Health and Care Bill

Baroness Northover Excerpts

Lords Hansard - Part 2 & Committee stage
Thursday 13th January 2022 Lords Chamber

[Lord Stevens of Birmingham (CB)]

My Lords, it is a great privilege to follow the noble Baroness, Lady Hayman, and support all the amendments in this group in her name. I speak particularly to Amendments 201 and 210 which, as she said, refer specifically to using the purchasing power of the NHS to drive this agenda. Given how brilliantly she has set out the case, I shall be extremely concise.

There are two evidence-based reasons why these amendments are important. The first, as the noble Baroness said, is because the health consequences of the environmental crisis are increasingly clear. The Royal Society and the Academy of Medical Sciences laid all of those out. Whether on heat-related deaths, the disruption to care through climate emergencies, the increased risk of vector-borne infectious diseases, or the fact that up to a third of preventable asthma cases may be linked to the consequences of air pollution, the health case for action is clear. The second evidence-based reason, again as we have just heard, is that unfortunately healthcare itself is not blameless. It is part of the problem as well as part of a solution. By one estimate, if all the health systems in the world were their own country, they would be the fifth-largest greenhouse gas emitter on the planet. Therefore, the NHS must get its act together, given that it contributes 4% to 5% of our country’s emissions.

Those are the two evidence-based reasons. The NHS has stepped up in the way that the noble Baroness has set out. An expert panel led by the brilliant Dr Nick Watts made it the first health service in the world to charter a practical blueprint to net zero, but to do that, we must recognise that only about 28% of the carbon footprint of the NHS arises directly from care being provided. Another 10 percentage points are associated with travel on the part of patients, staff and visitors, but 62% of the carbon footprint arises from the supply chain—the medicines, the devices, the anaesthetic gases, the asthma inhalers, that the NHS uses, which it procures from 80,000-plus suppliers.

I am grateful to the noble Lord, Lord Prior of Brampton, and the noble Baronesses, Lady Young of Old Scone and Lady Hayman, for their support of my Amendments 201 and 210. Their purpose is simply to harness the £150 billion of purchasing power that will flow through either the new NHS payment system or the procurement rules to achieve the two evidence-based rationales that we have been discussing.

[Baroness Northover (LD)]

My Lords, this is my first foray into this Bill. I have a sense of déjà vu, having deputised for the noble Earl, Lord Howe, on the 2012 Bill. Despite our absolute confidence at the time, it seems that some things need to be tweaked and rectified, though I now find myself on this side and the noble Earl on the other.

From these Benches, I support these amendments. The noble Baroness, Lady Hayman, put it very effectively. Climate change needs to run through to the very foundations of the Bill, as does addressing the health inequalities which were the subject of the previous debate. We have had such a long-standing debate about them over the years.

As the noble Baroness has said, at the moment, the UK is taking the lead internationally on combatting climate change through COP 26 and in the year after. We have been urging the world to take urgent, deep-rooted action if the enormously damaging effects of climate change are to be tackled and reversed. We know that the poorest will be hardest hit and can already see that effect, but no part of the globe will be spared. We can already see this as well.

As the noble Lord, Lord Stevens, said, we also know the effects on human health worldwide. We can see them already in developed countries: we saw the effect of that heat dome in Canada and the deaths that resulted from it. We know that climate change might have played a part in seeding the pandemic from which we have suffered during the last two years. We know all that. We also know that we cannot lead internationally without addressing climate change nationally. I pay tribute to the staff supporting Peers for the Planet, a group of which I am a member, for making sure that we address climate change at every stage, in every Bill.

We are rightly proud of the NHS. It is the major employer in the United Kingdom. The health and social care of our ageing population will play an ever more important role in our lives. It is therefore right that, in the Bill, as in every other area of life, tackling climate change must run as a thread through all we do. The Climate Change Committee makes this clear. It is not something for only Defra or the COP team. It requires fundamental change in everything we do and the scrutiny of every area of life.

The NHS has already made strides forward. Here, I pay tribute to the noble Lord, Lord Stevens, in making sure that that was the case. At COP 26, the NHS made a commitment to net zero. As we have heard, 14 other countries followed the NHS’s lead. More than 50 countries, representing more than a third of global healthcare emissions, have committed to developing sustainable, low-carbon health systems. This is incredibly encouraging. It is also encouraging that, at COP 26, a new international platform was set up—to be hosted in partnership with NHS England and the WHO—to bring together those in the healthcare systems, so that people can learn from each other.

Why does this matter? As the noble Baroness, Lady Hayman, has said, the healthcare sector is responsible for almost 5% of global emissions. Of course, public health is assisted by tackling climate change. Although we pay tribute to what the NHS has managed to do so far—and it is ahead of its requirements under the Climate Change Act—we need to make sure that this is built in and sustained for the future. This is what these amendments are about. Progress is being made, but we need to ensure that it is locked in and does not necessarily depend simply on who is leading these organisations at any particular time.

The noble Baroness, Lady Hayman, has explained how her first amendment affects the overarching structure within NHS England. The other amendments put in place the necessary pragmatic steps to make sure that this is addressed. Thus, we have identified individuals for these particular responsibilities. This is obviously of key importance.

