Health and Care Bill

Baroness Greengross Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Baroness Greengross (CB)]

My Lords, I add my sincere congratulations to the noble Lord, Lord Stevens. I am delighted that he is joining us in this House.

May I start by saying that the Government correctly acknowledge that their White Paper proposals to be enacted by this Bill will not solve all the problems affecting adult social care in the UK? They refer to their reforms as a “journey”, but we have been on this journey for decades now, and the people of this country cannot wait any longer for meaningful and equitable reforms to be enacted. People across the country are suffering now from inadequate social care, and as our population ages these problems will multiply unless we seize this opportunity at last to enact a system that is sustainable and fair.

We all know that demand for social care is not being met, causing hardship for families. Local authority budgets continue to be under great strain, private providers are withdrawing service provision, experts warn that the system is unsustainable, and the system is terribly inequitable. People with dementia, for example, must pay for their care, whereas people with cancer can rely on the NHS. That is grossly unfair.

However, under the Government’s proposals, we will to see one inequitable regime replaced by another. The Government’s proposed cap of £86,000 on the social care costs that individuals will have to pay is significantly less generous than that recommended by the Dilnot proposals. As a wise friend observed to me, the Government’s proposal appears to be more a means of protecting the assets of the wealthy than resolving our social care funding problems. Under these proposals, most people in this country, who do not have huge personal assets, will still lose most, if not all, of their savings, and they will now be paying the Government’s new levy as well.

As a result, many people with modest assets—perhaps only the value of their home, if they own one—may be worse off than before. In addition, most of the funds raised by the Government’s new levy will initially be used to support the NHS, not social care. One wonders how it will ever be politically feasible for this distribution of levy resources to be realigned to pay for social care alone, which remains the Cinderella service under the Government’s plans.

I recognise and welcome the Government’s proposals to support the integration of housing into local health and care strategies, with a focus on increasing the range of new supported housing options available. I welcome the Government’s stronger overall support for independent living, including more funding to enable the greater adoption of technology to support independent living. I also welcome more funding to ensure that social care workers have the right training, but I have to question whether the sums proposed are adequate to meet even current needs in these areas.

The Government have to improve on their proposals, particularly in overall funding for the social care system and social care workers. The Government should reduce the cap on social care costs paid by individuals to provide much more generous support to people who have only modest assets. They should not require young people to pay the levy, given the high housing costs and the burden of student loans that so many of them face. There are better ways to raise the funds needed to provide decent care, including replacing higher rate tax relief on pension contributions with a lower flat rate relief. The levy should also be used simply to pay for social care and not the NHS, which already absorbs the bulk of government revenue.

There is not time for me to set out the myriad inadequacies of the Government’s White Paper and this legislation, but in addition to a fairer system for funding social care, we know that the glaring need is for social care workers to be much better paid and to have a clear career path. Until these valuable workers are more fairly rewarded, I am afraid we will continue to see an exodus of staff to easier and better paid work. The best carers provide a wonderful service, but they do so despite our social care system, not because of it, and this remains a great injustice. They, and the people they care for, deserve so much better.

Health and Care Bill

Baroness Greengross Excerpts

Lords Hansard - Part 1 & Committee stage
Thursday 13th January 2022 Lords Chamber

[Baroness Greengross (CB)]

My Lords, in October last year, during the debate on the Ageing: Science, Technology and Healthy Living report, the Minister, the noble Lord, Lord Kamall, confirmed that the Government maintain their commitment to ensuring that people live at least five extra healthy and independent years of life. A practical first step towards achieving that goal would be to ensure that tackling health inequalities is a priority in this legislation, and the amendments in this group seek to achieve that. We know that health inequality is a problem that has been getting worse, and we need to tackle it as an emergency. I support the amendments in the group calling for NHS England, NHS trusts and the integrated care strategy to collect relevant information and data, as well as to take the necessary action to prevent health inequalities and improve healthy living.

In 2010, as we know, Sir Michael Marmot published his report on health equity, finding that social position determined people’s health outcomes and that people at the lower end of the social gradient had worse health. At the time, the report recommended that the focus on improving this should not be targeted just at those from the most disadvantaged parts of the country but should take a universal approach to improving health outcomes, which is very much needed. The report highlighted the economic benefits of addressing health inequalities. In particular, it raised the issue of lost productivity, increased spending on welfare and lost tax revenues due to people having to leave work as a result of poor health.

Just before the pandemic, in 2020, Sir Michael Marmot did his 10-year review, and we know how alarming the findings of that report were. For the first time, life expectancy had stalled in the UK. In the poorest 10% in England, the life expectancy of women actually declined between 2010 and 2012 and between 2016 and 2018. Mortality rates for people between 45 and 49 years old increased, and in many cases those were deaths of despair, due to suicide or substance abuse. That is terrible news. The level of child poverty has also increased in the UK to 22%—compare that with Norway, for example, where child poverty is 10%. That is also alarming. The number of years lived in poor health across England has increased and continues to be worse in the poorest parts of the country.

We hear much about the so-called levelling-up agenda from the Government. One finds it hard not to dismiss it as little more than a glib and somewhat trite slogan, because there is little to back it up in real policy to try to address issues such as health inequality. However, I am an optimist and I see the Bill as a step towards trying to address these challenges. But to do this effectively we must have a better understanding of the drivers of health inequality. We must have plans at a local and national level to address those drivers. This group of amendments offers some solutions to start addressing health inequalities through this legislation. I look forward very much to the Minister’s response to these amendments and to hearing his view on how the Bill is going to achieve the Government’s goal of people living at least five extra healthy and independent years of life.

Health and Care Bill

Baroness Greengross Excerpts

Committee stage
Thursday 20th January 2022 Lords Chamber

[Baroness Barker (LD)]

My Lords, it is a pleasure to speak in support of the noble Lord, Lord Howarth. When I read these amendments I was immediately taken back about 20 years, to the offices of a charity that noble Lords might remember called the British Trust for Conservation Volunteers. It had a very worthy reputation. I think most people who knew vaguely of its work but did not know it in any great detail regarded it as middle-class do-gooders in bobble hats who went out and cleaned up local rivers and things that nobody else much bothered about. But 20 years ago, it began to do some of earliest work that charities did in drilling down into not only what they did but the impact of what they did. When the trust did that, it discovered two things. First, it discovered that the volunteers were much more diverse than one would have thought—there were all sorts of people from all sorts of different backgrounds, many of them in urban settings. Secondly, it found that the biggest impact it had was on the mental health of the people who volunteered. As an organisation, it tracked that as best it could in its non-clinical fashion.

I bring my observation up to date, to about three years ago, just before lockdown, when I had the great good fortune to be invited to the offices of Google one night. I remember it was a winter’s night with absolutely filthy weather, and 250 young people—or youngish people—turned up to talk about mental health and tech. The big question was around what we can do, given who we are, who we work for and the data that we are amassing now, about not just what people are doing but what they intend to do and the profiles we are beginning to build up about people’s behaviour.

