I have also lived through a revolution in digital in healthcare. Over the past two years, we saw amazing breakthroughs in individual areas, the vaccine rollout being a really good example to which my noble friend Lady Cumberlege referred, but also in non-present appointments with GPs and in other areas. But it took a pandemic to drive that progress as quickly as it did, and I never again want to see such a horrible emergency be required to create change.

The message to the Minister is that the Bill is a remarkable enabling document that helps the healthcare system in the UK make important progress across the board on many different areas, but the big challenge of our generation is digital transformation. It does not require a lot of legislative change. These amendments are not what will make a difference. My noble friend needs to have the energy, passion and determination to see through that transformation when he gets back to the department, and I hope that the Bill gives him the tools to do that.

Health and Care Bill

Lord Bethell Excerpts

Lords Hansard - Part 2 & Committee stage
Tuesday 11th January 2022 Lords Chamber

[Lord Warner (CB)]

My Lords, I will say a few words about specialised services on the basis of a committee that I chaired about five or six years ago at those services’ request. It followed the demise of strategic health authorities under the 2012 Act. The one thing that this committee demonstrated very clearly was that population was significant and that, if you ignored population, you were not likely to get good outcomes. There was no magic figure on population but it was of a size common in the territories of most of the SHAs. That is not to say that the SHAs did a crackingly good job, but they were the organisations with the size of population necessary for good commissioning of many of these specialised services.

The trouble was—and it is the same trouble mentioned by the noble Lords, Lord Lansley and Lord Sharkey—that if you have a regional system, by definition you give it some degree of control over its priorities. It follows almost as night follows day that different regions will take different views about the significance of specialised services in their particular region. We have struggled with this issue for many decades and not found it easy to come up with a solution.

You can go the whole hog and put it on NHS England, but that poses the problems that the noble Lord, Lord Sharkey, honestly owned up to: many of the people with these conditions are getting a range of services outside that specialised commissioning service. I came to the conclusion that you have to have something that is of the size of, or of a similar size to, the former SHAs, but you do need a role at the centre trying to ensure a level of consistency of approach in those larger areas. I think we are still fumbling our way towards the right mix of that and I cannot see that we will be able to put in this legislation a definitive answer to that particular set of conundrums.

While I am on my feet, I shall speak to Amendment 215, to which I have added my name. To some extent, I reinforce the seriousness of the situation that Ministers and the public face with the enormous backlog of patients awaiting treatment that the noble Baroness, Lady Wheeler, drew attention to. I refer the Committee’s attention to the excellent report by the National Audit Office published about six weeks ago. This report made it absolutely clear that in September 2021 there were nearly 6 million people on the waiting list for elective care and that one-third of these people had been waiting longer than the waiting standard of 18 weeks. Some 300,000 rather unlucky people had been waiting in pain and discomfort for more than a year. The NAO made it clear that even before Covid-19, many parts of the NHS were not meeting the waiting time standard and that about one in five cancer patients was not meeting the waiting standard for urgent referrals by GPs—that is a pre-Covid situation that has simply got worse as time has progressed.

I recognise that the Government have promised to provide an additional £8 billion between 2022-23 and 2024-25, some of which they expect the NHS to use to increase elective capacity by 2024-25 by 10% more than its pre-pandemic plans. I have to say, as a former Minister responsible for reducing waiting times and implementing the original 18-week maximum wait, that Ministers need to realise that announcing the extra money is the easy bit; putting in place a system for ensuring that the NHS leviathan actually uses the money for its intended purpose and can demonstrate delivery of the promised outcome is an entirely different matter. It took the Blair-Brown Governments from late 2004 to early 2008 to deliver the 18-week maximum wait and the cancer targets, using a lot of different tools in the ministerial toolbox.

There is not one simple solution to delivering these changes. The regimes that were implemented by those two Governments used a lot of extra money; a relentless, transparent measurement; and a great deal of clinical and political management pressure. They used expanded patient choice, so that patients could drive change, and I have to say to the noble Lord, Lord Davies of Brixton, that they also used the private healthcare system to increase diagnostic and surgical capacity by about 10% to 12%, but they did so at NHS prices. So, there is not a single solution; there are a lot of solutions that have to be applied and measured.