It is fundamental that, in addressing climate change, we do not just see this as hosting a major meeting or siloed in one department—whether Defra or BEIS. I am a member of the Select Committee on the Environment and Climate Change. When our committee asked the different departments to report on what they were doing in advance of COP what came back to us, in many regards, was a kind of surprise that they were relevant to it. They felt that it was something for Defra, for BEIS in particular, or for the COP unit. They did not see it as their responsibility. Some of the responses were superficial in the extreme. That is why it is important to make sure that we mainstream this issue, and this is another opportunity to do so. I strongly support the amendments that the noble Baroness, Lady Hayman, and others have tabled.

[Baroness Bennett of Manor Castle (GP)]

My Lords, it may not surprise your Lordships’ House that as a Green Peer, I rise to offer my full support to all these amendments. I also declare my involvement with Peers for the Planet.

In introducing this group so comprehensively and, I would say, brilliantly, the noble Baroness, Lady Hayman, said it was just important as the group that we were discussing previously, which addressed inequalities in issues such as smoking and alcohol and their impacts on health. I would actually go further and say that the two groups are intimately related, in that when someone arrives at the NHS needing treatment for an illness or a disease, at a point where their environment and society, often, has failed and has created or amplified that disease, the NHS then has to deal with the problems created by society and that environment. We need a systems-thinking approach to health—not just “Here’s a disease” or “Here’s a limb or an organ with a problem” —that considers the whole person. I say in passing that I regret that I was not able to take part in that earlier group due to my being unable to be here at the start.

I am not going to run through all the amendments, which have been very well covered, but they go all the way from the duty of the NHS to have regard to climate and the environment, right down to the detail of procurement. I particularly commend the noble Lord, Lord Stevens. We would like to see the Government take control of procurement more broadly to improve our society. The Preston model comes to mind here.

I want to address the climate side of this issue, and then I am mostly going to talk about the environmental side, which has not been discussed much yet; I want to add something different rather than repeat. However, I have to highlight the fact that we are talking about 5% of UK climate emissions and 40% of public service emissions.

We really have to think about the interrelationship of environment and health. We know that heatwaves have huge impacts, particularly on the health of older people. They can be a significant cause of death among older people, and as long as the NHS contributes to climate change, there is a disastrous cycle there. Also, some 10% of London hospitals are at risk of river flooding. I have not been able to find figures for the country as a whole, but I am sure that will be true for many other hospitals too.

While preparing for today’s debate, I looked at the Medicines and Medical Devices Act, which we debated last year. It is a little unfortunate that, as I look around the Chamber today, practically no one is present who attended those debates. That Act was a huge missed opportunity. It requires that when the appropriate authorities are approving veterinary medicines, they must have regard to their environmental impacts. I moved an amendment—but lost the vote—that would have applied the same judgment to human medicines. This point applies particularly to antibiotic resistance. I am not going to repeat everything I said in Committee on 26 October, but it is all there. The management of antibiotic resistance is a huge issue that the NHS needs to do a great deal more on, as do all global health systems.

I want to focus on some other aspects of the environmental impacts of the NHS today, particularly in light of the report by the Environmental Audit Committee in the other place on the state of our rivers. The Bloomberg Green newsletter going around the world today has the following headline:

“English Rivers Join Europe’s Most Noxious with Chemical Cocktail”.


That report notes, as have many others, that:

“No river … received a clean bill of health for chemical contamination.”

--- Later in debate ---

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

I thank the noble Lord, Lord Stevens, for the amendments and the noble Baroness, Lady Hayman, for her opening remarks. I also thank the noble Baroness for her suggestion yesterday that it might make my life a lot easier if I just accepted amendments. I understand that advice, having just gone through a two-hour debate on the previous group.

A number of noble Lords referred to how these amendments relate to our previous debate on inequalities. I point out that that is sometimes not quite in the way that we would expect. We might think there is a direct connection, but sometimes the green agenda can be seen to be for those who can afford it—as I explained before, for the white, middle-class, patronising people who tell immigrant working-class communities what to do and push up their costs. Anti-car policies push up costs for those in rural areas, and there are higher fuel costs as we replace gas boilers with potentially more expensive heat pumps. We have to be aware of those issues. In the long term, I am optimistic. I look forward to the day when we have solar power and wind power, with storage capacity, which will reduce costs.

[Baroness Northover (LD)]

Will the Minister look at this globally and recognise that the poorest are affected the worst? When he talks about those in poverty, he should think globally.

[Lord Kamall (Con)]

I accept that point, but I also accept that, sometimes, one can be patronised, and I do not accept being patronised as I was in the earlier debate. One day, there will be cheaper fuel, and we can look forward to it, but we have to make sure that the transition along the way is not seen to push up costs for working people, because we all feel passionately about this green agenda.

Health and Care Bill

Baroness Northover Excerpts

Lords Hansard - Part 1 & Committee stage
Monday 31st January 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I hope that I do not slow us down again after the provocative words of the noble Baroness, Lady Chisholm, but I am going to talk about access to dental treatment and fluoridation. Although the House is somewhat empty, I expect that as the debate goes on it might fill up a little.

