Foetal Sentience Committee Bill [HL]

Baroness Thornton Excerpts

2nd reading
Friday 22nd March 2024 Lords Chamber

[Lord Jackson of Peterborough (Con)]

I think that is a fatuous conspiracy theory again, but, if the noble Baroness satisfactorily answers my question about the involvement of Marie Stopes International and BPAS in the RCOG, I will gladly debate with her on the issues that she raises.

If I can continue—

[Baroness Thornton (Lab)]

I really must ask—

[Lord Jackson of Peterborough (Con)]

I will not give way.

[Baroness Thornton (Lab)]

I am not addressing the noble Lord. I am speaking to my colleagues on his Front Bench. I am very sorry, but shouting “you” and pointing is not the conduct that we expect in this House. It is in our guidance, so I ask the Government Whip to please remonstrate with his colleague not to behave like that.

[Lord Jackson of Peterborough (Con)]

I say to noble Lords that the noble Baroness, Lady Kennedy of The Shaws, had ample opportunity to make her points. She intervened on me and I put a very reasonable question back to her. Perhaps I can now continue.

Noble Lords may be aware of a fascinating peer-reviewed academic study published in 2010 of twins in the womb at 14 weeks of gestation. The study found that the twins’ self-directed hand movements were more calibrated than movements to the uterine wall, while movements towards the co-twin exhibited even greater care. The study determined that such deliberate actions could not be the result simply of spontaneous reflexes. The team behind the study concluded that these findings force us to predate the emergence of social behaviour. Another study published by a team of child psychologists and neuroscientists in 2006 found “surprisingly advanced motor planning” in foetuses at 22 weeks’ gestation, again pointing towards a sentience of the foetus during the second trimester of pregnancy.

These are precisely the kinds of studies that ought to be informing government policy, yet neither was cited in the RCOG reports on foetal sentience to which my noble friend alluded earlier. Some will no doubt argue that a committee is not required when we have the Royal College of Obstetricians and Gynaecologists to guide us, but, on the contrary, I would suggest that RCOG reports on foetal sentience highlight the need for objectivity in this area and there are a number of good reasons to be cautious about accepting the conclusions. The RCOG itself has now distanced itself from some of the conclusions in its 2010 report. For example, its updated 2022 report no longer asserts, as the earlier one did, that a foetus is in “continuous sleep-like unconsciousness or sedation”. The 2022 report also removed a section on responding to common questions that included answering the question, “Will the baby feel or suffer pain?” with “No, the foetus does not experience pain”. Seemingly, it is no longer sure.

Since the RCOG has rejected sections of its own report, it would seem wise not to assume that its 2022 update is wholly reliable either. In a letter published in the European Journal of Pain, Italian neonatologist and bioethicist Carlo Bellini, who has written extensively on foetal pain, has questioned the conclusions of the 2022 report, arguing that they were based on misrepresentations and incorrect extrapolations of research cited in their support. As a layman of course it is difficult for me to comment objectively on differing research, but what is clear is that government policy would be assisted by a committee that can provide objectivity in this debate and consider all relevant findings. In fact, this is something that ought to be supported by the RCOG.

Let me finish with a final reflection on why this matters beyond simply informing the abortion debate. A 2007 academic journal cited in Neurodevelopment Changes of Foetal Pain asserted:

“Exposure of the foetus and premature newborn to pain has been associated with long-term alterations in pain response thresholds as well as changes in behavioural responses relating to the painful stimuli”.


In other words, if a baby experiences pain before birth, it may impact its development and behaviour in later life. It is therefore imperative that we understand foetal sentience adequately so that any treatment of unborn babies is performed in a way that will not lead to long-term damage. I therefore strongly support my noble friend’s Bill.

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[Baroness Thornton (Lab)]

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

[Lord Moylan (Con)]

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

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[Baroness Thornton (Lab)]

The noble Lord will note that my noble friend made all her remarks within the guidelines of the House on how we address each other. He may not enjoy what she had to say, and he may disagree with her—some of us do agree with her—however, she did it within the rules of the House.

First, I would like to congratulate—

[Lord Alton of Liverpool (CB)]

I am sorry to interrupt the noble Baroness. I do not think I have ever misused the procedures of the House and I do not intend to start now. I respect the noble Baroness and we have made common cause on my occasions. Does she think it is within the rules of the House to talk about other noble Lords as if they are dupes or as if they are in receipt of money from outside that has been undeclared?

