Organ Donation (Deemed Consent) Bill

Lord Carlile of Berriew Excerpts

2nd reading (Hansard): House of Lords
Friday 23rd November 2018 Lords Chamber

[Lord Carlile of Berriew (CB)]

My Lords, I too join in congratulating the noble Lord, Lord Hunt, and indeed the two colleagues in another place he mentioned, on bringing this Bill to Parliament. His characteristic modesty meant that he did not remind us of his enormous experience of the National Health Service, in the management context before he came to your Lordships’ House, as a member of the Government and as a Member of this House. That experience gives us some extra reassurance about the integrity of the Bill and what it proposes.

Debates such as this raise serious, and sometimes acute, ethical dilemmas. I think the ethical dilemmas in relation to the Bill are strongly affected by the fact that this issue is about saving life, not ending it. As your Lordships know from previous debates, I take a very different view on issues that affect the ending of life. I am happy to support the Bill, because it seems to make an entirely positive ethical contribution to the debates we have on such issues, perhaps uniquely, in your Lordships’ House.

I know that repetition rarely improves the quality of any argument. However, the support for the Bill, repeated from all parts of this House, and from all walks of life represented here, provides further important affirmation for it. We know that we are a somewhat unusual institution in this House; if a Martian were to walk in and look at the rules by which we come here, we would not pass the Martian test. Nevertheless, where else in the parliamentary world can we hold such ethical debates? Where else do we hear the kind of evidence that we are hearing in this debate? We very recently heard a wonderful speech from the noble Lord, Lord Elder, who told us of the heart transplant he had over 30 years ago. As we have seen today, it left him a very fit person: he has climbed more mountains than most of us have looked at. I hope he has also been able to enjoy some of the more traditional Scots remedies for exhaustion and other concerns.

We have also heard evidence from my noble friend Lady Finlay, who has spoken about the changes to the law in Wales and how effective they have proved. I think she gave some reassurance to the right reverend Prelate the Bishop of Carlisle about the increasing transplant figures in Wales.

I also look forward to hearing the contribution from my old friend the noble Baroness, Lady Randerson. She and I have known each other for many decades and I pay tribute to her determination. What she did in Wales on this issue was of great value, and I am sure she will provide very valuable evidence in a few minutes’ time.

That leads me to Wales. For many years I was an MP in a Welsh rural constituency and I am completely unsurprised that this system in the United Kingdom was first introduced in Wales. People in Wales tend to think more empirically than many in politics realise. Also, the devolution settlement in Wales, in which the noble Baroness, Lady Randerson, played a very important part, has made it much easier to bring to the statute book changes such as this in matters not reserved to the United Kingdom Parliament. Wales has been able, as has Scotland in some things, to be a trailblazer on this issue and has provided a great deal of evidence.

My belief is that the system in Wales has worked very well. My noble friend Lady Finlay described the advertising campaign, which means that everybody in Wales, unless they spend 24 hours a day asleep, knows about this system and it is discussed in families, as well as in more public forums in Wales. It has worked very well and has widespread popular support, as it will have in England.

I turn to the duties of the medical profession and return to something that the noble Lord, Lord Hunt, said at the beginning of his speech. He told us that he is fortunate enough to have just been appointed as a member of the General Medical Council. I was a lay member of the GMC for 10 years, albeit in its former incarnation as a much more parliamentary-style body than it is now. At the heart of the General Medical Council—I am sure this is true of the much smaller and very distinguished current council—are strong and heartfelt debates about ethical matters. The GMC translates those ethical decisions made by the council into guidance for doctors. If you look at its website, you come very quickly to the guidance currently given to doctors on after-death care and organ transplantation.

I say to the noble Lord, Lord Hunt, that one of the most useful things he can do in his first few weeks on the GMC is to persuade it that that guidance needs to be expanded somewhat so that the section relating to cadavers, parts of which can be used for transplantation, are much more explicit and so that the genuine concerns about that area are addressed. When doctors breach such guidance, of course it should be treated as serious professional misconduct which can bring the most condign remedies against them. However, for doctors to know where they are in these matters, it needs to be set out more explicitly.

The ethical responsibility is laid firmly on the regulator, the GMC, which passes it on to doctors. I hope that the General Medical Council will recognise that what I hope will be the passing of this Bill and the creation of a new system in England as well as in Wales means that it must be very vigilant about the behaviour of doctors in this area. There have been some horrendous cases—such as the Alder Hey case, which has not been mentioned so far in this debate—that have made one a little cautious about presuming that doctors can always be assumed to behave with superb ethical judgment. Sometimes they fail, and they need a stronger regulator to protect the public and themselves from such failures. I add that one of the principles that was often discussed when I was on the GMC was the responsibility of doctors to report other doctors who fall below appropriate standards. That failure, too, can be serious professional misconduct.

