Mental Capacity (Amendment) Bill [HL]

Lord Cashman Excerpts

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

[Lord Cashman (Lab)]

My Lords, I start with an apology, as I have not spoken on the Bill before. I thank, in particular, POhWER, the organisation of which I am a patron, for alerting me to the Bill and to its concerns, as well as the concerns shared by a wide range of groups, including Liberty, Age UK, Mencap and so on.

As other speakers have outlined, it is essential that we get this absolutely right, because we are talking about potential deprivation of liberty. According to those organisations, people with dementia or a learning disability are at risk under the proposed changes. Therefore, I speak in support of Amendment 1, proposed by the noble Baroness, Lady Finlay, and Amendment 20 in the name of my noble friend Lady Thornton. I believe that this amendment would ensure that the views of the donees and deputies already appointed by cared-for persons to make decisions in their best interests were given appropriate weight with regard to where the cared-for person resides for care and treatment.

I will say no more than that because there are experts on this issue in the Chamber. I sit willing to support but more willing to listen and learn.

[Baroness Barker (LD)]

My Lords, I apologise for being slightly late. I was taken by surprise at the swiftness with which we concluded our previous business.

I thank the noble Baroness, Lady Finlay of Llandaff, for many of the points that she made in her speech. It took a lot of work to get the concept of an advance statement on wishes into this legislation, and I, like her, regret that it has not been more widely adopted or accepted, particularly by the medical profession. She will know that when the Select Committee reviewed the legislation, one of the biggest disappointments was the extent to which the Mental Capacity Act had not been understood by the medical profession. She will perhaps remember that when representatives of different parts of the medical profession come to talk to us, they began by saying that in an A&E department it is extremely difficult to work out somebody’s advance decision. We knew that when we passed the initial legislation, but that legislation was not meant solely to take its lead from that; it was meant to apply to a whole range of matters just within medicine. It is a shame that the medical profession still relies on a very conservative interpretation of the existing legislation and takes a read-out from emergency situations when it really should not, as there is plenty of time to discuss with the person what is happening and to understand their previously stated wishes and feelings.

I am glad that the noble Baroness has raised this issue. She is right that at the heart of the Bill is a fundamental change from the Mental Capacity Act. There will no longer be a whole series of decision-specific assessments of people who lack capacity, and that is not something that I object to. Over the last few years while this legislation has been in place, we have quite often found people being subjected to unnecessary assessments. It is quite clear that when somebody has a medical assessment for advanced dementia, say, they will not have the capacity to make the same decision, even though they go to live in a different place. I accept that it is possible to make a decision of a lack of capacity and to carry that forward throughout a person’s care. What I am not clear about, though—given that people will be subject to fewer assessments, and therefore be less likely to have changes in their conditions brought to light—is the extent to which that will interplay with somebody’s statement of advance wishes. I would rather like it if the Minister, in his response, could talk about how that will work.

I agree with the noble Baroness, Lady Finlay. The safeguards on liberty and safeguarding have been thoroughly confused by many people. That is fundamental. Whether we turn this around from safeguards against deprivation of liberty or safeguarding the liberty of somebody, I do not think that anything I have seen in the Bill has yet addressed that fundamental misunderstanding. In fact, in some cases, it probably compounds it. I want to put that on record as we discuss the many issues the noble Baroness, Lady Finlay, has introduced so well.

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[Baroness Murphy]

My Lords, I support this amendment. As the noble Baroness, Lady Thornton, has already said, the Royal College of Psychiatrists feels strongly that this would clarify decision-making. There may be issues arising from the fact that when the Bill was being put together we had not yet had the Birmingham judgment, which is why we are not quite there yet. However, having the four regimes that we currently have to choose from for this age group makes it very difficult to make appropriate choices. This would clarify it. It was strongly supported by the Law Commission in its first recommendations, and I support it.

