Foetal Sentience Committee Bill [HL]

Lord Moylan Excerpts

2nd reading
Friday 22nd March 2024 Lords Chamber

Moved by

[Lord Moylan]

That the Bill be now read a second time.

[Lord Moylan (Con)]

My Lords, I propose that the Bill be read a second time with some trepidation, not because this is a momentous Bill but, on the contrary, because it is a very modest measure indeed.

I shall go through its clauses, which are very few. The first requires the Secretary of State to establish a committee and allows the Secretary of State to appoint the members of that committee. I have not chosen to specify who they should be or how many they should be, because I trust the Secretary of State in whatever Government, of whatever political colour, to make sensible decisions about that and appoint appropriate and skilled people. The clause also states what the purpose of the committee is, which bears reading out. It is

“to be a source of evidence-based, scientific expertise on the sentience of the human foetus in the light of developments in scientific and medical knowledge, and to advise the government on the formulation of relevant policy and legislation”.

The second clause requires the committee to publish reports. It actually requires the committee to publish only one report per annum, for the purposes of transparency, saying what the committee has done and giving an account of any income or expenditure it has had, as well as who its members are—a normal sort of annual report. The Government are not required to respond to that, but the committee is then free to publish further reports of a more scientific character. Clause 3—I shall come to this—requires the Government to respond to reports of that character. The other part of Clause 2 is language that ensures that the Bill is consistent with devolution legislation.

Clause 3 refers to the response that the Government have to make to those reports. There is nothing to stop the Government responding by simply saying that they have noted the report, if that is as far as they wish to go.

Finally, Clauses 4 and 5 are supplementary and general clauses, which I have been advised are appropriate for this Bill.

Why would such a committee be needed, and what value would it have? The question of human foetal sentience has been addressed by a number of bodies, but principally by the Royal College of Obstetricians and Gynaecologists. As the very helpful note from the Library makes clear, the current conclusion—because, of course, this is a shifting and developing scientific field—is that, to date, evidence indicates that the possibility of pain perception before 28 weeks of gestation is unlikely. However, one of the members who formed the committee that reached that view has now changed his mind and takes the view that the perception of pain could arise as low as 12 weeks.

The British Association of Perinatal Medicine takes the view that foetuses born as early as 22 weeks’ gestation show physical and physiological responses to pain, and there is no reason to think that foetuses at this gestation are any different. In addition, it might be said that the NHS recommends the use of analgesia for the foetus in the case of operations in utero for spina bifida from 20 weeks onwards.

So it is fair to say that there is considerable breadth of view on the question of human foetal sentience and when it kicks in. We would all benefit—government and all the relevant professions—from having a forum in which a clearer and more determined view, and one which developed over time, could be thrashed out between different medical professions. It would also have the advantage that the Government generally, in responding to questions on this issue, have tended to rely on the work of the Royal College of Obstetricians and Gynaecologists, which places a heavy burden on it. The advantage of having a committee such as I propose would mean that there are opportunities to bring together other royal colleges, including those representing paediatricians, midwives and others, so that their view could be contributed on an equal basis.

This all brings me to the question of advances in medicine and medical science, and rapid advances in surgery. I have referred to the rare but important cases of operations in utero for spina bifida, but there are other reasons why operations may need to be carried out on the human foetus while still in the womb. There are also, of course, cases where it is necessary to operate on a pregnant woman for her own sake, and in those circumstances consideration should also be given to what consequences might arise in relation to the sentience of the foetus that she is carrying in her womb.

All of this, at the moment, is being conducted against a background of inconsistency of professional opinion. If one says, as one could, that this should all be left, as a matter of clinical judgment, to the medical practitioner, I am all in favour of medical practitioners being able to exercise clinical judgment freely and professionally, but in fact it is very difficult to do that without some sort of agreed guidance. We do not, as a matter of practice, leave practitioners free of guidance—there is a great deal of guidance on a range of topics, which they follow when carrying out their necessary and valuable work—so I do not think it impinges on the freedom of the medical practitioner to exercise their professional judgment that there should be a better-informed agreement on the time at which foetal sentience arises than currently exists, given the inconsistencies that I have drawn attention to.

There are also inconsistencies with the way in which we treat sentient animals. The then Animal Welfare (Sentience) Bill 2022, which came through your Lordships’ House, established a precedent for this Bill by requiring the Government to set up and maintain a committee precisely to give them advice on policy in relation to animal sentience. That Act, noble Lords may recall, declares mammals and certain categories of shellfish to be sentient. I would be surprised if my noble friend the Minister wanted to say that a human foetus should be denied the same esteem as a lobster, but in fact that is the current position. We have legal protections for lobsters and decapod crustaceans—I remember the discussions during the passage of that Bill about those animals—as well as all mammals, but we have no view, let alone protection, for the human foetus.

There is also an inconsistency with the Animals (Scientific Procedures) Act 1986, which defines protected animals and protects their foetuses from a point two-thirds through the gestation period. We have legal protection for canine foetuses from seven weeks onwards, but we do not even have informal policy advice for the human foetus and its own sentience. This Bill would open a path to correcting that, by allowing scientists to come together and reach an agreed view and a developing view, in the light of new discoveries.