It is to those two memories that I attach these amendments, because I think the noble Lord, Lord Howarth, is right. Everybody knows the value of this—we all know it as individuals. Who did not go nuts during lockdown and head out to the nearest bit of green space to cheer themselves up? We all know it, but how do we prove it to those in the NHS who, rightly or wrongly, hold fast to scientific data and evidence?

My point is simply that we should be trying to get this on to the agenda of the acute services, rather than primary care, and that we need to do so in a way that is collaborative. I think we should be challenging the acute services to tell us how they would evaluate this—what evidence would convince them? It might be the sorts of biometric evidence that people who are involved in mindfulness are beginning to generate; the fact that we can actually see differences in people’s brain patterns if, over a sustained period of time, they are engaged in things such as mindfulness.

I sincerely hope that we do not pat these amendments on the head and send them on their usual way into the background and to the byways of primary care. I hope that, although the amendments may not make it into the Bill, noble Lords might well challenge the department, NHS England and the acute sector to see this as a far more important part of prevention, particularly in mental health but also in a number of physical conditions, than they might otherwise have done.

[Baroness Greengross (CB)]

My Lords, I am in favour of the amendments in this group in the name of the noble Lord, Lord Howarth, specifically Amendments 59, 67, 71, 77, 80 and 82. My own Amendment 290 will be debated in group 41 and specifically addresses the importance of social prescribing for people with a dementia diagnosis and how this can form part of a wider care plan.

Social prescribing plays a very important role, not just for people with diagnosed conditions but generally, as part of wider brain health. Research by Arts 4 Dementia found that music-making provides a tool for a total brain workout and improves plasticity in the cortex, which enhances the ageing brain’s cognitive abilities, perception, motor function and working memory. It also improves cardiovascular strength while reducing stress. The Coda Music Trust provides a range of musical social ensembles and bands, as well as courses and classes for learning and well-being. In other studies, drama and poetry have been found to improve concentration and cause new neurons to develop and adapt.

Social prescribing has been recognised as playing an important role. It is part of the NHS long-term plan, and the Department of Health and Social Care has allocated funding to establish a national academy for social prescribing. This growing recognition of the role that social prescribing, specifically of music and art, can play in overall health is a welcome development because many of the programmes that exist at present rely on the voluntary sector.

During the pandemic, these programmes, like most of the voluntary sector, have struggled with funding and with being able to continue their work under Covid-19 restrictions. We also know that many arts venues have struggled through this time and many theatres and music venues now face an uncertain future. This sector therefore needs much more support right now if it is to continue its work. It is crucial that integrated care boards are empowered to promote social prescribing and can work with organisations that provide these services.

Although the evidence for the benefits of social prescribing is growing, more work is needed to research what types of social prescribing are successful for specific conditions, a point that I will elaborate on when we debate my Amendment 290, which addresses social prescribing and dementia. To help promote social prescribing, we need more training for GPs and other health professionals on how and when to prescribe these services. We also need to include arts awareness for mild cognitive impairment in the medical and social care educational curriculum.

There also needs to be greater availability of these services, with links to every GP. The current NICE guidelines for dementia recommend referring patients for these services only post diagnosis when, in fact, to promote overall well-being and brain health, we should encourage them much earlier from the onset of symptoms. For this, we need training, and integrated health boards must prioritise the availability of these services.

I thank the noble Lord, Lord Howarth, for these amendments and fully support their inclusion in the Bill. I look forward to the Minister’s response. I also want to take this opportunity to thank the noble Lord, Lord Kamall, whom I have often heard recently. He confirmed that his blues band, Exiled in Brussels, will play at an event supporting Music for Dementia later this year.

[Lord Best (CB)]

My Lords, I thank the noble Lord, Lord Howarth of Newport, for his inspiring speech. I declare an interest as a vice-president of the Local Government Association. I also chair the University of Oxford’s Commission on Creating Healthy Cities, which brings together academics, policymakers and practitioners. We hope to support city leaders and their citizens by shedding light on the policy interventions that are most likely to be effective in enhancing the health of their cities.

The Oxford commission is not due to report until later this year, but it is already clear that the two core issues raised by the noble Lord, Lord Howarth, in this group are likely to be central to our conclusions. The first relates to the wider determinants of health creation that take us beyond the integration of health and social care services towards recognising the relationship of public and personal health to other non-clinical services, including those affecting the built environment. The second issue relates to the value of engaging local and community organisations in a variety of ways in achieving health outcomes.

Health and Care Bill

Baroness Greengross Excerpts

Lords Hansard - Part 1 & Committee stage
Wednesday 26th January 2022 Lords Chamber

The Government say that this is the Bill that will transform the commissioning of health and social care. In a perfect world, they would be a seamless service, both properly funded to deliver what the patient needs. By adding continuing healthcare to the Bill, it will be strengthened, and that golden thread between the NHS and the social care sector will run all the way through it. I hope the Minister will accept these three amendments, which would help to deliver exactly the change the Government want.

[Baroness Greengross (CB)]

My Lords, I will speak to Amendments 133, 139 and 161 in my name, and to Amendments 143 and 144 in the name of the noble Baroness, Lady Finlay, to which I have added my name.

Amendments 133, 139 and 161 are intended to clarify the role that continuing healthcare—CHC—will play, along with other commissioned services. The Continuing Healthcare Alliance has raised concerns about the provision of NHS continuing healthcare. The package of care is there to support people with ongoing and substantial needs in England. Examples of conditions for which someone may qualify for CHC include Parkinson’s, motor neurone disease and dementia, but there are many others as well.

Amendments 143 and 144 would strengthen the power of NHS England to give directions to integrated care boards. They would help to ensure national consistency of CHC services, which, sadly, is not always the case at present. When the Bill was debated in the other place, the Minister, Edward Argar, responded to a similar amendment as follows:

“It is right that clinical commissioning groups, as they are currently called, are held accountable for NHS continuing healthcare within their local health and social care economy. That will also be the case with the national move to integrated care boards, where the board will discharge those duties and be accountable for NHS continuing healthcare as part of its NHS commissioning responsibilities.”—[Official Report, Commons, Health and Care Bill Committee, 28/10/21; col. 825.]


Given this earlier response, I believe that it is the intention of the Government to improve the national delivery of continuing healthcare and to ensure more consistent delivery throughout England. The intention of this group of amendments is to clarify that in the Bill, so I commend Amendments 133, 139 and 161.

[Baroness Finlay of Llandaff (CB)]

My Lords, I added my name to Amendments 133, 139 and 161, which were so ably introduced by the noble Baroness, Lady Greengross, and others. I also have Amendments 143 and 144 in my name. All the amendments aim to tackle the accountability gap: the inconsistency of provision of continuing healthcare across different parts of England.