With those slight reservations, I support the Bill strongly, and look forward to England, once again, following Wales.

Gosport Independent Panel: Publication of Report

Lord Carlile of Berriew Excerpts

Wednesday 20th June 2018 Lords Chamber

[Lord Carlile of Berriew (CB)]

Does the Minister agree that it is particularly shocking that those who did not cover up—the brave staff who expressed concerns about what was happening—were ignored for so long? Does he agree that the culture of closing ranks among some medical staff should be regarded in itself as serious professional misconduct by doctors and others? Does he also agree that there should be training in the whole of the NHS which makes it easier for staff to identify the excessive use of opiates and to have action taken upon it?

[Lord O’Shaughnessy]

The noble Lord makes two excellent suggestions. His suggestion about whether cover-ups should count as serious professional misconduct will be something the regulators will want to consider, as is better training on the use and prescription of opioids. We have made some progress in recent years. The freedom to speak up guardians are in place, and we talked about the learning from deaths programme. There is also the duty of candour. They are clearly steps forward but the panel has exposed that we are still not there yet. The suggestions the noble Lord makes are good and serious and we will want to consider them.

General Practitioners: Workforce

Lord Carlile of Berriew Excerpts

Monday 5th March 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Baroness might be interested to note that in 2014, the number of GPs in specialty training was 2,671, and in 2017, it was 3,157—an increase of nearly 400. That is how we are filling the places.

[Lord Carlile of Berriew (CB)]

Is the Minister aware of the increasing number of inner-city general practices where the entire GP workforce consists of locum doctors because of recruitment problems? Does he agree that that is an expensive way to provide GPs, and one which diminishes the doctor-patient relationship?

[Lord O’Shaughnessy]

I agree with the noble Lord: we need to crack down on agency and locum spend. That has been falling in recent years. The way we will fix this issue and the demand for general practice in a sustained way is to increase the number of GPs coming into the service, and, as I said, that is exactly what we are doing.

End of Life Care

Lord Carlile of Berriew Excerpts

Tuesday 14th March 2017 Lords Chamber

[Lord Carlile of Berriew (Non-Afl)]

My Lords, I am sure the whole House will have been moved and instructed by the courageous speech that we have just heard from the noble Baroness. I look forward to the Minister’s response to it.

I pay my tribute to my noble friend—and indeed my very good friend—Lady Finlay for obtaining this debate and opening it with such skill. We in this House all benefit from her knowledge of palliative care, and indeed many of us have deferred on many occasions to that knowledge in quite specific circumstances.

It is a very good thing that we are able to debate the subject in this House and that so many noble Lords wish to take part. Indeed, I pay my tribute to the Government producing a document called Our Commitment to You for End of Life Care: The Government Response to the Review of Choice in End of Life Care. I cannot imagine that such a document would have appeared from a Government 10 or even seven or eight years ago. We are now beginning to talk properly about death and end-of-life care.

There must be many in this House—many of us have lost our parents, for example—who have witnessed the death of someone we love and have long loved. We heard the phrase “the quality of death” earlier in this debate. For me, one of the greatest privileges I have had was to witness a quality death in people whom I loved. Witnessing the death of someone you love and have long loved is a profoundly moving experience if it happens to you. To my mind, it is capable of being as profound an event as witnessing the birth of someone you are about to love as a parent. For death to be an event of that quality, however, good end-of-life care is essential.

I turn to children’s end-of-life care, a subject very eloquently spoken to by the noble Baroness, Lady Bakewell, and the noble Lord, Lord Suri. At the end of the 1990s and the beginning of this century I was a trustee of a children’s hospice, as it then was, on the Wales/Shropshire border. It made an enormous contribution to the lives of sick children and the lives of their families, who sometimes desperately needed respite from the difficulties that their dying children brought to the whole family, including their siblings, who often find that situation very difficult to cope with. It provided a process of death for children that was effective and moving and meant that everyone in the family was able to look back on that death as one of the most significant and historic events in the life of the family.