[Baroness Thornton (Lab)]

If the noble Lord reads Hansard, I am not sure that that is actually what my noble friend said. However, she is perfectly capable of defending herself.

I want to start my remarks by congratulating the noble Lord, Lord Moylan, on introducing the Bill with such clarity. He called it “modest”, but I beg to differ: this is not a modest Bill. It is short, which definitely helps, but it is not modest. I also need to start by stating that Labour’s policy is that abortion is an essential part of healthcare. We support a woman’s right to choose and we believe that access to safe, legal abortion should be available throughout the UK.

We need to be clear about the true intentions of this proposal: it seeks to chip away at the Abortion Act and change how we govern abortion law. The noble Lord, Lord Moylan, may have said that this is not about abortion or the Abortion Act, but the fact that so many of his supporters have said exactly the opposite—that this is indeed about abortion—shows that that is what the Bill is actually about. We can be clear that that is the intention behind the Bill.

The topic of foetal sentience is under constant review by the Royal College of Obstetricians and Gynaecologists, and its last review found no evidence of a foetus experiencing pain before 24 weeks. It is best that we trust expert medical bodies and scientists, not a Government-appointed committee, to say what is the case and how we should proceed. We need to be clear that the Bill seeks to circumvent expert clinical guidance because it has an ideological disagreement with its conclusions. I was looking at the list of participants on the committee of the royal college, and I suggest that noble Lords do the same because it is a truly impressive medical and scientific body that takes its job very seriously. One noble Lord said they had changed their view between 2010 and 2022. In a way, that proves the point: the point of that committee is to do that review.

Has there ever been a time when a Bill has been brought to this House asking the Government to set up a committee to analyse the medical evidence for, for example, coronary heart disease or endometriosis? No, because we trust the relevant expert medical bodies to do that job for us. We believe the Bill represents a dangerous move to politicise the way that we make decisions about healthcare, and for that reason I will not be supporting it if it moves forward.

The review of foetal awareness of pain reception undertaken by the Royal College of Obstetricians and Gynaecologists found in 2010 that the cerebral cortex is necessary for pain perception, and that connections from the periphery to the cortex are not intact before 28 weeks. It was therefore concluded that a foetus cannot experience pain in any sense before that stage. In the light of that, I ask noble Lords to ask why we would vote to set up a committee on that issue, unless that evidence is not considered robust.

I note that, if the Bill were to pass, the remit of this government committee would not extend to the health and well-being of pregnant women, as the noble Baroness said. The comments about sentience in fish, animals and so on make one question where the supporters of the Bill place women’s health, well-being and reproductive rights on the scale of animals, fish and so on. One has to question where that is coming from.

No other area of healthcare is subjected to a dedicated government committee designed to limit access to its treatment. The Bill would leave a woman’s right to access to care at the whim of a committee focused solely on the foetus, with no remit to consider women’s experience, needs or rights. I will certainly not support the Bill as it progresses.

Maternity Services

Baroness Thornton Excerpts

Thursday 25th January 2024 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, it is a great pleasure to be taking part in this debate, and I thank my noble friend for her balanced introduction. I declare an interests as the maternity safeguarding non-executive member of the Whittington Hospital board and, of course, my day job as the shadow Women and Equalities Minister, both of which will inform my contribution today.

My life and possibly my son’s life might have been lost without maternity services when he was born 37 years ago at the Homerton University Hospital. I think he was the fifth baby born there—it was a brand new hospital—and the midwife and I were wandering around trying to work out where the light switches were. There is no doubt that they saved our lives; 100 years ago, we would both have died. We must recognise the great progress that has been made in antenatal and natal care in our NHS. I was particularly moved by the contribution of the noble Lord, Lord Patel, the importance of which is reflected in the Ockenden review and the need for multidisciplinary teams in our maternity units. We are talking about not just midwives but the role of people such as the noble Lord and our gynaecologists.

I meet amazing and dedicated midwives in the course of my work as a non-executive member of the Whittington Hospital board, and they are all too aware of the challenges they face, because there is a desperate need for more resources and better staffing. The Whittington is an old hospital. Some bits were built in Victorian times, including the entrance to our maternity unit, which might still have “lying-in” signposted on it. The noble Baroness, Lady Cumberlege, graciously opened a new birthing suite for us about a year ago and will bear testament to our having to adapt our facilities all the time.