[Lord Cashman]

My Lords, I too support Amendment 2 in the name of my noble friend Lady Thornton, and the consequential amendments. I am grateful to her for bringing her personal experience to this and reminding us of the young individuals involved. This amendment and the subsequent amendments are to be welcomed. By including 16 and 17 year-olds, it offers better safeguards to those who are not served well at the moment. The amendment would see 16 and 17 year-olds protected by the LPS. It would simplify the system, would bring clarity and ensure that their rights under Article 5 of the European Convention on Human Rights were therefore protected. For those reasons and many more, I support this amendment and the subsequent amendments.

[Baroness Tyler of Enfield]

My Lords, I rise briefly to support this group of amendments. I strongly support bringing 16 and 17 year-olds within the scope of the Mental Capacity Act, and support the proposed amendments to the authorisation and safeguards scheme. I will raise a couple of points, and I would be grateful if the Minister were able to provide some answers or reassurance.

First, clarity will be needed on the role of those who currently have parental responsibility, and how that will fit in with the proposals that are being put forward. Secondly, we need to make sure that there is a fully co-ordinated and joined-up approach across a number of different pieces of legislation. I have already talked about the join-up between the Mental Capacity Act and the Mental Health Act, but I am conscious that, when we are looking at 16 and 17 year-olds, we need to look also at other legal mechanisms that authorise a deprivation of liberty, such as Section 25 of the Children Act 1989, and at how the model dovetails with legal frameworks for the provision of care and support, such as education, health and care plans under the Children and Families Act 2014. So I would ask for some reassurance that someone is looking at the join-up with other relevant bits of children’s legislation.

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[Baroness Tyler of Enfield]

My Lords, the essence of this amendment is about language and use of language—in particular, the term “unsound mind”. I think we would all agree that language is important; it sends very important signals. Many noble Lords raised this point with passion at the Second Reading debate. I was pleased that the Minister’s helpful letter of 24 July referred to the debate about “unsound mind” and made clear that the Minister was sensitive to the points made and would welcome views. I guess this amendment is my way of putting forward my views.

The fact remains that, despite growing awareness and acceptance of mental illness, stigma and discrimination remain a regular experience of people with mental illnesses and their families and can put people off seeking help. We were given to understand that the use of the term “unsound mind” within the Bill was to ensure that it was in line with the ECHR—but this was written in the 1950s. Many people, both inside this Chamber and outside, have expressed serious concerns about the inclusion of this language in the Bill in 2018. Frankly, it perpetuates very unhelpful negative stereotypes. I would contend that the phrase “unsound mind” is out of place in today’s society; it is out of place in legislation being looked at in 2018; it is stigmatising and has no clear clinical meaning; indeed, I would say it is offensive to many.

Therefore, my amendment proposes that, in paragraph 2(2)(c) of Schedule 1 to the Bill, the term “is of unsound mind” is replaced by “has any disorder or disability of the mind”. This terminology is already a well-established term in the Mental Capacity Act and has proven to be compliant with the ECHR without, in my view, having anything like the same stigmatising connotations of “unsound mind”. A disorder or disability of the mind, I am informed by the Royal College of Psychiatrists, has a clear clinical meaning. It is well understood by clinicians and should be no more stigmatising than saying someone has a physical disability.

I am aware that the BMA, which supports not using the term “of unsound mind”, has put forward a proposition that this term should be reconsidered and experts and patient groups consulted to find an alternative to it. The BMA may be right, but I felt that, for my starter for 10, I wanted to put forward terminology that I thought was right. I am sure that others will be able to improve on it.

To conclude, above all this Bill must put the people most affected centre stage—that means some of the most vulnerable people in society, as we have already heard. In my view, it is simply not good enough to continue using terms that lawyers and drafters of legislation may find helpful—it might help them fit things in with other bits of legislation and other conventions—but which causes harm and distress to those we are all trying to help. I believe there is a real and welcome opportunity to change the narrative and discourse in a positive way, and this amendment is a way of taking that opportunity.

