Brexit: Food Standards Regulations

Lord Deben Excerpts

Tuesday 4th September 2018 Lords Chamber

[Lord O'Shaughnessy]

I can tell the noble Lord that we will be maintaining the same standards of safety and protection. We will be seeking not just continuity but equivalence. We may want to go further in other areas. Of course, this will be for discussion with the House. The ongoing role of the Food Standards Agency will be as it is now, to make sure that public health and consumers’ interests continue in relation to food. There is no need to issue a ministerial direction or anything else to ensure this because it is its legally given role and one it will continue to fulfil.

[Lord Deben (Con)]

Is the Department for International Trade aware of these facts? It appears to be thinking of agreements—were we to leave the European Community—in which we would have to accept the much lower food standards of countries like the United States.

[Lord O'Shaughnessy]

There are no suggestions that there should be lower food standards. Obviously, after we leave the European Union, the Food Standards Agency will carry out any risk assessments. There are no proposals to change these rules; we will continue with them. Of course, there would be a proper scientific and evidence-based assessment if there were such suggestions.

National Health Service (Pharmaceutical and Local Pharmaceutical Services) (Amendment) Regulations 2017

Lord Deben Excerpts

Thursday 19th October 2017 Lords Chamber

[Baroness Seccombe (Con)]

My Lords, I am fortunate to live in a lively Warwickshire village. There are two doctors with their own pharmacies, but every time I want something as simple as paracetamol I have to get the car out and drive eight miles to the nearest pharmacy. Last week, I was thrilled to see that the closed HSBC bank had a sign above it saying “pharmacy”.

I understand that in an NHS with increasing demands for funds it is not sensible to have pharmacies—each of which costs the NHS, on average, £220,000 a year—in abundance every few yards in urban areas. However, in rural areas it can be more than difficult to buy those essentials we rely on, especially if you do not have a car and there is an infrequent bus service. I congratulate the Government on being selective in supporting pharmacies that make life easier for country people while encouraging those small businesses to expand their basic service. In another village, I recently saw a sign in the window saying, “Opening hours: 6am to 9pm Monday to Saturday, and 9am to 5pm on Sunday”. What a service.

Last Saturday, I went inside the empty pharmacy and met Steve, the new pharmacist who is planning to open next week. He is enthusiastic to get going. So to him and all independent pharmacists who are free to flourish and to respond to the needs of the community, I say good luck, as they provide a really worthwhile service to the community. I am sure noble Lords will understand why I am not able to support this Motion.

[Lord Deben (Con)]

My Lords, I declare an interest as chairman of the Climate Change Committee. I intervene only because one of the largest uses of vehicles is for health reasons. I hope my noble friend will not mind if I say that the Department of Health has perhaps not shown itself to be quite as central to the solution of our problems with climate change as other departments have. I hope this is going to change, and I am intending to bang on his door quite a lot until it does because this is a central issue.

This debate has shown that it is a useful one to have. I am not sure I want to enter into the party politics of it but there are quite good arguments about how many extra community pharmacies there have been, and there is certainly no doubt that the Government have shown themselves to understand this. No doubt there are other arguments, but the issue for me is proximity and propinquity. I am thinking not just about rural areas, although I live in a rural area and I understand the point very strongly; for many people in urban areas who do not have access to motor cars and where bus services are exiguous, the fact that they can walk to a pharmacy or ask others to do so if they themselves are unable to, is an important part of the kind of service that we need. It is disappointing that in the various collections of data we have not spent a bit more time looking at how many journeys are made and how many hours’ worth of diesel are used by people in accessing the health service. We know exactly how many journeys by lorry carry food—it is about 42% of all the lorry journeys in Britain—so we know a lot about these things, but I am not sure we know enough about what happens in the health service. When we are making these judgments, we have to make them in a holistic way.

So I do not apologise for the fact that on this, as on many other issues, I shall try to dramatise the fact that we should not be making decisions without asking ourselves, “What is the issue here in trying to meet the requirements which are now statutory?”. By 2050 we have by law to cut our emissions by 80%. We have to meet by law the fourth and fifth carbon budgets, and we have just issued the clean growth plan which is designed to deliver that end. There is nothing in any of that on the contribution of the NHS. It is time we asked the NHS to recognise that part of its role is to ensure that people’s access is as convenient as possible, not just for their convenience or because it saves money for other bits of the NHS, but because we as a community have to look at our statutory requirements to meet our climate change targets.

I hope that my noble friend will accept this as a preliminary thrust on the subject of the health service’s contribution to what we need to do. Indeed, in doing it, it is of course a circular system. Many of the problems the NHS has to deal with result from the subsidiary effects of pollution. It is not a matter not just of changing our climate but of the pollution at a much lower level physically but very high-level in terms of air pollution, and the damage that that does to health. I do not think this is something the health service can avoid and I hope my noble friend will take it into account.

[Lord Shipley (LD)]

My Lords, I should like to ask the Minister to clarify four issues. First, does he agree that community pharmacies are for many people the most accessible healthcare location, particularly where there are no GP surgeries locally; that community pharmacies in those situations can take pressure off GPs, and that in fact overall community pharmacies can take pressure off accident and emergency? Both GPs and A&E are experiencing rising demand.

Secondly, I am not clear whether the Government have responded to the Murray review and whether they plan to be clear what they think about that review, which was published in December last year. What policies do they have for community pharmacies as a consequence of that review?

Thirdly, we have heard about rural areas. I agree entirely with what has been said, but I shall talk in addition about deprived urban neighbourhoods where few people have cars. Has the department done an impact assessment on deprived communities’ access to health and care services, because I think it is material to this debate, particularly in the context of my fourth question? Do the Government accept that many pharmacies have cash flow problems? Many do, and I understand that it will be much worse from next month. What exactly is the Government’s grand plan? I cannot see one at the moment.