One thing I am sure of is that a change in culture is still required in the NHS if it is to place the value on maternity services that it places on other medical services. I was conscious that maternity did not feature as often or as highly as it should have in our governance arrangements. It does now, but that is probably writ large in our hospitals right across England. As my noble friend Lady Taylor said, the core of the challenges outlined by the Ockenden and CQC reports is staffing. In its briefing, the Royal College of Midwives notes all the relevant points: 2,500 midwives are missing, we need to improve retention of experienced midwifery staff and increase the number of newly qualified midwives, and we need to place real value on our existing maternity services. There is no doubt that some maternity services have failed women and families. It is important that those lessons are learned and that we ensure that those mistakes do not happen again.

We must eliminate the stark, persistent, unacceptable disparities in the maternity death rates suffered by black women, Asian women and women from some of our most deprived areas, as eloquently described by the noble Baroness, Lady Gohir. I agree with her about the need for collecting data. Having been involved in equalities work for a very long time—some 40 years—I know that if you do not monitor and do not have the data, you cannot know where discrimination is taking place or show where deeply rooted discrimination is embedded in our systems. You have to collect that data. This Government have not always done that, and occasionally they have stopped funding. They need to collect that data.

The Commons report on black maternal health was vital to this debate. I raised this with the then Minister, and we had an exchange about the root causes of black and ethnic minority mothers dying at a starkly higher rate than white women. We both agreed that it was partly embedded racism in our maternity delivery services, and partly socioeconomic reasons and deprivation in some of those communities. That does not mean that we do not need to address this. A report by the Muslim Women Network said that black Muslim women, especially black African women, were most likely to receive poorer standards of care, followed by south Asian women, particularly Bangladeshi women. The Commons report noted that the themes included—as the noble Baroness, Lady Gohir, said—a gap in data and information collection on the needs, experiences and outcomes of minority ethnic women; women not being listened to; and women receiving care that was neglectful and lacked dignity and respect. Those are some of the challenges we need to address in tackling the difference in mortality rates in our maternity services.

We also need to recognise that we must take urgent action to tackle what is acknowledged as systemic racism in UK maternity services. It is always hard to say that when you have worked in public life on equalities for as long as I have, but the noble Baroness, Lady Gohir, absolutely illustrated it. I am shocked. I did not know that we were not collecting data on the claims and financial implications of maternal and infant death.

I turn to a more positive story concerning working with a general integrated hospital at a local level, like my noble friend Lady Taylor. We are both from Yorkshire, and Bradford and Huddersfield are the hospitals with which I am familiar at home. We know that it is important that those hospitals respond to the needs of the populations they serve. As an adopted Londoner and a non-exec at the Whittington Hospital, I can tell the House that we have tried to address these issues in various ways. I want to mention some of them because they are important. We are a local general hospital slap-bang in the middle of the inner city, serving mostly the very mixed population of Islington and Haringey. By the way, I am particularly proud of the fact that during Covid, all our births were attended. We did not stop fathers and relatives being present at the birth of babies in our hospital.

The specialist services that our midwives offer have to reflect the needs of our local population. I am impressed—and I hope this will be a generalist remark—that, for the varying conditions presented by pregnant women, whether epilepsy, diabetes, bipolar or sickle cell, we have midwives who are specialists in those areas. They need to be, because these conditions would have been barriers to giving birth in the past or would have made it a very dangerous procedure. In our part of London, we have a sickle cell unit in our hospital—it is a generalist unit of which we are very proud, and it has this very specialist unit—and, of course, it works right across into our maternity unit. That is very important, because we have mums coming in who have sickle cell, with all the problems that that presents.

As mentioned by the noble Baroness, Lady Watkins, for instance, combining midwifery with other expertise and experience, particularly mental health services, is very important. A woman who has a serious mental health condition and is having medication for that will need to be carefully monitored right through her pregnancy. Those specialities are very important indeed, to say nothing of the fact that mental health problems can sometimes assert themselves anyway as a result of a pregnancy.