The noble Baroness, Lady Greengross, alluded to some diseases, but this goes much wider. There are people with spinal injuries and long-term multiple sclerosis and there are people who have had strokes. They all need ongoing long-term healthcare at a high level—way above the level that can be provided by social care.

The problem is that the accountability gap exists and there is inconsistency in the quality of provision, with eligibility criteria being interpreted differently in different areas. Amendments 143 and 144 aim to strengthen the powers of NHS England in the Bill to give direction to integrated care boards, with the particular aim of closing this accountability gap. Within the existing system, NHS England is responsible for holding clinical commissioning groups accountable for their discharge of continuing healthcare and functions.

In the reformed system proposed by the Bill, NHS England will hold these boards accountable in a similar way, but I question whether it has adequate authority both in the current system and the proposed system and whether the levers available to it to act meaningfully are adequate. While the intention prior to the Lansley reforms was to give NHS England powers to intervene to create meaningful change in practice, the powers were restricted to high-level interventions where there was a failure of governance at the highest level, rather than interventions where a CCG was failing to implement good practice or to adhere to national policy.

The 2018 report by the Public Accounts Committee in the other place supported these concerns and stated:

“NHS England is not adequately carrying out its responsibility to ensure CCGs are complying with the legal requirement to provide continuing healthcare to those that are eligible.”


There are limited accountability mechanisms and there is inadequate data collection at present. These amendments seek clarification and would drive long-overdue improvements in the quality and, importantly, the consistency of the way that continuing healthcare decisions are made and the process is administered, with the aim of improving outcomes and reducing the strain of applying for continuing healthcare for people who live with complex health needs and for their loved ones, in particular their family and carers.

Health and Care Bill

Baroness Greengross Excerpts

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

[Baroness Greengross (CB)]

My Lords, I rise to speak to Amendment 235 in my name, which seeks to implement the social care contribution cap recommended in the 2011 Dilnot report. He recommended that a cap be set at £35,000. Care cost inflation runs at 1.5% above the consumer price index, so to replicate the 2011 recommendation, adjusting for this cap would now be set at £50,000, and that is what this amendment seeks to achieve. The amendment would also adjust the cap with care cost inflation each year.

I first want to acknowledge that the Government’s proposed cap in this Bill of £86,000 is a significant improvement, as it introduces a cap and puts some limit on what people pay in care costs. There are some who still do not believe that there should be a cap and feel that this will just be a means of helping wealthy homeowners, but not all homeowners are automatically wealthy or sitting on some high-value property portfolio. For many people, as we know, their only real asset is a modest family home, which, in certain parts of the country, may have increased in value over time but even so not enough to make them wealthy.

There is an equity issue in that, if someone is diagnosed with cancer, the NHS will cover the full treatment cost, whereas if someone is diagnosed with dementia, they may require many years of care, which will cost families thousands of pounds as this is not covered. My Amendment 291, which will be debated in a later group, addresses the issue of dementia care plans and specifically talks about the different types of dementia and how each requires a different type of care and support. If someone is unlucky enough to be diagnosed with a certain type of vascular dementia, Lewy body dementia, or Parkinson’s-related dementia, these conditions often require many years of care—up to a decade or more in some cases.

I am not suggesting that there should be a different cap for people who have been diagnosed with long-lasting forms of dementia, but we must understand that people with these types of dementia will be the most impacted by this provision. The proposed cap of £50,000 in this amendment, the equivalent to that recommended in the Dilnot report nearly 11 years ago, is a much better one. According to the ONS, the average yearly earnings for people in the UK is £31,000. The cap of £50,000 is roughly just under two years’ average earnings, whereas £86,000 is nearly three years’ average earnings.

I anticipate that, when the Minister responds, the main objection to this amendment will be the cost to the Government, and I have no doubt that the Treasury will have concerns if the cap is lowered. In response to this, I refer the House to the debate in this Chamber on 16 September 2021 on the Intergenerational Fairness Forum report, Grasping the Nettle. As chair of the Intergenerational Fairness Forum, I introduced this debate, outlining that the report recommended that the Government introduce a social care levy at a rate of 1%, which could be raised to 2% for those aged 50 and over if there were a need for extra revenue. The levy would apply only to adults over the age of 40, placing the heaviest burden on those best placed to contribute to the cost of this bill. I mention the recommendation from this report to highlight that there are still other options to fund social care, and it would mean that the Government could lower the cap.

Some will feel that it is better at this time to focus on implementing the current cap and then, over time, press for a lower cap. Certainly, history shows that when other social security measures, such as the pension, were first introduced, they started at quite a small amount of money but then became more generous over time. I accept the logic of this, but still feel that the case must be made for a lower cap and that this should be considered and debated in Committee.

[Lord Lipsey (Lab)]

My Lords, this is a rather strange grouping. In the earlier debates we were dancing at times on the heads of pins, and now we have the noble Baroness, Lady Greengross, with her proposals for a lower cap, and the noble Baroness, Lady Bull—with whom I agree—largely exempting people of working age with a disability, and it is difficult to cover the whole field. However, I will attempt to give a small synopsis leading up to my own amendment, which is about the taper.

I first declare an interest as an unremunerated president of SOLLA, the Society of Later Life Advisers—the people who really know a lot about this stuff. I should also apologise for not having participated in the Second Reading debate but, like the noble Baroness, Lady Bull, I was in a crucial meeting of our House’s Communications Committee, which made doing so impossible.

On Mondays, Wednesdays and Fridays I am a strong supporter of the cap as recommended by Andrew Dilnot, for the obvious reason that it ends an unfairness to people who happen to live for a long time and therefore lose their assets. Unfortunately, in 54 minutes’ time I shall go back to the way I am on Tuesdays, Thursdays and Saturdays, which is to be broadly opposed to a cap of the kind that has been proposed. That is for two reasons. First, all parties should take into account that it is wildly expensive—some £3 billion, which will rise as the number of old people rises. I would much rather that that money was spent on better care for those who need it than on paying for the rich. Do not be in any doubt: whatever gloss is put on it, half the people in care are paid for by the state now, so all the expenditure on the Dilnot cap will go on the other half. A lot of them are not rich people—some of them are quite modestly wealthy—but it is the richer half of the population that this cap supports. As a socialist, that is why I cannot go along with it—at least on Tuesdays, Thursdays and Saturdays. It is not too long until next Sunday, when the good Lord will advise me on what final position to take.