A critical factor in this is keeping everybody honest through transparent information about how progress is being made. If that is lacking, you are probably doomed to fail. The strength of Amendment 215 is that it puts in place a system for regular reporting of progress being made—or not being made, in some cases. It is important, as my own experience has shown, to know which parts of the country are doing well and which are not doing so well, so you can actually ensure that some action is taken on the slowest ships, as they say, in the convoy.

It should come as no surprise from what I have said that I strongly support Amendments 6 and 19 and do not support Amendment 21. I recognise, as we were discussing earlier this afternoon—time flies; I mean this evening—the whole issue of health outcomes and outcomes frameworks. Those are very important. However, at the end of the day, you cannot secure good outcomes without speedy access to clinical services. You do not get them. Waiting times of the length we currently have can lead only to poor outcomes. We must put in place systems that measure the progress being made in driving these waiting lists down. Given the seriousness of the situation, we need something about this in primary legislation to ensure that people across the country and the NHS are moving in the same direction in driving waiting times down.

[Lord Bethell (Con)]

My Lords, I want to say a brief word in support of the amendment on innovation in the name of the noble Baroness, Lady Thornton.

Having just been the Minister for Innovation, I can tell noble Lords that they could fill their entire diary travelling the country and seeing fantastic innovation in the NHS up and down the country. Noble Lords could fill their Zoom calls speaking to countries around the world that look to the NHS for some of the best innovation and partner with it on innovative programmes. However, that innovation is often extremely isolated and rarely spread evenly across the whole country. In fact, I often thought that my job title should have been not Minister for Innovation but Minister for Adoption because my role should have been to take the best that the NHS does and spread it across the country more evenly. That is the objective of the Government’s health policy at the moment: to see a much more even spread of best practice right across the country.

Although we cannot legislate for culture, we can give signals to the system about what we think is important. I therefore think that the noble Baroness, Lady Thornton, is on to something in suggesting this amendment. It should be given careful thought by the Minister.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I rise to offer Green support for all the amendments in this group. I will split them into two groups internally. First, I will speak to Amendments 6, 19, 60 and 215; I will then deal with Amendment 21 in the name of the noble Lord, Lord Davies, separately.

All these amendments are about transparency and targets. When we look back to when targets were a particular focus—when the NHS was under the control of the party on these Benches—there were concerns that targets could sway provision and medical judgments. There was a concern that this was about the management of targets rather than the outcome for the patient. However, if we think of targets as foundations and basic standards that need to be met, it is really important that we ensure that there is enough funding for local priorities and concerns to be addressed to reach a higher level.

Amendment 215, which refers to an annual report, is particularly interesting; I know that it has full cross-party support. This is about people knowing what the NHS is achieving and, importantly, whether there is enough provision in it. Of course, your Lordships’ House is not in a position to demand that more money goes into the NHS; by constitutional norms, we cannot deal with spending. However, I think that we should frame this debate—this is my first contribution in Committee—by looking at the pre-Covid figures. The UK was spending £2,989 per person on healthcare; this was the second-lowest in the G7. France was spending £3,737; Germany, £4,432.

Of course, the great outlier in this is the US, spending £7,736 a year. It is worth noting that we seem to be chasing so much after the US healthcare model, which is so absolutely disastrous. Most of the amendments in this group are a way for your Lordships’ House to give the public the tools to say that we need to improve the resources of our NHS.

Early Years Interventions

Lord Bethell Excerpts

Wednesday 1st December 2021 Lords Chamber

[Baroness Chisholm of Owlpen (Con)]

The right reverend Prelate is a great champion of young children. We have both worked with a charity called the Nelson Trust, which looks after disadvantaged children. There is £300 million to transform Start for Life services and create a network of family hubs in half the councils across the England. It will provide thousands of families with access to support where they need it. The Department for Education, the DHSC, the DWP and the Department for Levelling Up, Housing & Communities are working together to ensure that those who need the help get it.

[Lord Bethell (Con)]

My Lords, perinatal mental health issues cost the NHS and social services £8 billion a year, much of that because of the impacts on children, yet half of such cases go undiagnosed and even those who are diagnosed rarely get evidence-based treatment. We welcome the women’s health strategy, but what more is being done to address this frequently overlooked cause of misery and sometimes death?