Finally, I come somewhat reluctantly to the question of abortion, which I have not mentioned until now because the Bill is not about abortion. The question of sentience is much broader than that and relates to foetuses where the mother is extremely keen, devoted and committed—as indeed are her professional carers—to the healthy birth of that child.

The Bill does nothing to change abortion law or the way in which any proposed future changes to abortion law are carried out. It has no implications, other than to provide a focus for scientific knowledge, on the course of legal developments relating to abortion. It does nothing to impinge on the legal rights of women to terminate a pregnancy. Anyone who argues that it does is implicitly arguing that those rights are defensible only if scientific knowledge is somehow suppressed and dispersed.

This is a modest Bill intended to provide scientific knowledge and inform public debate. It is also based on a clear precedent advanced by the Government; the Animal Welfare (Sentience) Act was a government Bill. It is hard to see on what grounds the Government or noble Lords would object to it. I beg to move.

[Baroness Kennedy of The Shaws (Lab)]

My Lords, when I saw this Bill on our prospectus I was immediately suspicious. It follows close on the heels of an effort during the Public Order Bill to enable protests on the doorstep of abortion clinics. Happily, that effort failed and it was agreed that buffer zones were necessary. The amendment would have allowed people who totally opposed the termination of a pregnancy to harass women as they entered clinics for medical attention.

Why would an independent committee be needed to respond to the issue before us today? The Royal College of Obstetricians and Gynaecologists updated its research and guidance less than two years ago, in 2022. The royal colleges—I am a fellow of three of them—are the seats of high-level monitoring of global developments in research and conduct of medical matters. They do it with great care and their research relates to what happens not just in the United Kingdom but around the world.

Why am I concerned? The politics of the United States of America is riven with divisions on the issue of abortion. For many decades it has been weaponised by far-right, deeply misogynistic organisations calling themselves Christian, which oppose women’s right to reproductive freedom. I always say, “Follow the money”. Dark money has surged into the United Kingdom’s anti-abortion groups in recent years. We should be concerned about overseas political influence inside our country. Sadly, many far-right organisations are being funded by such sources. Shadowy funds whose sources are obscured or not fully disclosed play an alarming part in enabling think tanks and far-right political groups to distort our politics.

One group, the Alliance Defending Freedom, has doubled its activities in this country in the last couple of years. Founded in the United States in 1993, the Alliance Defending Freedom—the freedom of only some—is an influential conservative group that aims to promote Christian principles and ethics. It is behind legal efforts to roll back abortion rights, remove LGBT+ protections and demonise trans people—that is not very Christian, and I count myself as one. It claims that its tireless work—

[Lord Moylan (Con)]

Is the noble Baroness suggesting that I have been in receipt of dark money or any money at all, or would she like to take the opportunity to state that she is not making such an allegation?

[Baroness Kennedy of The Shaws (Lab)]

I am perfectly happy to say that some innocent dupes are used by some of the organisations funded in this way.

This organisation claims that its tireless work helped the United States Supreme Court overturn Roe v Wade, which guaranteed the right to abortion. The ADF has supported controversial anti-abortion activity in this country, including supporting and funding protesters outside clinics. We are seeing the ramping up of spending to bring US-style abortion politics into our country.

--- Later in debate ---

[Baroness Thornton (Lab)]

My Lords, I refer noble Lords across the House to the Companion at 4.18, where it states clearly that we address each other as “noble Lord”. We do not use the word “you”, and there is a good reason for that, which is that that actually makes us a politer House. Standing up, even in impassioned debates on subjects about which people feel strongly, and saying “you” will lead to people pointing, which is not acceptable, and there is a reason for this. I have been in this House for 26 years, and there are some things that are wise, and this is one of those.

[Lord Moylan (Con)]

My Lords, I heartily endorse what the noble Baroness has just said about how we address each other. Does she think that stating quite clearly that those who disagree with you are either in receipt of “dark money” or are “innocent dupes” meets the standards of the House?

--- Later in debate ---

[Lord Moylan (Con)]

My Lords, I am grateful to those who have spoken in the debate. I am not proposing to answer them individually, but I shall make some comments, if I may, about the extraordinary speech made by the noble Baroness, Lady Kennedy of The Shaws. The first thing is that nobody, certainly not I, made any deprecatory remarks about the Royal College of Obstetricians and Gynaecologists. The idea that we were, or I was, holding it in institutional contempt is simply not borne out by anything that was said. All that was said was that other professional bodies of equal reputation have reached different views, and that a forum for bringing them together so that something could be worked out that might have a more robust character was something that could be recommended. It was complete fantasy and totally unfair to claim that we had said, or I had said, anything deprecatory about the Royal College of Obstetricians and Gynaecologists.

The second thing that I feel I have to say is that, given an opportunity, as the noble Baroness was, to state that she did not think that I was in receipt of dark money, or any money, in relation to this, her only answer was to accuse me of being some dupe. Without making any judgment, I will say that I have never heard anything like that said in your Lordships’ House, in the admittedly short time I have been here.

I shall only repeat, in a way, what I said earlier, in response to the noble Baroness, that the right to an abortion—any right that depends on blanking out developing scientific knowledge—cannot be regarded as a very robust right.