Mental Health Services: Children and Adolescents

Lord Deben Excerpts

Monday 17th July 2017 Lords Chamber

[Lord O'Shaughnessy]

I accept the point that the noble Baroness makes. Unfortunately, we are starting from a low base, over many years, in mental health provision, and that is what we are trying to rectify. She will know that the Prime Minister is deeply committed to this agenda. Let me point to a couple of issues. First, there is the introduction of the first waiting time standards—and indeed there are positive early data on meeting those stretching standards—as well as an increase in the number of beds available for those suffering from the most severe episodes of mental illness.

[Lord Deben (Con)]

My Lords, this is an area which has been not only underfunded but not cared about for a long time, and we have got to get it right. Someone has to stand up for these people because in their own home circumstances they do not have the kinds of opportunities and support that many others do. Will the Minister commit himself personally to make this worth fighting for? This issue is perhaps in the front-line of human rights in Britain.

[Lord O'Shaughnessy]

I completely agree with my noble friend and I commit myself personally to this issue. He may know that I have opened up primary free schools which focus on improving mental health and well-being, so I feel this personally. He mentioned children coming from chaotic homes, which is true in some instances. However, it is not always true. Mental illness can strike anyone, and all families and schools need to be prepared for it. Another commitment in the manifesto, about which there will be more detail in the Green Paper, is the introduction of a single point of contact in schools so that there is a champion, if you like, for any child who needs to access mental health services that go beyond the school gate.

Human Fertilisation and Embryology (Mitochondrial Donation) Regulations 2015

Lord Deben Excerpts

Tuesday 24th February 2015 Lords Chamber

Moved by

[Lord Deben]

To leave out from “that” to the end and insert “this House declines to approve the draft Human Fertilisation and Embryology (Mitochondrial Donation) Regulations 2015 laid before the House on 17 December 2014 and calls on Her Majesty’s Government not to lay new draft regulations until a joint committee of both Houses has been established and has reported on (1) the safety of the procedures permitted by the draft regulations, (2) the compliance of the draft regulations with European Union and domestic law, and (3) the key definitions used in the draft regulations”

[Lord Deben (Con)]

My Lords, first, I have to say that I am in favour of mitochondrial donation. I am not opposed to it in principle. I tabled this amendment because otherwise it would have passed through this House—in the Moses Room—without the kind of concern that we now have. The numbers present show it to have been right to discuss this matter very carefully. It is right because we are dealing with something of incredible importance to the families concerned: the fathers and mothers who can produce children but cannot, because those children will, almost certainly, carry this terrible disease. They deserve all the care that we have expended on them. The fact that some suggest that there are not that many of them is nothing: if there were but one we should be as concerned about this as we are.

I yield to no one in my determination to try to do what is right in this area and I do so for a personal reason, which is that I am thankful every day that my wife and I produced four children who in that sense—though perhaps in no other—are perfect. Those of us in this situation have a particular need to be concerned. We should be concerned with the parents; we should be concerned with the wider community; and we should be concerned with the children who would be born in these circumstances. My concern is that the Government have approached this in a way that is very unhappy. Because there are so many of us who would find the movement of a spindle from a non-diseased egg to a diseased egg something that we could accept, there was a basis for a commonality of understanding and support. That was there. All we needed, therefore, was to be assured that the procedure was safe and legal.

My noble friend—and he is a noble friend; he was one of my Ministers, and we worked closely together—has carefully covered his view of the law. I think that the law is very often an ass. I am certainly not one who would demand that lawyers should decide what we should want. I say sorry to the noble Lord, Lord Pannick, who looks unhappy at that comment. However, I believe that we should obey the law and it is quite clear that there is considerable disagreement—I put it simply like that—about whether this action is legal under European law. Although my noble friend gave the best account that he could, it is worth saying that many others take a different view. What is more, the two law officers, the Attorney-General and the Lord Chancellor, voted against these regulations. The Attorney-General has said clearly that he did so on legal grounds, so it cannot be said that those of us who suggest that the legal arguments are at least uncertain have an entirely unreasonable position.

Many who are present will have been sitting through the last part of the previous debate on ticketing. I had taken a particular view on that but felt that the House had heard enough of me without intervening on that occasion. But it may be within the memory of the House that the Government fought very hard not to take action on ticketing until they were absolutely sure about the legality, under European law, of what was being proposed and that there was a proper investigation of it. I had expected my noble friend to say that he had been to outside experts and to the European Union itself to be assured that he was not going to find himself in court were this passed. He has not done so. The only legal advice that has been presented to this House is the internal advice of the Department of Health. I do not find that satisfactory.

[Lord Willis of Knaresborough (LD)]

I am grateful to my noble friend for giving way. Does he accept that the Wellcome Trust has published and given to all Members a legal position which has all the authority of its own lawyers and which backs up the position of the Minister?

[Lord Deben]

The Wellcome Trust has certainly done that but I was referring at that moment to the ministry and the Minister. However, the Wellcome Trust has not gone to experts in European law; it went to an expert that it chose. I am perfectly happy about that but it is only one of a series of opinions, which are contrary one to another.

I started with this point because of my concern about the families. It seems that it would not be a good beginning for this change if, immediately afterwards, the large number of Members of the European Parliament —from the right to the far left—who have said that they would see this as so clearly contrary to European law seek to refer it to the courts. That would not start this off very well. The real question is why the Government have not taken the steps which would enable us all to accept that this was legal. I do not understand why they have not done that, so my first questions to my noble friend are: why was that not done and why, even after we asked for it, did the ministry not go out and see that it had exterior and clear European advice, so that we would know where we were?

