Assisted Dying Bill [HL]

Lord Crisp Excerpts

Friday 18th July 2014 Lords Chamber

[Lord Crisp (CB)]

Speaking 70th—or perhaps 69th—I feel privileged to have listened to so many outstanding and moving speeches today, with more to come. They have certainly given me a great deal of food for thought. Although I disagree with the Bill, I agree that it should go to Committee for full scrutiny to see whether we can find a positive way out of the very difficult problem that we are addressing. The noble Lord, Lord McColl, put it well earlier by saying—I paraphrase him, because I did not write it down—that we are trying to balance the wish to improve the situation of some people dying in great pain and anguish with what he described as the foreseeable dangers of passing the Bill.

There are very good and important principles on both sides of this argument but, in the end, it will not be decided by reference alone to principles but by looking at the consequences, the details and the practicalities. As I see it, there are some obvious benefits and beneficiaries from the passing of the Bill. First, there will be a small but significant number of people who are able to receive assistance with dying. I am sure that not everyone would be able to receive and benefit from palliative care and that is very valuable. Secondly, there will be another group of people comforted by the thought that this ultimate option will be available to them. Thirdly, I am sure that there will be others whose conditions are not covered by the Bill but who will be comforted by the thought that this is a step towards a wider right to assisted dying. I thought that my noble and right reverend friend Lord Harris of Pentregarth made the point well when he said that the arguments about autonomy apply equally to voluntary euthanasia.

If there are clear benefits, what are the downsides? First, there is a real risk that some people will be pressurised—overtly or covertly, intentionally or, crucially, unintentionally—towards choosing an assisted death. In saying this, I agree with my noble friend Lady Warnock that feeling that your care and continued living are a burden on others is a legitimate reason that someone may choose to end their own life. However, it is also a reason why people may feel unreasonably pressurised into doing so. Sadly, we know that abuse and exploitation of older people exists. I suspect that we have all had e-mails and letters describing people’s feelings and fears about precisely this.

Secondly, there is the insidious impact on the valuing of life and therefore on how society sees disabled and dying people. My noble friend Lady Campbell explained this very well. The point has also been made about people being depressed. I would add the other side of that equation, one which we all know from working and caring for older people and people in the last stages of their life: the importance of offering them reassurance and morale boosting and making that, wherever possible, a positive experience. We should also take account of the cultural point made by the noble Lord, Lord Mawson, which I do not think has been picked up by anybody else: that people from different cultural backgrounds within our society will see this differently and behave differently, and that pressures will therefore be applied differently. The noble and learned Lord, Lord Falconer, made an excellent opening speech but he dismissed these fears rather lightly. I would like to see him acknowledge them properly and give us his estimate of how large these risks and problems would be.

Thirdly, I add my voice to those worrying about the impact on nurses and doctors. This will change the relationship between clinician and patient. Do we understand properly what that impact will be?

Finally, I note and agree with the points made by the noble and learned Lord, Lord Mackay of Clashfern, and the noble Baroness, Lady O’Neill of Bengarve, among others. This is about assisted suicide and that is, at best, only part of dying with dignity. I am sorry that the slogan of “dignity in dying” has rather been taken as the marketing slogan for this debate. After all, how society looks after people in the last stages of life and how we think about death are profoundly important issues for us, going well beyond the remit of the Bill. I hope that we will return to those issues in this House on other occasions.

Legal Aid, Sentencing and Punishment of Offenders Bill

Lord Crisp Excerpts

Tuesday 27th March 2012 Lords Chamber

[The Earl of Listowel]

My Lords, bearing in mind the wish of the House, I imagine, to move to a speedy conclusion in this debate, I shall say one sentence in support of my noble friend Lady Howe on Amendment 5 with regard to children leaving care. The noble Lord, Lord Phillips, just spoke of 18 to 24 year-olds and of his doubt that there is a necessity to protect them in law in this way with regard to legal aid. However, I would draw the House’s attention, and his attention in particular, to the experience of young people in care leaving care. A quarter of young people in care leave their foster carer or children’s home at the age of 16. These children have been traumatised—they would not have been taken into care unless that was the case.

Very few of them can stay with their foster carer or in their children’s home beyond the age of 18, so past that age most of these traumatised young people have to fend for themselves. They get some additional support, but they are pretty much on their own. The average age at which most of our children leave home and have to fend for themselves is 24, so I hope that your Lordships will keep in mind the particular vulnerability of young people leaving care. It is recognised in the Children (Leaving Care) Act, which gives them special consideration until the age of 21 and until the age of 24 if they are in education or training. I hope that the Minister will give that a sympathetic ear.

[Lord Crisp]

My Lords, I have added my name to the amendment proposed by the noble Lord, Lord Cormack, and I would like to speak very briefly following on from his eloquent speech and those of the noble Baroness, Lady Eaton, and others. First, like others, I am appreciative of the concessions that have already been made, but I think that they do not go far enough on clinical negligence. I recognise that it is a relatively small number of children who are left out by the concessions that have already been made.

As a former chief executive of the NHS, I add my simple tribute to Lord Newton of Braintree. He was chair of one of our great hospitals and, like others, I benefited from his wise and useful advice on many occasions.

