Terminally Ill Adults (End of Life) Bill
Lord Forsyth of Drumlean Excerpts(1 day, 3 hours ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, I start by thanking all noble Lords for an extensive, passionate and insightful debate. As noble Lords have observed throughout this debate, its quality and its conduct have been exemplary, and I believe that that has allowed the expression of differing and deeply held views. I thank my noble and learned friend Lord Falconer for his work in introducing this Bill to the House, and I know that many noble Lords are waiting to hear from him as the sponsor.
We have all heard the debates across the country, in which campaigners on both sides have made their case with conviction and care. We have also heard the debates in the other place, and we know the previous consideration that this House has given to the topic of assisted dying. Now it is our turn to scrutinise this legislation.
I turn first to the important issue of the role of the Government, which relates in some part to the Motion in the name of the noble Lord, Lord Forsyth, and the amendment to it from the noble Lord, Lord Carlile. The Government are neutral on the principle of assisted dying. It is a matter of conscience. Whether the Bill becomes law is a decision for Parliament, and my role, alongside that of my noble friend Lady Levitt, is to help ensure that, if this legislation is passed, it is legally and technically effective and workable. So, as with any legislation, if Parliament chooses to pass the Bill, the Government will be responsible for its implementation.
The noble Lord’s Motion refers to time being made available for consideration of amending stages. Scheduling is of course a matter for my noble friend the Government Chief Whip, who will indeed keep this under review. The Government have a duty of care to the statute book and, as such, my officials and those in the Ministry of Justice have worked with my noble and learned friend Lord Falconer and the Commons sponsor Kim Leadbeater MP to offer drafting support and workability advice. This will continue throughout the passage of the Bill and is and has been usual practice.
Turning to the Motions in the name of my noble friend Lady Berger—
Lord Forsyth of Drumlean (Con)
Can the Minister explain why, despite requests from the sponsors of the Bill, and despite the precedent which has been taken with other Bills which were Private Members’ Bills but matters of conscience, such as capital punishment and abortion, the Government are not prepared to provide time so that this House can ensure that it is properly scrutinised and considered?
Baroness Merron (Lab)
I can only repeat the point I made that the Government Chief Whip will listen to the will of Parliament and will review as necessary.
The Motion and the amendment in the name of my noble friend Lady Berger refer to a Select Committee reporting to the House ahead of Committee of the Whole House commencing. The Select Committee should report by Friday 7 November. The outcome of these Motions and any others are indeed a matter for this House to decide on.
To the points that noble Lords have raised over whether this matter should have been for a Private Member’s Bill or a government Bill, I remind us all that, on matters of societal change, the Private Member’s Bill, with government neutrality, has long been used as the right vehicle to handle matters of sensitivity and importance such as this one. On this point of neutrality, I hope that noble Lords will understand my role and why it is not appropriate or possible for me as the Government Minister responding to respond to every point raised during the debate.
I thank the Delegated Powers and Regulatory Reform Committee and the Constitution Committee for their scrutiny of the Bill. As many noble Lords have highlighted, their recommendations will be important in the consideration. The content of this Bill and any delegated powers are a matter for the sponsor and Parliament. I am grateful to both committees because their recommendations will inform the scrutiny of your Lordships’ House. Noble Lords heard my noble and learned friend Lord Falconer’s opening remarks. He has already considered those reports and will continue to do so.
Many noble Lords have spoken about the importance of high-quality palliative care for all those who need it. I want to be clear that irrespective of any legislation on assisted dying, everyone must be provided with high-quality compassionate care through to the end of their life. While the majority of palliative and end-of-life care is provided by the NHS, we recognise the vital role played by the voluntary sector in supporting people at the end of their life. That is why we are providing the hospice sector with £100 million of capital funding for eligible adult and children’s hospices, to ensure that the best physical environment for care is available.
We recognise that more could be done to support people who need palliative and end-of-life care, as a number of noble Lords said. We are looking at how to improve the access, quality and sustainability of all-age palliative and end-of-life care, in line with the recently published 10-year health plan, and to make the shift from hospital to community, including making that care part of the work of neighbourhood health teams.
I thank noble Lords once again for their engagement, care and thoughtfulness during this debate. As I have said, the Government remain neutral on whether the Bill becomes law. Should Parliament pass this legislation, I can say to your Lordships’ House that it will be our responsibility to ensure that it can be implemented safely and effectively.
Lord Forsyth of Drumlean (Con)
My Lords, I do not know if I am alone in being frequently asked by people, from time to time, “What is the point of an unelected House of Lords?” I now have the absolutely mind-blowing answer, which is to refer them to these two days of debate on this really difficult subject and the range of expertise which we have heard.