That is of course only the first part of it; the second is a question of safety. I have said that if we talked about transferring the spindle from one egg to another, I would not have any ethical objection. Indeed, it would be the opposite; I would want to support it. I ought to say that, because one noble Lord, who I know is going to speak later on, at an earlier meeting said, “Well, he only says all those things because he’s a Roman Catholic”. I think I will face that. Those Members of your Lordships’ House who took part in the proceedings on the Marriage (Same Sex Couples) Bill will remember that I spent a good deal of time supporting the Government’s position on that.

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[The Deputy Speaker (Lord Geddes)]

I assume the noble Lord would like to move his amendment.

[Lord Deben]

I beg to move.

[Lord Patel]

My Lords, I am sorry for rushing in, but the noble Lord, Lord Deben, excited me so much with the comments he made that I have to answer some of his points, particularly on safety. I hope that noble Lords will have patience, because I need to go through each of the points he has made on safety, as I have no doubt that they will come back again in subsequent debate.

It is important that I put down some ground work. What are we talking about? We are talking about a mitochondrial DNA disease that commonly affects multiple different organs. Symptoms include severe muscle weakness, diabetes, heart problems, cardiac failure and sudden cardiac death, as well as central nervous system problems, which include dementia, epilepsy, stroke and such other horrible conditions. It results in death, which can occur early in childhood or after a prolonged period of incapacity and pain that can last for years.

It is important to have some facts about mitochondrial DNA genetics and inheritance. Mitochondrial DNA is strictly inherited maternally, via the egg. The mitochondrial DNA copy number and the number of mitochondria vary between cell types, with more than 200,000 in the egg and early embryo down to perhaps as few as 10 to 20 in many cells of the two to three-week old embryo, and hundreds to thousands in most cell types in adults, where the number tends to correlate with energy demand. Cells can have a mixture of two or more types of mitochondrial DNA sequence, a condition referred to as heteroplasmy, in contrast to homoplasmy, where each copy has the same sequence. More than 300 distinct mutations of mitochondrial DNA have been found in patients with mitochondrial disease. Although some mutations are far more common than others, if an individual is heteroplasmic, with a mixture of mutant and normal mitochondrial DNA, the proportion of the former determines whether they show symptoms of mitochondrial disease. Some women at risk of transmitting mitochondrial disease to their children are heteroplasmic and may have levels considerably below the disease threshold, but their eggs can have very high levels of mutant mitochondrial DNA or even be homoplasmic. This can be explained by the so-called bottleneck, which I will not go into in detail, but, during the development of the egg, only a certain number of mitochondria go into fertilisation, and that causes a bottleneck that sometimes results in only the mutant mitochondria getting through.

It is estimated that at least one in 200 children in the UK is born with some faulty mitochondrial DNA—so quite a lot of them may well have some faulty mitochondrial DNA. It is estimated that one in 6,500 babies goes on to develop serious mitochondrial disorders. The severity varies from mild to extremely debilitating and may result in early childhood death. Almost 2,500 women of child-bearing age in the UK are at risk of transmitting mitochondrial disease to their children. Estimates based on this figure suggest that between 100 and 150 births a year in the UK risk passing on mitochondrial disease to the child. If today we were discussing cancer or dementia, and how we could modify those diseases with some form of genetic or mitochondrial manipulation so that people would not get it, everybody would be in favour of it; but as mitochondrial disease affects 100 to 150 people a year, we do not take it so seriously—or so it seems.

I will now go on to what the noble Lord, Lord Deben, said about the two techniques that we are likely to be discussing—the maternal spindle transfer, which the noble Lord prefers, and pronuclear transfer—and I will say why I believe it is necessary that currently the HFEA, as a regulator, is allowed to decide which method might be appropriate for a given patient in a given centre. We do not know which technique is the more efficient and safer, despite what some others may believe. In fact, they may not be equally efficacious in every woman.

Pronuclear transfer has been used successfully in animals for more than 30 years with no evidence of adverse effects. On the other hand, maternal spindle transfer is a newer technique, which is likely to result in less carryover of mitochondria but has a higher risk of chromosomal abnormalities. That is an important point: pronuclear transfer may have more carryover of mitochondria but maternal spindle transfer has a higher risk of chromosomal abnormality. Maternal spindle transfers are very sensitive to manipulation. The embryo is less sensitive in its early stage to such manipulation.

Furthermore, both techniques have been found to be variable for avoiding mitochondrial disease. Which technique will be used for each individual patient will be a decision for the patient, based on their informed consent, their clinicians, the evidence from research and the safety aspects. In my view, it would be inappropriate for Parliament to make a scientific judgment as to which technique should be able to be used. One thing is certain: the scientists and the clinicians will go with whichever method is the safest and most efficacious. If it turns out, through research that is currently going on, that we can make maternal spindle transfer safer and less likely to lead to chromosomal abnormalities, that is the method that the scientists and the clinicians will choose. Research is going on to make that process safer. There are many ways of doing this. I am not being flippant when I say that one of the methods that has been tried is to use a small amount of caffeine to make the maternal spindle transfer more stable. Eventually, we will get that research right and whatever method is safest will be used. However, it would be wrong to opt now for one method which is not as successful as others.

Issues have been raised about the health and safety risks of some of the techniques. I agree with the noble Lord, Lord Deben, that it is never possible to be certain that new medical procedures will be 100% safe or effective. That applies to the whole of medicine—drugs, devices or surgery. Risks have been assessed in detail. As the Minister said, there have been three separate reviews of the scientific evidence on the technique’s safety by a specially convened independent panel of experts. It would be wrong to suggest that these experts might be biased when none of them has any financial interest in mitochondrial research or treatment, or that they might not have understood the issues and that we in this Parliament are more likely to understand the science which underpins this research, which has led to the point where it is now possible to use this technique to help women to have normal babies.