The second thing I want to talk about is female genital mutilation. As a local hospital, in 2000, we had to respond to the fact that we had a growing number of pregnant women presenting who had suffered female genital mutilation. So the Whittington Hospital now has a female genital mutilation clinic, which used to be known as the African Well Woman Clinic. It was established in 2000 by a woman called Joy Clarke. Today, that clinic provides services on FGM: counselling, antenatal care, assessment, de-infibulation—reversal of FGM—and post-surgery and postnatal follow-up. It provides that service not only in Islington and Haringey but to the whole of London, and women from all over the country come to avail themselves of those important services. The midwife who leads it is called Huda Mohamed. She trained as a midwife at the hospital, joined the FGM service in 2012 and became our FGM lead in 2016. It is such a highly regarded service nationally, and she has played such a crucial role in providing a comprehensive and holistic approach to managing and raising awareness of FGM and the significantly positive outcomes and benefits for women who have undergone this procedure. She was given an MBE in the New Year Honours List, and we are very proud of that.

Black and Minority Ethnic Babies: Mortality Rates

Baroness Thornton Excerpts

Wednesday 15th November 2023 Lords Chamber

Asked by

[Baroness Thornton]

To ask His Majesty’s Government what steps they are taking to reduce the mortality rates of black and minority ethnic babies, following the publication of research from the National Child Mortality Database.

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

The Government are committed to tackling disparities for parents and babies. We are addressing this through the National Health Service three-year delivery plan for maternity and neonatal services, which sets out how care will be made more equitable for women, babies and families. Support is also provided through the universal public health programmes and programmes that target vulnerable families.

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[Baroness Thornton (Lab)]

My Lords, what is very worrying in a rich country such as the UK, with a universal, mature healthcare system, is that this figure of infant mortality rates for babies and children from black and minority ethnic backgrounds is going up and not down. What does the Minister believe the drivers of this data show and how will the Government reverse it? For example, the Apgar score for testing the health of babies, which is a skin tone test, does not work for black and brown babies.

[Lord Markham (Con)]

I thank the noble Baroness for her Question and for her work in this space. I have tried to delve into the numbers. It seems that roughly half the reasons why black and ethnic minority people have higher death rates are to do with socioeconomic and lifestyle factors: where they live, levels of obesity, drinking, smoking and those sorts of factors. Clearly, behind that there is a lot that needs to be done in terms of education and support, folic acid in bread and folic acid generally. The other half is more to do with racial factors. English as a second language is a key thing behind that. I hate to make generalisations, but the fact that black and ethnic minority mothers can often be less assertive means that clearly there you need training of staff to take more time, listen more, make sure that they are understanding and asking the questions to find out whether the issues are there.

Suicide Prevention Strategy

Baroness Thornton Excerpts

Thursday 26th October 2023 Lords Chamber

Asked by

[Baroness Thornton]

To ask His Majesty’s Government why claimants of out-of-work disability benefits are not included as a high-risk group in their latest suicide prevention strategy.

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

The actions in the new suicide prevention strategy for England are informed by the existing and emerging evidence, by engagement with people with expertise in suicide prevention, including people with lived experience, and by the mental health call for evidence. This strategy is population-wide and the actions within it aim to support as many people as possible, including those on out-of-work disability benefits.

[Baroness Thornton (Lab)]

I thank the Minister for that Answer, but I am not sure that clarifies this issue. This issue concerns one bit of government not heeding the research of another bit. NHS Digital’s Adult Psychiatric Morbidity Survey clearly shows that more than 43% of ESA claimants—that is employment and support allowance out-of-work disability benefit claimants—have considered suicide, compared with 7% of non-ESA claimants. The argument that this group should be included in the NHS suicide prevention strategy was made five years ago, and it was not included with no explanation. We now have the new suicide prevention strategy, and they are omitted again. I would like the Minister to clarify whether this group will be included in the Government’s—actually rather good—suicide prevention strategy or not, and if not, why not?

[Lord Markham (Con)]

What the strategy is trying to do is to look at those high risk groups and the risk factors behind them. One of the biggest risk factors causing suicidal thoughts are financial difficulties, which of course out-of-work disability benefits come into. One of the highest groups in terms of priority are middle-aged men, who are often the people suffering in this space. There are other groups as well, such as children and young people, pregnant women, new mothers and autistic people. There is a range, and what we are trying to do in this strategy is hit those areas of highest risk. To put this into context, those people on all DWP benefits in the reviews done on suicide make up less than 1% of the population of suicides. What we are trying to do is hit the major risk groups.

