Health and Care Bill

Baroness Jones of Moulsecoomb Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Baroness Jones of Moulsecoomb (GP)]

My Lords, it is a pleasure to follow the noble Lord, Lord Bichard, who talked about his parents. My parents never owned their own home, but they had exactly the same emotional reaction to the creation of the NHS and the security it would give them in later life. I extend a Green Party welcome to the noble Lord, Lord Stevens of Birmingham. I am probably going to disagree with him today, I am afraid, and possibly many times in the future, but I welcome him anyway. I enjoyed the humour in his speech; there is never enough humour in this House, so that was fantastic.

I have no expertise in health and no role of any sort in the care system, but I do have a small expertise in government failings. It would be hard to be an expert in them, because there are so many, but I can spot when the Government are making a big mistake and this Bill is one of them. I will talk about three issues; I am going to gallop through them because I am well aware that we have been given a tiny amount of time. The first is fluoridation; the second, carrying on from that, is dentistry; and the third is drugs.

About a quarter of the population does not trust tap water and refuses to drink it. This has obvious consequences for the environment, as most of those people will be drinking water out of plastic bottles instead. Mass fluoridation is not going to help people to trust tap water. The Government are making a decision to mass-medicate populations by modifying their drinking water without any explicit informed consent. The pandemic has revealed an atmosphere in which scepticism of expert advice and anti-science sentiment runs high. Forced fluoridation risks entrenching anti-science views in a significant segment of the population, making future public health interventions that much harder. Other options have been found in other countries, for example fluoride pills or fluoridised milk.

It is obvious that the dental care crisis has been brewing in this country for a very long time. It seems harder and harder to get an appointment with a dentist or even to register with one. People are being turned away and told that the practices are full, so the Government need to get a grip on dental care and change the contracts that pay dentists. These currently operate on a quota system; those quotas are nowhere near sufficient to provide for the level of population in need. Dentistry should be provided on the basis of need, not an arbitrary quota set by the Government. On a related note, the Government need to get a handle on the severe health inequalities experienced by people facing social exclusion, such as people who are homeless, those with substance misuse issues and Gypsy, Roma and Traveller communities.

On the topic of drugs, the Government are failing completely on addiction treatment. By talking constantly about the war on drugs, they are trying to avoid the fact that that war is lost. We have to do drugs differently: we need a drugs policy which prevents criminals profiting from the supply of drugs. That is why the Greens support a legalised, regulated system of drug control, focused on minimising harm to individuals, society and the environment. The war on drugs has been a catastrophic failure. As ex-undercover police officer Neil Woods says in his book Drug Wars, we have lost that war. I suggest that your Lordships read it; he was an undercover officer working among drug gangs and experienced that at first hand.

It is time to take a health and care approach to the whole drug problem—and we obviously have a drug problem at the other end of this building. I am curious as to what the Government are going to do about that. If 10 out of 12 lavatories tested had cocaine in them, there are clearly quite a lot of MPs, or staff, using cocaine. I would have thought that one of the first stops on the Minister’s reconnoitring today would be to make sure that people stop using those drugs here in Parliament.

There is so much wrong with the Bill, like so many other pieces of legislation that we get in this House, that I will give the Minister two bits of advice. First, it should go back. He should take it away and say to whoever wrote it, “Make it better”, and bring it back to us in the sort of condition where we can amend it and do a bit of redrafting, not the wholesale redrafting that it needs. Secondly, he made some very uplifting comments about the NHS at the start of his speech. Why not give NHS staff the pay rise they deserve? That is what we would like to happen.

Health and Care Bill

Baroness Jones of Moulsecoomb Excerpts

Committee stage & Lords Hansard - Part 1
Tuesday 11th January 2022 Lords Chamber

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I generally support the direction of the Bill. I welcome it; I think a move towards less competition and more collaboration is the way forward. I support—[Interruption.]

[Baroness Jones of Moulsecoomb (GP)]

I am so sorry.