The noble Baroness, Lady Barker, suggested that somehow the evidence before this committee was going to be selected. I have really no idea where this idea comes from or who it is she thinks is going to do the selection. But that brings me to another point—one, I am sure, of genuine misunderstanding—the fault for which I have to attribute to myself.

There was a suggestion by some noble Lords, in particular the noble Baroness, Lady Thornton, that the committee would be full of politicians or politically appointed persons. That was never my intention. I thought that I had made it clear, and perhaps it should have been made clear in the Bill—that is something that could happily be addressed by an amendment—that the membership of the committee was to be made up of experts with scientific knowledge. That is how it would generate scientific knowledge and examine the research. Of course, leading among those experts, I would expect appropriately chosen representatives of the relevant royal colleges and other professional bodies, not politicians at all. I do not think that the Animal Sentience Committee, to take an example that provides a parallel, is stuffed with politicians or political appointees. I think that it has members who know something about animals and how they respond to pain. But that point may be a genuine misunderstanding, and one that I would be happy to address, as I say, in Committee.

As for the Minister’s response, I am grateful for his tone but very sorry to hear his content and the fact that he feels that he cannot agree. In effect, as another noble Lord pointed out—I think that it was the noble Baroness, Lady Smith of Newnham—he is rejecting an opportunity to make policy-making more robust and evidence-based. There were some very clever but totally unpersuasive words about the Animal Sentience Committee. The Minister said, in effect, that the Government’s view was that crustaceans deserve higher esteem and regard than the human foetus. Neither position, in my view, is sustainable. With that, I beg to move.

Bill read a second time and committed to a Committee of the Whole House.

Smoking

Lord Moylan Excerpts

Thursday 25th January 2024 Lords Chamber

[Lord Markham (Con)]

Again, we are mindful of trying to get the balance right. Inevitably, by taking away a major market, which the over-18s will become as we go into it, smoking sales through retail units will go down more and more. We expect them to reduce as a result of that. We think that is probably getting the balance right, rather than trying to be overburdensome by saying, “No, you shall not be licensed to do that any more”. We think that will happen naturally through the market, because we are of course taking out a whole segment of future customers.

[Lord Moylan (Con)]

My Lords, is my noble friend aware of the report published this week by University College London, in association with Cancer Research UK, which suggests that banning disposable vapes would lead to fewer adults giving up smoking? Will he give an assurance that any proposals brought forward by the Government will be based on clear evidence and common sense, and not unevidenced enthusiasm?

[Lord Markham (Con)]

I hope I could give my categorical agreement that everything is based on evidence and common sense; I will let people draw their own conclusions as to whether that is always the case. But, seriously, clearly anything we look at must be evidence-based. We will shortly be announcing the results of the consultation, which has a 28,000-strong evidence base, to show that we are really doing rigorous analysis.

General Practitioners: Shortage

Lord Moylan Excerpts

Tuesday 12th July 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Lord makes the very important point that GP practices are evolving. Some are moving premises; some are merging in larger premises; some are moving into primary care centres, where they are able to offer not just traditional GP services but some of the services that secondary care currently offers. I am not entirely sure of the specific point that the noble Lord makes. He would be welcome to have a conversation so that I can follow it up with my department.

[Lord Moylan (Con)]

My Lords, does my noble friend agree that an increasing number of GPs prefer to work part-time because they face a marginal tax rate of 62% on earnings over £100,000? Will he consider discussions with his friends at Her Majesty’s Treasury to address those anomalies in the tax system?

Health and Care Bill

Lord Moylan Excerpts

Consideration of Commons amendments
Tuesday 5th April 2022 Lords Chamber

[Lord Moylan (Con)]

My Lords, I rise briefly to support the amendment in the name of my noble friend Lady Eaton. I listened very carefully to what my noble friend the Minister said about protections and safeguards offered by the NHS, and the system of abortion provision to young people. But it seemed to me that those safeguards related principally to pregnant children up to the age of 16. There is a gap here, because the age of 18 is important in this debate, and it does not seem to be covered. As the noble Lord, Lord Morrow, said, it was only last night that an opposition amendment said that, in the case of child refugees, the Government must give priority to the best interests of the child—and, as I recall, that amendment was passed and is now back in the Bill. But “child” was defined in the amendment as a person under the age of not 16 but 18. So the best interests of the refugee child must take priority but the best interests of the pregnant child are not even mentioned anywhere in the amendment.

If I recall correctly, only last week we were debating a Private Member’s Bill—but one which I believe had government support—which would raise the permitted age of marriage to 18. Marriage is a natural law right, and also arguably a convention right, because there is a right to a family life, but, correctly, we are allowed to moderate how that right is implemented and affected by putting age restrictions on it. We may decide that 16 is an appropriate age or that 18 is an appropriate age; these are all perfectly legitimate decisions to make. But if our movement is in the direction of saying that 18 is the age at which you should be allowed to marry, it seems to me that there is a huge gap in the amendment in Motion N, which my noble friend Lady Eaton is doing her best to correct.

I regret that my noble friend has said that she is not going to move to a vote, so I am left to ask my noble friend the Minister whether he can explain to me, when he replies, what it is that the Government see as being the means of safeguarding pregnant children between the ages of 16 and 18, who are regarded so carefully in relation to other types of protection that are debated in this House and command widespread cross-party support but seem to have fallen through the traps here.