[Lord Cashman]

My Lords, it is a great pleasure to support this amendment. Language is crucial. Several times during the day I question whether I am of sound mind, and I think that the concept of unsound mind is extremely dubious. I welcome the amendment from the noble Baroness, Lady Tyler, because it seeks focus and clarity, substituting for “is of unsound mind” the words,

“has any disorder or disability of the mind”.

I believe that the Royal College of Psychiatrists has supported this approach. The BMA also suggests that there should be a different approach because the term “unsound mind” reinforces stigma and discrimination, and equally it is outdated. Its continued use merely perpetuates negative stereotypes of vulnerable people, particularly when we are trying to get over those stereotypes in order to get people to speak more openly at the beginning of their problems—our problems—with mental health issues. Therefore, it is a pleasure to support this amendment.

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[Baroness Watkins of Tavistock (CB)]

It might be complex to find the right nomenclature, but I heard the noble Baroness, Lady Tyler, say that this was a starter for 10. I cannot see why we have to regress to 1959 language in the Mental Health Act without further exploration of whether we could redefine the term about perhaps affecting the mind, to take in that very small minority of people with severe physical illness that occasionally affects the mind. We have worked so hard to destigmatise both learning disability and mental health that it seems very sad that we cannot work a bit harder at this point on this issue.

[Lord Cashman]

I want to reaffirm the point made by the noble and learned Lord, Lord Woolf. Surely it is not beyond the wit of drafters and our legal experts, when referring to the starter for 10 offered by the noble Baroness, Lady Tyler, to refer to the European Convention on Human Rights and the jurisprudence arising from the European Court of Human Rights? It seems to me that it is elegantly simple to take such an approach, reassuring the rights that relate to the “unsound mind” in relation to the new definition offered. I hope my intervention makes sense—it is not often best practice to speak on the hoof on such legal matters. I hope that noble Lords will forgive me if I have not made sense.

HIV Prevention Services: Public Health Funding

Lord Cashman Excerpts

Thursday 30th November 2017 Lords Chamber

Asked by

[Lord Cashman]

To ask Her Majesty’s Government how reductions to the public health grant since 2015-16 have affected access to sexual health services and HIV prevention services, particularly in London, for (1) men who have sex with men, and (2) people from black and minority ethnic groups.

[Lord Cashman (Lab)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and refer to my entry in the register of interests, particularly as patron of the Terrence Higgins Trust.

[The Parliamentary Under-Secretary of State, Department of Health (Lord O'Shaughnessy) (Con)]

My Lords, the UK is one of the first countries to witness a substantive decline in new HIV diagnoses in gay and bisexual men. Between 2015 and 2016, new HIV diagnosis fell by 21% across the UK and by 29% in London due to reduced transmission of HIV. New diagnosis in heterosexual black, Asian and minority-ethnic groups fell by 16%, mostly due to changing migration patterns.

[Lord Cashman]

My Lords, I thank the Minister for that response. Great progress has been made and I pay tribute to all those concerned, but there is concern at the cuts seen in HIV support services and sexual health services across the United Kingdom, not least in the two areas with the highest prevalence of HIV, Lambeth and Southwark, through to Oxfordshire, Portsmouth and Bexley. How are the Government working with local authorities in England to ensure that such services are fully funded and meet the needs of local communities at risk of HIV? Furthermore, what steps are they taking to ensure that people living with HIV have access to support services that fully meet their needs?

[Lord O'Shaughnessy]

First, I pay tribute to the work of the Terrence Higgins Trust and its leadership in this area in making progress in the UK in dealing with the HIV/AIDS epidemic. The delivery of open access to sexual health services is mandated for all local authorities, which are funded to do so by the public health grant. It is incredibly important to point out that over the last four years there has been a 500,000 increase in the number of attendances at sexual health clinics, and more testing and treatment is taking place. That is starting to show in the reduced number of diagnoses, as well as in other factors. It should also be pointed out that as regards looking after those suffering from the consequences of HIV/AIDS, the Care Act 2014 is extremely clear that the legal framework for social care applies to adults, including those who live with HIV.