--- Later in debate ---

[Baroness Jones of Moulsecoomb (GP)]

My Lords, I rise as a member of the general public who can barely tell the difference between paracetamol and ibuprofen but does know, after all my years observing people, that people in good mental health often exhibit much better physical health as well, because they have more resilience, they are more aware of their physical health and they take measures to make themselves healthier. Parity of esteem is a beautiful concept because it does not sound competitive and the more we spend on mental health, the less we might have to spend on physical health. Therefore, it is a no-brainer. I am astonished that the Government did not put it in the Bill when it is such a well-known concept. I very much hope that the Minister will—[Interruption.] That was a Tory intervention and now there is a Labour intervention.

I understand that this is a huge challenge, but it is just smart, quite honestly. It offers us a chance to make a real positive change—a societal change for people. I also very much support Amendment 5 tabled by the noble Lord, Lord Stevens, and all the subsequent changes through the Bill, and Amendment 138, tabled by the noble Baroness, Lady McIntosh of Pickering, which my noble friend Lady Bennett has also signed. I look forward to subsequent discussion with the Minister on this issue.

[Baroness Tyler of Enfield (LD)]

My Lords, I rise to speak to the rather large list of amendments in this group—15 at the last count—to which my name is attached. I declare my interests as laid out in the register, particularly my new registered interest as a non-executive director of the Royal Free London NHS Foundation Trust.

Before turning to specific amendments, I have a couple of general points which apply across the board. The first concerns the scale of demand. Despite welcome investment and greater focus in recent years on mental health, there are now an estimated 1.6 million people waiting to access mental health services and so on a waiting list, and prevalence data suggests that some 8 million people with emerging mental health issues would benefit from services if they were able to meet the thresholds to access them.

Frankly, there are still too many instances of mental health services not being prioritised, such as the lack of investment in the mental health estate, which has a real impact on the trust’s ability to ensure both a safe and, particularly, a therapeutic environment. Also, the Prime Minister’s announcement on investment in new hospitals almost entirely overlooked the needs of mental health trusts.

The second general point is that the need to replicate the parity of esteem duty in the 2012 Bill throughout this Bill is more important than ever at a time when there is growing unmet need across multiple areas of health and care. Local health systems therefore face difficult choices around the allocation of resources. The full mental health impact of the pandemic is still emerging but mental health trust leaders report extraordinary pressures; in particular, a high proportion of children and young people not previously known to services are coming forward for treatment, often more unwell and with more complex problems.

The various amendments in the names of the noble Baroness, Lady Hollins, and my noble friend Lady Walmsley to which I have attached my name, and which I strongly support, recognise the important role that NHS England, ICBs, NHS trusts and foundation trusts will each have in advancing parity of esteem between mental and physical health. It will be important that amendments to the Bill that explicitly require the prioritisation of both physical and mental health are made at each level of the system. Simply put, trusts’ ability to prioritise both physical and mental health is crucially dependent on the extent to which integrated care boards and NHS England do the same. Ultimately, of course, each level in the system’s ability to meet this requirement is reliant on the Government prioritising both physical and mental health.

I will turn briefly to various sets of amendments. As I have said, a lot of these amendments are about explicitly including mental health on the face of the Bill, at each level and relating specifically to the NHS triple aim. I want to explain why that is important. As I said, Section 1 of the Health and Social Care Act 2012 enshrined in law a duty for the Secretary of State to secure parity of esteem between mental and physical health services. While the new Bill does not remove the duty from the Secretary of State, it fails to replicate it in the triple aim, and this sends out an unhelpful message. I fully accept that culture change needs far more than legislation but legislation can and does send an important signal, which is why we need parity of esteem strengthened throughout the Bill.

We know that the burden of mental illness in the UK far outstrips spend and that referrals to mental health services were at a peak during the pandemic. Thus, I strongly support the amendments tabled by the noble Baroness, Lady Hollins, and my noble friend Lady Walmsley which explicitly reference mental health in parts of the Bill setting out how the triple aim applies to trusts, foundation trusts, integrated care boards, NHS England and the licensing of healthcare providers. This would ensure that the whole of the NHS is aware of its duties around parity of esteem.

I turn briefly now to what is happening at the local level. A recent survey by the Royal College of Psychiatrists found that almost two-thirds of responding psychiatrists considered that their local area had been ineffective in working towards parity of esteem, and fewer than one in 10 said that their local area was effectively promoting parity. That is why each ICB should be required to promote parity; it should be included in their forward plans and they should be required to report on it as part of their annual reports. This would help transparency and help to hold the system to account; that is why I have added my name to the amendments from the noble Baroness, Lady McIntosh, and strongly support a separate amendment from the noble Baroness, Lady Hollins, which calls for a duty on ICBs to promote and seek parity of esteem between physical and mental health and, critically, to annually report on their efforts to do so.