[Baroness Chisholm of Owlpen (Con)]

This is such a distressing time for all mothers. They have babies and expect things to be very special and magical but so often discover the opposite. We must make sure that things are put in place to help them. As of April 2019, all areas in England now have comprehensive specialist community perinatal mental health services in place, which saw 30,700 people in 2020-21, re-expanding access to psychological and talking therapies with specialist perinatal mental health services. This will see 26 hubs, with 10 new hubs in the process of being set up and the rest due to open in April 2022. These hubs will offer treatment for a range of mental health issues, from postnatal depression to severe fear of childbirth to around 6,000 new parents in the first year. The new centres will also provide specialist training for maternity staff and midwives, as well as services for reproductive health and bereavement.

Coronavirus Bill

Lord Bethell Excerpts

Committee stage & Committee: 1st sitting (Hansard) & Committee: 1st sitting (Hansard): House of Lords
Wednesday 25th March 2020 Lords Chamber

[Lord Russell of Liverpool (CB)]

My Lords, first, I strongly support the very sensible amendment moved by the noble Baroness, Lady Thornton. As I think we all know, and as the noble Baroness, Lady Grey-Thompson, said so eloquently yesterday, myriad people are very worried about what is going on and are concerned that things will happen to them but their voice will not be heard. The Government have enough to worry about, so, from their point of view, it seems very sensible to have a review process in which an organisation such as the Association of Chief Executives of Voluntary Organisations acts as a sort of funnel, pulling together all the myriad concerns that many of us seek to represent today through a single forum which can communicate regularly with the Government —it would be a two-way process. It seems eminently sensible to make sure that the people who are most worried feel that they are being heard and that there is a dialogue.

Secondly, I support the amendment in the name of the noble Lord, Lord Scriven. The variety of powers that local authorities will be required to have—particularly in relation to children in care, children going through adoption or fostering, and child carers—is incredibly important. If they are worried, think what that is doing to the people they are caring for. Therefore, I feel that clarification in that respect would be enormously helpful.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, I start by welcoming this amendment, which in its spirit and intention is utterly sensible, thoughtful and right. I would like to speak on it in a way that reassures the House that the intention of the amendment and the many speeches in the Chamber today are exactly aligned with the way government is thinking and in which we have sought to build the Bill.

I also echo the many noble Lords who have mentioned the speech by the noble Baroness, Lady Grey-Thompson. Who could not have been moved by both the emotional way in which she explained herself and the very real and tangible anxiety of people—particularly in the disabled community, but anyone who depends on local authority services—who must feel incredibly vulnerable and worried that their affairs may not be given the priority they deserve, and may feel exposed and anxious about the future? That testimony was incredibly powerful and moving. It was taken to heart.

I also say a big thank you to all those who have engaged with us as we have drafted the Bill at pace, both at a senior level from major organisations such as the LGA and smaller ones and stakeholders. I assure the House that we absolutely are listening to groups that have concerns about provisions for their stakeholders. We have our ears open. The Government’s whole “protect life” strategy is shaped around an absolute priority of trying to save the lives, affairs and futures of the most vulnerable in our society. These provisions are here not because we want to leave anyone behind but because we want to enable local authorities to make the decisions they need to in order to make a fair, pragmatic and sensible distribution and prioritisation. It is our hope that these provisions will never come into play and that the commitment of resources we have made into the local authority area will see a generous and sensible provision for all those most vulnerable in society.

I will take just a moment to outline a few provisions that are in place, to reassure the House that we are not in any way removing all safeguards. For instance, I assure noble Lords that the Care Quality Commission will continue to provide independent expert regulation of health and care providers. It has already announced arrangements for a proportionate approach to ensuring standards of care over the coming period. We have published an ethical framework to provide support to ongoing response planning and decision-making. This sets out a clear set of principles and behaviours when challenging decisions on how to redirect resources where they are most needed and how to prioritise individual care.

We are working closely with the sector on additional guidance to ensure that procedures and prioritisation of needs operate in the best way possible during this period. The emergency Coronavirus Bill also contains provisions allowing the Secretary of State to direct local authorities to comply with the guidance we issue.

Legislation underpinning our crucial safeguarding arrangements to protect vulnerable people from neglect or abuse remains in place. That was a point that many noble Lords made very well yesterday. We are leaving all statutory duties relating to deprivation of liberty safeguards fully in place.