What worried me then, and worries me still, is that the statutory sector was reluctant, and remains reluctant, to recognise the contribution made by charitable organisations that provide hospice care for children. At the time when I was a trustee, there was barely any funding coming from the statutory sector to charities that were running children’s hospices. The situation is better now. Nevertheless, nearly one in five of commissioning groups do not commission children’s hospices at all, and seven commissioning groups refuse to commission children’s hospices to provide care just because they are charities. That is part of the very useful information that I and other Members of your Lordships’ House have received from Together for Short Lives and the Rainbow Trust, which I applaud for the assistance they have given to us towards this debate.

I shall simply ask the Minister one or two of the many questions posed by those charities. Given that it is the Government’s stated intent to make sure that commissioners prioritise children’s palliative care in their strategic planning, will the Government now take steps to make sure that clinical commissioning groups understand that they are responsible for commissioning for children’s palliative care and that they embrace the work that is done in the third sector? Will the Government also make sure that they are accountable to NHS England for delivering comprehensive children’s palliative care to end the postcode lottery that has been mentioned?

The final point I shall mention, because the hospice that I was a trustee of was in a rural area, is to ask the Government to try to ensure that rurality is not a handicap for families with dying children.

Access to Palliative Care Bill [HL]

Lord Carlile of Berriew Excerpts

Friday 23rd October 2015 Lords Chamber

[Lord Carlile of Berriew (LD)]

My Lords, I apologise to some noble Lords who spoke earlier, whose speeches I unavoidably had to miss. The noble Baroness, Lady Finlay, and I have stood side by side on the legislative battlefield on numerous occasions. I have always been willing to serve as her Baldrick, but when I use that comparison I do her an injustice because she is most certainly no Blackadder. Indeed, on all subjects, but especially on this one, she is very wise and knowledgeable, and I know that there are Members of your Lordships’ House other than myself to whom she has generously given private time when they have had issues around what we are talking about today. I support this Bill wholeheartedly.

This Bill is, of course, essentially about death. We should not have to feel gloomy about death in the way that seems so traditional in our country. I carry in my mind memories of my father’s death. I was lucky as I had a wise and wonderful father and his death was therefore a great sorrow to me. As I recall the last 24 hours of his life, every moment of which I witnessed, I can get almost a precise replay in my mind’s eye of everything that happened, everything that he said and all the thoughts that we exchanged before he was no longer able to speak, and it brings me great joy.

Today, 2,000 families in this country will face a death in the family. I wish that they could enjoy what I and, I believe, my father enjoyed on that day more than 25 years ago. My father did not want to die, but he was not afraid of dying. What occurred was almost the perfect end to life, but I am well aware that that does not happen everywhere.

Settings for death differ, and I have witnessed some of them. They include hospitals, nursing homes, residential homes and homes. I agree with the noble Lord, Lord Warner—wherever he cares to sit in your Lordships’ House—that if at all possible people should be able to die at home as long as home is the right place for them to die and the circumstances are there. Wherever possible, those circumstances should be provided. That is much of what this Bill is about.

Let us face it: in most cases death is predicted, at least within a relatively narrow timeframe. We prepare for birth over a period of nine months. We do not know exactly when the birth will occur, in most cases, but we are ready for it. We are ready to move as a family; we are ready to drop everything; we are ready to be part of a great family event at which we rejoice. I wish that we could do the same about death. In many cases, we can prepare for it and be at the side of the loved one who is departing from the family.

What has happened is that there has been almost a postcode lottery in relation to the way in which death is managed. In some parts of the country, provision has been very good and holistic; in other parts, and I have seen this too in my own family, it is, frankly, haphazard and disconnected, and you depend on the chance that there is at least one nice and sympathetic person present as the relative dies.

The Bill is about creating much wider knowledge and of creating training so that people are ready to deal with death. Dr Twycross, emeritus clinical reader in palliative medicine at Oxford University, wrote a very compact and telling letter to me about this. One of the things he said was that lectures are not enough, and that apprenticeships of an appropriate length and intensity are vital, particularly for doctors training to become specialists in gerontology, oncology, respiratory medicine, cardiology, neurology and pain medicine. I agree with him absolutely that training is about much more than lectures; it is about creating standards and knowledge. I believe that the noble Baroness’s Bill would help to achieve those high standards and good knowledge.

Mental and Physical Health: Parity of Esteem

Lord Carlile of Berriew Excerpts

Thursday 10th October 2013 Lords Chamber

[Lord Carlile of Berriew (LD)]

My Lords, the noble Lord, Lord Layard, has taken a long and influential interest in mental health; not least as a leading economist, he has made a powerful economic case for parity of esteem. We are very grateful to him for securing this debate.