Starting from that scepticism about the concept of a cap, I will say one thing about Dilnot’s proposals. Whatever you think, whether you are for it or against it, the case for the cap is much less strong than it was when Andrew Dilnot proposed it in his brilliant report, and for three reasons. First, no one now has to sell their house to pay for care. They did then but they do not now: they can borrow the money from the local authority and pay it back afterwards. Secondly, house prices have risen by 30%, so many people have more assets they could spend on their own care without leaving themselves with no assets to leave to their children. Thirdly—an important point which has been wholly missed so far in the debate—the private sector, belatedly but slowly, has started to get its act together about this. There are two relevant products: equity release, which enables somebody to get some money out of their house to pay for their care without selling the house, leaving plenty for the children; and, more importantly, annuities and deferred annuities, which are paid from the point of care in the case of an annuity, or after you have been in care for two years or so in the case of a deferred annuity. I was amazed to read through the impact assessment, which went through every possible argument on caps and alternatives to them, and not see a single reference to deferred annuities. They are part of a holistic solution.

I ask the Minister in all sincerity—I know he is very open to suggestions—that, before this Bill completes its passage and, preferably, before we have decided whether to leave Clause 140 as part of the Bill, we look at the role that the private sector can play in supplementing a cap, for example in allowing people to pay for better care for themselves, or indeed possibly replacing it with a less regressive way of paying for care. It should be looked at; it has been ignored since Dilnot, and the case that Dilnot then made against it is not quite the same today, so it really deserves to be looked at.

Finally, on my own amendment on the taper, I am very distribution-minded about this cap. What motivates me is that I hate taking scarce state money, which is needed to provide decent services for people who cannot provide decent services for themselves, and spending it on a subsidy for “Disgusted of Tunbridge Wells”. This seems wrong to me. I would love to see the welfare state expand. I am rather shocked to find a Conservative Government seeking to expand it in order to help the better-off at the cost of much more public spending. The better-off should be able to look after themselves.

If we are to have a cap, we should make it as good in terms of redistribution as we can, with less favouring of the rich than is the case with the present cap. That is why I brought in another thing that has not been mentioned in the debate: the taper. At the moment, the taper does not matter much; it applies in only a very narrow band of incomes. However, under this system, the taper will apply to assets of between £20,000 and £100,000. For every £250 you have in the bank, you lose £1 a week in benefits. That will hit the people who have between £20,000 and £100,000 in assets. They are not rich; they are the kind of people I want to help, but they are being struck by this taper.

Of course, addressing this will cost money, and I am reluctant about that. For every £50 you put on the £250 for the taper, it would be about £200 million a year; it is not nothing, but it is less than the £1 billion or so that would be lost if Clause 140 does not stand part of the Bill. If the Government want to show that they are interested in redistribution, as well as pleasing their richer supporters, I ask them to look at the taper as an alternative. I saw the vote in the Commons: Clause 140 is down the pan. It is not going to win. If he takes it back to the other place, he will be voted down, so it is not going to happen. Therefore, we all, particularly in your Lordships’ House, need to use our imagination to find alternatives to the proposal that the Government have put forward. That proposal will not pass this Parliament in its present form and in its entirety. Working with the Minister, we need to find a better proposal that meets the various considerations I have put forward and, in particular, uses the private sector and does not protect the assets of just the rich.

--- Later in debate ---

Part of the training for the tertiary prevention activities mentioned in the noble Baroness’s amendments should include the ability to assess which of these technologies are appropriate for the reablement of each patient and the skills to help them learn to use them. Such technologies, correctly diagnosed and provided, could do a lot to reduce the pressure on residential social care and support. These tertiary prevention and rehabilitation activities are vital for levelling up health disparities, which means that the staff who deliver them are vital too, and that is why I support the noble Baroness’s amendments.

[Baroness Greengross (CB)]

My Lords, I rise to speak to my Amendment 289, which would ensure that every hospital has sufficient accommodation to allow a bed for any patient who is rehabilitating and who no longer needs to be in hospital, but who cannot be discharged to their own home. Further, this amendment would place a duty on the Secretary of State to ensure that hospitals use any spare land owned by the NHS to build this accommodation.

For many years I have been an advocate for this type of accommodation. The NHS has struggled for a long time with a lack of available hospital beds, a situation made worse by the coronavirus pandemic. Having rehabilitation accommodation for people who need to be near a hospital in case they need to see a doctor, but who do not need the full services of an NHS hospital bed, which is considerably more expensive, would be of considerable benefit. In Scandinavia, patient accommodation of this nature has been part of the state health system since the late 1980s. Having patients stay in these facilities, which are designed to cater for people needing medical care, has delivered considerable savings to the public health system.

The cost of someone staying in one of these hotel rooms is less than a third of the cost of someone staying in a hospital bed. This is a great example of how the private sector, working in conjunction with the state, can enhance efficiency and deliver better public health outcomes. Over the last couple of years I have had the privilege of working with chartered architect Jimmy Kim, who has identified various opportunities throughout England to use NHS-owned land or vacant buildings for this sort of development. These sites could be given to the private sector to develop into non-clinical units, with a guarantee of a utilisation contract from the Government. At present, NHS trusts are spending money putting up patients in hotels, with rooms costing as much as £275 per night. One hospital has spent over £1 million on hotel rooms in the last three years. From a cost perspective, it would be better for the NHS to provide this accommodation in symbiosis with the private sector, rather than paying hundreds of pounds a night for hotel rooms or having patients stay longer in hospital beds which are not designed for the context of health rehabilitation.

We need to bear in mind the widening context of what a patient is in today’s society, which is one with dementia, adult-disabled, mental health issues and, progressively, those for whom the social services have yet to find suitable accommodation.

The need to reform both health and care is long overdue. The pressure to invest more in social care has been building up over many years, and Governments have been slow to respond. But part of this must also be looking at prevention and helping people to remain independent, which we can do through supporting rehabilitating patients and helping people to remain independent. We also know that pressure on our hospital system means that many people wait far too long to get treatments, while others stay too long due to there not being suitable accommodation when they are discharged. In too many cases, people end up in hospital for too long or in the social care system where, instead, the step-down accommodation that I am proposing in my amendment would be the most suitable option.

I would love to discuss this further with the Government as I believe that the concept has real merit, as it would reduce NHS costs and improve patient outcomes. My amendment would help the NHS save money and result in better outcomes for patients. I know that one such experiment is being developed now in London; I am really delighted to know about that and I think many patients will be too.

[Baroness Watkins of Tavistock (CB)]

My Lords, delayed transfers in care is an ongoing challenge for health and social care services, made worse with the pandemic. We need to remember that hospitals are for assessment and treatment. As other noble Lords have already said, extensive stay in hospital is not good for your health.

In February 2020, there were over 155,000 delay days in hospital, costing a significant amount of money. A majority of the delays—21%—were caused by delays in packages of care in patients’ own homes, while 18% were due to delays in receiving further non-acute NHS care. With over half a million emergency admissions in the same month, intervention is urgently needed to reduce systematic pressures and maintain safe and timely discharge.