Childbirth: Black Women

Baroness Thornton Excerpts

Wednesday 3rd May 2023 Lords Chamber

Asked by

[Baroness Thornton]

To ask His Majesty’s Government what steps they are taking to address the fact that Black women are almost four times more likely to die in childbirth than White women.

[Baroness Thornton (Lab)]

My Lords, in begging leave to ask the Question standing in my name on the Order Paper, I draw the House’s attention to my interests in the register.

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

While births in England are among the safest globally, we must do more to tackle maternal disparities. Local maternity and neonatal systems have begun to publish action plans to tackle disparities in outcomes and experiences in maternity care at a local level. The Maternity Disparities Taskforce, which held a meeting on 18 April, brings together experts from across the health system, government departments and the voluntary sector to explore and consider evidence-based interventions to tackle maternal disparities.

[Baroness Thornton (Lab)]

I thank the Minister for that Answer. On 17 April I asked the Government about discrimination in the UK experienced by people of African descent—the Minister for Equalities pooh-poohed this report and strongly rejected most of the findings of discrimination. The following day the House of Commons Women and Equalities Committee published a report which said that black women are four times more likely to die in childbirth than white women in the UK. Does the Minister now accept that there was a point to my Question, and that research conducted on behalf of the Government since 2000 has shown that black women as a group have consistently remained at the highest maternity risk?

I would also like to ask the Minister about continuity of carer, which means having the same midwife throughout your pregnancy. It is a cornerstone of the Government’s and the NHS’s commitment to deliver safer maternity services, and indeed the report itself says that it is one of the ways to overcome barriers and improve communication and understanding throughout a pregnancy. When will the Government invest in the recruitment of midwives, bringing up their strength by 2,500, which the Royal College of Midwives says is essential to deliver this personalised care?

[Lord Markham (Con)]

I thank the noble Baroness; there were a number of questions there. I accept that there is a disparity, which is why the Maternity Disparities Taskforce was set up. I was speaking to Minister Caulfield just this morning, and I assure noble Lords that this is very high on her agenda. That is why, in providing continuity of maternity care, the focus is on making sure that people from ethnic minorities, particularly black women, get priority.

Long Covid

Baroness Thornton Excerpts

Thursday 17th November 2022 Lords Chamber

Moved by

[Baroness Thornton]

That this House takes note of the short and long term challenges presented by Long Covid.

[Baroness Thornton (Lab)]

My Lords, I think the first thing I need to say is that Covid is not over. People are still catching Covid; some are still being very ill; some end up with long Covid. Our NHS is still battling with Covid itself and the terrible effect it has had on the whole of the NHS’s ability to do its job and catch up with the backlog which Covid produced, on top of the waiting lists which already existed and were growing in 2019 before the pandemic. This is the background of our discussion today

Given the number of speakers across the House for this debate, I am very pleased that so many agree it is about time we reflected on the emerging short and long-term challenges of long Covid. I thank the Library, the British Medical Association, Nuffield Health and many others who provided us with such large quantities of briefing.

I thank all the speakers who will follow me, and I anticipate a well-informed debate which will no doubt be challenging for the Minister, not least because, although this is designated a health debate, I think if 2.1 million—and I have seen lower and higher figures—of our fellow citizens are reporting experiences of some or many of the range of symptoms of long Covid, then this has wider societal implications. It affects the workplace, incomes, families and our mental health and social care services. It raises questions about defining a disabling condition, which will affect treatment, support, insurance, pensions, income support, careers, jobs and the reasonable adjustments which need to be made, and how we will support children who may get long Covid.

Part of the challenge is that it seems there is yet no internationally agreed clinical definition of long Covid, and the evidence base on what constitutes long Covid, in terms of range and length of symptoms, is still emerging. In October 2021, the World Health Organization defined “post-Covid-19 condition” as occurring

“in individuals with a history of probable or confirmed SARS CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms and that last for at least 2 months and cannot be explained by an alternative diagnosis.”

More recently, the NICE guidance on managing the long-term effects of Covid-19 covers care for

“people who have signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than four weeks and are not explained by an alternative diagnosis.”

As noble Lords will be aware, common symptoms include fatigue, shortness of breath, chest pain, problems with memory, heart palpitations, dizziness, joint pain and many others.