We had an Oral Question this afternoon about dentistry, and I do not want to repeat everything that was said then. I have enjoyed debating dental issues with the Minister, the noble Earl, Lord Howe, for many years. He will know that there is widespread concern about the lack of access to dentistry. At Oral Questions the Minister, the noble Lord, Lord Kamall, referred to the £50 million that had been provided, but I am afraid that the 350,000 treatments that it will pay for are a drop in the ocean compared with the 38 million patient treatments that have been lost as a result of the pandemic.

Many people are finding accessing dentistry almost impossible at the moment. The Minister referred earlier today to people being able to use the access centres, and to the 111 service, but I am afraid that it has broken down in many parts of the country. One is led to the conclusion that dentistry issues are not a priority. Many adults and children are suffering in pain because of their lack of access. The Government must focus on this and develop a proper strategy. I pay tribute to Healthwatch for its work in this area—it has had a lot of interest from members of the public—and to the BDA for its briefings.

Treatment is one thing, prevention is another. Here, I must remind the Committee of my presidency of the British Fluoridation Society. This brings me to effective preventive measures. I welcome Clauses 147 and 148. Unfortunately, the noble Lord, Lord Scriven, is not here to hear me say this, but essentially, giving this responsibility to local authorities has proved to be a failure. Not one local fluoridation scheme has gone through under the auspices of local authority leadership, and we must conclude that leaving it to local authorities is likely to mean that we will not see fluoridation developed in any part of the country.

So this is a national issue and it is right that the Secretary State should take over responsibility; it is also right to acknowledge that, in September last year, the four Chief Medical Officers stated:

“As with all things in medicine and public health there is a balance of risk and benefit.”


We have certainly learned that in the last two years. As they said:

“There is unquestionably an issue with tooth decay in the UK and an entrenched inequality which needs to be addressed. Fluoridation of water can reduce this common problem … On balance, there is strong scientific evidence that water fluoridation is an effective public health intervention for reducing the prevalence of tooth decay and improving dental health equality across the UK. It should be seen as a complementary strategy, not a substitute for other effective methods of increasing fluoride use.”


I think that is a very wise assessment of the situation. The effectiveness of fluoridation of water supplies to improve oral health has been evident for many decades. Some communities such as my own—Birmingham—have taken advantage and, as a result, we generally enjoy good overall oral health, but progress in spreading these benefits has been very slow. The transfer to local government, I am afraid, did not work.

So I strongly support the thrust of these clauses; in fact, they are the two most welcome clauses in the whole Bill. The question, however, is whether they will bite, and this is what lies behind my amendments. Amendment 260 concerns the consultation process. I do not think I have got the wording in quite the right place—frankly, trying to find my way through the Water Act and changes to it over the last 20 years or so proved beyond me—but the intent is to ask: if there is to be consultation about schemes, please can we move away from the local consultations that have to be gone through at the moment? They are an absolute nightmare. They bring out opposition from national bodies that causes mayhem in the locality.

The issue is not the practicalities of the scheme but about going back over the principle. The very fact that the Government have brought these clauses has decided the principle of the benefit of fluoridation. If there is to be a consultation, for goodness’ sake, let us have just one instead of the myriad local consultations that have obviously got in the way of progress in the past.

My Amendment 261 is part probing. Currently, the Bill gives the Secretary State power to make regulations to require a public body to meet the costs to the Secretary of State in relation to fluoridation schemes. I would be interested to hear from the Minister the reasons and circumstances under which they would be used. My concern would be that asking too hard a subvention of local bodies might inhibit the progress of fluoridation schemes. Amendment 262 requires the Secretary of State to ensure that a programme for implementing water fluoridation schemes is established within 12 months of the Bill being passed. I would like to see a report every three years, laid before Parliament by the Secretary of State, on the progress made in implementing new water fluoridation schemes. The basic purpose would be to ensure that the Government get on with this, establishing more schemes and spreading the benefits across the entire community as soon as possible. I beg to move, and hope that I have met the noble Baroness’s test.

[Baroness Northover (LD)]

My Lords, I will speak in support of Amendments 260, 261 and 262 in the name of the noble Lord, Lord Hunt, on water fluoridation.

The NHS rightly prides itself on being evidence-based. Nevertheless, when Ara Darzi became health Minister, he was concerned that, in a number of areas such as the treatment of diabetes, there was not a full assessment of regular outcomes, as opposed to the fantastic clinical trials on new treatments for specific diseases. Hence, he introduced his atlas of outcomes. It showed, for example, absolutely unacceptable different outcomes for diabetes if you lived in Cornwall—where you were more likely to lose a leg—compared with Essex. There were serious lessons to be drawn from that, which needed to be applied in other areas, too.

Health and Care Bill

Baroness Northover Excerpts

Committee stage
Friday 4th February 2022 Lords Chamber

[Baroness Northover (LD)]

My Lords, the noble Lord, Lord Hunt, has introduced Amendments 265 and 282 on this appalling subject extremely effectively and I wish to make clear the support for both those amendments from these Benches. I am also sympathetic to the different but separate Amendment 297H on tissue being retained for research, educational and audit purposes, which would bring legislation in England and Wales into line with that in Scotland and which I am sure the noble Baroness, Lady Finlay, will address shortly.