Older Persons: Human Rights and Care

Lord Cashman Excerpts

Thursday 16th November 2017 Lords Chamber

[Lord Cashman (Lab)]

My Lords, I refer your Lordships to my interests in the register and to my date of birth. I congratulate my noble friend Lord Foulkes on securing this important debate and on his excellent report. Of course, the noble Lord, Lord Balfe, will remember that I was one of the co-rapporteurs on the framework directive of 2010 from the European Parliament on combating discrimination on access to goods and services on the grounds of age, disability, sexual orientation or gender. That is still resting and blocked by Governments who do not want to take the necessary action—so there needs to be taken at national level on this important issue.

The reality is that we are failing many older people when they need us most. The Care Quality Commission’s annual state of care report of 2017 found that only 2% of adult social services were rated outstanding: 78% were good, 19% required improvement and 1% were rated as inadequate. Before we congratulate ourselves, let us remember that the 1% represents 303 locations and approximately 16,000 individuals whose care was inadequate.

The report also, importantly, reveals wide variations in quality ratings between different types of homes and services. Community social care services were rated the best overall when compared with other services. Domiciliary services and residential homes received similar ratings. However, nursing home services received the worst ratings, with 68% rated as good, 28% as needing improvement and 3% as inadequate. Within these stark statistics are hundreds and thousands of vulnerable adults whom we are failing.

I am pleased to be reminded by the noble Lord, Lord Haskel, of the issue of human rights that is predominant in this Motion. That is why I turn specifically to the issues of human rights and discrimination and other issues faced by older people—in particular, people living with HIV. The Terrence Higgins Trust report, Unchartered Territory, surveyed nearly 250 people living with HIV across the UK, all of them aged over 50. Some 58% of respondents were defined as living on or below the poverty line. Over one-third of individuals living with HIV were reliant on social security payments. Some 84% were concerned about future financial difficulties and a third of respondents were socially isolated. Some 79% were concerned about memory loss and cognitive impairment in the future and how they would cope with managing multiple health conditions.

The challenges are many and varied. There is a difference in needs and experience, depending on whether an individual was diagnosed before antiretroviral drugs were available or after. Individuals diagnosed before treatment was available were more likely to have more additional health conditions. Social care is not currently meeting the needs of people living with HIV as they grow older because they face the prospect of managing multiple long-term conditions that are made more complex by their interactions with HIV. Even those who have been able to access social care have faced discrimination from social care professionals due to their HIV status. This discrimination is fuelling myths and stigma around HIV by treating people living with HIV differently from other social care users.

The Minister and his department will also need to address discrimination faced by older LGBT people. Care providers need to recognise and respect LGBT identities and should ensure that LGBT identity is not marginalised, nor rendered invisible, and that LGBT elders are not outed deliberately or inadvertently. There are human consequences to this. Unfortunately, the problem, as evidenced in the Stonewall/YouGov research, Unhealthy Attitudes, found that a quarter of health and social care staff had never received any diversity training at all. Some 72% had not received any training on the health needs of LGBT people and, shockingly, only a quarter of staff had received any training on trans people’s healthcare. The training of health and social care staff in understanding and engaging with the particular needs of LGBT+ people is an important and deliverable objective to improve the quality of life of these people.

Time does not allow me to offer the House further examples, but I ask your Lordships to imagine what it must be like to once again have to validate your life, your love and your relationships at a time when you are vulnerable and when these have been, and should remain, the one constant in your life.

