Health and Care Bill

Baroness Fox of Buckley Excerpts

Lords Hansard _ Part 1 & Report stage
Wednesday 16th March 2022 Lords Chamber

[Lord Lansley (Con)]

My Lords, I was not intending to intervene, but I was prompted to do so not least by the noble Lord, Lord Stevens of Birmingham. That the PPRS has been sustained by Governments, albeit amended from time to time, should not lead us to the conclusion that all products should have their pricing and regulation controlled by government. I do not think that the analogy runs at all, so we should ignore the PPRS for these purposes.

My noble friend on the Front Bench whom I believe is replying to this debate and I were in a coalition Government with the noble Baroness, Lady Northover, and we were pretty clear then. I remember a decade ago creating a bit of a storm by saying that I wanted to end up with a smoke-free England. We have reached a point now where there are tobacco companies which think that we are going to arrive at that position, and so we should. I do not think that this debate is about whether we achieve that; it is about the mechanisms by which we do so.

If my noble friend reiterates the Government’s intention, willingness and sense of urgency about bringing forward measures, as I hope he does, I would not bind the hands of the Government with these amendments. Frankly, even if they were passed, nothing would happen unless and until the Government bring forward legislation for the purpose. It would be better for us to have the debate and make the position clear. I do not disagree with the arguments presented by the noble Lord, Lord Crisp, and others—when we were in government, we implemented things such as the ban on display in shops and preventing the availability of cigarettes to youngsters through vending machines, which I think was one of the most important things we could do. We made progress; we need to make more. We need the Government to come forward with proposals for that, but these amendments are not necessary if the Government say that they are willing to make progress.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I was not intending to speak, but I wanted to counter the point made to the noble Lord, Lord Naseby, that he was simply rehearsing lines from FOREST, the pro-freedom to smoke group. I also inadvertently receive communiques from ASH, the anti-smoking lobby group—I think it has me muddled up with someone else—and I have heard many of its lines rehearsed here as well on the other side of the argument. I thought it might be worth noting that.

Secondly, I have to declare an interest: I smoke. I appreciate that this means that I am beyond any redemption—goodness knows, I am controversial enough on a range of other things, but that is probably the worst.

[A noble Lord]

Hear, hear!

[Baroness Fox of Buckley (Non-Afl)]

Well, good. I have got a few “hear, hears”.

[Lord Rennard (LD)]

Does the noble Baroness accept that a crucial difference is that organisations such as ASH are funded by organisations concerned with public health, including Cancer Research UK and people who deal with trying to save lives, while FOREST is funded by the tobacco industry, which kills half its customers?

[Baroness Fox of Buckley (Non-Afl)]

I was coming on to that point. I would really appreciate a dose of honesty in this House. If those people who are so hostile to smoking a legal product believe that it is the killer they allege, they should call for smoking to be made illegal and be done with it. At the moment, tobacco companies are legal companies. People talk about them with such distaste, as though they should be abolished. It would be better and more heartfelt if they argued that tobacco should be illegal; then we would have a different debate. Public health is not always neutral when you talk about public health lobbyists, in my opinion. The freedom to choose to do something that is bad for your health is still allowed in a free society, despite some people wishing it was not.

[Baroness Walmsley (LD)]

My Lords, I do not recall anybody suggesting in the debate that tobacco companies should be made illegal. I hope that the noble Lord, Lord Naseby, is not suggesting that, just because the number of smokers is going down, nothing more should be done. I thought I heard the noble Lord, Lord Crisp, suggest that, if we carry on at this rate, it will be another 25 years before we get to where we need to be.

--- Later in debate ---

I offer these stories, which come from recently retired doctors. They believe the time has come for a change in the law to allow rational human beings to slip away in peace. I changed my mind on this issue some seven years ago, and I know that I am out of step with my church, but I believe that those of us who take this approach are on the right side of history. Therefore, I support the amendment in the names of the noble Lords, Lord Forsyth and Lord Baker, and the noble Baroness, Lady Meacher.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, the noble Lord, Lord Forsyth, made the accusation that lots of the amendments to the Bill of the noble Baroness, Lady Meacher, were a sort of Machiavellian plot to subvert the democratic process. I want to point out that I had tabled one of those amendments, about mental health, partly because I thought that that was our job here, that when a Bill was before Parliament, we followed it through—to every Bill that I have followed through here, there have been myriad, endless amendments. I thought that our role was to scrutinise proposed laws, to debate the merits and demerits and so on. I was therefore disappointed that there was no Committee stage of that Private Member’s Bill. So I do not accept the suggestion that those who put down amendments did so somehow to avoid debate; in fact, it was the opposite.