I come now to the Secretary of State’s responsibilities in all this. Having the parity of esteem in the 2012 Act has helped to secure welcome and important initiatives, such as the five-year forward view for mental health and the review of the Mental Health Act. Amendment 263 in the name of the noble Baroness, Lady McIntosh, to which my name is attached, builds on this duty and requires the Secretary of State to outline to Parliament how the resourcing of mental health services and prevention efforts have ultimately improved care for people with mental illness and those at risk of developing poor mental health. This will bring further and much needed parliamentary scrutiny to this issue, and help us understand how we can build on current efforts to improve care and, most importantly, improve outcomes.

I turn finally to Amendments 5, 12 and 136, in the name of the noble Lord, Lord Stevens, regarding the funding of mental health. Of course, financing is one of the most important indicators of parity of esteem—if it is real—and legal teeth to ensure clarity on it are absolutely critical. As I highlighted earlier, even with recent efforts, spending on mental health is not commensurate with the burden of mental illness in this country. Indeed, a King’s Fund analysis recently found that mental health outcomes accounted for 23% of the burden of ill health in the UK but received only 11% of spend for both prevention and treatment.

The Government’s recent spending review did not specifically allocate any additional funding for mental health services, despite over £44 billion being pumped into the NHS over the course of the spending review and services facing increased and sustained pressure. The mental health sector has made it clear that it will need to cut services from April 2022 if additional funding is not received. The noble Lord, Lord Stevens, is very well placed to know the right mechanisms and levers to pull to ensure improvements in how we fund mental health services, and how different parts of the system are held accountable for their efforts to do so.

These three amendments, which build on the mental health investment standard—something I very much welcomed at the time—at a local level for ICBs, adding an additional legislative lever and helping to increase overall transparency on how local areas fund mental health services, are extremely important. Finally, at national level, I strongly support the need for greater transparency for both the Government’s intentions on mental health spending and NHS England’s response to, and meeting of, these intentions.

While we often hear encouraging and warm words of support on mental health from the Government—and they are welcome—these amendments would make clear where those words have been put into action. As the old saying goes, what gets measured gets done.

Health and Care Bill

Baroness Jones of Moulsecoomb Excerpts

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

[Baroness Jones of Moulsecoomb (GP)]

My Lords, the Green group would like to throw its considerable weight behind the two noble Lords who have just spoken. What we saw last night was disgraceful, and I hope we never see it again.

[Earl Howe (Con)]

My Lords, in the absence of my noble friends the Leader of the House and the Chief Whip, I will respond very briefly to the noble Lords who have spoken by saying that I shall ensure that the comments and questions do reach the Leader, and are treated with appropriate seriousness. We have all heard propositions from both noble Lords on the Front Benches opposite with which there would be wide agreement in the House as to the way we should conduct ourselves. In a spirit of sympathy with many of the comments made, I hope noble Lords will agree that it is appropriate that we discuss this in the usual channels.

Amendment 284

Health and Care Bill

Baroness Jones of Moulsecoomb Excerpts

Lords Hansard - Part 1 & Report stage
Thursday 3rd March 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I will just speak to my Amendments 111 and 168. On Amendment 111, when the noble Baronesses, Lady Brinton and Lady Masham, and the noble and learned Lord, Lord Mackay, have already put forward the arguments, there is very little for me to say, but the exclusion of the Scottish colleges from the appointment process needs to be rectified. It is an irritant, a hold-up.

In Committee, the noble Lord said that we needed to go through consultation. That was a dreary and negative response. The Scottish colleges have done that. They have consulted and got the support of the Academy of Medical Royal Colleges, NHS Employers and the NHS Confederation. Surely the Minister can just accept this amendment. To simply say that there is no need for it and lots of consultation has to take place is just a ludicrous waste of time and money. This is the time to do it. He should bring an amendment back on Third Reading and be done with it. The noble Lord says that he wants to improve efficiency in the health service. I am afraid I take that with a pinch of salt, because he is just letting officials run riot around him in relation to petty, bureaucratic objections to this change.