Mental Health: Young People

Lord Cashman Excerpts

Thursday 9th February 2017 Grand Committee

[Lord Cashman (Lab)]

My Lords, I too wish to place on record my thanks to the noble Baroness, Lady Massey. I welcome the briefing There For You. It is eloquent, and the parents involved in the survey are hands-on, informed and know how to connect. But what about those who do not? What about those who are not connected and who, in fact, feel disconnected from where to seek help or advice? These are the groups that we need to target and, I would argue, prioritise—those who are unable to recognise or cope with the reality that their child may have a mental health problem. We need to remove the stigmas and barriers around discussion. In that respect, some of us need to come out and admit how all of us, to a greater or lesser degree, battle with mental health problems that our friends and colleagues so rarely understand or acknowledge as a health issue. We need to deal with the causes of mental health problems, both physiological and psychological.

In that regard, I wish to say a few words about young people who are overlooked and often fall through the safety nets we try to construct: lesbian, gay, bisexual, trans and intersex youths. The 2014 What about YOUth? survey of 15 year-olds presents deeply worrying facts that have, sadly, been overlooked by the Department of Health and the Department for Education. The research revealed that 31% of lesbian and gay 15 year- olds and 39% of bisexual 15 year-olds had low life satisfaction, compared with 12% of heterosexuals. Of those who had been bullied in the period under question, 74.5% were lesbian and gay and 81% were bisexual, compared with 53.4% who were heterosexual. These are 15 year-olds, crying out for help but help is not coming their way. These young people are crying out to be understood, especially among their own community and within their social structures. That is why we need comprehensive sex education that is mandatory, not something that schools or religious organisations can opt in or out of, so that people are not bullied or mistreated but are understood.

We need action plans to prevent the damage that is inflicted upon young children from a very early age. That harm affects us all. Parental support is not always there for LGBTI children because, for that to happen, the child would have to come out to their parents or teachers, and sometimes they are not ready or able to do so. If you put religious adherence in to this mix, the damage is toxic. Young people are shut out from families and religious communities and cast aside. There are some organisations doing great work in challenging circumstances, such as FFLAG, of which I am a patron. However, they are underresourced and always in demand. Schools Out is another, and is working hard to educate, particularly in this LGBT History Month. I urge the Minister to work cross-departmentally with these organisations and others to ensure that no child suffers.

Residential Care

Lord Cashman Excerpts

Monday 6th February 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness makes a very good point. There is clearly a need for additional capacity, because there is a much greater population. The number of people aged over 85 has increased by about 25% in the last five years and that will increase at a similar rate over the next five years, so more capacity is needed both at hospital level, in residential and nursing homes, and at a domiciliary level too.

[Lord Cashman (Lab)]

My Lords, there are worrying trends of discrimination suffered by people in vulnerable groups, people with HIV, those who are ageing and others. Therefore, will the Minister work with care providers to ensure that such discrimination, ignorance and stigma are absolutely outwith the provision of such services?

[Lord O'Shaughnessy]

I completely concur with the noble Lord’s point. He is right, of course: there should be no such discrimination on those grounds or any other. I will certainly investigate that and see if there is anything worrying going on and write to him.

HIV: Barriers to Treatment

Lord Cashman Excerpts

Thursday 1st December 2016 Lords Chamber

Asked by

[Lord Cashman]

To ask Her Majesty’s Government what assessment they have made of barriers to accessing treatment to prevent the spread of HIV; and what steps they are taking to address those.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, HIV treatment in itself is preventive. HIV positive people are now being given early access to HIV drugs, resulting in an undetectable viral load, which makes it very unlikely that the virus will be passed on to others. To ensure that we continue to make progress in preventing HIV, NHS England and Public Health England will say more about their further plans for a new programme in the next couple of days.

[Lord Cashman (Lab)]

I thank the Minister for his response and indeed for his commitment on this issue. However, there has been much prevarication and procrastination over who is responsible for providing access to PrEP, a drug that is known to prevent transmission of HIV. More people are at risk than ever before, so will the Government explain how they are working with NHS England and Gilead, the supplier of PrEP, to take the lead on this issue? If the price of PrEP does not decrease, how and when will the Government ensure that those at significant risk from HIV will have access to it?