I notice that the noble Lord is sitting alongside the noble Lord, Lord Bragg, on what I suppose one could describe as the polymath Bench this afternoon. This morning, the noble Lord, Lord Bragg, presented a most interesting Radio 4 programme featuring the life of Galen, the extraordinary second century Roman doctor. Galen discovered many things about medicine. One was that he realised that much of the variation in physical health and in human behaviour can be explained by temperament and stress, as he put it. He identified the inseparable links between physical pathology and psychopathology 1,900 years ago. To some people suffering from mental illness in this country and in particular to those who live with them, it can sometimes appear as though little more has been learnt in the past 2,000 years.

Of course, that is unfair. Generally speaking, huge advances have been made in the treatment of mental illness. Drugs are available which, for example, have vastly improved the quality of life for patients suffering from bipolar disorder and, more recently, for patients suffering from acute schizophrenia and other conditions. Therapies, not always involving drugs, have had a remarkable and beneficial impact on many individuals—albeit, I am afraid, with patchy availability in this country. I had the privilege of serving as Member of Parliament for a constituency in rural mid-Wales for some years. This is a bit historic, but even today I understand that the availability of therapies is very uneven in an area like that. You can get a therapy, but not necessarily the right therapy. Providing the correct therapy is extremely important.

The stigma of mental illness remains an obstacle to progress. The fear of telling an employer of a psychiatric diagnosis remains much greater than revealing a physical illness, however serious. In my own legal profession, I have seen careers destroyed by a psychiatric illness of limited duration, whereas a physical illness of similar duration has been received with sympathy and patience and people have been able to return to practice.

There has been some progress. The media have taken a commendable lead. I do not only listen to the noble Lord, Lord Bragg, on the radio; sometimes I watch television drama. Storylines in recent crime noir series, in “Homeland” and elsewhere, have highlighted that anyone, including the at least apparently heroic, can suffer from a mental illness and still lead a perfectly normal life and provide service to society.

Recently, I enjoyed the privilege of co-chairing with Professor Dinesh Bhugra an investigation for the Mental Health Foundation into the future of mental health services. Our report, Starting Today, was produced last month. There is not enough time in a debate such as this to go into the detail of the report, but one of its foundations was pleasure at the 2011 English mental health strategy, which rightly committed this country to parity of esteem. However, the declaration, welcome as it is, has not been matched by progress, which has been variable and not yet quick.

The Mental Health Foundation report has headlined a number of issues which could develop parity of esteem in the coming years. I will refer to a few of them. We certainly took the view that we need to look at fresh ways of implementing known best practice alongside developing technology. Above all, I would like to highlight mental health in primary care. GPs should become—but in only a few cases have become—leaders in mental health care, providing quickly accessible services in their surgeries.

I referred earlier to rural mid-Wales. I know of one practice which years ago introduced a psychotherapist into the health centre in a small Welsh market town. It had a remarkable effect. It meant that the doctor could say to the patient, “I think you need to go down the corridor and talk to my colleague”. An intervention was made which beneficially affected the life of the patient concerned. We need to see more of that. By the way, a two-week wait for an appointment with a doctor just will not do for someone suffering from a growing mental condition. GPs need to know as much about mental illness as about physical illness. So far as possible, primary and secondary mental health services should merge to produce early treatment and the value for money that the noble Lord, Lord Layard, has identified in some of the work he has done over the years on mental health.

The Mental Health Foundation report also found that there is value in self-management. So far as possible, patients in a personalised service should be encouraged to take training in the management of their own care in partnership with therapists and clinicians. A stake in your own recovery is a real incentive for a person who is suffering from mental health problems, but it needs some formal help.

Turning to crisis care and community support, every accident and emergency facility should be equipped to deal with emergency mental health issues, to be followed up by community support. They are not. All over the country, they are not equipped. That is not acceptable.

On collaborative working, I emphasise something that I have encountered in other areas, such as child safeguarding, which is the sharing of information. When somebody with a mental illness goes into an accident and emergency department, a solicitor’s office, a police station or a school, they go into a silo. That is not acceptable. Data protection is used as an excuse for not sharing information. Actually, it is near criminal not to share information for people who have needs that are demonstrated by mental illness. We must ensure that those who have information to share do not sit in silos and that the ability to pool funds from different funding streams into a single integrated care budget, shared protocols and partnership agreements, co-location of services, multi-disciplinary teams and liaison services becomes a reality.