Obviously, my other amendment is not major compared to Amendment 80, which is substantial and very important. The noble Baroness, Lady Cumberlege, has really put it forward with great force. Again, I think the noble Lord needs to take a more vigorous approach with the Treasury, because clearly that is where the objection to this is coming from.

My other amendment is about the terrible problem of GP distribution, or the wide variations. I am not going to tempt the noble Baroness, Lady Cumberlege, to come in on the GP issue—but the latest figures, for 31 December 2021, show, for primary care networks in England, the huge variation in the number of GPs. In 24 of the networks, the average list of registered patients for fully qualified full-time equivalent GPs is more than twice the national average. There are five primary care networks where the average is more than three times the national average; these are often in the most deprived areas. No wonder there is an issue of burnout, early retirements and a move to part-time working.

The Government’s response so far is the targeted enhanced recruitment scheme—an incentive for GPs to go into these areas. It is not enough; a much more substantive piece of work is required, and I hope again that the Minister will come forward with a positive response.

[Baroness Jones of Moulsecoomb (GP)]

I shall speak to Amendment 82 in the name of my noble friend Lady Bennett of Manor Castle. I attended Second Reading and made my views felt then, but I have not been able to join the deliberations on the Bill since then because of the pressure of other Bills in your Lordships’ House.

Even I, as someone who does not know very much about medicine, know that the most urgent challenge currently facing our health service is a shortage of nurses. I have been lobbied very heavily by the Royal College of Nursing, because Amendment 82 is its number one priority. It feels that, without a co-ordinated work plan, a coherent forward view and knowledge of exactly how the situation is at the moment, it cannot possibly achieve the sorts of numbers that are needed. There were almost 50,000 vacancies before Covid, and you can imagine the pressure that Covid has put on to the NHS—extreme pressure at completely unsustainable levels, and with staff numbers that are actually unsafe. We all know this, yet Boris Johnson and the Conservatives made big promises at the last election—their manifesto made a promise of 50,000 more nurses—and instantly that number began to unravel, as it included existing nurses who do not quit. That is unclever and unsophisticated number crunching.

I do not understand why this Government will not live up to their manifesto commitments. One reason why I have not been able to speak on this Bill since Second Reading is because of all the other Bills coming through, on which the Conservatives have said that they are aiming to achieve their manifesto commitments. They are actually going rather beyond their manifesto commitments in lots of areas—but the fact is that they are picking and choosing as if from a box of sweets the ones that they prefer.

The Royal College of Nursing represents over 480,000 nurses in health and social care. These are people whose pay requests are constantly ignored—and who constantly have their pay cut; in real terms, it has reduced. Just at the point when MPs are getting very welcome extra pay, nurses hang on by their fingertips. We know that vacancies are also a huge problem, with retirement age approaching for a lot of nurses. Nurses need the certainty of planning, and I do not hear those plans coming from the Government, although this is really their job—to manage the economy and manage society in a way that benefits everybody. Clearly, if the NHS fails in any area, that does not benefit anybody at all.

I argue very strongly for Amendment 82, and I just hope that the Government wake up in time to see how necessary it is.

[Lord Stevens of Birmingham (CB)]

My Lords, I am very pleased to co-sponsor the amendment proposed by the noble Baroness, Lady Cumberlege, Amendment 80, and to speak in support of a number of the other amendments in this group. I declare my honorary fellowship of the Royal College of Physicians and the Royal College of GPs, and thank them and the 100 other organisations across the health and social care sector that have joined in the cross-party support that this amendment is likely to generate.

In considering how to vote on this amendment, I think it really boils down to two very straightforward questions. First, do we need regular, rigorous and independent workforce planning for health, social care and public health? The social care point, as the noble and learned Lord, Lord Mackay of Clashfern, has just reminded us, is so crucial here. The second question is: if so, will we get it, with appropriate rigour and independence, without this amendment? I suggest that the answer to that question is, unfortunately, no.