To advance our understanding of long Covid, it is crucial that prevalence data is collected, and this is my first substantive point for the Minister. Government commitments have been made; for example, in June 2021, NHS England committed to setting up a long Covid registry to collect long Covid activity data. However, to date, data is not collected accurately and consistently across the UK, meaning the UK Government are still relying on ONS self-reported data. When will this important data collection happen in a consistent fashion?

There are currently a lot of unknowns when it comes to treating long Covid. Despite recent investment, more research is needed to increase the understanding of the condition, including psychological aspects, and to develop more effective treatments. In October 2020, NHS England and NHS Improvement set out a five-point plan for long Covid support, which included a commitment of £50 million to fund research. The Government said that £20 million of the £50 million previously committed to research would go into 15 UK-based research studies, through the NIHR, the National Institute for Health Research, to better understand the condition, improve diagnosis and find new treatments. As part of this investment, various studies are investigating whether there might be potential pharmaceutical treatments that would be effective in treating long Covid.

Long Covid is a focus for researchers globally, with the European Commission announcing it would accelerate its research into long Covid and develop treatments, while the United States is also running clinical trials. I would like to ask the Minister whether we are participating in these research programmes, and, if so, what are the outcomes?

Similarly, major pharmaceutical companies have demonstrated an interest in developing targeted new treatments or repurposing existing ones. Although researchers have been surveying the broad spectrum of symptoms associated with long Covid, it has to be said they have not found one biological explanation. It is likely there are various mechanisms involved. Similarities between long Covid and other post-infection syndromes need to be considered, and I am confident this will be raised during the debate today.

Despite the investment into research for treatments for long Covid, much of the research is in its early stages, resulting in a lack of evidence on effective treatments. In terms of resources, of the million or more who are reporting with long Covid, only 60,000 patients can access treatment. This means that hundreds of thousands of people with long Covid are feeling isolated and frustrated in their search for treatment, and as a result sometimes live in poverty and despair. I would like to commend the patient groups that have been doing a great job in mutual support and campaigning.

Let us look at the research, of which there must be much more. It is true the Government agreed to invest £50 million in research, although I think there are some blockages, which I would like to raise with the Minister, such as approvals to facilitate research pathways, and through developing pathways support more rapid implementation of promising findings in relation to the diagnosis, assessment, and treatment of long Covid. It would seem, despite the increased funding in research, the UK Government need to increase the infrastructure to meet the scale of the problem. While the MHRA, through the Innovative Licensing and Access Pathway, aims to accelerate the time it takes to get treatments to market, there may need to be some changes to clinical trials research legislation to enable this to be carried out. Is that the case, and are the Government considering it, and what should happen next, because it is vital that if the research is there and the pharmaceutical industry wants to bring forward treatments, we should make sure the pathway is completely clear of any obstacles.

There are huge challenges concerning work and long Covid. The first is the need to support the post-pandemic return to work, which we have discussed before in this House. Since the pandemic, there has been a marked increase in the number of workers aged 50 to 64 who have left employment. Recent labour market statistics from the ONS found that the number of people in this age group classified as “economically inactive” stood at 374,000-plus from June to August this year, compared with 37,000 in the first three months of 2020, as Covid-19 took hold. A recent analysis by the ONS found that 51% of people in this age category who had left work since the pandemic and had not gone back had reported a physical or mental health condition or illness, including long Covid. Apart from anything else, this points to the fact that people need extra support from employers to prevent them being squeezed out of the workplace. It seems to me that guidelines for employers are required—are they available? Are they being planned?

There are health and social care workers who have been particularly exposed during the pandemic. Of course, long Covid makes it even more difficult for the NHS to function as it should, to say nothing of the lives being wrecked and the families suffering terribly. The Industrial Injuries Advisory Council has made its recommendations to the Secretary of State regarding the circumstances in which long Covid should be prescribed as an occupational disease. Why have the Government not acted on this? Covid special leave provisions ended across the UK by 1 September 2022. The British Medical Association has repeatedly called for enhanced Covid-19 sickness pay provisions to continue until a long-term strategy for dealing with Covid-19 is in place. I need to know why the Government have not put a sufficient compensation scheme in place for healthcare workers who are developing long Covid.

Further to this, the Secretary of State for Work and Pensions published the Industrial Injuries Advisory Council report on Covid-19 and its occupational impacts. This report was provided to the Secretary of State and was laid before Parliament yesterday; I thank the Minister for making it available to this House. The council argues that there is sufficient evidence to recommend prescription for health and social care workers whose work brings them into frequent proximity to patients and clients where there is a significantly increased risk of infection, subsequent illness and death. Now that the Government have that report, and it has been made public, will they act upon it?