I therefore particularly support Amendment 289 to optimise existing space and develop new accommodation for hospital patients who no longer require acute treatment. There are a range of options, including community hospitals, NHS nursing homes, contracts with not-for-profit social enterprises and, as my noble friend Lady Greengross has said, independent sector companies.

However, these issues are not new. I have in my hands a paper by Sir Cyril Chantler for the King’s Fund, The Potential of Community Hospitals to Change the Delivery of Health Care. The salutary point about this excellent paper is that it was written in 2001.

Health and Care Bill

Baroness Greengross Excerpts

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

Moved by

[Baroness Greengross]

290: After Clause 148, insert the following new Clause—
“Social prescribing
The Secretary of State must seek to ensure that health professionals are aware of any benefits of practising social prescribing of music and the arts for dementia, in particular for patients at the onset of symptoms so as to preserve their brain health and resilience in the community.”

[Baroness Greengross (CB)]

My Lords, I wholeheartedly support Amendment 297A in the name of the noble Baroness, Lady Hodgson, and Amendment 291D in the name of noble Lord, Lord Hunt, but I will speak only to Amendments 290 and 291 in my name in this group. Amendment 291 calls on the Secretary of State to

“publish a plan for dementia care”

which recognises

“the different types of dementias and the specific care needs of each type”.

It also places a duty on local authorities and the

“NHS integrated care system to implement this plan for their own areas”.


Some 70% of care home residents and 60% of home care recipients in the UK have some form of dementia. When we talk about the crisis in social care and the urgent need for social care reform, one of the major drivers of this crisis is the growing number of people living with dementia, with one in 14 people over 65, and one in six people over 80, living with some form of dementia. By 2040, the number of people living with dementia is expected to have grown to 1.5 million. Globally, the World Health Organization reports that over 55 million people are currently living with dementia; by 2050, this number will have grown to 153 million.

It is easy to get caught up in the numbers, but we need to remember that these are usually people with family and loved ones who often become carers, even once the person with dementia ceases to recognise their loved ones, and in many cases spend prolonged periods of time in a state of distress and even anguish. It is not just unpaid carers who struggle to help those with dementia: Skills for Care has recorded that only 44% of care staff have any form of training in dementia. Social care staff should have tier 2 training in the dementia training standards framework to support the delivery of more personalised care for people with dementia.

As co-chair of the All-Party Parliamentary Group on Dementia, I work closely with the Alzheimer’s Society. This organisation has been working with the small team at the Department of Health and Social Care that has been trying to develop a new national dementia strategy. With no co-ordinated strategy for dementia since 2020, and with the conditions of people living with dementia deteriorating during the pandemic, the strategy needs to be published promptly. There also needs to be dedicated funding to deliver it.

There are over 100 types of dementia. We know that the most common are Alzheimer’s disease, which accounts for over 50% of dementia cases; vascular dementia, which accounts for roughly 20% of cases; Lewy body dementia, which accounts for just over 10%; and frontotemporal dementia—FTD—which affects 2%. Each type of dementia has its own symptoms and has different care needs. Also, some forms of dementia can develop tragically at a younger age, and some may cause deterioration of memory and cognitive function for many years.

Dementia is a condition that uniquely cuts across social care and healthcare, because it has no disease-modifying treatment, meaning that the main support someone receives is through the social care system. As I said on Amendment 235 on the social care cap, there is a clear inequity where, if someone is diagnosed with cancer the NHS will cover the full treatment cost, whereas if someone is diagnosed with dementia they may require many years of care, which will cost them and their families thousands of pounds, as this is not covered. That is made much worse by the fact that, despite best intentions, the care being delivered may not even be suitable for the type of dementia the person needs care for. That brings me to my next amendment.

Amendment 290 requires the Secretary of State to ensure that health professionals are aware of the benefits of the social prescribing of music and art for those with dementia, especially at the onset of symptoms to preserve brain health, and protect against cognitive decline, loneliness and fear in the months and years leading to diagnosis. Over 200,000 people are expected to be diagnosed each year. A third more do not even have a diagnosis, so the arts have a vital part to play for them. When I spoke in support of the amendments in the name of the noble Lord, Lord Howarth, on social prescribing, I and others who spoke on that group outlined the many benefits of social prescribing for the social exercise of arts activity, which empowers patients to preserve their brain health. This amendment specifically outlines the importance of this for those affected by dementia as part of an overall care plan, so links to Amendment 291.

If we look at the four main types of dementia I spoke of earlier, we can see how different forms of art can play an important role. The charity Arts 4 Dementia has found that, for those with Alzheimer’s disease and vascular dementia, participating in music, dance, visual arts, poetry and drama, and trying new techniques and art forms, stimulates interest and joy, relieves anxiety, preserves confidence and improves cognitive functioning. Some musicians continue to play for years, artists to paint and dancers to dance. People with frontotemporal dementia are better able to read words and music and are more interested in dialogue around pictures and the mechanics than creating art. Musicians and artists with frontotemporal dementia can often continue to enjoy singing, playing and painting for years after diagnosis. Researchers have found that those with Lewy body dementia are happier to be involved in social arts programmes, poetry and dressing up than physical drawing, or going to arts events, galleries, concerts or the theatre rather than performing. For those with Parkinson’s-related dementia, dance can be helpful.

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[Baroness Penn (Con)]

My Lords, this has been a long debate but it has touched on a number of different and important subjects. I join noble Lords in paying tribute to the work of the noble Baroness, Lady Greengross, and her work.

I turn first to Amendments 290 and 291. I reassure noble Lords that the Government are absolutely committed to the rollout of social prescribing across the NHS. We exceeded the targets in our manifesto and the NHS Long Term Plan of 1,000 new link workers by 2020-21 and are aiming for at least 900,000 people to be referred to social prescribing by 2023-24.

NHS England, the National Academy for Social Prescribing and Music for Dementia have produced guidance for social prescribing link workers to expand music prescriptions for those with dementia. The department has also published two resource guides for social workers on embedding music in personalised social care plans for people living with dementia and their carers.

While the Government are committed to promoting the benefits of social prescribing of music and arts for people living with dementia, it would be inappropriate to focus in the Bill on one form of therapy. Instead, we rightly provide scope in the Bill for the NHS to undertake a range of social prescribing.

Turning to Amendment 291 and the need for a dementia strategy, I reassure the noble Baroness and others that the Government are committed to publishing a new strategy this year. As part of this, we will be looking at arts and music-based interventions. More broadly, the strategy will focus on the specific health and care needs of people living with dementia and their carers, including looking at dementia diagnosis, risk reduction and prevention, and—importantly, as noble Lords have mentioned—research. Our priority is for the strategy to be credible and shaped by a range of experts, including people living with dementia and their carers. At the end of last year, we established a stakeholder-led task and finish group to help develop the strategy and deliver it in a timely way.