The Mental Health Foundation report also emphasised the beginning and the end of life as key areas where mental health interventions should be made available quickly and fully. Early interventions in schools can identify mental health issues that affect not only the child but the child’s parents and carers. Many cases have been highlighted in some terrible reports that have been produced after fatal events that show that to be the case.

The final issue that I want to raise in the time available concerns the elderly. Perhaps this is an issue that we can raise comfortably in your Lordships’ House because so many of us are OAPs these days. There is a growing issue, as we all know, about elderly care. Many of us have enjoyed having parents who lived into their late 90s and indeed, happily, there are Members of this House in their late 90s, but we know that this issue needs a great deal more work than it has received. It will enable elderly people to lead a full life albeit while suffering from some incipient dementia.

There are many challenges and this debate highlights them. It allows us to show Parliament’s determination that parity of esteem should be a must and not merely a phrase.

Health: Anorexia

Lord Carlile of Berriew Excerpts

Monday 25th February 2013 Lords Chamber

[Lord Carlile of Berriew]

I congratulate the noble Lord, Lord Giddens, on initiating this debate. I agree with everything that has been said so far. This is an extremely important subject, which we should address more often, both in this House and in another place. In a very densely packed sentence in its College Report 170 of 2012, the Royal College of Psychiatrists said:

“Eating disorders are serious mental disorders with high levels of physical and psychological comorbidity, disability and mortality”.

It is not just a free-standing condition, in other words.

Anyone who has ever been close to a serious eating disorder knows that it can prove extremely debilitating to the whole family in which the sufferer lives. Indeed, it is an ordeal for families that can lead to permanent effects, even if the person concerned appears to recover, although there can be and sometimes is good recovery. If there is to be good recovery, it is vital that there should be early interventions, which must be the right ones—not just any intervention. In too many parts of the country, the wrong intervention is provided because the services needed for that person are simply not available. If a sufferer from anorexia needs cognitive behavioural therapy, it may damage them to give them drugs, and vice versa. It is a very subjective illness.

My perception of how the illness is treated throughout the United Kingdom is that it is very unevenly dealt with. For a number of years, I was a Member of another place for a constituency in rural Wales. Today, as then, the services available in rural Wales—in an area affected by its rurality—are far less clear and certain than in many urban areas.

In opening the debate, the noble Lord referred to the internet and I agree with him entirely about its effect. There are far too many sites on the internet that worship the slender. I am shocked, too—for I still sometimes see teenage magazines in my household—by the primacy given to thinness in magazines. These are everyday, perfectly respectable magazines, purportedly edited by responsible people. With my children, stepchildren and grandchildren, who regard me as quite a decent sort of shopper, especially if there is a credit card in my pocket, I sometimes go into well known clothing stores. Some barely have anything larger than a size 10, yet that is a very small size which probably truly fits a minority of young women in their undieting state. It seems shocking that we are not capable of addressing in a more realistic way the natural state of our young women and young men.

I also believe that there is a complete failure in outcome monitoring, as the Royal College of Psychiatrists has said. We would have more consistent services if we knew the results. We even talk about paying for prisons by results but we do not pay for psychiatric services by results. It seems to me that one way of disciplining the relevant providers of services would be to judge their results. If they do not perform properly, someone else is available to do the job. The principles applicable to child safeguarding standards, which include removing child safeguarding from local authorities in certain circumstances, should also be applied to psychiatric and psychological services, especially those affecting eating disorders.

There are some innovative ideas around which really are not all that innovative. In some respects, it is a case of returning to what happened in the past. However, I suggest to your Lordships that annual medical examinations of every schoolchild, up to and including year 11, could be introduced. Looking around the House, those examinations were certainly undergone by everybody who is here today. Very simple and rudimentary checks, such as weighing, measuring and looking at teeth and feet, tell you an awful lot about a young person, especially if the figures can be compared with those taken a year or a term ago. I do not understand why we have abandoned these rudimentary measures, apparently on the grounds of cost, when any cost-benefit analysis shows that this kind of examination saves a great deal of money further down the line.

Finally, I wish to say a word in favour of school nursing and school health services. They seem to have been abandoned in an awful lot of educational institutions, yet the rumour mill that takes children to the school nurse saves lives. I wish we could look at that more closely for the future. There is a great deal to do and we do not seem to be doing it.