We need to address the issue of preventing long Covid in children. Will the Government develop a campaign with more consistent messaging about long Covid and clear information and guidance for parents regarding the benefits of vaccination for children and how it can protect children from long Covid?

Clearly, there needs to be more support for health professionals to identify and treat long Covid. All health professionals should be supported and equipped with up-to-date information to ensure that they understand the variable symptoms of long Covid and are aware of the available support and how to refer people to it. In terms of the funding and resources to establish multidisciplinary services, pathways for long Covid should focus on addressing patients’ multisystem symptoms and rehabilitation needs and provide individualised care plans accordingly. There also needs to be a more consistent provision of long Covid clinics, including for children, so that there is less variation in waiting times for treatment. Increased funding and independent workforce planning are key to the success of these services. How many more multidisciplinary centres are planned, and by when?

Turning to improved financial and wider support for people unable to work due to long Covid, the Government need urgently to provide employers with better guidance on how to support employees with long Covid. Perhaps the Government should set up a task force to review the UK’s statutory sick pay allowance system and whether it should be increased so that it is in line with other OECD countries. Does the Minister accept that the decision to end special Covid leave for NHS staff has put patients and healthcare workers at risk? Why do the Government not reinstate this scheme until a longer-term compensation scheme to support staff is in place?

At the end of this debate, I would welcome an acknowledgement by the Minister that the Government recognise that long Covid is having a major impact on productivity, employment and wider society, as well as our health services. I would like the Minister to tell me that they have a plan for this to be tackled in a comprehensive fashion across government. I beg to move.

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[Baroness Thornton (Lab)]

My Lords, I thank the Minister for that reply and the noble Baroness, Lady Neuberger, for outing me, because I did not declare my interest as a non-executive director of the Whittington; she is my boss there. I will just use these last few minutes to say that this was an excellent debate and I hope it has the kind of impact that most speakers said they would like. I will just mention a few of them.

I thank the noble Lord, Lord Bethell, for a wonderful contribution. There was a time when he and I felt that we saw more of each other than we did of our partners. I should include the noble Baroness, Lady Brinton, in that comment.

The noble Baronesses, Lady Scott and Lady Meacher, were correct to make the links they did and to raise issues such as there being no diagnostic blood tests for ME and CFS, even now. My noble friend Lady Donaghy was also completely right about the need to raise awareness.

The noble Lord, Lord Kakkar, is always concise and I am always grateful for the medical exposition he gives, which I would never dare attempt. I was hoping he would do so and indeed he did. I wish I had thought of the words “national protocol”, and I hope the Minister takes the opportunity to look at what he said about how data could be used. I do not wish to bring the two together, because I am sure they know each other, but I thought that his offer was very pertinent.

The right reverend Prelate the Bishop of Exeter and the noble Baroness, Lady Watkins, brought to our attention the problems in rural areas and with mental health. I am very grateful to my noble friend Lord Stansgate because he and other noble Lords, such as the noble Earl, Lord Clancarty, and the noble Baroness, Lady Masham, talked about the personal experiences of long Covid of people they had spoken to. It is very important that we give voice to those experiences in this Chamber. Many noble Lords did that and I had hoped they would, because I knew I would not be able to in my opening remarks.

I am very grateful to my noble friend Lord Griffiths for his extremely kind words and for reminding us, as he often does, about the human costs of the pandemic—not just the medical costs. My noble friend Lady Taylor talked about the significance of long Covid for society, and I was very struck by the noble Baroness, Lady Brinton, who again reminded me of a book that I still have to read. I promise her that I will now read it because, as she says, history has things to teach us and we need to hear those words—and the Minister does too.

My noble friend Lady Pitkeathley quite rightly talked about carers and unpaid carers. I thank her too for her expert round-up.

I thought that the Minister did the best he could—I have been in his place; there are so many experts in this House, and as a Minister you can only do your best with them—but I think the noble Lord needs to go through this debate. I asked about eight or nine specific questions, some of which he answered and some of which he did not. For example, he did not address the question of the Industrial Injuries Advisory Council. It is very important for our NHS staff to know the answer. I should be grateful if the Minister and his officials could go through this debate, pick out those questions and write to everybody who took part in this debate, putting the answers in the Library, so that we can see and take this forward as we know we will need to do.