My general view on the problems of parliamentary and democratic process was best summed up by the noble and learned Baroness, Lady Butler-Sloss. I also feel queasy that there is a kind of subverting of the parliamentary process by an amendment on assisted dying or assisted suicide being put down on the Health and Care Bill. It is totally inappropriate. It is hijacking a Bill. Whatever else assisted dying and assisted suicide is, it does not contribute to improving anyone’s health. It requires ending a life; it is not a healthcare matter, and it will require a major change in the criminal law, so this is the wrong Bill.

However, I have every sympathy with the noble Lord, Lord Forsyth, and feel his frustration. I feel all the time that there are lots of laws I want to change; there are lots of things I want to change about the country; there are lots of times when I feel as though the public think one thing and the Government ignore them. What one therefore needs to do is to lobby the Government—the noble Lord probably has closer access to them than a lot of us—or, as maybe I would do, to organise a demonstration or a protest, unless the Government had got away with banning that by the time we got there. In other words, in a democracy, there are lots of frustrations that need to be expressed if you want to change the law. Using our position as unelected legislators to add an amendment to an inappropriate Bill seems to be completely wrong on a matter of such huge importance.

[Baroness Hayman (CB)]

My Lords, I am glad to have the opportunity to follow the noble Baroness, Lady Fox, because it is important to recognise that she is quite right. We should be able to debate all the amendments that Members wish to debate, in both Houses, on a Bill of this sort—a Bill which, as the noble Baroness, Lady Campbell of Surbiton, said, addresses one of the most fundamental social issues facing society.

However, I disagree that this amendment is nothing to do with health. The last days, weeks and months of your life, the healthcare that you receive, and the options open to you are part of the healthcare provided throughout the NHS and elsewhere. So I believe that it is appropriate to discuss this here.

It is a novel procedure. It is not a procedure that mandates the Government to support the draft Bill that would be brought in. The amendment is precisely designed not to do that but to ensure that a proper and full debate is held. I normally follow the noble Lord, Lord Cormack, closely and often agree with him, but I do not accept that we are imposing something on the other House by passing an amendment to a Bill which is going to have lots of amendments made to it and will go to the other place, where those amendments will be debated and accepted or not accepted.

Most of all, I support this amendment because it is now nearly 20 years since I served on the Select Committee on the Joffe Bill. There have been numerous attempts since then to resolve this most important issue. They have all run into the sand one way or another. Our legislature has not found itself able to produce a result that satisfies everyone that there has been full debate and resolution found to how we should go ahead as a society. In that time, 20 other jurisdictions have managed that task, because they have found a way of providing adequate time so to do. For those reasons, I support this amendment.

Health and Care Bill

Baroness Fox of Buckley Excerpts

Lords Hansard - Part 2 & Report stage
Wednesday 16th March 2022 Lords Chamber

[Baroness Sugg (Con)]

My Lords, Amendment 183 in my name, if accepted, would maintain the existing provision of at-home early medical abortion following a telephone or video consultation with a clinician. It is very late in the evening, but this is an important issue which will impact hundreds of thousands of women. The existing provisions, which the amendment simply transcribes into the Bill, were adopted in March 2020. It is a straightforward and narrow amendment with the sole purpose of retaining a service that has been in place for the last two years.

Early medical abortion, which can take place up to 10 weeks into a pregnancy, involves two medications. Previous government policy in England was that only the second pill could be taken at home, with women having to attend an abortion provider in person to take the first pill. The approval that was put in place simply enables women to take both pills at home. This was a pandemic-led shift to telemedicine, but the clinical benefits of telemedical service were known even before Covid-19, with NICE recommending it in September 2019. Sadly, following a government announcement a few weeks ago, this approval is currently set to be removed in August this year.

At this point, we should briefly be clear on what removing the existing provision would affect. It would have no impact on the requirement for face-to-face consultation, for face-to-face safeguarding, for ultrasound scans or to be seen in person by both doctors. Any of those changes would require amending existing regulations and that is not what we are debating tonight. The only thing impacted by this amendment is the requirement for women to visit a clinic and then leave again. I hope noble Lords agree that we can focus on just that.