Decisions on safety and efficacy should be taken by the statutory regulatory authority created to do this—the HFEA. Risks must be balanced. Evidence suggests that any risks of mitochondrial donation are proportionately less than the significant risk that children will continue to be born who will develop severe mitochondrial disease if these techniques are not used. Ultimately, it will be up to affected families to judge the balance of these risks. They are the ones who will take the risks.

I would like to explore some of the health risks that the noble Lord, Lord Deben, mentioned, although he did not mention that of the potential effects of the donated mitochondrial DNA on the rest of the cell. I turn first to traits attributed to mitochondrial DNA. On variations in the 37 well studied genes, a whole mitochondrial genome has been sequenced for all these genes and they have all been found to have one function in expressing the protein that produces energy. No other trait has been identified from the sequencing of the whole mitochondrial genome. Therefore, the variations have been well studied. Although this is still contentious among mitochondrial experts, theoretically—I admit—it is possible that a child born after mitochondrial donation might have a slightly different energy metabolism compared with his or her female ancestors. However, none of this has resulted in devastating mitochondrial disease.

Evidence has also been cited that a mismatch between the DNA in the donor’s mitochondria and the mother’s nuclear DNA might have a negative impact, namely sterility and impaired growth—the noble Lord mentioned sterility—in the resulting child, as well as slow metabolism. This issue was considered in great detail by the HFEA scientific panel. In normal human populations the mixing of nuclear DNA during sexual reproduction means that there can be a complete exchange of nuclear and mitochondrial DNA type over a few generations—I calculate it to be about six generations. Given that I married an English lady, the mitochondria of my children have changed dramatically. My ancestors’ mitochondria are no longer in my children—they have English mitochondria. However, I am glad to say that they have produced terrific children. Evidence of mismatch between nucleus and mitochondrial genomes has come mostly from research where new combinations have been made experimentally across animal species that have been separated for many hundreds of thousands of years or longer—for example, rats and mice. Within species, such as in some experiments involving mice or fruit flies, evidence of mismatch is seen only when particular sub-strains of a species have been reproductively isolated from each other and each inbred. The one species, the human race, is the most outbred species there is. Some of us are examples of that.

--- Later in debate ---

I will now conclude. In introducing the regulations I outlined the rolling programme of work that has gone into assessing the safety and efficacy of these techniques, as well as their ethical and public acceptability. That process has, I believe, been admired and commended across the world. So much progress has been made in the lifetime of this Parliament that in the Government’s view it is right that Parliament should now have the opportunity to vote on whether to allow the families who wish to use these techniques to have children free of the devastating consequences, which we have heard about from noble Lords, within a robust regulatory framework. The request to the Department of Health to develop these regulations was made at the start of this Parliament in 2010. The subsequent in-depth consultation and assessment has taken place through the lifetime of this Parliament. It seems highly appropriate that we complete the task by approving the regulations today.

[Lord Deben]

My Lords, if ever anyone questions the value of this House, this evening proves it. It has been a really valuable debate and I hope that all noble Lords who have taken part in it and those who have listened will recognise that we have all learnt and valued what we have heard, even from those who have spoken from a different point of view.

There was a phrase used during the debate that particularly annoyed me—an attack on playing God. I do not believe that that is a proper way to discuss these issues, not least because it is of the nature of the Christian understanding of creation that we share with God in His creative power. It is the great gift of the Almighty to us. Therefore, the idea that we should not do any of these things because for some reason or other they are reserved to God seems to me to be fundamentally theologically unsound as well as philosophic nonsense. I hope no one has suggested that those who take the view that I take do so from some arcane understanding of the Almighty.

Nor do I think anyone will now suggest that we were trying to push this whole debate into the long grass—and in case anyone should be worried, I do not intend to take up the time of the House for very much longer. The long grass was certainly not my intention. As the Minister knows, I have unbounded admiration for him and he again showed why we should return to the position of Ministers in this House being Cabinet Ministers as well. However, in describing his side he still left me with three very fundamental reasons for saying that we need to have certain things in place before we vote.

First, on the two issues, he is perfectly right to say that it is reasonable to bring them before the House. The objection is that they are brought before the House without it being able to make a decision on each of them separately because they each present separate issues. I do not think he has answered that. I know why he said that. It is because the Government know perfectly well that if you divide the two it would become clear that there is an ethical distinction between them. We did not discuss that today because we knew we could not discuss that ethical distinction because only one of them held it and the other did not. So my objection to the Government’s position—not of course to my noble friend’s position—is that they could have given us that choice and they decided not to.

It is the choice that I object to, not the fact that one might use the two techniques if both were approved. I suspect that both would have been approved, but we would have been able to explain why we hoped that the work done on the maternal spindle transfer and the third mechanism, which is coming along, would be prioritised and done in an ethically acceptable way. That is the first reason why I believe it would be better to allow a committee to look at this very rapidly and to insist that it be a decision in which we have a choice.

The second reason is that there is clearly a legal disagreement. I bow to nobody in my support for my noble and learned friend Lord Mackay of Clashfern. I know that it is normal in this House to accept that what he says is infallible. If it were not for his denomination, I would use that word, but I think that it would probably embarrass him considerably if I were to use it in conjunction with his name. However, I point out that the noble and learned Baroness, Lady Scotland, spoke for a number of people, including the Attorney-General, whose statement made it clear that he felt that this was unsound for legal reasons. Incidentally, I want to say that it is perhaps surprising that the Lord Chancellor is not a lawyer. I think that the Lord Chancellor should always be a lawyer. I also think that he should not be a career politician but ought to sit in this House. I make that point while I have the chance to say it, as until now I have not had a chance to make that provocative comment. However, the fact is that there are very clear legal disagreements.