To return to the issue of human abuse—it is more than the abuse of tissue—this subject has been much debated in your Lordships’ House and I pay tribute to the noble Lords, Lord Hunt and Lord Alton, and others for making sure that we do so and for ensuring that step by step we make progress. I also pay tribute to the noble Baroness, Lady Penn, for listening and engaging, for her responsiveness when dealing with the issue and for helping to take it forward in earlier legislation. However, we all know that there is a distance to go.

As the noble Lord, Lord Hunt, said, these amendments seek to protect UK citizens from complicity in forced organ harvesting and organ trafficking. Amendment 282 prohibits UK citizens from travelling to countries for the purpose of organ transplantation. The restrictions are based on ensuring appropriate consent, with no coercion and no financial gain. If appropriate consent is not given, the country supplying the organ must have a legitimate opt-out system in place and must not be considered to be committing genocide, as now determined, as the Government have moved to agree, by resolution of the House of Commons. This will be based on an annual assessment by the Secretary of State.

We cannot say that we do not now know about forced organ harvesting. We also have the reports of both the China Tribunal and Uyghur Tribunal and much other evidence. I pay tribute to the FCDO for engaging in relation to the Uyghur Tribunal. As the noble Lord, Lord Ribeiro, mentioned, UN human rights experts have called on the Chinese Government to allow independent monitoring by international human rights bodies. If China had nothing to hide, it would accede. We have previously debated the conclusions of the China Tribunal and referred briefly to the Uyghur Tribunal. In 2020, the China Tribunal reported:

“Forced organ harvesting has been committed for years throughout China on a significant scale”.


As I said, more recently we have had the Uyghur Tribunal reports, which give a lot more detail. A number of countries, including Spain, Italy, Belgium, Norway and Israel, have already taken action to prevent organ tourism to China. We surely must do the same.

Amendment 265 aims to put a stop to real human body exhibitions being put on display in the UK when the cadavers do not have proof of identity or consent, such as those sourced from China. Again, the noble Lord, Lord Hunt, laid this out clearly. Almost a decade and a half ago, exhibitors in New York were forced to add a disclaimer stating that these bodies came from China and could have come from prisons, which clearly rubbished the idea that people had willingly donated their bodies for such displays.

Once again, certain countries, including France and Israel, and certain US cities have banned such body exhibitions from coming into their territories. We have high standards for dealing with human tissue in this country, as noble Lords are aware. Various noble Lords here today, including the noble Lord, Lord Hunt, have played a part in producing those. We need to make sure that we do not become complicit in what happens elsewhere, particularly—as we speak—in China. The noble Lord, Lord Alton, and others have made it crystal clear that we know what happens. I therefore commend these amendments.

[Lord Alton of Liverpool (CB)]

My Lords, I am raising my voice to speak in favour of Amendments 265 and 282. Following the noble Baroness, Lady Northover, and the noble Lords, Lord Ribeiro and Lord Hunt of Kings Heath, I hope that it demonstrates to the Minister that there is widespread concern from all parts of your Lordships’ House, especially in support of these amendments. It also gives me the chance to thank the noble Lord, Lord Hunt, for the leadership that he has given on this issue. He has been dogged and focused, insisting that we ensure that this country never becomes complicit in one of the greatest crimes committed against humanity. I join the noble Lord, Lord Ribeiro, in thanking the noble Baroness, Lady Penn—like others, I am pleased to see her back in her usual place. During the course of the earlier legislation, she was not only receptive in dealing with the issues that we raised, but organised meetings for us at the department with officials. I thought that the attitude that was shown at that time was exemplary and I am grateful to her.

It disturbs me that, although the United Kingdom signed the Council of Europe Convention against Trafficking in Human Organs, unlike 11 other European countries the United Kingdom has not ratified it. I would be grateful if the Minister, when he comes to reply, could say why we have not and whether we have any intentions of doing so. In addition, though, the signature of the United Kingdom has the following reservation:

“In accordance with the provisions of paragraph 3 of Article 10 and paragraph 1 of Article 30 of the Convention, the Government of the United Kingdom reserves the right not to apply the jurisdiction rules laid down in paragraph 1.d and e of Article 10 of the Convention.”


Given all that we now know and what has been said in your Lordships’ House this afternoon, I wonder whether we are going to persist with that reservation. The reservation means that the United Kingdom does not have to take legislative or other measures to establish jurisdiction over any offence established in accordance with the convention when the offence is committed by a UK national or a habitual resident of the United Kingdom, unless it is within our own territory. Therefore, in short, the reservation means that even if it were to be ratified, it would not prohibit citizens of the United Kingdom from partaking in unethical organ tourism.

Let us not forget why the Human Tissue Act was created in the first place. Thousands of families, some in my former constituency in the city of Liverpool, had devastatingly found their deceased family members, including children, had had their body parts and organs removed and kept in National Health Service facilities without consent. The Liverpool Alder Hey scandal created a public outcry and it was our parliamentary duty to respond and take appropriate legislative action, as we did.