The noble Baronesses, Lady Hussein-Ece, Lady Thornton and Lady Uddin, all raised the question of carers. I assure the House that we totally agree with the intent of the amendment. We need to ensure that users and carers retain a clear voice in the coming period and are able to make their concerns known. Our guidance on the Care Act changes will cover this. A national steering group is leading the sector’s preparations for Covid-19; it includes both user and carer representatives.

The noble Lord, Lord Adonis, quite rightly raised the question of commitment to democracy and oversight. I assure the House that we absolutely embrace the ongoing functioning of Parliament. While I cannot speak for the House authorities and their arrangements for Parliament, I can speak for the health department. We are introducing technology there, such as video data and home-working, at pace. We are seeing a generational transformation in working practices in the last fortnight. These arrangements have been embraced, and I expect them to be embraced in other parts of the workings of the House.

We will also continue to report on the eight-weekly cycle. The noble Baroness, Lady Watkins, and others emphasised the importance of monitoring. We will put in place structures for providing the correct kind of monitoring.

The noble Lord, Lord Blunkett, rightly emphasised the importance of civil society, which is absolutely key, while the noble Lord, Lord Hain, emphasised the importance of volunteers. I reassure the House that the Bill contains extensive arrangements for a volunteer army to be recruited in a safe, orderly and accountable way and for funding to be put in place for volunteers. The Chancellor has announced generous and important provisions for charities; the noble Lord, Lord Hain, is entirely right that they have seen their donations dry up. They need support and provision if they are to play an important role against this contagion.

I completely understand the intent of the amendment in the name of the noble Lord, Lord Scriven. We have spoken offline about his concerns, which I have taken back. I reassure him that we have worked closely with the LGA and, in its dialogue with us, its emphasis has been on financial commitment rather than changes in the law. We have made a substantial £1.6 billion commitment but we will keep the question of legal changes under review.

The noble Baroness, Lady McDonagh, mentioned PPE, which although it lies to one side of this amendment is of concern to us all. I reassure the Chamber that a massive global procurement programme is in place. Distribution of existing PPE stocks is happening via the Army. A hotline has been issued to all front-line workers in the NHS and social care. We are moving fast and impactfully on that situation.

Lastly, we should not overlook Wales. The Welsh parliament has considered every question of this Bill and has signed off its legislative consent Motion. I am extremely grateful to Vaughan Gething, the Minister for Health and Social Services in the Welsh parliament, for his support.

For those reasons, I ask the noble Baroness to withdraw her amendment.

[Baroness Thornton]

I thank the Minister for that comprehensive answer. I also thank all the House for its supportive remarks on this amendment.

I say to my noble friend Lord Adonis that the two things we are talking about—the accountability of Parliament and our need to monitor these things, and the voice of the users and people at the receiving end of care, or non-care—are not in conflict. We need to be doing both, of course.

The noble Baroness, Lady Hussein-Ece, was quite right to point to vulnerable children and their care. My noble friends Lord Hain and Lord Blunkett were also absolutely correct about the importance of civil society in getting us through this crisis.

My noble friend Lady Pitkeathley is not here, but she is listening to us. She texted me to say, “Thank you for mentioning carers”. Of course in all this, the carers —people who are at home, many of them quite elderly themselves—are caring for people who will be at the sharp end of what comes next. We should not forget that.

I found two things very useful. First, the noble Lord, Lord Russell, mentioned the NCVO’s role in this, and he is absolutely right. Secondly, and finally, the Minister mentioned that the Government will produce guidance on the enactment of these clauses. This has to be done quickly but I put in a plea: that the voices we have talked about in this short but pertinent debate should be heard in the construction of that guidance, too. On that basis, I am happy to withdraw my amendment.

--- Later in debate ---

[Baroness Thornton]

My Lords, I attempted to put my name to this amendment. For some reason, presumably because the Public Bill Office staff are all working from home, it did not quite get through. The Government need to give this very serious consideration indeed.

[Lord Bethell]

My Lords, I completely recognise the good intentions of this amendment and the desire to protect women in an awkward situation at a difficult time. I also recognise the strong stakeholder views given to me by the royal college, Marie Stopes and others, but it is the Government’s priority to ensure that women who require abortion services should have safe, high-quality care and that abortions should be performed under the legal framework already set out by the Abortion Act.