I perfectly agree with the noble and learned Lord, Lord Hope, with whom I am normally ad idem: we have marched together on most of the subjects when I have rebelled against the Government and I have taken much pleasure in our arguments. However, I say to him that there is a distinction here. It is very dangerous for this House to leave it to someone else to decide whether something is legal. I think that this House should make that decision itself, and then, if it makes the wrong decision or a questionable decision, the matter will come before the courts. I understand that distinction but I agree with the noble and learned Baroness, Lady Scotland, on that front. However, I am worried about entering into legal issues because I have always prided myself on being the only member of the Cambridge mafia who did not read law.

That leads me to the third point, which is safety. It is no good—we cannot kid ourselves about this. The terms under which we were originally told that we were going to have this debate have not been met. The experiments which we were told would be done have not been completed. The most important of those is the primate experiment to make sure that such procedures do not result in sterility. People have said that even suggesting that is an attempt to frighten people. I am not doing that at all. It is simply the case that that was what we wanted to do but there has not been enough time to do it, although it would not take very long. Therefore, I again come to the question of why this measure is being pressed at this moment when we could very rapidly have the answers to all the questions that we have raised. I want to end on that but I shall say why I think that that is important—much more important even than the issue itself.

I believe that we are moving into a society in which the search for consensus and agreement is becoming increasingly much less urgent and much less important to people. I believe that we could have gained very considerable support for this measure. The noble Earl caused a certain amount of laughter when he referred to the ComRes poll. It was intended to ask people, in the words that they had read in the newspapers, what their reaction was. That is why the poll was held. Therefore, passing the matter to the Wellcome Trust and others to look at it as though it were a scientific statement was entirely contrary. I was pleased to find out that we had so failed to communicate with the public that 90% did not want us to go ahead with these regulations, and that was the case when using words which had meaning for the public. The Government’s consultation was in fact very limited. That is not the burden of this whole debate, but I just want to say to the House that we are beginning not to try to take everyone on board. There was a real opportunity to do so here and I would still like to recapture that. That is why I would like to test the opinion of the House.

[Lord Winston]

Before the noble Lord does that, I wonder whether he would consider this point very seriously for a moment. If we delay this measure, we will, as I am sure he understands very well, be committing a number of people to terminating pregnancies. Not only will we be terminating their pregnancies but those women will experience a number of lost pregnancies—a loss of life. Is that what the noble Lord really wants in pressing this amendment?

[Lord Deben]

I do not want to prolong this but the fact is that the human embryology committee and the terms under which it can give the permissions will take longer than it would take to have the committee that I am calling for in my amendment. It would not hold matters up for one moment. However, I think that the House wants to go to a vote.

Care Bill [HL]

Lord Deben Excerpts

Monday 21st October 2013 Lords Chamber

[Lord Low of Dalston (CB)]

My Lords, I shall speak briefly against Amendments 145, 146 and 149. As the noble Baroness, Lady Greengross, has just pointed out, these will take away the requirement that the CQC conduct periodic reviews of adult social care commissioning. These amendments seem perverse, coming hard on the heels of the latest care home scandal, revealed by the coroner’s finding that neglect contributed to the deaths of five residents at Orchid View care home in West Sussex.

Last week, the Close to Home report on human rights and home care by the Equality and Human Rights Commission concluded that some commissioning practices were likely to put at risk the human rights of older people receiving care. The Leonard Cheshire report, Ending 15-Minute Care, also points to problems with commissioning. It would therefore seem to make sense to leave Clause 83 unamended so that the CQC is empowered to oversee the practices of those commissioning adult social care and not just of those providing it.

[Lord Deben (Con)]

My Lords, in general terms, I support the government amendments. I am sure that my noble friend will want to answer the specific issue which the noble Baroness, Lady Greengross, raised. However, I support the Government with a slight caveat. Similar parts of the localism agenda of the Government have likewise seemed to have devolved in order to encourage people to take responsibility. I agree that there is a problem of prescription—if I may use that word in the context of the health service—because we all want to add in to any freedom the particular issues about which we have a special concern. I have real sympathy with those for whom dementia is one of those issues; it certainly is for me. However, we have to guard against that because, in the end, it may produce an artificial series of priorities. In this case, it is much better for the Care Quality Commission to make its own mind up, because it is going to be responsible. I take a rather different view about the recent scandals, in that the commission has to take responsibility for the claims that have been made. If it has to take responsibility, it must have as much control over its agenda as it possibly can.

My concern is simply that the Localism Act claimed to give localities all kinds of new controls over their futures. Yet, this week, we again find the Secretary of State for DCLG calling in a locally agreed solar decision, one supported by the local authority and by the inspector, but turned down—for reasons which are extremely difficult to see—by the centre. I want an assurance from my noble friend that this is real devolution; that the powers which have been given will not be circumvented by some other mechanism within this Bill or other Bills. The purpose of such devolution is to enhance responsibility. My concern is that, often, people who are given and who claim to have responsibility find that the structures are so prescriptive that they cannot take that responsibility seriously. If the amendments are an attempt to ensure that they can carry through their responsibilities in a way which enables the country to look to them to do the job they ought to be doing, that is fine and dandy. However, I hope that we can have reassurance that this is a real change, and not something that is going to be circumvented for the convenience of some Secretary of State by other bits of this or other Bills.

[Baroness Barker]

My Lords, I draw to the House’s attention three questions put forward by Leonard Cheshire Disability. That organisation has worked extremely hard to support the Government in their stated objective of stopping 15-minute care appointments for older people, and its questions are worth following up.

First, why is it necessary to remove this power completely from the CQC; what will the CQC be stopped from doing by the absence of this power that otherwise it would not be? Secondly, the Government are committed to tackling poor commissioning and poor practice. If it is not going to be the role of the CQC to challenge local authorities on their commissioning practices, whose job will it be? Thirdly, is there any evidence that that power, as it exists, has been misused? Whatever one’s view about where responsibility should lie—the noble Lord, Lord Deben, made interesting points about that—those three questions are worthy of an answer when we come to formulate that view.