Today, throughout China, forced organ harvesting of prisoners of conscience is taking place. What legislative action are we going to take concerning that? The predominant victims have been Falun Gong practitioners, the Buddhist spiritual meditation group that, at its peak in 1999, had an estimated 100 million adherents in China. The former CCP leader, Jiang Zemin, set up the 610 Office and gave the order to—his word—eradicate Falun Gong. It is believed by many experts that, while young Falun Gong organs gradually became less available over the years, the CCP—the Chinese Communist Party—began to also target Uighurs, as we have heard this afternoon, for forced organ harvesting, with the same torture methods, blood tests and organ scans happening in the Uighur camps as those in the Falun Gong camps. There are also some lines of evidence of Tibetans and Christians in China, referred to by the noble Lord, Lord Hunt, suffering the same fate. I should declare my interest as the vice-chair of the All-Party Parliamentary Group on Uyghurs and as a patron of the Coalition for Genocide Response.

For those who had any doubts about China’s state-sanctioned organ harvesting, it is worth noting that as early as 1994 Human Rights Watch reported that

“it has become increasingly evident that executed prisoners are the principal source of supply of body organs for medical transplantation purposes in China”,

and that

“executions are even deliberately mishandled to ensure that the prisoners are not yet dead when their organs are removed.”

Dr Enver Tohti, a Uighur doctor whom I have personally met and taken statements from, described to me that he had been required to remove organs and ordered to “cut deep and work fast” on a victim who was still alive. The theft of organs has been described as an almost perfect crime, because no one survives. Just this week Dr Tohti was interviewed by the London Evening Standard, from which I quote:

“Driven well out of town, he recalls: ‘There was a small hut and two surgeons there waiting. They said, “wait here and come around when you hear gun shots”. Time passed and I started to hear the noise of people shouting, chanting, whistles blowing, trucks running, then gun shots, many rifles shooting at the same time. So, we got in the van and came around the mountain to find 10 corpses in prisoners’ clothes with shaved heads on the left side slope of the mountains.’ He was called away from the corpses to the body of another man in civilian clothes and was told ‘that is yours’, and ordered to remove the liver and kidneys. The man was not dead. ‘I had no choice but to harvest the organs,’ he said.”


It is extraordinary, as we heard from the noble Lord, Lord Hunt, that on this day of all days, when what are now known as the “Genocide Games” are beginning in Beijing, we should be having this timely debate in your Lordships’ House. Not since 1936, when the Nazi games were held in Berlin and the world saw Hitler use the Olympics to promote his hideous ideology, and most Jewish German athletes were barred from taking part in the Games, have we seen the Olympic ideal so scandalously debased.

However, forced organ harvesting is just one of many human rights abuses taking place in China. Other noble Lords have referred to Sir Geoffrey Nice’s Uyghur Tribunal, which met here in Westminster in Church House. I sat through many of its hearings and, during our recent debate on this Bill concerning genocide and the purchasing of equipment and medical supplies from places such as Xinjiang, I heard harrowing accounts from those who gave evidence to that tribunal. Sir Geoffrey Nice QC—the prosecutor in the Milosevic trials, who knows more about these issues than probably any other living person—and his panel came to the conclusion that what is happening in Xinjiang amounts to genocide. As the noble Baroness, Lady Northover, has said, so has the House of Commons—and, indeed, so has our Foreign Secretary, Liz Truss, who has said “it is a genocide”.

Uighurs and other ethnic minorities have suffered torture, rape and forced abortion and sterilisation by the CCP, but the crime does not end there. There is a further twist to this infamy. Anonymous plastinated corpses taken from Chinese prisons have been paraded, as the noble Lord, Lord Hunt, told us earlier, in a carnival of horrors at money-making exhibitions, a final sneering insult to these victims. In 2018, after the exhibition that the noble Lord referred to, I wrote to the Times, along with Professor Jo Martin, president of the Royal College of Pathologists, and 55 others. We said:

“We believe that the legislation requires reform.”


However, I would go further—here, I agree with the noble Baroness, Lady Thornton, who it is good to see in her place—and ask why on earth we allow these things at all. There should be a complete prohibition by law.

I conclude by returning to the opening ceremony of the Beijing 2022 Winter Olympic Games. The Olympic charter states:

“Olympism seeks to create a way of life based on the joy of effort, the educational value of good example, social responsibility and respect for universal fundamental ethical principles.”


The irony of that is beyond belief. This simply should not be acceptable, at least to those corporations and companies that are sponsoring the Games in Beijing, such as Coca-Cola. The China Tribunal stated:

“Governments and any who interact in any substantial way with the”


People’s Republic of China

“should now recognise that they are, to the extent revealed above, interacting with a criminal state.”

We must do more to stop these human rights abuses. I wholeheartedly support the amendments, which are not country-specific but would serve to close the loopholes in the Human Tissue Act so that the United Kingdom could do its part in preventing collaboration in these appalling crimes.