It is vital that everyone, regardless of their views on abortion, be assured that this Bill’s provisions work alongside existing priorities of legislation, including abortion legislation. As I have described a number of times from this Dispatch Box, the powers in this Bill are solely and entirely to meet the needs of tackling this current pandemic. It is in that spirit that the Bill has moved so quickly through the House and that we have had such strong multi-party support for it.

The safety of women remains our priority, but it is vital that appropriate checks and balances remain in place regarding abortion services, even while we are managing a very difficult situation such as Covid-19. We have worked hard with abortion providers, including the Royal College of Obstetricians, and listened to their concerns, but there are long-established arrangements in place for doctors to certify and perform abortions, and they are there for good reason. We do not think that it is right that midwives and nurses are suddenly expected to take on expanded roles without prior consultation, proper training or guidance in place.

The coronavirus outbreak is a global issue. We are not the only country having to make difficult and uncomfortable changes. All over the world, clinicians and service users are coming to terms with extremely difficult workloads and workarounds to normal procedures. We are doing an enormous amount to help the NHS cope. We are doing this to protect life and to protect the NHS, but we expect doctors to work flexibly during this time. That means that certification can still take place in a timely way. It should not delay women receiving treatment. There is no statutory requirement for either doctor to have seen or examined the woman, as I described at Second Reading yesterday. Assessment can take place via telemedicine, webcam or telephone. Guidance from my department is crystal clear about that. The doctor can also rely on information gathered from other members of their multidisciplinary team in reaching a good-faith opinion. However, we do not agree that women should be able to take both treatments for medical abortion at home. We believe that it is an essential safeguard that a woman attends a clinic, to ensure that she has an opportunity to be seen alone and to ensure that there are no issues.

Do we really want to support an amendment that could remove the only opportunity many women have, often at a most vulnerable stage, to speak confidentially and one-to-one with a doctor about their concerns on abortion and about what the alternatives might be? The bottom line is that, if there is an abusive relationship and no legal requirement for a doctor’s involvement, it is far more likely that a vulnerable woman could be pressured into have an abortion by an abusive partner.

We have been clear that measures included in this Bill should have the widespread support of the House. While I recognise that this amendment has some profound support, that the testimony of the noble Baroness, Lady Bennett, was moving and heartfelt, and that the story of her witness from Lincolnshire was an extremely moving one, there is no consensus on this amendment and the support is not widespread. Abortion is an issue on which many people have very strong beliefs. I have been petitioned heavily and persuasively on this point. This Bill is not the right vehicle for a fundamental change in the law. It is not right to rush through this type of change in a sensitive area such as abortion without adequate parliamentary scrutiny. For example, there has been widespread support for measures such as permitting cremations to proceed on the basis of only one medical certificate. We simply do not have the same widespread support to make similar recommendations on the certification of abortions. For that reason, I urge the noble Baroness to withdraw the amendment.

[Baroness Barker]

Can the Minister concede that we are tabling this amendment because of how the NHS and medical services are affected by the Bill. We are not asking for any change in the criteria for abortion. We are asking simply for the process of the administration of decision-making to change.

That is being done right across the whole of the health service. The Minister has explained that telemedicine is being rolled out at a surprising rate. I do not understand why an experienced clinician or a midwife cannot make the judgments that he was talking about via video. They see women all the time and they will be able to make the same judgments. I do not understand that. If the Government do not accept this proposal, I ask him to accept that they should at least be under an obligation to continue to meet very regularly with the Royal Colleges and the organisations involved in this situation day to day, and they should be willing to come back with the power to make this change under a separate piece of legislation—because if, in seven weeks’ time, there is a clear pattern of women being failed, we cannot let it continue.

[Lord Bethell]

I completely recognise that the noble Baroness’s intentions are totally and 100% benign. She has the interests of the women concerned at heart. That intention is completely clear to me and I utterly endorse it. Where there is a difference of opinion and where we have taken a huge amount of advice—we have worked with the scientific advice in the department —is in the fact that the changes being offered are a fundamental change to the way abortions are regulated and administered in this country. Those regulations and administration arrangements have been worked on for years and are subject to an enormous amount of consensus. Her point on monitoring the situation is exactly the one that the noble Baroness, Lady Watkins, made earlier. I commit the department to monitoring it. We will remain engaged with the Royal College of Obstetricians and Gynaecologists and other stakeholders. She is absolutely right that we can return to the subject with two-monthly reporting back, and it can be discussed in Parliament in the debates planned on a six-monthly basis.