Care Bill [HL]

Lord Deben Excerpts

Wednesday 9th October 2013 Lords Chamber

[Lord Deben (Con)]

My Lords, I support what my noble friend has just said. I have to say to the Minister that this amendment is rather necessary because there is a generalised belief that forces in our society are determined to marginalise that which has actually made our society and has had such an influence on the provision of healthcare for our people. The history of healthcare in Britain shows that it was fundamentally founded by those of faith. That does not say anything about anyone else, but it does say that if we want holistic medicine—I am not a great believer in anything other than orthodox medicine, so I am not encouraging all kinds of what I consider to be alternatives, which are best left alone—we have to understand that it is about the whole person, and for many people this is a most important part of the whole person. For this not to be in the Bill will be seen by many as another example of society specifically seeking to marginalise an important section of our community on whom we depend widely for many of our voluntary activities, and certainly on whom we have depended and do depend for our health services. I hope very much that the Minister will take this point seriously.

[Lord Cormack (Con)]

My Lords, I would like very briefly to support what my two noble friends have just said. Surely this is not the Government conceding to a secular society and surely they recognise that for many sick people, the spiritual dimension is extremely important. It is not a question merely of healing physical ills and curing physical diseases, it is a question of recognising that many people, particularly as they near the end of their lives, have a great need to fall back upon their faith, and that should be recognised and encouraged. For the life of me, I cannot see what the Government are doing here and I hope that my noble friend will be able to give us a satisfactory answer. I am only sorry that the Bishops’ Benches appear to be empty this afternoon because one would have liked to have heard a contribution from them.

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[Earl Howe]

First, we are not dealing with the NHS; we are dealing with local authorities and adult social care. Secondly, the NHS has not rowed back on this. We have debated hospital chaplains on many occasions and I have made very clear the Government’s view that hospital chaplains perform an important role in the spiritual context. So on the NHS front, I want to reassure my noble friend that here we are dealing with local authorities and adult social care. I was trying to explain that the way in which this Bill is framed is perhaps different from how my noble friend has construed it.

[Lord Deben]

If it does not make any difference to add this to the Bill, why cannot the Government accept that many people would feel much reassured by its addition?

I have been in my noble friend’s position—and he knows with how much respect I view him—and I cannot remember an occasion when I have said, “This does not make any difference” that it did not quite mean that. What worries me here is that it does not quite mean that. I should be much happier if he would please look again at this, because it is a matter which does concern people. If it makes no difference, surely we can do these things in order that people should not be concerned? Their not being concerned would make a difference.

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[Lord Deben]

My Lords, I declare an interest as chairman of the Association of Professional Financial Advisers. One of the areas that regulated financial advisers are most concerned about is that they should be able to do the job that they are there for. I am concerned that recent “reforms” have meant that there are fewer people available to give advice and fewer people getting advice. One of our problems is that this means that people get bad advice. They say something to their friend round the corner, or somebody says “I think so-and-so’s OK”, or they have read something in the newspaper. One of our difficulties here is that the perfect gets in the way of the good. People are frightened to say things like, “here is a list of people” or “here is somebody I have used”, in case they then incur some kind of responsibility. Yet if we do not help people to find someone who can give them advice, the very people who most need advice do not get it. I am concerned that this is becoming almost a social problem in the sense that those who are best off and least need advice get the best advice while those who are less well off and need advice do not get it because we have got ourselves into this mess.

I am not in a position to say that this or that amendment is ideal, but I hope the Minister will accept that, in today’s circumstances, unless we give clarity to people and make it relatively easy and simple for them to go to get advice, they will not go and will not be able to.

I have two more short points to make. First, we have concentrated on the simplicity of the advice when you get it, which seems to me to be the wrong place. It is the simplicity of getting the advice that really matters. Very often, the advice that is given may not be all that simple, because the circumstances may not be all that simple, but if the simplicity of getting the advice is right then it can be moved through more effectively.

Secondly, in considering these amendments and, indeed the Bill—at this stage and going forward—I hope the Minister will realise that one of the problems about seeking advice is that the language used is incomprehensible to anybody but the professional. I find this embarrassing: I once sat on an FSA committee designed to try to make more people more financially literate and spent my whole time asking superior people in the finance world to explain to me what they meant. I discovered that they did not always know what they meant. There is a sort of language which is used and batted backwards and forwards between these people. There is a terrible fallout in this. I remember that a friend of mine was asked for advice—not about finance, but about how to buy a theatre ticket—by a man had never gone to the theatre before but whose wife wanted to go to something. She explained and dealt with it but a friend of hers said, very superiorly: “Of course everybody knows how to buy a theatre ticket”. My friend asked, very simply: “Could you buy a football ticket”.

That is one of the problems, so I hope we can try to do this in a way which is comprehensible and simple and which does not mean that the most needy are unable to get the service they need.

Care Bill [HL]

Lord Deben Excerpts

Monday 22nd July 2013 Lords Chamber

[Earl Howe]

I can reassure the noble Lord that we are aiming to have uniformity. Merely because one local authority may present us with some rather maverick objections, I do not think that I could possibly envisage us capitulating to that kind of pressure. We want to see a system where people, wherever they live in the country, can rely on some clearly set-out rules and can thereby have peace of mind if they take out a deferred payment scheme. I hope and sincerely believe that the noble Lord’s fears will prove groundless, but I am happy to clarify as much of that as I can, given that we have only just gone out to consultation, in the letter.

[Lord Deben]

I wonder why the particular councils which were chosen by the noble Lord are all among the best councils in Britain, which would certainly behave in the most generous way.