I am speaking because I tabled an amendment. That was last Friday, so some noble Lords may have actually forgotten what it said. It called
“upon His Majesty’s Government, in the light of the 32nd Report from the Delegated Powers and Regulatory Reform Committee, to ensure sufficient time is available for consideration of amending stages of this bill, and to provide full support at ministerial and official level to the peer in charge of the bill for its remaining stages in the House of Lords”.
Despite the differences that we have heard in these two days of debate, there is a clear and absolute consensus across the House that the Bill is in need of amendment and further scrutiny.
I listened very carefully to the speech of the noble Baroness, Lady Berger, and I see her amendment. I am a little doubtful about how a Select Committee—which is not really a Select Committee because it is not going to produce a report; it is simply going to hear evidence—is going to change or alter the noble Baroness’s opinion on this matter, or indeed anyone else’s. However, it means we cannot actually start that task until 7 November, so we have lost some time.
As many speeches pointed out, none of us knows when and how we are going to die; none of us even knows when the end of the Session is going to be. So, between 7 November and the end of the Session, having listened to all the speeches and thinking of the number of issues that are going to have to be addressed, I venture to suggest that four Fridays for private Members’ legislation, unless we are going to completely destroy the prospects of other people with Private Member’s Bills, are not going to be sufficient time. It therefore seems essential that the Government provide time.
I understand why they do not want to do that: if I were in government and in the Prime Minister’s Office, I would be saying, “But that means we won’t have time for this, that or the other”. But this is an absolutely life-and-death issue and it is important that it is considered properly and put on the statute book, if it is to be put on the statute book, in a way that will satisfy my noble friend Lord Wolfson of Tredegar in his brilliant speech. He showed that what we are doing here is making legislation and we should put legislation on the statute book that has been properly thought through, which means that there has to be government time.
I happen to know that the Cabinet Secretary advised the Government that this should be treated in the way that all Private Members’ Bills dealing with matters of conscience are. Abortion, the death penalty and the decriminalisation of homosexuality were Private Members’ Bills that the Government took on board in order to ensure that they had proper time and were properly supported, and I do not—I was going to say “for the life of me”—understand why that should not apply to this Bill, having listened to these two days of debate. I suspect it might be because the Health Secretary and the Justice Secretary were opposed to the Bill—but we are told that the Government are neutral, and therefore I do not see why they should not provide that time in order to satisfy those people who have written to us on both sides of the debate.
I say to the right reverend Prelate the Archbishop of York, who threatened to vote down the Bill at Third Reading, that I hope he will think again about that. The expectations are sky high and to vote down a Bill that had not been properly considered or given enough time would put this House in a very awkward position, for no good reason. Our duty is to scrutinise the Bill, send it back to the House of Commons and ensure that we have the time to do a proper job.
Lord Carlile of Berriew (CB)
My Lords, noble Lords may recall—but I will remind them in case they have forgotten—that I tabled an amendment to amend the amendment from the noble Lord, Lord Forsyth, because it seemed to me that the noble Lord wanted to turn this Bill into a government Bill and give it all the authority of a government Bill, with a Minister in charge, or by putting the noble and learned Lord in the position of being a Minister. However, I have listened to the noble and learned Lord and he has said—absolutely rightly, and I totally agree with him and the noble Lord, Lord Wolfson—that this absolutely should be, and should remain, a Private Member’s Bill.
I have also looked at the potential effect of the amendment to the commitment Motion from the noble Baroness, Lady Berger, who I think has approached the Bill with great energy, superb intelligence and good judgment, and has done great credit to the House. Having considered that and the state of play as it is now, I think it is right that I should withdraw my amendment so that we can move quickly on to other, more substantive matters. I beg leave to withdraw the amendment.
Social Care Reform
Lord Forsyth of Drumlean Excerpts(3 months, 4 weeks ago)
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Baroness Merron (Lab)
My noble friend makes very strong points, which I absolutely concur with. This is an issue that needs to be able to stand the test of time and changes, whether they be in leadership or of Government. That is why we are taking the approach that we are. My noble friend will have seen the terms of reference that have been published. They are deliberately broad because we are tasking the noble Baroness, Lady Casey, to lead the work fully independently, which is particularly important in seeking cross-party consensus. Indeed, the noble Baroness’s review is very much about having the conversations cross-party and seeking to bring people together across parties and across sectors and the many individuals who have an interest in this.
Lord Forsyth of Drumlean (Con)
My Lords, is not the truth of the matter that there is a consensus between the parties? The Economic Affairs Committee of this House published a report some five years ago. There was unanimity across the House. There has since been another report. This setting up of commissions and so on is just to appease the Treasury, which refuses to provide the money that is needed for social care and is the key to cutting waiting lists and moving forward in the health service. Should not the Government just have the courage to commit to the resource that is necessary instead of kicking this into the long grass for another three years while elderly people and young people suffer from inadequate services and clog up beds in the health service?