[Baroness Uddin]

I say this with the sincerest due respect. The Minister will be aware that there are huge concerns about the power to have just one doctor decide whether a body should be cremated, especially in the light of the crisis becoming more intensive and critical.

[Lord Bethell]

The noble Baroness’s concerns are noted.

[Baroness Bennett of Manor Castle]

My Lords, before I get to the procedural part I will refer the Minister to some of his own words. He referred to the Government’s desire to ensure that everyone should have safe, high-quality medical care. In this area in particular, given that the option has been given to provide alternatives, that is something that the Government will be judged against, and I hope that he will be able to live up to his promise. However, it is with a heavy heart that I beg leave to withdraw the amendment.

--- Later in debate ---

[Baroness Uddin]

My Lords, I too beg the indulgence of the Committee. I have raised this point on a number of occasions; I am raising it now with respect to the powers within the Bill relating to necessity and proportionality, particularly as regards matters of dignity in death and what may happen in the unforeseen circumstances that thousands of deaths occur among the faith communities, and cremation may be decided upon due to the lack of burial spaces and storage facilities. I am suggesting that Schedule 28 affects our human rights obligations.

I am requesting, therefore, on behalf of the many hundreds of individuals who have written to me, including faith leaders and organisations, that the Government remove from paragraphs 13(1) and (2) in Part 4 of Schedule 28 the words

“have regard to the desirability of disposing”

and replace them with “dispose”, and then delete from paragraphs 13(1)(b) and 13(2)(b) the words

“in a way that appears”

so that the necessary guarantees are provided in the legislation, which will be required to provide assurance to the relevant faith communities.

[Lord Bethell]

My Lords, the noble Baroness, Lady Ludford, and all those who have signed up to this amendment have made incredibly important points that the Government utterly confirms. I reassure the Committee that this Bill is very clearly focused on the present danger of SARS-CoV and the Covid-19 disease. If there is any other virus—and even if this virus mutates— we will need a new Act or at least to amend this one.

The Government are 100% committed to protecting and respecting human rights. We have a long-standing tradition of ensuring that rights and liberties are protected domestically and of fulfilling our human rights commitments. That will not change. We have strong human rights protections, with a comprehensive and well-established constitutional and legal system. The Human Rights Act 1998 gives further effect in UK law to the rights and freedoms contained in the European Convention on Human Rights. Nothing in this Bill contradicts that.

I reassure a number of speakers—including but not limited to the noble and learned Lord, Lord Falconer, the noble Lord, Lord Anderson, and the noble Baroness, Lady Kennedy—that there is nothing in this Act that allows the Government to breach or disapply the Human Rights Act or the Equality Act. The Bill itself is fully compliant with the Human Rights Act and the Government have certified this on the face of the Bill— in fact, I signed it myself in accordance with Section 19. Pursuant to Section 6 of the Human Rights Act, every exercise of power by a public authority under this Bill is already required to be compliant with the Human Rights Act. I further reassure the House that, at all times, this Government will act with proportionality.

I am advised by legal counsel that the amendment is potentially both unnecessary and unhelpful. If we accept it, it might imply that the Human Rights Act and Equality Act do not apply in this way in other Bills or Acts that do not feature this sort of provision. For that reason, I suggest that the amendment should be withdrawn.

[Baroness Ludford]

My Lords, I thank the Minister for what he said, which gave considerable reassurance—up to the last sentence or two. I was permitted by the Public Bill Office to table this amendment, so I am therefore slightly surprised at his reporting of the advice he has had from legal counsel. Obviously, I have to take note of what he said. No doubt they have greater legal minds than mine, although I note that the noble Lord, Lord Anderson, co-signed my amendment. I am a little taken aback by what the Minister said, but I none the less welcome the rest of his response. I beg leave to withdraw my amendment.