Moving on to Amendment 297D, we fully agree that visits from loved ones are of vital importance to care home residents’ health and well-being. DHSC guidance emphasises that visits to care homes should be facilitated, based on individualised risk assessments. Care home residents should also be supported to nominate an essential caregiver, who may visit in most circumstances, including if the care home has been closed to visiting for any reason.

There is an existing process in place if a resident or their family are concerned that guidance is not being followed. We encourage anyone with concerns to raise them. That can be done both with the care home, which has a legal obligation to operate a complaints procedure, and with the CQC. The CQC will follow up on concerns and take regulatory action if needed. It has provided mechanisms for people to feed back on concerns over care. The CQC responds to all concerns passed to it, and can receive concerns anonymously via representative groups, such as Rights for Residents. Where those concerns have named the provider or service in question, the CQC has followed up the cases. Some 54 concerns regarding care home visiting arrangements have been raised during the pandemic. The CQC gained reassurance in all cases that visiting is now in line with guidance. In 12 cases the CQC secured this assurance by inspecting the service.

My department has not seen any data or reports on evictions of residents following complaints against care homes. If a care home were taking such action, it would be in breach of guidance. A complaint should not lead to a resident being asked to move to a different home, and the terms of evictions and processes followed should comply with consumer law, as per the CMA guidance. People should feel confident that complaining will not cause problems for them.

I recognise this has been a difficult time for care home residents. However, the existing powers in legislation are robust and give protection to those who need it. We therefore do not feel at this time that an independent review is necessary.

I turn to Amendment 297A. Continuity and oversight of care is crucial in meeting the needs of all patients, including those aged over 65. That is why, since 2015, all practices have been required to assign their registered patients a named, accountable GP. This GP must lead in ensuring that any GP services that they are contracted to provide, and are necessary to meet the patient’s needs, are co-ordinated and delivered to that patient. Practices must take reasonable efforts to accommodate patients’ requests to be assigned a particular accountable GP and must endeavour to comply with all reasonable requests to see a particular practitioner. Practices are also required to take steps each year to identify any registered patient over 65 who is living with moderate to severe frailty. The practice must undertake a clinical review of any such patient and provide them with any other clinically appropriate interventions.

The noble Baroness, Lady Tyler, is right that delivering on this is linked to the number of GPs in the system. I assure her and others that the Government remain committed to growing the number of doctors. There were 1,841 more full-time equivalent doctors in general practice in September 2021 compared to September 2019. In 2021-22, a record-breaking number of doctors started training as GPs. I therefore consider that existing regulations already address the welcome intention of my noble friend Lady Hodgson, and I regret that the Government cannot accept the amendment for that reason.

I hope I have given noble Lords and noble Baronesses some reassurance on the amendments in this group and that the noble Baroness will feel able to withdraw the amendment.

[Baroness Greengross (CB)]

My Lords, I have listened to an extraordinary range of speeches and addresses. People have spoken from the bottom of their hearts. I am very moved myself by what I have heard. I thank all colleagues and Ministers who have spoken today. I will look very carefully at the record of today and come back, but, in the meantime, I beg leave to withdraw the amendment.

Amendment 290 withdrawn.

Health and Care Bill

Baroness Greengross Excerpts

Lords Hansard - Part 1 & Report stage
Monday 7th March 2022 Lords Chamber

[Baroness Greengross (CB)]

My Lords, I will speak very briefly to these two amendments: 114 and 184ZB. The amendment of the noble Lord, Lord Howarth, would require the Secretary of State to review and commission a report on social prescribing and other creative health interventions which have already been outlined. My Amendment 184ZB follows on from the discussion in Committee, when the Government agreed to include social prescribing as part of the overall dementia plan, and I am very pleased about that.

In the Committee debate, the noble Lord, Lord Watson, cited a study that cast some doubt on the merits of social prescribing. Briefly, I refer the House to the research conducted by the Global Brain Health Institute, which showed that lifestyle interventions, including art and music, can reduce dementia risk by up to one-third—that is a huge proportion. We have real-life studies such as that of Chris Norris, a 67 year-old man who was diagnosed, aged 58, with frontotemporal dementia in December 2012. Musical interventions have slowed the advance of his dementia. There are plenty of other real-life examples of this which I would be very happy to share with any Member of the House or, indeed, the Government.

The Government have already made commitments in this area, so I will not take up any more of the House’s time. However, I ask the Government to give serious consideration to Amendment 114 moved by the noble Lord, Lord Howarth, as this could make a huge difference to many people’s lives.

[The Lord Bishop of Durham]

My Lords, I rise to speak to Amendment 114 in the absence of my right reverend friend the Bishop of London, who is having to self-isolate due to having tested positive for Covid—which seems to be a bit of a theme of the first two amendments.

Members of the House will know that my noble friend is very involved, and was very involved in Committee, in speaking about health inequalities. Today, we want to share and highlight the strength of social prescribing and especially the role of faith organisations in helping to deliver this. There is evidence from the All-Party Parliamentary Group on Arts, Health and Wellbeing and the National Academy for Social Prescribing. But everyone who sits on these Benches would be able to tell you stories of where faith communities and local charities aid and assist with health improvements through activities which happen through them. Through cultural, creative, art, nature—all sorts of—interventions, people find health relief and are moved forward in improving their health.

My right reverend friend the Bishop of London herself runs a health inequalities action group, which she shares with six different faith leaders, healthcare workers and people with lived experience of health inequalities. They all highlight the role of faith organisations as legitimate community assets in delivering social prescription. An example is Art is Freedom, an art exhibition which features the work of survivors of modern slavery, curated by the crisis charity Hestia, which works closely with the Salvation Army. Not very far away from here, in Hackney, some churches run an intervention called Psalms & Stretches—a meditative form of gentle exercise which uses breathing, stretching and strengthening.

There is growing knowledge among multifaith groups—of all faiths—and volunteer organisations of informally doing work to reduce health and social inequalities, so our ask is simply that local communities are included in the solutions towards personal and community health. Civil society and all the people and groups that make it up are doing work that is worth learning from, and we need to consult them, as is mentioned in subsection (3) of the new clause proposed by the amendment. Alongside the professionals, they have insights to offer, so I hope that the Minister will consider the amendment and join us in creatively tackling health inequalities and improving population health through social prescribing.

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[Baroness Altmann (Con)]

My Lords, I rise briefly to support Amendment 141, which I would have added my name to had my noble friend Lord Lansley not done so himself. As he is not here, from these Benches I add my support for the deletion of Clause 155. As an adviser to the Dilnot commission at the time—around 2011—I believe it runs directly counter to the aims of the cap, which had such strong cross-party support. I am sorry to say to my noble friend that I struggle to understand the Government’s concept of fairness in this regard when Clause 155 imposes much greater losses of wealth on the least well off and forces longer waits on them while those with significantly more assets lose only a small proportion of their wealth before state funding starts.