The first question is self-evident to most people. We discussed it throughout Committee: workforce pressures mean that it is obvious that we need regular workforce planning. The very long lead times make it critical. Earlier this week, your Lordships were debating pressures in young people’s mental health services and eating disorder services. It is worth reminding ourselves that a new consultant psychiatrist specialising in eating disorders, starting work in NHS mental health services this morning, will have entered medical school 15 years ago. It is worth reminding ourselves, too, at a time when the NHS is confronting long waits for routine operations and needs to deal with a backlog of care, that the new medical student starting undergraduate medicine in September will report for duty as a consultant orthopaedic surgeon in 2037.

So the lead times are clear, yet we have a paradox: more young people and, indeed, mid-career people, would like to join this great campaign, this social movement—the health service, social care and public health—but we are turning them away. In 1945, Nye Bevan said:

“This island is made mainly of coal and surrounded by fish. Only an organising genius could produce a shortage of coal and fish at the same time.”


I suggest that, if Bevan were recasting his aphorism for today, he would say that, at a time when the NHS and social care have such a clear need for more staff, only a workforce planning system of organisational genius could turn away bright and committed young people from undergraduate medicine and other oversubscribed university places for health and other professions.

We have to accept that there will be extra costs from getting this right. The noble Baroness, Lady Cumberlege, was quite right to draw attention to the fact that there will be savings, including from the £6.2 billion spent in 2019-20 on agency and bank staffing across the health service. But there will be extra costs: the Royal College of Physicians has estimated that doubling undergraduate medicine places would cost perhaps £1.85 billion, which is about one-seventh of the amount that the House of Commons Public Accounts Committee identified last week as being likely to be lost from fraud and waste through the various furlough and other schemes introduced during Covid. So I think we need to put these costs in perspective.

The fact that there will be those costs gives us the answer to our second question. Of course, we need workforce planning, but are we going to get it without this amendment? I am afraid that I do not think we are. In Committee—although I shall not rehearse it—using publicly available materials, I set out the sorry history of what I described as the “wilful blindness” that has been inflicted on the health and social care sector and, indeed, on health Ministers and the Department of Health and Social Care itself, as they have sought to go about this task down the years.

The question before your Lordships is: has the leopard changed its spots? I suspect—and I genuinely sympathise with the Minister’s predicament—that he will tell us that the baton has now been passed from the Department of Health and Social Care to NHS England, so that for the first time it has the responsibility for undertaking this task, and we should be reassured by that fact. In that case, I ask him to give clear guarantees at the Dispatch Box that the proposed new powers of direction for the Secretary of State will never be used to veto or censor any independent estimates that NHS England itself puts forward, including those with a financial consequence. Indeed, I ask that he goes further than that and gives us a Dispatch Box guarantee that NHS England will be entirely free to publish, every two years, without approval, veto or censorship from either the Department of Health or the Treasury, the workforce need, demand and supply models implied in Amendment 80. If those guarantees are not forthcoming from the Dispatch Box, I think your Lordships will be entitled to draw your own conclusions.

Health and Care Bill

Baroness Jones of Moulsecoomb Excerpts

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

[Lord Warner (CB)]

My Lords, my Amendment 100 requires NHS England to

“conduct a public survey of whether patients have been offered choices about where they obtain treatment and must report to the Secretary of State what action they will take as a result of the survey.”

I am grateful for the support of the noble Lords, Lord Hunt and Lord Lansley, and the noble Baronesses, Lady Cumberlege and Lady Brinton.

Currently, there is no regular survey of whether patients are aware of their right to choose or of how many have exercised it. The last NHS England official survey of whether patients were aware of their choices was in 2015, when just 47% of those questioned said they were aware.

Waiting times vary enormously by geography. Knowing about the right to choose could mean a significant cut in the waiting time for treatment. For example, waiting times for orthopaedic care vary from 89 weeks in Bedfordshire Hospitals NHS Foundation Trust to 25 weeks in the relatively nearby Milton Keynes trust. Recent polling by the Royal College of Surgeons showed that 73% of patients questioned would willingly travel to a surgical hub which was not their local hospital if they could be treated more quickly.

There is no system for monitoring whether patient choice is working. Amendment 100 fills this gap and restores the situation to where it was before 2015. I hope the Minister will accept this simple amendment in the interests of patients.