Health and Social Care Bill

Lord Carlile of Berriew Excerpts

Wednesday 8th February 2012 Lords Chamber

[Lord Walton of Detchant]

My Lords, in rising briefly to support the amendment so ably proposed by my noble friend Lord Patel and supported by the noble Lord, Lord Alderdice, I ask the Minister one very simple question. In Clause 1(1)(a) the Bill talks about the,

“physical and mental health of the people of England”,

and says that the health service must be “designed to secure improvement” in that health. What on earth could the objection possibly be to inserting in paragraph (b) at line 6 the unexceptional words listed in the amendment? They simply stress the crucial importance of mental as well as physical illness. How on earth could this be construed as doing any damage whatever to the Bill? It is something that I hope very much the Government can be persuaded to accept.

[Lord Carlile of Berriew]

My Lords, I should like to say a word on behalf of those who have had to care for family members—often a young member of the family—who have suffered from severe mental illness. Those who have suffered that experience—and I am one—know how marooned they feel when they find that someone in their family has a serious mental illness. If somebody has a broken leg, you can locate the leg and take the medicine. If somebody has even cancer, it may not be curable but at least you have the knowledge of the location or locations of the cancer and the topical treatment that is to be applied to it.

The problem for families who experience in their midst mental illness is that no medicine can be applied topically to the place where the hurt or illness is taking place. The prognosis is uncertain, the mortality rate is depressingly high and usually at the hands of the sick person, and accessing good health service facilities is quite chancy, I am afraid. There is a real postcode lottery with mental health treatment. If, for example, you live in a remote rural area, only some therapies will be available and they may be the wrong therapies, particularly if the patient is a child or adolescent suffering from serious mental illness. Therefore, I simply say to the Minister who, as has already been said, cares deeply about these issues, that the adoption of this very simple amendment, as the noble Lord, Lord Walton, rightly described it, would send out such a telling message of support to families who have to care for people who suffer, perhaps temporarily, from mental illness that it would be seen as a declaration of purpose by this Government.

[Baroness Whitaker]

My Lords, briefly, from a lay perspective, I urge the Minister to take this amendment very seriously. I will not rehearse what I said at Second Reading from my experience on the board of the Tavistock and Portman clinic or from other walks of life about how widely damaging and destructive it is not to have parity, and how it needs to be explicit parity to change culture and to erode the stigma and the neglect associated with mental ill health. If the Government are rash enough not to accept the amendment—and I am quite sure that the noble Earl is not like that—I hope that there will be a Division. If the debate lasts until five o’clock, when I am committed to chairing a meeting, I hope that the House will accept my apology but I will return to vote.

Health: End-of-life Care

Lord Carlile of Berriew Excerpts

Monday 16th January 2012 Lords Chamber

[Earl Howe]

My Lords, the end-of-life care strategy that we are pursuing, published by the previous Government, highlighted the need for a cultural shift in attitude and behaviour related to end-of-life care within the health and social care workforce. The noble Baroness is quite right that this is an issue. In partnership with the national end-of-life care programme, we have taken forward a number of initiatives to develop the workforce’s understanding. We have commissioned the development of an e-learning package, which is turning out to be popular, that includes advance care planning and communication skills. Core competences and principles for end-of-life care have been developed, and a number of pilots have been taken forward in that area. A document called Talking About End of Life Care: Right Conversations, Right People, Right Time has been published and was completed early last year. There are a number of initiatives in this area.

[Lord Carlile of Berriew]

Does my noble friend agree that the new NHS commissioning arrangements are such that they give an opportunity for advance directives to be collected and collated in a coherent way by general practitioners? Will he also confirm that, whatever advance directives are given, the need to provide comfort to patients remains a duty on clinicians?

[Earl Howe]

I agree with my noble friend on both counts.

Health: Pathfinders

Lord Carlile of Berriew Excerpts

Thursday 12th January 2012 Lords Chamber

[Lord Carlile of Berriew]

Can my noble friend confirm that the NHS will take fully into account the success of pilot pathfinder projects in places as diverse as Newcastle, Swindon and Bedfordshire so that the NHS itself encourages the development of pathfinder projects? Will he also take into account the fact that GP co-operatives were very successful as long as they lasted, but the discouragement they were given by the previous Government brought a disastrous end to some very good schemes?

[Earl Howe]

I am grateful to my noble friend. I think everybody agrees that integrating services, however one defines that—although the common denominator is surely from the point of view of the patient—is a good thing. We do not wish to lose sight of the lessons that have been learnt so effectively in the places mentioned by my noble friend. It is true that other areas have yet to catch up. We recognise that, and the focus over the next 12 months will be very much on sharing the lessons that have been learnt by the pathfinders that we know are working well.