I support Amendment 141. I hope my noble friend will either be able to accept it or that the other place will have a chance to consider this unfair change, which was added at the last moment without giving Members there an opportunity to do so.

[Baroness Greengross (CB)]

My Lords, I am in favour of deleting Clause 155, as proposed by the noble Baronesses, Lady Wheeler, Lady Brinton and Lady Campbell. I will also speak to my Amendment 182, which would lower the social care cap to £51,000 from 2023. I will not be putting my Amendment 182 to a Division but I feel that it is important to bring it back on Report as this would be the level of the cap recommended by the 2011 Dilnot report, then adjusted for care cost inflation. I understand that the Government’s cap of £86,000 is based on the increase in property values since the Dilnot report was published—can the Minister please confirm that? If so, was this for properties throughout the country and does it factor in that, while property values in London have increased significantly over the last decade, in many parts of the country they simply have not? Can the Minister please explain how the Government came up with that figure?

Clause 155 is a break with what is currently in the Care Act, which would mean that means-tested support does not count for an individual’s progress towards the social care cost cap. According to analysis from the Institute for Fiscal Studies, with Clause 155, someone with that care need who has an annual income of £16,000 and assets of £100,000 would take almost six and a half years to reach the cap, whereas without Clause 155 the cap would be reached after three to four years. I declare my interest as set out in the register as co-chair of the All-Party Parliamentary Group on Dementia. For many people with long-lasting forms of dementia who require many years of care, Clause 155 will disadvantage them considerably.

I will be voting to delete Clause 155 and for the Government to return to the sound and sensible recommendations from the 2011 Dilnot report, with numbers adjusted for inflation, and implement them.

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[Baroness Wyld (Con)]

My Lords, this morning, I told my three daughters that they needed to be more assertive at school, but I have completely failed to intervene tonight. I will be very quick in paying tribute to the noble Baroness, Lady Merron, and my noble friend Lord Lansley, who is not here tonight, and in thanking the Government for the amendments on cosmetic interventions. I sponsored the Botulinum Toxin and Cosmetic Fillers (Children) Bill in this House, which assisted with the regulation of non-surgical interventions for children. At the time, we said that this was only the start and that there was a lot more to do. We acknowledged that others had done a lot of spade work, and I pay tribute to all those who have done yet more spade work. I want to put on record my appreciation to the Government for listening and reacting.

[Baroness Greengross (CB)]

I will be very brief because this is a slightly different subject. I shall speak to Amendment 181, which places a duty on the Secretary of State to ensure that each hospital has sufficient accommodation for patients who are rehabilitating and no longer require a hospital bed but still have needs. Further, as part of this duty, the Secretary of State must ensure that any spare land owned by the NHS is considered for this use.

In Scandinavia, patient accommodation of this nature has been part of the state health system since the late 1980s. Having patients stay in these facilities, which are designed to cater for people still needing some medical care, has delivered considerable savings to the public health system. The savings from these facilities is significant. In the previous group, much of our discussion—as always—was about the cost of our health and care system to the taxpayer, and to those who need care. This amendment, as well as delivering better rehabilitation and care for someone recovering from being in hospital, also delivers a significant saving. As I pointed out in Committee, NHS trusts are currently spending money putting up patients in hotels, with rooms costing as much as £275 a night. One London hospital has spent over £1 million on hotel rooms in the last three years. The cost of someone staying in a hospital bed for longer than they need is even greater than that. This is something that I would very much like to take up further with the Government.

Over the last few years, I have been working with a chartered architect who has identified various sites where this could happen throughout England. One is not terribly far from here. This is a real opportunity and I hope the Government will take it to include this as part of the Bill.

[Lord Kamall (Con)]

My Lords, I start by thanking noble Lords who have spoken in this debate. In the end, this turned out to be an eclectic mix of amendments. Given that, I hope I can get the right balance between giving noble Lords comprehensive enough responses, while bearing in mind the more basic need of a dinner break for some noble Lords who have been in this debate today. I will be as brief and as comprehensive as I can be.

I turn first to Amendment 144B. We should be clear that the CQC is not intended to be an investigative body for an individual seeking redress. Other statutory bodies already exist to investigate individual cases and complaints, including the NHS complaints system. If complainants remain unsatisfied, they can raise their complaint with the independent Parliamentary and Health Service Ombudsman. Where the risk is serious or life-threatening, the CQC can act on a single concern and take regulatory action. Similarly, complaints about adult social care services should be made first to providers. They can also be made to the local authority, if the local authority is commissioning the care. Thereafter, complaints can be made to the Local Government and Social Care Ombudsman. Providers must investigate all complaints thoroughly and take necessary action where failures have been identified. The CQC monitors health and social care providers’ complaints processes and can compel providers to provide a summary of complaints received and their responses. Failure to do so within 28 days is considered a breach of the regulation and could lead to prosecution of the provider.

On Amendment 147A, I hope to assure the noble Lord that work is already in place for a framework for assuring the quality of people working in social care. Registered managers are already assessed by the CQC, to confirm their fitness to be registered. Nurses are regulated by the Nursing and Midwifery Council and social workers by Social Work England. Any person delivering personal care must have a DBS check. If, in the future, it was decided that adult social care workers in England should be subject to statutory regulation, the power to do so already exists in Section 60 of the Health Act 1999.

I turn now to the amendments in my name. I start by thanking the noble Baroness, Lady Merron, for raising this issue with the House, and thank all those noble Lords, including the noble Baroness, Lady Finlay, who have raised concerns about the need for regulation of this ever-evolving industry. As I hope noble Lords will now acknowledge, the Government are committed to improving the safety of non-surgical cosmetic procedures by establishing a licensing system. This will support the introduction of consistent standards that individuals carrying out such cosmetic procedures will have to meet, as well as hygiene and safety standards for premises. The definitions in the amendment are intended to cover the broad range of cosmetic procedures which, if improperly performed, have the potential to cause serious injury and harm. The subsequent regulations will set out in detail the treatments to be covered by the licensing system, and the detailed conditions and training requirements individuals would have to meet. The purpose of this amendment is not to ban procedures or stifle innovation, but rather to ensure that consumers who choose to undergo a cosmetic procedure can be confident that the treatment they receive is safe and of a high standard. The Government will work with stakeholders, including noble Lords, to put in place a licensing regime that works for both consumers and providers, protecting those who choose to receive cosmetic procedures without placing unnecessary restrictions on legitimate businesses.