[Earl Howe]

My noble friend is, of course, completely right. They are model councils of their kind. It is rather fanciful to present them as possible examples of councils that might wish to do badly by their residents.

This is a major reform that we have committed to introduce in this Parliament. While I am the first to agree that that in itself should not drive the timetable, we think that the timetable is achievable. We are consulting to get the details right and working with the care sector to ensure that implementation goes as planned. The noble Lord raised some important points. I am sure that he knows me well enough to accept that this is not the last occasion when I shall look at the points that he has raised. I shall do so further. For the time being, I hope that I have responded to his satisfaction, at least on some of the amendments, and that he will feel able to withdraw the amendment.

Health and Social Care Bill

Lord Deben Excerpts

Monday 19th March 2012 Lords Chamber

[Lord Deben]

My Lords, I would like to share with your Lordships’ House, for the first time, my experience of trying to deal with the complicated matter of BSE as it makes clear this distinction. I committed myself to total openness; I knew nothing that the public did not know. It was the only way in which one could be sure of obtaining people’s trust. Nothing was hidden. We did not have risk registers in the sense that we do today but it would be quite wrong to say that we had not considered every possible risk.

I put it to your Lordships that there is a difference between what you know and the extreme cases which you ask about in order to make sure that what you know covers everything that you could know. If in the middle of that terrible crisis newspapers more interested in their numbers of sales had accused the Minister of uncertainty because he had asked about risk—and I do not need to go into the kinds of risk you had to ask about—it would have been impossible to make what were already difficult enough decisions. It turns out now, 20 years later, that the decisions were right but at the time they could only be what you knew, and what I knew I shared.

Consider also what it meant for my civil servants. Do your Lordships really believe that your civil servants would be able to be as frank and direct and complete if they found themselves and their relationships being used as part of a battle? There were some terrible battles at that time between people who had all sorts of other interests. Compare this to another case, which out of kindness I will not be too detailed about. For many years in the ministry of agriculture a particular view had been upheld and we had been told that it was true. When I sought further information I discovered it was not. It was at that point that I tried to establish a very clear distinction between what you know and what you have to ask about which you do not know.

The risk register has come into our governmental structure largely from private business. I sit on the boards of a number of companies and chair several; in all those cases we have a risk register. That risk register is only useful if it is kept entirely to the company itself, because you want to ask questions of a very extreme kind. I ask the noble Lord, Lord Owen, whether he can imagine a Foreign Secretary who had to reveal his risk register asking what would happen if this or that Government did this or that, or what would happen if some Middle Eastern state refused to allow our ships into the Strait of Hormuz at this moment. Would any Foreign Secretary be able to be Foreign Secretary?

[Baroness Thornton]

Does the noble Lord not think that the Information Commissioner and the tribunal have taken those points into account?

[Lord Deben]

I would not dream of suggesting that I know what the tribunal and the commissioner have taken into account. All I am saying is that if they have taken it into account and come to this decision, I think it is wrong, and if they have not taken it into account they ought to have done. That is why I come to the point that the noble Baroness raised when she said that it is all very good because the National Health Service has risk registers and publishes them. They are not risk registers, not in the sense that a business has risk registers. They are not risk registers in the sense that the Foreign Office has risk registers. They are such risks as the National Health Service believes will stand being in the public domain. The risk registers that a Government have are a wholly different kind of thing and need to be. I believe that we must protect them.

[Lord Harris of Haringey]

Before he finishes his remarks, will the noble Lord explain why the National Security Council publishes its own national risk register of security threats to the UK?

[Lord Deben]

For exactly the same reason that the National Health Service does.

[Baroness Williams of Crosby]

My Lords, what the noble Lord, Lord Deben, said is well worth listening to, but I shall add one other important factor before I come on to the amendment moved by the noble Lord, Lord Owen. As the noble and learned Lord, Lord Mackay of Clashfern, pointed out—and it is a crucial factor in our discussion—the risk register that was drawn up in autumn 2010 took no account of the changes made by your Lordships’ House. It could not because it could not foresee the future. That means that the risk register of 2010, the transitional register to which the chairman of the tribunal referred, is almost useless in enriching and informing the debate we are having in this House. Therefore, far from being helpful, it will in many ways be extremely misleading because it will confirm the incorrect beliefs of many members of the public who have not understood what has happened in this House. You only have to read the newspapers to see how widespread is the total ignorance of what we have done here, whether we talk about competition, training or constitutional change. That is the crucially troubling aspect of what we are discussing. It leads the general public and Members of this House and elsewhere back to an out-of-date and anachronistic finding.

I have one more thing to say about the amendment moved by the noble Lord, Lord Owen. The House needs to recognise that he has made a very substantial change of great importance in it: he has accepted that there will be a Third Reading in this House. He has accepted that the outcome of the Third Reading will be binding upon everybody in this House and beyond because it will be part of the system of law. What he has asked for is more time and opportunity to have the finding of the tribunal discussed in this House. In that, he is absolutely correct. I do not believe that we have gone anything like sufficiently far in trying to accommodate that reasonable request because there is time left in this Session of Parliament. It ought to be possible to transfer a day or two from the Scotland Bill to the health Bill so that it could be properly discussed; or there is something that the noble Lord indicated he would accept, which is a very narrow redaction of anything in the risk register that would be seen as desperately dangerous to public trust in the NHS.

My view is a rather curious one. It is that the noble and learned Lord, Lord Mackay, is right in pointing to the real dangers of treating the risk register as a source of knowledge and truth, but I also believe that the Government should have gone further in trying to find time somewhere, if necessary—dare I say it?—even taking a day off the sacred Easter Recess to enable this House to discuss in detail what is coming out of the chairman of the tribunal’s decision on the risk register so that we can get it straight.

