Health and Care Bill

Debate between Lord Mackay of Clashfern and Baroness Meacher

Lords Hansard - Part 2 & Report stage
Tuesday 1st March 2022 Lords Chamber

[Baroness Meacher (CB)]

My Lords, I shall speak briefly to add my very strong support for Amendment 17, promoting the provision of specialist multiprofessional palliative care services. I also welcome, and will comment on, the Government’s Amendment 16 on the same topic. Alongside all other noble Lords, I pay tribute to my noble friend Lady Finlay for her tireless work to improve palliative care services.

It is of course most welcome that the Government have tabled an amendment in this field, but their amendment leaves it to the ICB to decide what standard and extent of palliative care services are “appropriate” to meet what they deem to be the “reasonable” requirements of their populations—the Government’s words. What do these terms mean? Does the Minister accept that the amendment does not ensure that adequate specialist palliative care services will be available across the country? That is what we all desperately want to see. I hope that, in his response, the Minister can define these terms. What do the Government mean by “appropriate” palliative care services and a “reasonable” level of such services?

As I said in Committee, it is unbelievable that the NHS provides services according to need throughout our lives, until we are dying, when of course our health needs are at their greatest. At that stage, precious hospices have to raise their own money, as others have said in the past, to finance their doctors and nurses to care for the dying. Inevitably, hospital beds lie empty. Some 50% of beds in a hospice I visited recently were empty, because it simply did not have the staff to deal with patients in those beds. Can the Minister confirm that the Government will provide statutory guidance to supplement Amendment 16 and clarify what they mean by the terms “appropriate” and “reasonable”?

As things stand, I strongly support the amendment tabled by my noble friend Lady Finlay. As we die, we should all have high-quality palliative care services. We can then expect that, when assisted dying is legalised, a reasonably small percentage of dying people will suffer unbearably, despite benefiting from top-quality services, because of course there are situations when the best possible palliative care services have done everything they possibly can and yet certain patients suffer unbearably. We need a change in the law to ensure that those patients have control over the suffering that they can reasonably tolerate.

I look forward to the Minister’s response and, as I say, hope that he will clarify the definitions of the terms used in the amendment.

[Lord Mackay of Clashfern (Con)]

My Lords, this amendment adds a new paragraph to the new Section 3(1) set out in Clause 16 and it seems clear that what Section 3(1) says refers to all that follows it:

“An integrated care board must arrange for the provision of the following to such extent as it considers necessary to meet the reasonable requirements of the people for whom it has responsibility”.


One has to look at reasonable requirements in relation to everything in that list, with the first being “hospital accommodation”. The idea that there might be some areas with no hospital access at all is absolutely ridiculous. So this is a qualification, to be fitted in as paragraph (ga).

Immediately before it is another provision, which refers to services considered

“appropriate as part of the health service”.

That seems to suggest that it is absolutely essential that the needs and reasonable requirements of people who need palliative care are met. ICBs do not need to provide palliative care for the whole community, but are required to provide it for the proportion of people expected to require it, namely those getting near the gates of death. That is a reasonable interpretation of this clause.

I believe it goes quite a long distance in the way that the noble Baroness, Lady Finlay, and others for some years have asked for. I do not think it feasible to say that nobody in an area will require palliative care—unless its inhabitants are people who live for ever, of which there are only very few. It looks to me as though this is well constructed to ensure that palliative care must be provided where people die, in the area of the integrated care board.

I entirely welcome Amendment 17 from the noble Baroness, Lady Finlay, but the crucial amendment is provided by the Government and is written in a way that will be very difficult for any care board to try to escape, because it is very clear.

Psychoactive Substances Bill [HL]

Debate between Lord Mackay of Clashfern and Baroness Meacher

Tuesday 23rd June 2015 Lords Chamber

[Lord Mackay of Clashfern (Con)]

My Lords, it is wise to remind ourselves of what has been going on in relation to these substances in the past year or two. The system has been that, once a new substance is discovered, the procedures of the Misuse of Drugs Act have been used to add that substance to the prohibitions under that Act. It seems to me that the trouble with that is that it is very late in the day in relation to the emergence of the new substance. The purpose of this Bill, as I understand it, is to eliminate that particular difficulty and to make the provision operate in a general way so that you do not need to move, as in the past, during the emergence of a new psychoactive substance. So, that is what Parliament has been doing for some time. This seems to me to be a much better way to handle the problem than what has been available in the past.