--- Later in debate ---

The amendments are carefully drafted; we are not asking for the immediate introduction of a levy. They require the Government to consult on a statutory scheme and report back to Parliament within six months of the passage of this Act. Going ahead thereafter would reinforce the levelling up White Paper and help the Government secure their ambition for a smoke-free nation. I urge my noble friend to consider this very modest step.

[Baroness Northover (LD)]

My Lords, I have put my name to Amendment 270, which requires the Government to consult on raising the age of sale for tobacco to 21, and which the noble Lord, Lord Faulkner, has just introduced. I also express my support and that of these Benches for all the anti-smoking amendments in this group. My noble friend Lord Rennard will speak on them shortly. Together, these amendments seek to close loopholes, strengthen regulation and provide a mechanism to reinstate vital funding for tobacco control and smoking cessation. Tackling tobacco and the tobacco industry has strong cross-party support, as the noble Earl well knows, having been very much part of that himself over the last 20 years. He will note the number of us speaking to support these amendments, even though only four can sign each one. He will also note the contribution made by his noble friend Lord Young, not only here but in his Private Member’s Bill, and he will no doubt note that there are very few voices—possibly one—who tend to speak against such measures.

I welcome the progress that the Department of Health has made in this area, and that of local government, but other parts of government are not always totally aligned. We found that with pavement licences—the noble Earl will remember this—in the now-termed Department for Levelling Up, even though the new White Paper on levelling up has, rightly, as the noble Lord, Lord Faulkner, pointed out, identified addressing health inequalities as vital, and addressing smoking as part of that. Two cities in the north have the highest smoking rates in the country: Kingston upon Hull, at over 22%, and Blackpool, at over 23%. The average in the south-east is just over 12%.

These amendments are designed to help the Government and the Department of Health take forward their very welcome apparent intention for the country to be smoke free by 2030. The Government say they are committed to delivering a smoke-free country by 2030 but keep putting off what they have themselves declared to be the “bold action”, promised in 2019, needed to deliver what they said was an “extremely challenging” ambition. The tobacco control plan promised in July 2021 has been delayed again. When will it be published? No doubt “in due course”.

Meanwhile, instead of those bold actions, according to a recent leak to the Sunday Times, the Secretary of State “plots vaping revolution”, by providing e-cigarettes on the NHS. I agree that vaping has a role to play in a comprehensive strategy to end smoking. Vaping doubles people’s ability to quit smoking compared with existing nicotine replacement therapy. However, as we know, smoking is highly addictive, and even doubling success means that only a small proportion of smokers who were trying to quit would remain quit at the end of one year. Vaping is not a magic bullet and, although it will increase quitting, it will not prevent youth uptake, as raising the age of sale would, as the noble Lord, Lord Faulkner, has indicated. He set out extremely cogently the evidence for why this measure would be highly effective. I will briefly focus on why it would be proportionate and justified.

The age of 18 is often considered to be the age at which someone acquires all the rights and obligations associated with adulthood. However, this is not the case, and there are several examples of rights or obligations which are acquired earlier or later than the age of 18. Raising the tobacco age of sale to 21 would be consistent with the flexible approach that we apply to other age-restricted activities: those prohibited to under-21s in England include adopting a child, driving a large passenger vehicle, and supervising a learner driver, for example. Thresholds change over time, as demonstrated by the Government’s support for a Private Member’s Bill, which I welcome, to raise the age of marriage from 16 to 18.

It is now accepted that the late teens through to the early 20s—ages approximately 18 to 26—are a distinct period of life: young adulthood, when young people may still need support and protection. It was the period during which I hoped that my sons would develop what I thought of as a judgment gene—a gene that my daughter seemed to have had from at least the age of four, but they noticeably lacked. For care leavers it was excellent, for example, when in recent years social care was extended from 18 to 25. That had long been needed.

As we know, smoking is highly addictive and uniquely harmful, and an addiction which, if not begun by the age of 21, is very unlikely to happen at all. Tobacco is the only legal consumer product which kills when used as intended, causing the death of more than 200 people a day in the UK. This means that a unique response is required to minimise the burden of preventable death and disease that smoking inflicts. The evidence is surely sufficient to proceed with raising the age of sale, therefore this amendment is simply a modest proposal requiring the Government to consult. I commend this proposal and the other amendments in this group.

[Baroness Finlay of Llandaff (CB)]

My Lords, it is a great pleasure to follow the noble Baroness, Lady Northover, because I would like to pick up almost where she ended, on raising the age for the sale of tobacco. That measure has been successfully implemented in the United States, where smoking among 18 to 20 year-olds has been reduced by nearly a third as a result, so I support Amendment 270.

On Amendment 271, which affects the sale of nicotine products to children, it is rather horrifying to realise that it is not illegal for free samples of e-cigarettes to be given out to those under 18, even though it is illegal for them to be sold to those under 18. Amendment 271 would cover this. It would also cover the novel nicotine products, such as Japan Tobacco International’s widely advertised nicotine pouches—I do not particularly want to use their name because I do not want to advertise them. Unlike e-cigarettes, the marketing of these products is currently completely unregulated, despite the high levels of nicotine, which is an addictive substance. A quick search on the internet to look at the questions around them reveals that it is admitted that they are highly addictive, that they could affect the development of the brain and that they could result in mood changes in the user as well, possibly making them emotionally volatile. These are loopholes in the law, which can easily be fixed by our Amendment 271.