[Baroness Thornton (Lab)]

I shall be very brief, because it is time we draw this ping-pong session to an end. First, I congratulate the Minister on his introduction to the tele-abortion amendment, and on the reassurance that he gave to the House and the noble Baroness, Lady Eaton. The issue has been expressed very eloquently by the noble Baronesses, Lady Sugg and Lady Barker, and I have no intention of going into detail.

The only other matter before us right now on which we need to take a decision is that of the amendment put by the noble Lord, Lord Crisp. From these Benches, I need to say that we absolutely support the noble Lord in his amendment, and we will vote with him, if he divides the House.

Health and Care Bill

Lord Moylan Excerpts

Lords Hansard - Part 2 & Report stage
Thursday 3rd March 2022 Lords Chamber

[Baroness Smith of Newnham (LD)]

My Lords, I will speak to Amendment 108, while supporting the other two amendments introduced so powerfully by the noble Lord, Lord Hunt, and my noble friend Lady Northover, and to which the noble Baroness, Lady Finlay, spoke so eloquently.

I am completely in support of those amendments, but I wish to speak briefly to the genocide amendment today. On various occasions during the Covid pandemic questions were asked of the then Health Minister about the procurement of PPE. He was not able to give me a straight answer to say, “We can guarantee that no PPE procured could have had anything to do with slave labour or could have come from Xinjiang.”

The NHS seeks to be world leading. We all support it and want it to be able to deliver for every citizen in this country. But that should not be at the expense of the lives of those in other parts of the world. It is not good enough to say that we have the Modern Slavery Act if that will not lead to a change in practices. It is absolutely essential that our supply chains do not include anything that comes from forced labour.

If one looks at what is going on in Xinjiang, it is possible to barter to get numbers of people, just as it was 200 years ago during the slave trade. That is not acceptable. It may be the case that, as the noble Baroness, Lady Kennedy of The Shaws, pointed out, we will be told, “This is not the right piece of legislation.” If it is not, what will the Government bring forward that will mean that every point of our supply chain—every part of government procurement—ensures that we are not procuring things that have been made using slave labour?

We must not be complicit. This House should support the amendments, and if the Minister is not able to support the amendment, perhaps he could come back with a revised and better version of the amendment that will do what we all seek to achieve.

[Lord Moylan (Con)]

My Lords, I will speak briefly only to Amendment 108, which I understand the Government are likely to resist when my noble friend the Minister comes to speak. I say simply, very briefly, that to be persuasive, my noble friend has to explain how through administrative measures the National Health Service will achieve the effects of this amendment. He has to explain that in a credible way and that the effects will be rapid and comprehensive. Any idea that this will be kicked into a long review that ambles on and may or may not produce the effects required by at least the first two proposed new subsections of the amendment will lack credibility; I am less concerned about the chairman of the Select Committee part that comes in the third one. I would like my noble friend to know before he speaks that that is what I think we all want to hear.

Health and Care Bill

Lord Moylan Excerpts

Lords Hansard - Part 1 & Committee stage
Wednesday 9th February 2022 Lords Chamber

[Baroness Hollins (CB)]

My Lords, I added my name to Amendment 287, and I thank my noble friend for tabling Charlie’s law. Charlie Gard’s case was painful for all involved, including his parents and the doctors at the hospital where he was receiving treatment. Protracted disagreements can have far-reaching effects, particularly when they are played out in public, as has happened in a small number of cases. For the child, it can mean a delay in a decision about their care and treatment. For the parents and family of the child, there can be enormous distress, feelings of loss of control, and financial strain. Healthcare staff can also experience stress and anxiety, and they might be subjected to intimidation.

The parents of Charlie Gard, Alta Fixler, Alfie Evans, Tafida Raqeeb, and many others, wanted to do what any parent would do to try to improve their child’s condition and alleviate their child’s suffering. However, it is evident that the parents in such cases do not feel adequately heard and listen to when discussing options about their child’s treatment. This results in the devastating conflicts that lead to litigation. With this amendment, parents would be given the chance to discuss their views openly with the clinicians and hear the views of those clinicians, too.

Too often in my career, I have heard distressed parents described as “difficult” and “impossible to work with—nobody can work with them”. These are grieving parents who are looking for someone they can trust to help them. Mediation can sometimes help parents, and professionals to acknowledge that the consequence of conflict has been to shift focus away from the needs and welfare of the child. An independent mediation process can help to facilitate less confrontational conversation while supporting both parties. Thus, it provides support for both. Mediation across England is inconsistent. It needs to be available in every NHS hospital where conflict emerges, and at an early stage, so that the lives of very sick children such as Charlie are less likely to escalate to court.

In the rare event that a child’s case escalates to court, the amendment seeks to provide access to legal aid to ensure that families are not burdened with the financial strain of legal representation. Currently, families in this position are effectively punished, both financially and emotionally, through litigation for simply doing what they strongly believe is in their child’s best interest. Although this amendment makes provision for legal aid, the main purpose is to keep cases such as Charlie’s out of court, rather than arming everyone to be prepared to enter into long-winded and expensive legal disputes. Parents would not automatically win the right for their children to be given novel treatment, but the amendment would rebalance the dialogue towards resolution, rather than towards costly and distressing legal battles that do nothing to help the parents’ grief.