[Lord Prior of Brampton]

My Lords, negotiations have been going on between NHS England, Gilead and others, and we expect a positive outcome in the very near future—in the next few days. I cannot comment on the details at this time, but as soon as we have that information, I will ensure that it is placed in the Library of the House of Lords immediately.

Health: HIV

Lord Cashman Excerpts

Monday 4th July 2016 Lords Chamber

[Lord Prior of Brampton]

I am not an expert in this area, but having thought and read about this issue a lot over the past few days, it seems to me that the number of people who have not been diagnosed with HIV is a critical issue. As those people are not aware that they have HIV, their behaviour is not adjusted and because they are not taking treatment, they have a greater amount of the HIV virus. It is estimated that 18,000 people have not been diagnosed so, if one had to make a choice, increasing our rate of diagnosis must be crucial. However, I do not disagree with the noble Baroness that the evidence around PrEP as a prophylaxis is strong.

[Lord Cashman (Lab)]

My Lords, I have a simple question. Does the Minister agree that we cannot afford not to provide PrEP on the NHS, given that it saves lives and prevents HIV infection?

[Lord Prior of Brampton]

The critical issue is: to whom do we provide it? The whole purpose of the trials that NHS England is now funding is to ensure that when we provide PrEP, we do so for those who can most benefit from it.

NHS: Food Banks

Lord Cashman Excerpts

Thursday 26th November 2015 Lords Chamber

[Lord Prior of Brampton]

I thank my noble friend for that remark. It is entirely up to local organisations and local institutions, and those doing the work in Birmingham and Tameside are to be congratulated.

[Lord Cashman (Lab)]

My Lords, I do not doubt the Minister’s sincerity in his answers, but I point out that food banks result because people are going hungry. People are starving in this country and should not have to rely on such charity. Does he agree that obesity often occurs when people on very meagre budgets have to have the worst kind of food in order to feel satisfied?

[Lord Prior of Brampton]

The factors behind obesity and malnutrition are extremely complex. The all-party inquiry referred to complex and frequently overlapping factors. The work done by the University of Warwick found that there was no systematic evidence on drivers of food aid in the UK—and the evidence was drawn not just from the UK but from the US, Canada and Germany.

HIV/AIDS

Lord Cashman Excerpts

Thursday 5th March 2015 Grand Committee

[Lord Cashman (Lab)]

My Lords, I begin with what is a normal courtesy but I really mean it. I thank the noble Lord, Lord Fowler, for securing this debate and for his dedication and overwhelming commitment to the issues of HIV/AIDS and non-discrimination. I also want to develop the theme which he outlined. There has been a massive expansion globally of HIV interventions, which has transformed the HIV epidemic and the broader public health landscape, demonstrating that the right to health can be realised even in the most trying circumstances. I remember well the 1980s when, as a gay man, I saw AIDS and HIV portrayed in the media as the gay plague. We have moved further, and onwards, since then. I welcome that move and I welcome this Government’s commitment and their increased funding, particularly for the Global Fund.

There has been much progress in the developing world but I must express my concern at our view, now taken, that we should pull back in those so-called middle-income countries such as South Africa, where there is a high and increasing prevalence of HIV infection. To pull back in those middle-income countries, with this Government leading on asking the Global Fund to pull back in them, will reverse all the good that has been done.

I turn now specifically to the United Kingdom. People with HIV who receive appropriate treatment, as we know, have a near-normal life expectancy and are very unlikely to transmit the virus. Yet the proportion of people receiving a late diagnosis, according to Library statistics, was 47% in 2012. An estimated 22% of people living with HIV in the United Kingdom are unaware of their infection or status. Increasing HIV testing is therefore important so that treatment can be given and onward transmission prevented. Successful prevention depends on a combination of testing, treating and behavioural change. Giving antiretroviral drugs to those at risk could reduce infections. We know that that work is being rolled out in the United States. Work is also being done here on that. I have to express concerns at some parts of the media comparing the cost of this treatment to that of cancer care. When it comes to the health of an individual, comparisons are odious. There are concerns that the separation of commissioning HIV treatment and prevention has negatively impacted patients.