[Baroness Meacher]

I would like to point out that the Government introduced what I consider to be a very good instrument, the temporary class drug orders. These could be sped up. You can, or should be able to, put an order in place quickly for a 12-month period while an assessment is undertaken. If the drug is not deemed to be safe, it is placed under the Misuse of Drugs Act. There is an instrument in place.

[Lord Howarth of Newport]

From all his experience, does the noble and learned Lord anticipate that there may be problems in the criminal justice system over definition and establishing that a substance is indeed psychoactive; and that in the case of individuals it is their intention to supply illegally? Also, does he have any anxieties about the practicalities of enforcement? In the interests of the courts and of wider society, it is important that legislation that lays impossible burdens on the police, HMRC and other enforcement authorities is not enacted. They are going to have a large, complex and difficult additional set of tasks under this legislation, at a time of diminishing resources.

Children and Families Bill

Debate between Lord Mackay of Clashfern and Baroness Meacher

Wednesday 16th October 2013 Grand Committee

[Lord Mackay of Clashfern]

I was simply making the fundamental point that adherence to the paramountcy of the welfare of the child is the principle that should rule in all cases without exception.

I understand the problem to which this clause is directed, and I shall not repeat what has been said about where it came from and so on. There is a possibility that Members of Parliament get a slightly distorted picture of what goes on in the courts, because the people they see at their surgeries are generally not those who have won. People do not normally come along to say how well they have got on. I have never been a Member of Parliament myself, so noble Lords will understand that I am only speculating, but that is a possibility.

I believe that all judges—family judges, magistrates and so on—recognise the importance of trying to preserve the relationship between a child and both parents. I entirely agree that that should be affirmed but what I find very dangerous—and they appear in more than one amendment—are the words “unless the contrary is shown”. One can see immediately what might happen. Let us say that the wife decides that she wants to have the child. She concentrates on proving that the father is not fit or that he has done something, unless the contrary is proved. That puts a focus on what are often the most difficult issues.

I suggest that the important factor is the relationship between both parents, as expressed in the clause, and that should be one of the factors that have to be taken into account in considering the welfare of the child. It is obviously important that the relationship with both parents should be preserved if possible. A factor in the checklist that includes that would obviate a great deal of the difficulty that this kind of clause could produce in putting a focus on one party trying to show that the other party is not suitable for some reason or other. It would be much better for the judge or magistrates, in approaching the matter, to take account of the fact that it is very much in the interests of the child and of the paramountcy of the child’s welfare that both parents take an interest and be involved. Precisely how that is done can be looked at as part of the general picture, but it strikes me that focusing on this as a separate matter is very likely to make matters worse rather than better.

It is some time since I had experience of the working of the courts but I used to, and much of what I learnt then remains with me and was part of what I had in mind when the Children Act 1989 was formulated. It is also fair to say that the criteria set out in that Act have proved to be a considerable international instrument in developing justice for children. Therefore, I have a very strong affiliation to what was in that Act and I am not keen to see it much changed. So long as the change is an improvement, I welcome it, but one has to be careful that one does not distort the principle while making improvements.

[Baroness Meacher]

The noble and learned Lord referred to the clause possibly generating parental attempts to downgrade the other parent. Does he agree that that is absolutely the norm at present? That is what parents do and women are particularly good at it. They really go for the father and try to discredit him. I suggest that we already have that in spades.

[Lord Mackay of Clashfern]

It is the job of the judge to do his or her best to lower that. As I say, it is some time since I had experience of dealing with this issue but I have had that experience. However, it is counterproductive to do the opposite and to make important, and put up as a presumption which may be rebutted, something which is absolutely at the heart of the difficulty between the parents. As the noble Baroness says, this situation often arises. I feel that a judge would be better able to keep the situation under control if he or she did not have to focus on whether or not the contrary was proved. The judge would just have to take account of the nature of the relationships and make sure that they were properly taken into account when addressing the major question of principle.