I also strongly support the introduction of the significant harm test. This legal test would focus on whether an alternative credible medical treatment could cause a child “disproportionate risk of significant harm” when deciding whether a parent can seek that treatment for their child. A key point here is that no medical professional would ever be required to give care or treatment that they did not view as in the best interests of the child. The legal test is already widely used under the Children Act 1989 and should be applied to cases such as Charlie’s in the future. I am strongly in support of this amendment and commend it. It is a just and necessary package to support parents and doctors, and I hope the Minister will be in a position to welcome it.

[Lord Moylan (Con)]

My Lords, I have also put my name to this amendment. I congratulate the noble Baroness, Lady Finlay of Llandaff, on bringing it forward.

We need a broad debate on the balance of responsibility for children as between parents and the various arms of the state. Sadly, these have come to include the medical profession. Today is not the day for that debate, but this amendment does something to give a voice to parents who find themselves in dispute with doctors, often unaided, unsupported and dependent on voluntary contributions, so that they have at least a voice and a status in decisions about their sick child. I very much hope that the Government will be able to support this.

[Baroness Stowell of Beeston (Con)]

My Lords, I do not very often become involved in health matters, so I hope that your Lordships will indulge me on this occasion.

Five years ago, when Charlie Gard’s parents were doing everything they could to fight for his life, I, like everyone else, was moved by their determination. Even so, my instincts were to accept what the Great Ormond Street hospital doctors were advising and what the judge decided was in Charlie’s best interests. I fall into the camp which believes that, in such an unimaginable, heartbreaking situation, the objective and dispassionate professionals are best placed to make a decision that no parent would ever want to have to make for themselves. When Charlie sadly died, I was moved by his parents’ dignity in coping with their heartbreak in the midst of a legal battle and in the full glare of publicity. Probably like many others who felt so sorry for their loss, I soon moved on and thought little more about this tragic case.

Then, just over a year ago, during the Christmas lockdown, when I was out on my daily walk, I heard an interview that Charlie’s mother, Connie Yates, gave to Andy Coulson on his podcast, “Crisis What Crisis?” For well over an hour, I listened to Connie tell her story. She spoke clearly, intelligently and reasonably about their experience as a family during the year in which Charlie lived, and about all that she and her partner, Chris, went through in their fight to be heard and taken seriously by doctors and lawyers. From listening to Connie, I learned that their expectations were well-informed and reasonable but that as the dispute continued, the situation became increasingly fraught and distressing —to the point where their efforts to be heard as parents made them feel that others believed they were guilty of not wanting the best for their baby. Even so, she was at pains to praise all the medical staff who had cared for Charlie at Great Ormond Street.

Towards the end of the interview, Connie told Andy Coulson that a Private Member’s Bill was being sponsored by the noble Baroness, Lady Finlay, that would bring to life what she called “Charlie’s law”. The noble Baroness has described this law. When Connie talked about it, I was struck by how modest and reasonable it is to create a legal framework to allow for resolution, without the added stress and trauma that they had faced during the time when they were fighting for Charlie. It also struck me very powerfully that, in developing this framework, Connie had taken the time to contact and listen to the doctors who had opposed her, so that she could better understand them and their position. That is worth emphasising again: this young woman is so reasonable that she wanted to create a law that would work for the benefit of the medical profession, not just parents.

As I finished listening to Connie, I vowed that I would support that Bill whenever it appeared. But as we know, Amendment 287 is here in lieu of that Private Member’s Bill, and arguably is a better way to introduce this measure, rather than having to battle with the usual procedural risks that are associated with private Members’ legislation. I am delighted to lend my support to this amendment. I am sure there are technical matters within the amendment which might require discussion between the noble Baroness and the Minister, but I urge my noble friend to take this seriously.

Given the ordeal that Charlie’s family faced a few years ago, when no one in authority listened to them, I am sure it would bring them a huge amount of comfort to know that they are being heard now. That is my main point and motivation today. Of all the things we must do if we are to level up this country, listening and taking seriously people who feel ignored or misunderstood is the most important aspect of that agenda, and in this context it costs us nothing.

I also say to Connie Yates, should she be listening today or read the record subsequently, that she is one impressive woman. When I heard her speak, and listened to what she had to say, she changed my mind and made me realise I had been wrong not to listen more carefully a few years ago.

Health and Care Bill

Lord Moylan Excerpts

Lords Hansard - Part 2 & Committee stage
Monday 31st January 2022 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

My Lords, I will also be moving Amendments 225B and 225C in due course. Clause 4 sets a requirement for the Secretary of State to include objectives relating to cancer outcomes in the mandate to NHS England, and for these objectives to have priority over other objectives relating specifically to cancer.

I first thank John Baron MP in the other place, who introduced this clause, and noble Lords for their support in ensuring that the Bill best delivers on our shared intention of improving outcomes for cancer patients. I also thank the cancer charities that have contacted me to express their views, and the noble Baroness, Lady Morgan of Drefelin, for her engagement. The Government have worked with Mr Baron, NHS England and stakeholders to ensure that we deliver the greatest benefits for cancer patients while minimising the risk of unintended consequences. Amendments 225A, 225B and 225C, tabled in my name, have the full support of Mr Baron, and I strongly encourage your Lordships to support them.