In Amendment 278, the noble Lord, Lord Rennard, seeks to ban all flavours in smoked tobacco. Again, this is another gaping legislative loophole which has allowed tobacco manufacturers to flout the current flavour ban.

I have led on Amendment 279, which relates to the packaging and labelling of nicotine products such as e-cigarettes. A cursory search online for these reveals that widely available electronic cigarette e-liquids feature cartoon characters in garish, appealing colours, with child-friendly descriptors, including sweet names such as gummy bears. Such branding is clearly unacceptable; it is targeted at the young. It is therefore deeply disappointing to discover that an amendment giving the Government powers by regulation to prohibit child-friendly packaging was voted down by them in the other place. The Minister said then that the Government

“are committed to ensuring that our regulatory framework continues to protect young people and non-smokers from using e-cigarettes.”—[Official Report, Commons, 22/11/21; col. 88.]

The Government can prove their commitment by supporting Amendment 279, which requires the Secretary of State to consult and report to Parliament on e-cigarette packaging, in particular the branding elements designed to be attractive to children.

Health and Care Bill

Baroness Northover Excerpts

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

[Lord Hunt of Kings Heath (Lab)]

My Lords, it is a great honour for my two amendments to be grouped with that in the names of the noble Lords, Lord Alton and Lord Blencathra. As the noble Lord has discussed the supply chain, I should declare my interest as president of the Health Care Supply Association, although I am not speaking on its behalf when it comes to my strongly supporting his amendment, which sets the context for my own two amendments.

We debated this issue very fully in Committee. I think that the House believes strongly that the commercial exploitation of body parts in all forms is unethical and unsavoury. When it is combined with mass killing by an authoritarian state, we cannot stand by and do nothing. In 2019, the China Tribunal, led by Sir Geoffrey Nice QC, stated:

“The Tribunal’s members are certain—unanimously, and sure beyond reasonable doubt—that in China forced organ harvesting from prisoners of conscience has been practiced for a substantial period of time involving a very substantial number of victims.”


In June this year, 12 UN special procedure experts raised the issue of forced organ harvesting with the Chinese Government in response to credible information that Falun Gong practitioners, Uighurs, Tibetans, Muslims and Christians had been killed for their organs in China.

Currently, human tissue legislation covers organ transplantation within the UK, where we have a very ethical approach, but it does not cover British citizens travelling abroad for transplants, and British taxpayers’ money will pay for anti-rejection medication regardless of where the organ was sourced or whether it was forcibly harvested from prisoners of conscience.

I shall not repeat all that I said in Committee, but I have had a helpful meeting with Ministers for which I thank them. In that meeting and in subsequent meetings, the Minister was concerned that my amendment in relation to organ tourism would penalise vulnerable people seeking to pay for a transplant. I have thought about that carefully, but, in the end—and the noble Baroness, Lady Kennedy, expressed so well why this Bill is highly appropriate for these kind of amendments—we have to draw a line in the sand. That is particularly so today, in the horrific circumstances that we meet. We have to draw a line in the sand and send out a powerful message globally that we will not support these abhorrent practices in any way.

My Amendment 162 comes later, but I shall seek the opinion of the House at that time.

[Baroness Northover (LD)]

The noble Lord, Lord Hunt, has very effectively introduced the amendments to which I have put my name, Amendments 162 and 173, and I wish briefly to express the support of these Benches for those. We also support Amendment 108, to which my noble friend Lady Brinton has put her name.

As noble Lords know, we have been inching forward on these matters with Ministers, and I welcome that forward movement. I note, however, recent warnings from Ministers that, for example, there are “opportunity costs” in implementing these measures, as ensuring that proper standards are enforced requires effort and potential cost. I understand that. Nevertheless, we cannot allow ourselves to become complicit in any way in organ tourism where the source of those organs is forced or where selling the organ is to address appalling poverty.

Some say that this trade may be declining in and from China. If so, that is welcome and might reflect international pressure, not least on the Chinese medical profession. It is not clear that those involved in the China Tribunal and the Uyghur Tribunal would agree that it is declining.

Even if we were to accept that, and Ministers seemed to indicate that they thought that might be the case, we are also hearing now of an increase in the selling of organs in Afghanistan because of the dire situation there. There have been recent reports of journalists seeing the scars of those who have sold their kidneys. That is a terrible indictment of our walking away from Afghanistan and failing to address the appalling conditions that we have left there. How can we regard such potential “donors” as being anything other than the most extremely vulnerable? How can you put that up against the vulnerable who may need to have donations?

As for the bodies exhibitions, we have discussed before how distasteful they are—but then we realise with horror exactly where these bodies seem to have been sourced: among other things, from Chinese prisons. We should never have condoned that, turning a blind eye. I agree with the noble Baroness, Lady Thornton, who argued in Committee that they should simply be banned. There is no reason whatever to agree to their continuation.