Health and Social Care Bill

Lord Deben Excerpts

Monday 12th March 2012 Lords Chamber

[Earl Howe]

My Lords, I beg to differ with the noble Lord; this is an issue about routine release. I think I am right in saying that the department has received several dozen requests to release the risk register. If this were to become routine, as some people appear to wish it to become, policy formulation in any department would become virtually impossible.

[Lord Deben]

Does my noble friend agree that a number of the laws passed by the previous Government were also controversial? Can he point to occasions on which the risk register was released in those circumstances?

[Earl Howe]

I am grateful to my noble friend because I do not believe that there were any. The Opposition sometimes point to the risk register relating to the third runway at Heathrow, but the key difference with that was that it was to do with policy implementation rather than policy formulation. Once you know what you want to do, there are risks associated with rolling a policy out. It is a very different matter when civil servants wish to have safe space to think the unthinkable and then advise Ministers.

Health and Social Care Bill

Lord Deben Excerpts

Wednesday 21st December 2011 Lords Chamber

[Baroness Murphy]

My Lords, Section 141 of the Mental Health Act 1983 provides that where a Member of Parliament is detained under the Act, the Speaker must arrange for two registered medical practitioners—psychiatrists appointed by the president of the Royal College of Psychiatrists—to examine the Member of Parliament and report. Six months later, the Speaker must arrange for a second assessment by psychiatrists, and if in their opinion the Member is still suffering from mental disorder, the Speaker lays a report before the House of Commons and thereupon the seat of that Member shall become vacant. There is no appeal mechanism. This provision also applies to Members of the Scottish Parliament and the Welsh Assembly, but not to the House of Lords. There have been times in this Committee when I have wondered about that.

This clause has never been invoked. In fact, the last use of the preceding section was for the removal of Reverend Charles Leach MP in 1916. It was very interesting to read about his case. He was clearly suffering from what we would call multi-infarct dementia and was not actually refusing to give up his seat, although it is clear to me that he would not now be detained in the way he was in those days. The Victorian legislation was introduced by the Lunacy (Vacating of Seats) Act 1886, a Private Member’s Bill to deal with one particular issue, although it was too late for that and therefore post hoc. The legislation was transferred, word for word and process by process, substituting lunacy commissioners with two psychiatrists in 1959 and again in the 1983 Act, and here we have it still.

We know from a survey conducted by an all-party parliamentary group in 2008 that one in five Members of Parliament admits privately to having had personal experience of mental ill health. That is not significantly different from the general population. The majority of those would be mild forms of mental distress, but some of us are aware of serious breakdowns where Members of Parliament have recovered fully and returned to work with few people being much the wiser. Surprisingly, there is a very inclusive, supportive environment in the Commons for people who have suffered periods of mental ill-health.

There is widespread agreement that this stigmatising and discriminatory legislation is not fit for purpose. None of us would tolerate such discrimination against people with physical ill-health who were away from the Chamber of the Commons for six months or more—for example, with a cancer or following a stroke. I am sure that the Minister will remember his own words along these lines in our debates on the Mental Health Bill in 2007, when the noble Baroness, Lady Wilkins, tabled an amendment similar to this one. Unfortunately, we did not have an opportunity in those 2007 debates to pursue the matter at great length because the previous Government reached the end of their term.

The repeal of this section was recommended by the Speaker’s Conference in January 2010—I think that 68 per cent of those who voted were in favour. In February this year, Deputy Prime Minister Nick Clegg announced that it would be repealed when a suitable vehicle could be found. I pay tribute to him and to the Cabinet Office Minister, Mark Harper, for their continuing commitment to this cause. This Bill is a suitable vehicle. I thank the clerks in the Public Bill Office for finding the right place to include it.

We should get this measure off the statute book and demonstrate the House's commitment to the continuing campaign to reduce the stigma to which the voluntary organisations and the Royal College of Psychiatrists have given so much time and energy to make a success. It is time for change and I hope that the Government will respond positively.

The noble Lord, Lord Stevenson of Coddenham, has introduced in this Chamber an important Bill to repeal four pieces of legislation that discriminate against people with mental health problems, of which this was one. The others refer to jury service, governors of schools and directors of businesses. I am totally supportive of that Bill and hope that it is successful. I understand, however, that it is unlikely to be able to proceed through the Commons this Session and will therefore have to be reintroduced in the new Session. If this amendment were accepted today, it would require a simple revision to that Bill, but the major practical provisions are of much more widespread significance and would, I believe, continue to attract government support.

I had considered withdrawing the amendment and waiting for next Session to get that whole Bill through, but my anxiety is, as Harold Macmillan said, “Events, dear boy, events”. We have an opportunity now to get this right and we do not know for sure whether the opportunity will appear again soon. I would very much like to see the repeal of this section enacted this Session. What a Christmas present for the mental health world that would be. I beg to move.

[Lord Deben]

My Lords, the parallel is that things amazingly go on in this country until they are stopped. The Girls’ Friendly Society long ago lost any reason for existing because the girls with whom it was friendly no longer existed in the situations and houses in which they were, yet it took a good 40 years to decide that it was time for it to go. I remember sitting next to a person who explained to me that the trains from Ipswich did not go to Manchester direct but went down to London because there was a row in about 1850 between the Great Eastern Railway and the Grand Central Railway. No one knew that that was the reason, so the trains still went along that route. It was only on privatisation that people started to look again and discovered why that was.

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[Baroness Masham of Ilton]

What sort of bells are we not allowed to ring?

[Lord Deben]

No bells to summon Catholics to worship are allowed, because it was illegal at that time.

[Baroness Masham of Ilton]

My Lords, I, too, support the amendment. Having supported the Bill of the noble Lord, Lord Stevenson, it would seem wrong not to do so. I hope that the Government can speed up this legislation.