In recognition of the range of services offered to cancer patients, Amendment 225A will ensure that the scope of possible outcomes-driven objectives is broad enough to capture all cancer interventions, such as screening programmes or targeted lung health checks, not just those relating specifically to treatment. Connected to this, Amendment 225C will ensure that these objectives have priority over any other objectives relating to cancer, not just those relating to cancer treatment.

Amendment 225B, meanwhile, makes it clear that the objectives over which the cancer outcomes objectives have priority are those which relate specifically to cancer. When it comes to setting priorities for NHS England, including on cancer, it is vital to consider the outcomes that they should be directing the NHS to achieve. Improving outcomes means boosting survival rates—that remains our overriding aim. But the outcomes that matter to cancer patients are not limited to survival. They also include improving the quality of life for those living with cancer and the patient experience of those being treated.

We want to make sure the objectives we set benefit the outcomes of all cancer patients, whether the objectives relate to screening, early diagnosis or treatment. This is crucial as screening and early diagnosis interventions are one of the most effective ways of improving outcomes and chances of survival. I hope your Lordships can support these amendments.

[Lord Moylan (Con)]

My Lords, I greatly welcome the amendments proposed by my noble friend. In fact, I put my name to the equivalent amendments earlier, proposed by my noble friend Lady Morgan of Cotes. I rise to speak to my Amendment 294, the purpose of which is to draw attention to the dire state of the services and treatment offered to people suffering from cancer of the pancreas—although I could also say that there are other, equally forgotten and equally deadly cancers, such as bile duct cancer, that deserve a debate as well. I am grateful to my noble friend Lord Vaizey of Didcot and to the noble Lords, Lord Patel and Lord Aberdare, for their support of the amendment.

Many of us have seen family members and friends fall prey to this disease. Pancreatic cancer is the deadliest common cancer. It affects 10,000 people a year across the UK, and more than half will die within three months. Three in four will die within a year. Vague symptoms, lack of a simple early test, and low symptom awareness among both the public and primary care professionals result in three in five people with pancreatic cancer being diagnosed at a late stage, when curative treatment and life-saving surgery are no longer possible.

Research into pancreatic cancer has been underfunded for decades: it receives only 3% of the UK cancer research budget, despite being the deadliest common cancer. The result is that pancreatic cancer has the lowest survival rate of all common cancers, with five-year survival rates less than 7%. Five-year survival in the UK lags behind the rest of the world, with the UK ranking 29th out of 33 countries with comparable data. These survival statistics have barely improved in decades.

In addition, there is an unacceptable variability of services for pancreatic cancer sufferers, depending in part on geography, with those living near the few specialist centres able to access some services barely available elsewhere.

I wrote last year to my noble friend Lord Bethell with a particular suggestion being promoted by the small but excellent charity Pancreatic Cancer UK. In due course, on 1 December, I received a reply from my honourable friend Maria Caulfield, who said that NHS England and NHS Improvement had launched an audit of pancreatic cancer services with a view to reducing variations in treatment and improving outcomes. That is wholly welcome. The information we have nationally on pancreatic cancer treatment in the NHS is woefully poor. An audit is a good place to start. But she went on to say that the first data were expected in 2023—not the report, not the action plan that we need, and not the funding allocation, merely the first data.

My amendment seeks to impose certain reporting obligations on the Secretary of State, but its real purpose, and the real purpose of this debate, is to inject some urgency into the Government and the NHS. We cannot afford to wait years just to begin to understand the state of pancreatic cancer treatment and care, let alone to take action to improve outcomes. Pursuing the audit with urgency and dispatch should be a top government priority.

There is one thing the Government could do right away that would at least alleviate the suffering of pancreatic cancer patients—and this indeed is the subject I wrote to my noble friend Lord Bethell about at the urging of Pancreatic Cancer UK. The symptoms caused by pancreatic cancer have a very distressing impact. In particular, people are often unable to digest their food, ultimately starving the body of nutrients and calories, leading to rapid weight loss, malnutrition and loss of muscle mass.

The solution to these symptoms is pancreatic enzyme replacement therapy—PERT. PERT comes in tablet form; you take it with your food. It replaces the digestive enzymes that many people with pancreatic cancer can no longer produce. Taking the tablet helps food to be digested and absorbed by the body, and can vastly improve people’s quality of life. It can also, crucially, help them to gain the strength needed to undergo treatment. If people have lost weight and are too weak, they are sometimes not able to have surgery for that reason. NICE guidelines clearly recommend PERT for people with pancreatic cancer, whether the cancer is operable or inoperable, and there is widespread clinical consensus on its effectiveness. It is widely available and is cost-effective: it costs the NHS just £7 per day per patient.

However, a recent study has shown that only half the people with pancreatic cancer across the UK are prescribed PERT. The May 2021 RICOCHET study, undertaken by the West Midlands Research Collaborative, found that 50% of pancreatic cancer patients were not being prescribed the tablet they needed to digest food. The key reason people are not being prescribed PERT currently is a lack of dissemination of specialist knowledge about pancreatic cancer and the benefits of PERT to general healthcare settings. PERT is more likely to be prescribed in specialist surgical centres than in general hospitals, meaning that people whose cancer is operable are more likely to be prescribed PERT than those whose cancer is inoperable, because people whose cancer is operable are more likely to be moved to a specialist setting.