[Baroness Jones of Moulsecoomb (GP)]

My Lords, I am implacably opposed to privatisation of the NHS—not for ideological reasons, although the Green Party is strongly opposed as well. I think it is inefficient. Privatisation has not worked. It has failed to deliver on promises to increase quality, decrease cost and help patients. Rather than save money through reduced bureaucracy, the main cost savings of privatisation seem to be in cutting the terms and conditions—chiefly the pay and pensions—of staff. If private companies can compete for public services, let them compete on a level playing field, rather than simply capturing staff and paying them less.

I am pleased that the noble Lord, Lord Lansley, explained his Amendment 98 because I had understood it completely the other way around—that he was protecting private services. I was going to have a word with him afterwards about it, but there is now no need.

As the noble Lord, Lord Hendy, just said, most people in Britain do not want a privatised NHS. They want a public service because that is what will give them the best results.

[Baroness Thornton (Lab)]

My Lords, this group contains a number of helpful amendments. I welcome the amendments that the Government have tabled in response to the many and varied discussions we have had. I am grateful for this positive and constructive approach, which proposes transparency at the heart of procurement.

We have discussed with the Government at some length why the NHS has to have its own bespoke procurement regime, which the Bill paves the way for. We have seen two consultation documents about the scope, scale and nature of this bespoke regime. Although they seem quite sensible, we have been assured that the Government feel that the regulations will be based on a sound foundation.

The noble Lord, Lord Warner, is quite right about patients not knowing their right to choose. It is a hole in the provision. The right to choose is very important. People absolutely do not know that they have it.

While not being explicit, the new providers’ selection regime will actually get us to where Labour tried to get in 2010 with the NHS as the preferred provider, at least as far as the many complex and expensive services provided by NHS trusts, FTs and other core patient-facing services are concerned. Therefore, the principle is fine. The problem is that it does not extend across everything that the NHS procures, and that is partly the nub of what my noble friend said in his amendments, which I will return to in a moment.

Our view is that in any circumstances where competitive procurement is to be used, the national rules apply, so why does the NHS need a bespoke system for all non-clinical stuff? We have never actually had an answer to that, except that the NHS comes up with wider regulations, and we feel that that it is a waste of time and effort. However, we have had ample assurances from the Government that the NHS bespoke regime will be properly documented and all the rules set out, with some route to enforcement and challenge. We are assured that there will be no award of contract without applying the process that is set out—no back doors and no flexibility when contracting with private companies. With those assurances in mind and the knowledge that campaigners and trade unions will be vigilant and might even stump up for judicial review, and because of the ICB amendments agreed earlier in the week, we will get more or less what we wanted and we will not try to remove Clause 70 from the Bill.

I turn to the remarks of my noble friend Lord Hendy, who has our sympathy and approval. Had we been discussing this at a different time of day, we may have sought to support some of his amendments, and certainly the spirit of them. He has posed a legitimate question to the Minister: why do the Government not insist on good employment of staff as a criterion for their procurement regime?

We on this side of the House remain opposed to the outsourcing of NHS-funded services such as cleaning, catering and many others because we can see that it has led to staff being transferred into the private sector, corners being cut and standards dropping. It has been a symptom of chronic underfunding and it is a terrible long-term strategy. It has of course been completely counterproductive because it has sometimes meant that our hospitals have not necessarily been cleaned, serviced or looked after as we might have wished them to be. We have tried at various stages to introduce safeguards and to outlaw altogether the NHS’s tax-dodging habit of setting up SubCos, but those are probably matters for another day.

I would say to my noble friend that I am not sure that changing the procurement regime is the best way forward for this issue, although he has our support in the politics and context in which he introduced his amendments.

Health and Care Bill

Baroness Jones of Moulsecoomb Excerpts

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

[Baroness Finlay of Llandaff (CB)]

My Lords, I feel I have to remind the House that we have had 95 hours of debate in recent years on this topic; and the implication that we have not debated this is a misrepresentation. The noble Lord, Lord Forsyth, has asked us not to talk about assisted dying but then actually did talk about some aspects. We are being asked to test the willingness in both Houses, but I remind the House that the Marris Bill started in the Commons, was debated there and was defeated there by 330 votes to 118. That is where a Bill like this should start.