The noble Baroness, Lady Finlay, asked me a number of questions, so I will try to answer them. I begin with radiofrequency. Given the broad range of skin-tightening procedures, proposed new subsection (2)(e) provides scope to encompass a variety of treatments which involve a wide range of application techniques, including radiofrequency and ultrasound devices. The aim of the licensing scheme is to protect the public from the risk of harm. To achieve this, the regulations will specify the standards of training required. The proposed new clause will also allow regulations to make provisions about the duration, renewal, variation, suspension or revocation of licences.

The range of non-surgical cosmetic procedures available to consumers is vast. Therefore, drawing up the regulations will require detailed consultation with a range of stakeholders. This will include a number of partners, such as the cosmetics industry and local authorities. We will try to do this as quickly as possible, while ensuring that the list is as comprehensive as possible. We will try to get that balance. For these reasons, I hope I can ask noble Lords to support these amendments and I ask the noble Baroness to consider not moving her amendment.

Health and Care Bill

Baroness Greengross Excerpts

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

[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.

[Baroness Greengross (CB)]

My Lords, I want to add my support particularly for what my noble friend Lady Hayman has just said. This has gone on for a long time. I have been involved in it throughout my time as a Member of this House and I do not intend to repeat what I have said before. I want just to say that the amendment in the name of the noble Lord, Lord Forsyth, offers a useful way forward so that assisted dying is given time in both Houses to be debated properly. It must be given serious consideration. Whether one is for or against changing the law on assisted dying, we all surely agree that this is a very serious issue worthy of serious scrutiny and debate. It is unacceptable that, once again, my noble friend Lady Meacher’s Private Member’s Bill risks being lost, due not to lack of support but to not enough time being allowed to take the Bill through all its stages.

Assisted dying is very much related to health and care, and it is appropriate that this amendment should be included as part of this Bill.

[Lord Baker of Dorking (Con)]

My Lords, this is the second occasion on which I have spoken on assisted dying in your Lordships’ House. Five years or so ago, I supported the Bill in the name of the noble and learned Lord, Lord Falconer, and voted for it. I did not speak on the Bill in the name of the noble Baroness, Lady Meacher, but I was ready to vote for it. However, as we know, the vote was not called because the opponents of the Bill feared that, if there was a vote, there would be an even larger majority in favour of the Bill on that occasion than there was earlier, because the arguments against assisted dying are shrinking year by year.

This House has now accepted on two occasions a Second Reading for a Bill to ensure that assisted dying is placed on our statute book. That is the political and democratic decision of this House, yet it has now been thwarted twice, and the thwarting is most extraordinary.

We managed to survive constitutionally in the 17th, 18th and 19th centuries without trying to kill legislation by tabling so many amendments. It was a device invented by Conservative Back-Benchers in the 1970s to prevent a Bill passing through the House of Commons that prevented the hunting of foxes by dogs. A small number of devoted hunters devised this trick. The Member of Parliament was Marcus Kimball; older Members might remember it. It was a political trick which has been used in this House on three occasions: on the Bill of the noble Lord, Lord Grocott, on hereditary Peers; on the Bill of the noble and learned Lord, Lord Falconer; and on the Bill of the noble Baroness, Lady Meacher.

I remind your Lordships that the only way in which we as Back-Benchers in the House of Lords can effect personal influence on social change is through Private Members’ Bills. There is no other way in which we can effect a policy—we are all controlled by the agenda of the Government—yet we are being denied this. The democratic choice of this House in passing the Second Reading on two occasions is very clear, and it is being thwarted. That is very unfair.

I told my Whip three weeks ago that I was going to come in and support my noble friend Lord Forsyth’s Bill and vote. He said, “It doesn’t matter; it’s a matter of conscience”. He confirmed that in an email to me last week and in a conversation I had with him on Monday. I do not believe my Whip was lying—it was the Government’s view—but suddenly the Whip was changed last night, right at the last minute. Somebody must have spoken to people in the House of Lords, because the view has been very clear since my noble friend Lord Forsyth tabled his amendment. It was clear that the Government—a Conservative Government—were going to be asked to prepare a Bill on assisted dying and, in a reasonable amount of time, find time for it to be debated.

The great social reforms we have had in the last 50 or 60 years all started with the Government of the day being prepared to find time for them. The Wolfenden report in 1957 recommended the decriminalisation of homosexual activity. That was opposed by many Conservative Back-Benchers, yet the Conservative Government of the day made time for it to be debated. When David Steel produced his Abortion Bill, the Government of the day—I think it was the first Wilson Government—made time for it to be debated. Thirdly, when Roy Jenkins as Home Secretary introduced a Bill to abolish hanging, the Government of the day found time for it to be debated.

That is the principle, so I expected that we were going to have a free vote tonight. I am simply amazed that the Government have now suddenly changed the Whip. Someone has spoken to them. I do not expect the Minister to accept that, but somebody from the other House has certainly spoken to the Government and said, “We don’t want to be in a position to have to draft a Bill on assisted dying and find some time in the not-too-distant future for it to be debated”.

We are not suggesting that the Meacher Bill should come back and be debated in May or June this year, in this parliamentary Session, but there are other parliamentary Sessions in which it could be introduced: 2022-23, 2023-24 or 2024-25. If it has not been decided by the next election, I very much hope that all of the four major parties in our country—the Conservatives, Labour, the Liberals and the Greens—have a clear undertaking in their manifestos that, if they were elected, time would be found for the two Houses of Parliament to make up their minds whether they wanted assisted dying on our statute book. I am quite happy to leave that decision to the British people because, unlike the noble Baroness here, I happen to believe that the argument has moved decisively as far as the people of this country are concerned. There are now far too many people who have seen relatives or friends die long, lingering and miserable deaths.

The original argument against assisted dying was sanctity of life. I found it extraordinary that in the debate of the noble Baroness, Lady Meacher, not one of the Bishops or Archbishops addressed the sanctity of life. Other arguments are now put forward: the vulnerability of people who are dying, with relatives gathering around and wanting to polish them off—things of this sort, all of which can be addressed by amendments to the Bill.

I am very surprised that a Conservative Government should decide to vote against my noble friend Lord Forsyth. He and I go back a very long way. Thirty years ago he was the chairman of the Conservative Party in Scotland—that was when we had a Conservative Party in Scotland—and I was the chairman of the Conservative Party in England. I got to know him very well, and I can think of no one who more embodies conservatism in his whole mind and being than my noble friend. Whether it was a question of lower government expenditure, lower taxes, greater freedom of choice on housing or greater freedom of choice for parents, he was there. Conservatism runs in his blood—he has the bluest of blood—and I think it an insult to him and a disgrace that the Whips on my side of the House have said we should vote against him.

I hope that this amendment will be passed and that this House will recover the sense that, without it being passed, your Lordships’ democratic choice, which has been exercised on two Bills, is being totally disregarded by a political trick. That is simply not right.