However, three in five people with pancreatic cancer are not diagnosed until their cancer is at an advanced stage and no longer operable, so they will tend to be treated with palliative care in a non-specialist setting. This means they will be far less likely to be prescribed PERT than if they had been diagnosed early.

What I would hope to hear my noble friend the Minister say this evening is that without waiting for the results of the audit, he will immediately set a national priority that PERT should be routinely prescribed as a feature of pancreatic cancer care. Without setting this focus and without corresponding leadership from national and local health bodies, knowledge and expertise will continue to spread far too slowly for the people with the quickest-killing cancer.

[Baroness Morgan of Drefelin (CB)]

My Lords, I am delighted to rise in support of the Minister’s amendments to Clause 4, and I would like to declare my interest as chief executive of Breast Cancer Now. I am also absolutely delighted to pay tribute to the honourable member John Baron, from the other place, for his incredible leadership as chair of the All-Party Group on Cancer, his tireless campaigning for the interests of cancer patients and his relentless demands around prioritising improvement in cancer outcomes—hence the origin of this new clause.

For me and for those listening to this debate, it is extremely important that the Minister has been able to clarify that the wide range of outcomes covered by this new clause will include, for example, early diagnosis, objectives around end-of-life care, the importance of measuring quality of life as an outcome, and timeliness of care, as well as survival, because we know that all those factors lead to improved quality of life but also improved survival. We do not have the time to wait five or 10 years to see whether improvements in survival are occurring—we need to see them today, next month. We need to see, for example, that PERT is getting through to all patients with pancreatic cancer, rather than waiting for the longer-term survival results.

I am very pleased that these amendments have been tabled and that the Minister has confirmed that a wide range of metrics will be used to ensure a tight grip on keeping track of the system’s performance, identifying emerging problems and backlogs as they arise, because we do not have the time to wait to find out if the system is off-track. I am very pleased that we have some clarity around what is included in these objectives. I will read the Minister’s remarks properly—when it is not quarter to 10 at night—and reflect. I am very grateful for them.

Also, what a tremendous amendment we have on pancreatic cancer, which is, as we have heard, such a pernicious disease. The audit will be very powerful when it really gets to work on what is going on locally to unearth thoughtful ideas about how the system can be improved. So much good work goes on in these audits, not just on pancreatic cancer but other diseases too. Making sure that those improvements are put into practice as quickly as possible has got to be a really good thing that this House will care about very much.

--- Later in debate ---

With these amendments, the Secretary of State would continue to set objectives relating to outcomes for cancer patients in future mandates, to reflect the priorities that the elected Government of the day have for NHS England, but working in partnership with the cancer charities and cancer experts.

[Lord Moylan (Con)]

My Lords, before my noble friend sits down, on behalf of people who are currently suffering from pancreatic cancer or who might be diagnosed with it in the next few months, is anything going to happen faster in relation to dissemination of knowledge and prescription of PERT as a result of this debate than would have been the case had we not raised this with him?

[Lord Kamall (Con)]

I am afraid that I am not entirely sure of the answer to that, but I hope that we have raised awareness. I am very happy to have a conversation with my noble friend to see what more can be done, if anything.

Health and Care Bill

Lord Moylan Excerpts

Lords Hansard - Part 3 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Lord Mackay of Clashfern (Con)]

Exactly. A draft Bill is preliminary to a Bill; it is not there for the purpose of not being considered. A draft Bill is for making a proposal the subject of an ordinary parliamentary Bill, which has the same authority as a government Bill. All Bills are produced in draft; some are considered in draft in pre-legislative scrutiny. A Bill has to be in draft at some stage, but the object of producing this Bill is not that it should remain in draft but that it should be considered. The amendment does not say how long it should be allowed, but that is another matter. The point is that there is already a procedure by which government help can be obtained if it is asked for in the proper situation of Private Members’ Bills.

I think it is wrong in principle to consider the merits of this matter tonight. Some remarks have been made about that, and I refrain from making any remarks about it because I do not think that that is what is needed here. I submit that it is a view well founded on the rules that Private Members’ Bills are drafted by the private Member, are submitted and then are subject to procedure in the Private Members’ Bills system, including if the Government think it is right that they give additional time.

It is also questionable whether this Motion is in order, since the matter has already been discussed in this Session. There is a question about whether having have a separate procedure raising the issue in much the same form as it was considered some weeks ago is in proper order.

But my main point is about the procedure for dealing with Private Members’ Bills in our Parliament—we are not in the Scottish Parliament at the moment, and there may be some question as to whether my noble friend would like to be—and we have to apply the rules in this Parliament. In my submission, applying the rules of this Parliament, if we want help from the Government, it is to be asked for in the Private Members’ Bill procedures and the Government may, for all I know, be prepared to do something along the lines that my noble friend has suggested.

[Lord Moylan (Con)]

My Lords, I wish primarily to speak to the amendment standing in the name of the noble Baroness, Lady Meacher, but, before I do so, may I just reply, without any hint of rancour, to the comments made by the noble Baroness, Lady Hayter? She repeatedly described the amendments tabled to the Assisted Dying Bill as “wrecking amendments”. Certainly, my amendments are not intended to be wrecking amendments; the Bill raises very important consequences for the National Health Service, and my amendments are primarily about the effect on the relationship between doctors and patients. These are important considerations, and to call them wrecking amendments is a little unfair. I say that without any rancour at all.