I now hear that the Government may argue—and this is incredibly familiar—that these amendments are flawed. As the noble Earl knows, often Ministers are given briefs that say, “This is a flawed amendment, so turn it back.” I am very familiar with them. In those circumstances, the best thing is for your Lordships to pass these amendments, because Ministers know, or should know, that the essence is extremely clear, and with government lawyers we can work out how best to sort out any unintended consequences. I hope that I do not hear anything about these amendments being flawed—and I say that to the Box. I therefore commend them to your Lordships.

[Baroness Finlay of Llandaff (CB)]

My Lords, I support all the amendments in this group, and I shall speak specifically and briefly to Amendments 162 and 173.

These amendments are updates to the Human Tissue Act, which was born out of public outrage following the Alder Hey scandal, when over 100,000 organs, body parts and entire bodies of foetuses and stillborn babies were stored in NHS facilities. The body parts of dead patients, including children, were removed without consent. Today, the Human Tissue Authority’s guiding principles, as set out in its code of practice, are consent, dignity, quality, honesty and openness. These principles should not only reflect how human tissue sourced from within our own nation is treated, we must treat human tissue and organs with the same principles when sourced overseas.

In China, as has been said, there is substantial evidence of Falun Gong practitioners and Uighurs—as well as some evidence of Tibetans and house Christians—being killed on demand for their organs. Blood is taken off them for tissue-typing at the time when they were taken into custody, often with no idea why they were taken into custody at all, other than that they belong to one of those groups. There is no consent, no dignity and no transparency.

On 7 December last year, the British Medical Association released a statement on the abuse of Uighurs in China, expressing

“grave concern regarding the situation in China and the continuing abuse of the Uyghur population of the country as well as other minorities.”

It went on to state:

“We are particularly alarmed by the reports of organ harvesting, forced birth prevention, and the use of genomics data for racial profiling.”


It urged

“the UK government and international actors to exert pressure on the Chinese government to cease its inhumane actions towards the Uyghurs”.

If we do not pass amendments as laid before the House today, we will be complicit with these practices, because we will be looking at them with Nelson’s eye, with all the evidence that we have that they are going on.

On Amendment 173, on the exhibition of whole bodies using a plastinated technique, I suggest that there is no transparency whatever. Any attempt to claim that there has been consent is extremely suspect, because consent is very easily falsified. I went to one of these exhibitions because I thought you ought to go and see what you are criticising. This was not an anatomical, educational experience but a visual display of plastinated bodies in all kinds of different poses. But the one that horrified me the most was a pregnant woman, quite advanced in her pregnancy and with the foetus in her womb, which had been plastinated. I do not believe that that woman would have given consent for plastination. That raised real questions as to why such an advanced foetus was in the womb of a dead woman without something there explaining the nature of her death, the cause of death and the circumstances in which she had decided to consent to such a procedure.

Health and Care Bill

Baroness Northover Excerpts

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

I say to my noble friend on the Front Bench that I understand that the Government are bringing forward their tobacco control proposals, and of course we will look at those carefully. However, as someone who comes from a medical household, I know that other parts of the health service urgently need attention. The whole of the GP practice situation in our country is in very deep trouble at the moment and that is where the money should be spent, not on trying to administer some marginal levy system which will not work and will cost Her Majesty’s Government a fortune.

[Baroness Northover (LD)]

My Lords, briefly, I support these amendments; my name was on an amendment at an earlier stage. I hope that the Minister will have managed to persuade other parts of government that they will not achieve a smoke-free 2030 in the UK unless they move further and faster on tackling an industry built on promoting ill health and death—the reverse of what the health service seeks to do.

The Department of Health has come a long way in this area, with much cross-party working, and I know that the noble Earl himself has been part of that cross-party support in tackling the terrible health consequences of smoking. I have a sense of déjà vu, as I think others might. Over the years, the noble Lord, Lord Naseby, has been a rather lone voice on the other side. From time to time FOREST, which makes it plain that it is funded by the tobacco industry, kindly sends me its brief, no doubt inadvertently, and I recognise some familiar phrases that have just been voiced. I noted the rueful expression of the noble Lord, Lord Naseby, as the noble Lord, Lord Young, took apart what he had said about the levy.

The Government say that they are committed to delivering a smoke-free 2030, but keep putting off the action required. Not all parts of government are fully aligned to this in the actions taken. The steps proposed in the amendments are designed to help the Government achieve what they say they wish to do. I therefore commend them to the House.

[Lord Stevens of Birmingham (CB)]

My Lords, I want to make just a small factual supplement to the contribution from the noble Lord, Lord Naseby. In fact, it was a Conservative Government in 1957 who introduced the pharmaceutical price regulation scheme or PPRS, and that scheme has been sustained ever since by Conservative, Labour and coalition Governments. As the noble Lord, Lord Young, pointed out, if it is deemed appropriate to have a form of price and profit regulation for the medicines industry, which delivers products that are essential and life-saving, it does not seem too far a stretch to think that an equivalent mechanism might be used for an industry whose products are discretionary and life-destroying.