Parliamentary Buildings (Restoration and Renewal) Bill

Lord Bethell Excerpts

2nd reading (Hansard): House of Lords
Monday 8th July 2019 Lords Chamber

[Lord Bethell (Con)]

My Lords, it is quite formidable to follow such a worrying speech of disaster and doom, but I would like to return to a more optimistic tone because I for one am very hopeful for this project. Having been involved in the infrastructure industry in the past, I have a great belief in the British ability to deliver major projects. I am filled with hope for what can be achieved in this exciting restoration project.

However, there is one aspect of it that I shall dwell on, as referred to by the noble Lord, Lord Blunkett, in his excellent speech: the question of access and education. It is my belief that the determinant of success—how we will be judged by posterity, our children and the public—is not whether we answer security problems, heritage issues or create a comfortable arrangement for ourselves with our offices. We will be judged on whether this restoration and renewal programme helps to rebuild the connection between Parliament and the people.

There are some incredibly valuable opportunities to do so. Bringing more people on to the estate and having a much better approach to access will do a lot to bridge and heal the current disconnect. There is something really special about having people attending Parliament itself—being in the building and participating in education programmes housed in this building and the buildings nearby. We really have to think about how we can take full advantage of that opportunity.

These are precedents that have been maximised in other places. The Reichstag in Berlin, where the magnificent glass roof designed by the noble Lord, Lord Foster, shines light on to democracy, has a basement with a wonderful educational facility that we should emulate. The Capitol Building in Washington DC had a massive educational facility put in the hill underneath the Senate and the House of Representatives. We should think of that as a great precedent.

Clause 2(4)(f) and (g) make it clear that the sponsor body should ensure that Parliament is accessible to members of the public and that there is an education dimension to the project. However, I am concerned that this is not the full focus of the sponsor body. I was concerned that, on 7 May this year, the parliamentary authorities rejected the very sensible recommendations of the joint committee on the Bill that the sponsor body should have regard to the need to promote public engagement with and understanding of Parliament. For me, that was a great shame and a missed opportunity.

The Leader of the House of Commons and the Leader of this House said in explanation:

“We believe it is the role of Parliament to increase public understanding of its work and therefore do not feel this recommendation should be included in the Bill”.


I am not sure I agree with the logic of this, but we will probably have to live with it. It begs the question of who will champion access and education for this project. Public money will have to spent very wisely and difficult choices made about space, the management of public access, resources and investment. The noble Baroness, Lady Scott, put it very well and asked who will actually fight for this cause. My noble friend Lord Haselhurst put very well the kind of challenges the public face. Who will take responsibility for improving them? Without a clear mandate to put access and education at the heart of the project, I am worried that they will be overlooked.

Secondly, I am concerned about what the objective for parliamentarians will be. If responsibility for access and education is going to lie with Parliament, it is right that we give designers and project managers a very clear signal and something to work towards. I have a specific suggestion that I would like to share with noble Lords. I suggest that Parliament should make the simple commitment that every school student in the land should visit the Houses of Parliament at some point in their school career. After all, young people are key to the revival of political democracy and addressing disillusionment in this country. They are disillusioned at just the time when climate change, AI, migration and the other macro issues we face are at their doorstep.

At present, around 10% of schools visit Parliament and these tend to be richer schools in the south-east. Fulfilling a commitment of the kind I just described—by ensuring, for example, that all year 10 students visit Parliament—would mean some 5,000 young people visiting Parliament each working day. That is nearly 1 million students a year, a big increase on the current figure. Such a commitment would involve logistical challenges, but it would be achievable simply by doubling the number of visitors to the Parliament estate each day. I recommend the research done by Matthew Oakley and Christina Bovill Rose at WPI Economics, who are working on a scheme that expands Parliament’s existing programmes so that they can deliver practical and affordable access and education.

This is not a “nice to have” that we should ponder, and then move on. The dangers of ducking this, of not making such a commitment, are that our renovation plans could appear self-serving, our political alienation will continue and the loss of civic commitment to the British parliamentary system will grow with each generation. My pitch is that the prize is great. If we put the UK’s young people at the heart of renovation plans, we can ensure that this multimillion-pound project comes with a legacy that boosts engagement in politics and democracy and increases diversity across all our country’s political and policy institutions. Doing so would not be cost-free but could have lasting benefits for the country.