Health and Care Bill

Lord Moylan Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Moylan (Con)]

My Lords, as a fellow Brummie by origin, I congratulate the noble Lord, Lord Stevens of Birmingham, on his maiden speech. I also express my very strong agreement and support for my noble friends Lord Sandhurst and Lord Shinkwin in the emphasis they have placed on Clause 4 and the importance of improving cancer outcomes.

With regard to the speech by my noble friend Lord Naseby, I will say how remarkable it is that we seem to have accepted, almost without dispute or protest, the transformation in GP services in this country, which are no longer delivering what we have traditionally expected them to deliver. That is perhaps something that can be explored further as this debate continues, because it seems to pass by with nobody commenting, as if it would be rather rude or impertinent to say something about it. But it is a real phenomenon, which is being deeply experienced.

I generally support this Bill—it is a very good Bill —but I would like to make three points. First, we take it for granted nowadays that Nye Bevan was right to insist on a topdown centralised National Health Service. But that view was contested at the time, and by no less a person than Herbert Morrison, with his long service in local government.

I am grateful to the Library for finding for me a rather fiery Cabinet minute from Morrison arguing for local authorities to keep their role in healthcare provision. That did not happen, but perhaps if it had happened, we would have had a less troublesome bifurcation between the health service and social care that we have spent so much time since trying to address. We are back here now trying to do something to fix and amend that relationship.

My concern, with my experience of local government, is simply this: that the new statutory integrated care partnerships must maintain a proper balance between the National Health Service and local government and respect the democratic and local character of the latter. As was said, I think, by the noble Baroness, Lady Murphy, there must be the threat that when you have such a large shark in the room, some of the minnows get squashed. That might not be an exact analogy, but the drift is clear.

My second point is that I will be supporting my noble friend Lady Morgan of Cotes in her proposals for the collection of UK-wide health outcome data on an interoperable basis. The pandemic has shown that everyone in the UK is entitled to the same high health outcomes from our National Health Service. To achieve that, we must have comparable data and appropriate mechanisms.

My third and final point—I am sure that at least some noble Lords will recognise this, which the pandemic has brought to the fore—is that health policy is increasingly seen as the new form of social control. One hears calls for non-medical conditions such as gambling addiction to be treated as a medical problem. The phrase “public health approach” to a problem is the new code for policies designed to coerce, tax and nudge people into doing what is thought best for them.

This Bill gives us fluoridation. It gives us an advertising restriction on what are thought of as unhealthy foods, but even government figures, despite the catching enthusiasm of the noble Lord, Lord Rooker, show that this would result in a trivial reduction in annual calorific intake. In Committee, as the noble Lord, Lord Rennard, has already told us, we can expect a raft of further amendments of an illiberal character. I will end by saying that these will not be uncontroversial, nor should they be.

Cigarette Stick Health Warnings Bill [HL]

Lord Moylan Excerpts

2nd reading
Friday 3rd December 2021 Lords Chamber

[Lord Moylan (Con)]

My Lords, it is painful for me to find myself in disagreement with my noble friend Lord Young of Cookham. It is astonishing that he has brought this Bill forward in the middle of the Covid pandemic, because there are three well-established principal risk factors in relation to the harm you suffer if you contract Covid and fall ill with it. They are age, sex and smoking. To avoid the harmful effects of Covid infection, you overwhelmingly want to be young, moderately want to be female and mildly want to be a smoker—but he does not want to put that fact on cigarettes. I looked in vain in the schedule for a piece of scientific evidence or statement that would derive from that scientific proposition. What he actually wants to put on the cigarettes, as shown by the words in the schedule, is lurid propaganda, not facts or evidence.

We turn first to the evidence. I was confused—and I will give way if my noble friend wants to explain—by what he said about the evidence for the effectiveness of this measure. He said, first, that it had never been tried and that there was therefore no evidence. He went on to say that, since 2015, there had been a number of peer-reviewed studies on the effectiveness of health warnings on cigarettes. Perhaps he meant cigarette packs, but he actually said “on cigarettes”. What is it? Is there evidence that the measure he is proposing is going to work or, since it has never been tried, is there not? My view is that it is likely he is saying that there is no evidence at all. We now have a Bill promoting propaganda with selective statements based on no evidence at all. Why would we want this?

The second reason is that the Bill—and this is a really awful pun—is a smokescreen. It is intended as a provocation on the way to achieving the stated objective of Action on Smoking and Health, which is a smoke-free Britain or UK by 2030. I think that is the target date, but I am happy to be corrected. There is no electoral mandate or evidence of electoral support for this policy. It would be better if those promoting these provocative and regressive measures were more honest and came forward with a Bill that actually criminalises smoking cigarettes, so that we can have that debate.

Finally, it is a patronising Bill because it is based on the assumption that adults are incapable of making an appropriate trade-off between the pleasures of cigarette smoking and the undoubted risks that it brings for the smoker. That is another reason why I think this House should have nothing to do with it. In my limited experience here, some Bills are bad Bills, but this is the first Bill I have come across that I suspect is just designed to provoke. I hope that the Government will not give it their support and that it will not pass.