There is no medical reason why telemedicine, alongside interpersonal appointments, should not remain a permanent option. There is overwhelming evidence that allowing women the option to access early medical abortion at home, where clinically appropriate, has created a safer and more effective service. During the pandemic, the largest ever study of UK abortion care, published by the British Journal of Obstetrics and Gynaecology, found that this service shortened waiting times and enabled women to receive care much earlier in their pregnancy. Some 150,000 women have received telemedical abortions since March 2020 and the data on the number of women presenting to NHS services with complications has shown a decrease. Renowned medical bodies support its use, including the Royal College of Obstetricians and Gynaecologists, the Royal College of General Practitioners, the Royal College of Midwives, the British Medical Association, the Academy of Medical Royal Colleges and many more. Just last week, the World Health Organization made it a key part of its global guidance on abortion care.

It is not just the medical experts who want to see this service made permanent—women do too. A recent study in the British Medical Journal found that 89% of women who have used a remote abortion consultation would choose to have treatment at home. It helps women who may struggle to find the time and travel the distance to an abortion provider. This includes those who have childcare or caring responsibilities, who struggle to take time off work, who live in remote or rural areas with little transport and many other logistical, social and economic reasons. Importantly, it can also be a lifeline for women in vulnerable situations. Maintaining the service is fully supported by women’s groups, including Women’s Aid, the End Violence Against Women Coalition and Rape Crisis, which say that it enables women in controlling and abusive relationships to access essential medical care. Removal of telemedical abortion provisions would almost certainly lead to a resurgence in women seeking to access unregulated pills bought online. Without telemedicine, waiting times will rise and current staffing levels would be insufficient.

There is a serious risk that some women would, as a result, be unable to access legal abortion care, either because the providers do not have the capacity or because increased waiting times push some women over the legal limit. Of course, face-to-face services must still be provided for all women who require or request it. However, to take away from women a service that has proven safe, accessible and compassionate, and which enables women to deal with a difficult situation in the comfort and privacy of their own homes, is not the right way forward.

This amendment follows the guidance of medical professionals and would deliver on the Government’s aim to listen to women and put them at the heart of the women’s health strategy. I believe the case is clear and hope that the Government will accept this amendment. I beg to move.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, in speaking to this amendment, I apologise for not having spoken in Committee. I want to do so because I have received hundreds of emails urging me to vote against this amendment. I want to explain why I will vote for it—if there is a vote—and why the people who emailed me are worrying about the wrong thing. I emphasise that this is not about changing the law.

I will not make a long speech because the noble Baroness, Lady Sugg, explained the amendment brilliantly and thoroughly. I will make just a couple of points. Over the past two years, the Department of Health, the Government and SAGE—everyone—have told us to follow the evidence. The truth is that this telemedicine, pills-by-post approach to termination pre 10 weeks’ gestation is simply a medical practice innovation that is safe, effective and follows the best clinical practice. So I want to follow the evidence.

About the only positive outcome of the pandemic I can see is that an enforced pilot scheme has given us evidence of the efficacy of this. We also know, as has been mentioned, that many women appreciate this option because there is no clinical need for them to attend a clinic for this procedure. I really cannot see why the Government cannot see that women who do not need hospital care or in-clinic services to access a procedure should not be forced to take up valuable appointment slots and staff time and unnecessarily squander resources that would be better used to intervene in genuine medical emergencies.

Despite all this, I understand that, for many people, the issue of abortion cannot be reduced to evidence or medical practice because they have moral concerns. I assure them that nothing in this amendment, which is literally about the location where a woman swallows a pill, touches on moral values. This is not a law change. Who can and cannot have an abortion remains exactly the same. The grounds on which abortion is legal remain exactly the same. It is common sense and pragmatic as a matter for women but, if you are morally opposed to abortion, you will still be morally opposed to abortion because nothing in this amendment will change your moral objection. Be reassured: you must have a different fight but not on this amendment, which is total common sense. The Government should accept it.

[The Lord Bishop of Durham]

My Lords, I begin by paying tribute to the noble Baroness, Lady Sugg, for her tireless work on gender equality and areas of international development. We have often been collaborators on such matters. I also apologise to the noble Baroness if she has personally received any hurtful comments on this; some of the things I have seen were shameful. She should not have been abused in this way. Nevertheless, I will oppose her amendment; I hope she understands that this in no way lessens the way in which I honour her for her work.

I declare at the outset that the Church of England’s position on abortion is principled opposition, with a recognition that there are strictly limited conditions under which it may be preferable to any available alternative. My opposition to the amendment is based on that in part but also because I believe that the amendment is functionally inadequate in providing the necessary protections. This was a temporary measure introduced during the pandemic to allow continued access to abortion services, simply to meet a need in extraordinary circumstances. I support the Government’s decision to return to the pre-pandemic system for early medical abortions from August, which was supported by many in the public consultation response.