Baroness Merron (Lab)
I understand the noble Lord’s impatience—I am sure we share it—and I hear what he says, but I have to remind your Lordships’ House that the previous Government did not commit funding to their plans, and I am glad the noble Lord agreed with that. I do not accept the characterisation of this. As my noble friend Lady Pitkeathley said, it has to stand the test of time. We are not waiting to take action; we have already put a number of pieces of work in place to lay the groundwork, including additional funding for social care authorities, increasing the carer’s allowance weekly earnings limit and an extra £172 million for home adaptations. We are not just waiting for this report. By the way, I do not recognise the three-year characterisation because the first phase will report in 2026 and then there will be a further report back by 2028. I feel this is the right way forward.
Hospice Funding
Lord Forsyth of Drumlean Excerpts(8 months, 2 weeks ago)
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Baroness Merron (Lab)
I understand the point the noble Baroness is making, because planning ahead and certainty are key. I can confirm that my ministerial colleague, Minister Kinnock, will soon meet all major stakeholders to discuss long-term sustainability of funding. We are very aware of the difficulties that have been caused thus far and seeking a way forward.
Lord Forsyth of Drumlean (Con)
My Lords, I commend to the Minister a scheme that I introduced when I was Secretary of State for Scotland, at the suggestion of the broadcaster Martyn Lewis, who wrote a book on the hospice movement in tribute to Dame Cicely Saunders. That scheme introduced pound-for-pound funding: every pound raised was matched by the Government, which had the effect of greatly increasing funding and the incentive for people to support the hospice movement. Will she consider introducing such a scheme, which, alas, did not survive the introduction of the Scottish Parliament?
Baroness Merron (Lab)
The noble Lord makes a very interesting point. Of course, the introduction of gift aid supported charitable funding, including to hospices, and I know was very warmly welcomed. These are all important ways of looking at funding and we will consider the best way forward, but I note from discussions with the hospice movement that hospices very much value their autonomy in terms of funding; the more linked it is to government funding, the less autonomy they have. We want dignified and appropriate care for patients and families, and to find the best way to deliver that.
Northern Ireland Dentists: Amalgam Fillings
Lord Forsyth of Drumlean Excerpts(1 year, 1 month ago)
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Baroness Merron (Lab)
Yes, I can confirm that amalgam is safe. The reason for this phase-down of the use of mercury, which is in amalgam fillings, is related to the environment. When mercury is released into the environment—for example, through emissions from crematoria—it can get into the food chain, where it accumulates mainly in fish such as shark and tuna. That can affect those who have a fish-rich diet, in countries such as Greenland, Brazil, Japan and China. However, there is no evidence whatsoever that amalgam is unsafe, and it is with that in mind that we have sought this arrangement for Northern Ireland.
Lord Forsyth of Drumlean (Con)
Further to the noble Lord’s rather ungracious question, can the Minister confirm that if we had not left the EU, it would not have been possible to continue with the use of amalgam?
Baroness Merron (Lab)
I am sure that there are many opinions in your Lordships’ House about what would have happened if we had not left the EU, and I think it is probably appropriate that I leave it there.
Adult Social Care: Staffing
Lord Forsyth of Drumlean Excerpts(1 year, 9 months ago)
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Lord Markham (Con)
The shorthand for the German system is the “double doughnut”, which tries to give wraparound care. We can learn many things from that system, which is why a part 2 reform needs to happen here. I accept that we are clearly not there yet.
Lord Forsyth of Drumlean (Con)
My Lords, is not the truth of the matter that the Government have just shuffled off responsibility on to local authorities? Can the Minister tell the House what percentage of expenditure by local councils is now being spent on social care to fill the gap, at the expense of vital local services?
Lord Markham (Con)
My noble friend is correct: on average, it is about 74% or 75% of a local authority budget. I think we would all agree that that is not a good situation, because obviously a local authority has a number of matters it needs to deal with. This is one of the issues around long-term reform that we will need to consider.
Adult Social Care
Lord Forsyth of Drumlean Excerpts(1 year, 9 months ago)
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Lord Markham (Con)
I thank ADASS for its report. The outcomes we are seeing show a number of things: as well as the £8.1 billion investment we put in, we have brought down waiting lists for assessment by 13% since the peak level. We are seeing high levels of satisfaction with a lot of the work we are doing; 83% of people say that they are satisfied with the services they are receiving. Yes, there is a lot more to be done, but there is a lot of good progress as well.