I have specific questions for the Minister but I will come to those shortly. First, let me refer to the National AIDS Trust and its press release of 20 February 2015. In its report, HIV Prevention—Underfunded and Deprioritised, the charity states:

“Not enough money is being spent on HIV prevention to have any impact on the … new HIV infections”—

as was outlined by the noble Lord, Lord Fowler. The trust estimates that,

“in 2014/15 £15 million was spent nationally on HIV prevention compared with £55 million allocated in 2001/02 … In this time the number of people living with HIV has trebled whilst the amount spent on prevention has decreased to less than a third of the original budget”.

This makes no sense whatever. The report continues:

“This estimate is based on information provided to NAT from local authorities in England with a high prevalence of HIV. £10 million was spent in 2014/15 on HIV prevention in these areas—this works out at only 70p per person. The report found that in local authorities with high prevalence of HIV less than 1% of local authority public health allocation is spent on HIV prevention. In 2013 the NHS spent 55 times more on HIV treatment and care in these areas than local authorities spent on HIV prevention”.

According to the chief executive of the NAT:

“Our research found, shockingly, in the 58 areas of highest prevalence of HIV in England, seven local authorities weren’t spending anything on primary HIV prevention or on additional testing services. Worryingly we also found no correlation between level of HIV prevalence in an area and how much was being spent on prevention”.

The report continues:

“The HIV charity is also concerned that more problems are on the horizon when the ring-fencing for the public health budget is removed. Currently, local authorities are given money to provide basic services such as sexual health clinics. In April 2016 they will be able to spend this money on anything”.

To quote the chief executive:

“In the current climate of cuts and pressure on budgets we are extremely worried this money will be used to shore up other areas of council spend. This would be a disaster for public health in this country”.

I now come to my questions. Will the Government address this funding gap, maintain public health ring-fencing and prioritise HIV prevention and testing services? It is three weeks to purdah and the new financial year. The people who are supposed to be managing the national HIV prevention programme, which has been cut in half, have still had no instruction on how the money should be reallocated, let alone spent. They are dependent on getting approval for this from the Department of Health, which means that the charities involved will not even get the four weeks’ notice they need to give notice, in turn, to staff who may lose their jobs. How do the Government intend to ensure continuity of service?

We also need a nationally co-ordinated approach to ensure that we use ever-decreasing resources effectively to reduce undiagnosed HIV and forward transmission. How will the Government ensure a co-ordinated approach when they are not planning and consulting on it? We have a situation where reducing duplication and using money wisely is paramount, yet I am reliably informed that there is a total abdication of any national responsibility for this. Both the Department of Health and Public Health England say they can only advise. It is deeply worrying and I look to the Minister for his replies.

Health: Lesbian, Bisexual and Trans Women

Lord Cashman Excerpts

Wednesday 3rd December 2014 Lords Chamber

[Lord Cashman (Lab)]

My Lords, I congratulate the noble Baroness, Lady Barker, on introducing this extremely important topic. She rightly referred to the three lesbians who abseiled into your Lordships’ House. Why did they do that? They did it on the absolute principle of equality. From that brave fight against Section 28, which all parties were to recognise was wrong and should be repealed, came a determination that we would treat all our citizens equally.

The good news is that I prepared a very long speech. The even better news is that my computer refused to print it. I have yet to discover whether it was bi-phobic, transphobic or homophobic, or merely that the operator was technologically incompetent. I think that it was the latter. As a gay man, I will try not to rain on the parade of the important issues that we are discussing. Therefore I will not give a prepared speech, but, as Edgar says at the end of Shakespeare’s King Lear, I will:

“Speak what we feel, not what we ought to say”.