It is true that, historically, there have been major changes. Those have been in Bills that started in the House of Commons, when the public understood what they were about. The public knew what capital punishment was, and they know what homosexuality is. These Bills started in the elected House, and they then came to this Chamber. That has been our procedure.

I would, though, like to challenge the claim that there is overwhelming support among the public. I think it is questionable. In the poll, when asked a bit more detail, 57% of the public did not understand what assisted dying is; 42% think it is your right to stop treatment, which is already a legal right; and 10% think it is hospice care. Dignity in Dying has said it wants to have the largest record of public support, yet to date it has less than 0.5% of the population of England and Wales signed up to this list. So I do think we have to look at some of the claims being made and think about them.

Whatever noble Lords think about assisted suicide and euthanasia, this amendment would set a dangerous constitutional precedent for any Government. It is surprising that the noble Lord, Lord Forsyth, with his deep respect for parliamentary processes and Governments being able to govern, has taken this approach, because this amendment would set a precedent enabling any Back-Bencher from any pressure group to disrupt a Government’s agenda. Does the noble Lord plan to bring judicial proceedings if his proposal is not tabled in a year? That is the criterion in the text of his amendment. A draft Bill leads to a Bill, assuming and forcing government support, before exploring evidence of the complexities of licensing doctors to provide lethal drugs.

We do indeed already have a Bill before us, and it is awaiting debate. The amendments laid are not vexatious. Based on the extensive evidence from abroad, they expose the problems with the proposals from the noble Baroness, Lady Meacher. Where assisted dying is legal, palliative care has dwindled, legislation has widened, the safeguards have been seen to fail, and non-assisted violent suicide rates rise disproportionately. Post-event reporting, as in her Bill, does not work because it relies on the clinician. I could go on, but I will not.

Yet surprisingly, no request was made for Committee until months after Second Reading, and no one seems to have sought to discuss the amendments that have been widely criticised by those who have spoken today. Some Members openly want the prognosis requirement to be dropped from the Bill to make legal drugs available on request. We have to at least know what the content of the Bill is even before we proceed. An 18 year-old with severe anorexia is already eligible under the Bill that is currently before the House. The answer to harrowing accounts of inadequate care is not to force the Government to draft a Bill that would allow doctors to supply massive overdoses of unevaluated lethal drugs to patients. Good, holistic, palliative care has been made a right in this Bill by this Government, and people should ask for it and insist on it.

This amendment is not the way to seek a careful analysis of the complexities of assisted suicide and euthanasia. It creates a constitutional headache for any future Government’s ability to govern. The procedure is to debate a Private Member’s Bill properly in Committee; and that Private Member’s Bill should start in the elected House.

[Baroness Jones of Moulsecoomb (GP)]

My Lords, I hate to disagree with the noble Lords who have spoken against this amendment, almost as much as I loathe supporting the noble Lord, Lord Forsyth, on anything. But, for me, this is a matter of democracy. Public opinion is constantly moving on this, and it becomes more and more supportive as the public understand the issues involved. It is partly the duty of the Government to explain exactly what it is about. Having a proper debate like this is something we should all support.

Personally, I want this on the statute book before I need it. I have five grandchildren, and I try to talk them all into pushing me over a cliff if I were to get too ill. As soon as their mothers told them that it was illegal, they refused me. The idea remains that this is something which many of us want for ourselves, because we fear being incapable. Therefore, I support Amendment 170.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I would like to put a point to the noble Lord, Lord Forsyth. He said that his amendment simply provides time for Parliament to consider an assisted dying Bill. I note that proposed new subsection (2)(a) also says that the Secretary of State should

“respect that this is a matter of conscience”.

But a draft Bill is a draft Bill. It will be prepared by a government department; instructions will be given by solicitors, after consultation with Ministers, to parliamentary counsel; and that Bill will eventually be approved by Ministers in the relevant department and put before Parliament. There will be a Minister in charge of the Bill. Whatever mechanism is chosen—maybe a Joint Select Committee of both Houses—to consider the draft legislation, the Minister will be in charge and will be seen by the public to be driving through a Bill. If the noble Lord had said in his amendment that more time should be given for the Private Member’s Bill, I would have supported it. Businesses managers clearly need to take account of the obvious wish of this House to have more time to debate it—