Lord Forsyth of Drumlean (Con)
My Lords, in July 2019, the Government promised that they would fix the crisis in social care. When does my noble friend think that that will be redeemed?
Lord Markham (Con)
Always at this point, I find that the best tactic is to offer my noble friend a meeting. The People at the Heart of Care 10-year plan is exactly what we are trying to design here. I mentioned some of the progress that is being made: we have seen recruitment go up and an increase in staffing, and we have a put in place a qualification for staff, so that they feel there is a career structure for them. The number of people is going up year on year. Yes, there is a lot to do, but we are getting there.
Children’s Hospices: Funding
Lord Forsyth of Drumlean Excerpts(1 year, 10 months ago)
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Lord Markham (Con)
As I said, it is a responsibility for all of them, but I will happily give the noble Baroness a detailed reply so that it is very clear exactly what they are doing to make sure that happens.
Lord Forsyth of Drumlean (Con)
My Lords, a bazillion years ago when I was the Scottish Health Minister pre-devolution, we introduced a pound-for-pound match-funding system for hospices. That worked brilliantly because it meant that hospices could raise more cash and the Government provided support for organisations that depend on being voluntary. Would my noble friend consider doing that, not just for children’s hospices but for the movement as a whole, which does such fantastic work?
Lord Markham (Con)
My noble friend makes an excellent point. My understanding is exactly in this vein: £7 million was paid in match funding to children’s hospices in exactly the way he mentioned. As to whether we should be doing that more widely, it is a good idea, and I am happy to take it away and come back on it.
NHS: Staff Numbers
Lord Forsyth of Drumlean Excerpts(2 years ago)
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Lord Markham (Con)
My first point on that is to ask what the real facts are. Five years on from qualification, around 95% of doctors are still registered with the General Medical Council and still practising in the UK. So the fact is that retention is very high. That notwithstanding, we want to do everything that we can to retain people, and professional development is what the long-term workforce plan is all about. Also, we all know that pensions were a big reason for a lot of the brain drain and doctors leaving the profession, and that was something we were quite radical in supporting and changing. We are going through this bit by bit, asking what key things we need to do to retain our staff and resolve this.
Lord Forsyth of Drumlean (Con)
My Lords, I have seen press reports that suggest, from future projections, that one in 11 people in the workforce will end up being employed by the NHS. Does the Minister really believe that this is sustainable? What plans does he have to avoid what would be a completely impossible situation for the economy?
Lord Markham (Con)
Yes, I am aware of this. Health spending equates to roughly 11% of the GDP of our country. Not surprisingly, the number of people in the workforce reflect that. It is absolutely mind-blowing; the amount of investment going into this space is bigger than the economy of Greece. Without a doubt, we have to make productivity improvements and look to technology, AI and all the things we can do to improve output and make sure that that total is not just ever-increasing.
Ultra-processed Food
Lord Forsyth of Drumlean Excerpts(2 years, 2 months ago)
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Lord Markham (Con)
My understanding is that those guidelines are there; it is absolutely the right question. The Department for Education, working with the Department of Health, makes sure that a nutritionally balanced diet is there. There is also a joint DfE/DHSE programme in respect of nursery milk and fresh fruit and vegetables for young children, to give them a good start in life.
Lord Forsyth of Drumlean (Con)
My Lords, is it not the solution to this problem not to ban things but to improve education so that people understand what they are eating and make rational and clear choices? Is it not the case that many of these processed foods are bought by people because they are cheaper? If we could encourage people in schools to learn what used to be called domestic science—cooking skills and so on—so they can use fresh ingredients, then we would advance this case far more effectively than by banning things.
NHS GP Surgeries: Purchase by US Companies
Lord Forsyth of Drumlean Excerpts(2 years, 3 months ago)
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Lord Markham (Con)
My understanding is that it is a range of issues, clearly including workload, pay and conditions. We are trying to address those; I think the change in the pensions rule has been generally welcomed in terms of encouraging more doctors to stay on in place. But it is a range of those measures—again, all things we are hopefully addressing through the new training and skills programmes, and the long-term workforce plan.
Lord Forsyth of Drumlean (Con)
My Lords, could my noble friend take the Question from the noble Lord, Lord Warner, a little more seriously? If we look at what has happened to vets, for example, private equity has bought up veterinary practices and prices have gone through the roof in order to pay for the funding costs. If this were to happen with general practice, I think that would be a very retrograde step.
Lord Markham (Con)
My understanding on this is that actually it is not a massively profitable area at the moment. The biggest provider in this area, Babylon Health, as we all know, did not manage to make it work. So, while I think we all understand my noble friend’s concerns, I do not believe that this is the case with the GP funding model.