In the excellent work that is placed before us by the House of Lords Library it is clear that there is an inequality in access to health services for lesbians, and bisexual and trans women. It is clear in the sexual minorities report, which I have here and which conclusively looks at more than 2.1 million respondents, that the healthcare access and treatment experienced by people within GP services was poor and inadequate.

I must declare an interest as the co-founder of Stonewall. I want to refer to the Stonewall Healthcare Equality Index 2013. But before I do, I say also that I await eagerly the contribution of the noble Baroness, Lady Gould of Potternewton, who has a long and distinguished record within your Lordships’ House and beyond on the issues that we are discussing.

The really interesting part of the Stonewall Healthcare Equality Index 2013 is that,

“32 healthcare organisations entered, including mental health trusts, acute trusts, ambulance trusts, social enterprise organisations, community services, clinical commissioning groups and independent sector providers. The organisations provide services to over 15 million patients and are from across all regions of England”.

When you first read the report, you think it is good news, but the reality is that:

“A third of respondents said they felt the healthcare organisation they used was gay-friendly”—

in other words, two-thirds found that it was not. The report continues:

“Half of respondents felt they were treated with dignity and respect all the time”—

but what of the other 50%? The report also says:

“Two in five respondents felt comfortable telling healthcare professionals their sexual orientation all of the time”.

That was in 2013. I await the 2014 report because, despite the Government’s good intentions—I recognise that there are good intentions; there are enough reports and action plans on the way forward—I fear that the gap is widening rather than narrowing.

It is equally worrying that older gay, bisexual and trans women, as well as gay men, are increasingly fearful about what will happen to them when they approach social care in their later years. We must consider this with the utmost seriousness because I believe that access to health and healthcare systems defines the kind of civilised country in which we would like to live, and if we cannot serve the minorities of our society, we have failed.

There is a very interesting document in the Library, Advancing Transgender Equality: A Plan for Action—another one. The responses to the Government’s surveys indicate that,

“transgender people face persistent challenges in accessing public services … More than half of respondents said they suffered discrimination in accessing public services because of their transgender status … More than half of respondents said health was their most significant area of concern … Two thirds of respondents said they had experienced threats to their privacy (e.g. having one’s gender identity revealed at work without consent)”.

There is enough evidence for us collectively, on all sides of the House, to move forward with determination.

I believe that I have outlined quite clearly that there is inequality in healthcare services. I make a special plea on behalf of the trans community. Trans women and men are so often forgotten in the language of non-discrimination. Their needs are overlooked and it is shocking, indeed shameful, that the World Health Organization still classifies trans as a pathological disorder. I hope that the UK Government will lead discussions within the WHO to end that swiftly.

I also had the great good fortune to attend a Home Office LGBT internal networking group. It was a wonderful morning of sharing of experiences—good and some doubtful—of what it was like to work in the Home Office, and the Home Office is like any other big employer. There was a trans woman who stood up and gave her experience. At the end of her presentation there were questions and someone asked her, “What is it like at work? How are you described?”, and she said—I am paraphrasing—“Well, at work it is like it is for most people who are different. It is difficult. How am I described? I am described as ‘that thing’”. Can your Lordships imagine what that does to you and your mental well-being, let alone your physical well-being?

Now is the time to move forward. I look forward to hearing from the Minister about what action plans have been undertaken and what is actually being done within the NHS in England.

I have enjoyed speaking in this debate, although “enjoyed” is perhaps not the right word when we are talking about inadequate services and the expression of difference and human rights. I believe that access to decent healthcare is a human right. This country has a good and proud record on this, stretching back generations. However, I honestly believe that we need one more push so that we narrow the gap in accessing goods and healthcare services for good, decent, honourable women and men of this country, who deserve such. I thank your Lordships.