Like others in your Lordships’ House who are associated with the NHS, I know very well the distress to all concerned that is involved in these clinical negligence cases. It obviously affects the children and their families, but also the staff and the institutions. What is most important here is to make whatever processes that are available as simple and quick as possible.

The Government’s proposal fails on three key points. First, what impact will these changes have on access to redress for this vulnerable group? I do not think from anything we have heard in this and earlier debates that they will improve access in any way but will undoubtedly damage it. Secondly, will it save the Exchequer and the NHS money? It will save the Exchequer money in the sense of saving money on legal aid, but all the evidence I have seen is that it will cost the NHS more through the processes that are being introduced. Thirdly, will it speed up and simplify the process for all concerned? I stress “all concerned”, including the staff of the NHS. I think the comments by the noble Baroness, Lady Eaton, made it clear that it simply will not. For all those reasons, I urge the Minister to reconsider and to accept this amendment, which will bring into scope a relatively small number of children to the benefit of us all.

[Lord Faulks]

My Lords, I speak as a practitioner in clinical negligence. Doctors who work in the NHS might be slightly surprised to find themselves described as “agents of the state”, but I take the point that the noble Lord makes that they should be accountable. Of course, they are accountable, and they can still be sued under the CFA system. The difference between the children in cases that are still outside scope unless this amendment is allowed and the children who will be within scope because of the concession made by the Government is, as I understand it, because of an assessment of the complexity of the cases. The Government have taken the view that because brain-damage cases require an enormous amount of investigation, there is a real risk that no one will take them on a CFA basis, whereas these children cases are, by and large—and I admit that the lines are not always hard and fast—less complex than that. I would respectfully suggest that although these are hard choices, it is a reasonable choice for the Government to have made in the circumstances.

I conclude by saying that I, too, received a great deal of assistance from the late Lord Newton as a new arrival in your Lordships’ House. I know that he would regard these brief observations of mine as—as he would describe it—very loyal, and I fear he would not have regarded that as a compliment.

Civil Legal Aid

Lord Crisp Excerpts

Thursday 19th May 2011 Lords Chamber

[Lord Crisp]

My Lords, I am delighted to contribute to the debate and congratulate the noble Lord, Lord Beecham, on giving us all the opportunity to do so.

I declare an interest. My daughter is a lawyer practising in legal aid. However, I am not just standing here as a proud father: I have an interest in this topic and I am concerned, as noble Lords will see from what I say in these few minutes, with the knock-on effects in areas such as health and social welfare, which I do indeed know a lot about.

As a layman looking at these proposals I can see that the starting point of reducing dependency on the law and finding better ways to solve disputes is a good aim. I can also see that setting priorities and justifying the use of public funds is entirely appropriate. As a former permanent secretary I understand this well—but I also understand that the devil is in the detail and that there will be unintended consequences that must be managed and mitigated. It is particularly sad in this case that these unintended consequences can clearly be foreseen now. A large part of what is being proposed is about limiting the use of legal aid to crisis points, such as the point at which you lose your house, domestic violence, serious disrepairs and so on. That first begs the question of how well these are defined and interpreted. Then, picking up the powerful points made by the noble Lord, Lord Thomas, and others, there is the perverse effect of having to up the ante so that the problem is at that level before you can receive any legal advice.

There is another point. For many people seeking legal aid, the issue that they present with is one of a complex of other issues, not their only problem. Many people have housing problems. They may have health or mental health problems, they may be out of work or have chaotic lifestyles. They must just have multiple problems. The point is that we need to think in terms of not just the seriousness of the issue that is presented but also the scale of the situation and the vulnerability of the people who are presenting the problem. Smaller issues may trip some people over into needing much more help. As I have looked at this issue, I have seen many cases where good legal advice can stop problems and avoid further litigation. As other people have said, there is overwhelming evidence that this can be and is the case in many places.

The Government have also argued in their proposal that alternatives are available. Maybe it is entirely desirable that there should be alternatives available to reaching for a lawyer when you are in these sorts of problems—but are they available? From what other noble Lords are saying, there seems to be a great deal of evidence that there is no guarantee of reliably high-quality advice available elsewhere or everywhere. The point for the Government in making these proposals is that this is an eminently foreseeable problem. How are they going to make sure that alternative services for advice and help really are available—and available to the most vulnerable? In parenthesis, I take the point on the difficulties of having a single source of entry from a telephone system. The reality is that when you are dealing with people with multiple problems and issues you need to look at a range of different channels to reach them, not just one.

I also note that the Government have done an impact assessment of these proposals. Not only are there problems that can be foreseen, but they have foreseen them. They raise a long list of possible problems about social cohesion, increased criminality, the impact of resources on other departments, and a recognition, in their words, that,

“failure to resolve one issue may lead to another arising”.

On health, they recognise that there may be a potential negative effect on health. I will give some simple examples for which there is plenty of evidence. First, on health and housing, we know that unrepaired, damp houses affect both the mental and physical health of adults and children. Research by the LSE for the Department of Health shows that debt advice can not only lower costs for the health, social care and legal systems but can also reduce the risk of individuals developing mental health problems.

Finally, having done that assessment, what are the Government going to do about it? What policies will be put in place to mitigate and manage these problems which are affecting and will potentially affect the health of individuals? There may be unintended consequences of these policies but they are foreseeable. Indeed, the Government seem to have foreseen them.