Motion agreed.

Menopause

Baroness Thornton Excerpts

Tuesday 18th October 2022 Lords Chamber

Asked by

[Baroness Thornton]

To ask His Majesty’s Government what steps they are taking (1) to support women going through menopause, and (2) to increase general awareness about the challenges it poses.

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

My Lords, the menopause is a priority area in the women’s health strategy. The NHS has a programme to improve clinical menopause care in England and reduce disparities in access to treatment. It is also developing an education and training package on menopause for healthcare professionals. We have appointed Professor Dame Lesley Regan as the women’s health ambassador for England. Her role includes raising awareness of women’s health issues, including menopause.

[Baroness Thornton (Lab)]

I thank the Minister for that Answer. Today is World Menopause Day. My Question is broader than those which concern only the medical response, so I would regard the Minister’s response as inadequate. Given the doubling of menopause-related discrimination claims in a year, showing that we are losing working women from the economy who are otherwise at the peak of their skills and experience, should the Minister not counter employer mismanagement of a transition that all women go through by requiring the HSE and the EHRC to publish advice on this urgently, as neither of them do so?

[Lord Markham (Con)]

I thank the noble Baroness. I agree that it is fitting that we should be having this debate today, World Menopause Day. I completely agree with the importance of this subject for employers, productivity and the economy as a whole, as well as for women’s health.

As I am sure the noble Baroness is aware, 10% of people end up leaving their job during menopause. That is a real loss to business and those individuals. That is why, through our strategy, we are appointing an employee champion in this area. Their job will be to reach out to employers and work with them to make sure that this subject is very high up on their agenda. As an employer myself, in my personal entrepreneurial life, I agree that it is an area of utmost importance.

Disabled People: Personal Assistants

Baroness Thornton Excerpts

Wednesday 7th September 2022 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty’s Government what steps they will take to address the reported shortage of working age disabled people’s personal assistants, needed to enable them to work and live independently.

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

Personal assistants are invaluable in supporting people to live independently. The Government have in place a range of measures to support recruitment and retention, including delivering a national recruitment campaign, providing a £462.5 million boost for recruitment last winter and ongoing work with the Department for Work and Pensions to promote carers in adult social care. We are also investing £500 million to support and develop the social care workforce, including personal assistants, to address long-term barriers to recruitment and retention.

[Baroness Thornton (Lab)]

I thank the Minister for that Answer. The lack of PAs is a serious emergency and is creating huge anxiety for the working-age disabled, who need and have a legal right to be economically and social active. What seems to have happened is that the market for and availability of people who want and value this kind of job have vanished. Welcome as they were, none of the measures that the Minister mentioned address that emergency. For example, one no-cost action that would help—it would not solve the problem, but it would help—would be for PAs to be recognised as skilled workers and be made eligible for work in the UK, since more than 32% of them vanished as a result of Brexit. Are the Minister and his colleagues meeting the disabled groups that are very concerned about this matter?

[Lord Kamall (Con)]

I thank the noble Baroness for raising those issues. As she will recognise, some of them fall between DWP and the Department of Health, so I can take the second question back to DWP on her behalf. We recognise this issue as part of the wider social care sector but one issue with bringing people in from overseas—as many noble Lords will know, I am in favour of recruiting from overseas—is that personal assistants are often employed by individuals and, sadly, under the Home Office rules, they are not considered sponsors. When this was raised with me yesterday, I asked for it to be looked into in more detail and was assured that more conversations will be going on. It is a reasonable suggestion; we just need to have those conversations with the relevant department.

NHS Mental Health Patients in Private Hospitals

Baroness Thornton Excerpts

Thursday 28th April 2022 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty’s Government what plans they have, if any, to address the reported £2 billion per year the NHS is paying to private hospitals to take on its mental health patients as a result of bed shortages.

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

Non-NHS providers have always played a role in delivering NHS services for patients since the founding of the NHS. The CQC regulates both NHS and independent providers to deliver care to the highest quality. The Government and the NHS have an ambitious transformation programme to increase investment in community mental health services and to introduce new models of care so that more people are cared for in their communities, reducing reliance on inappropriate in-patient admissions.

[Baroness Thornton (Lab)]

I thank the Minister. I beg the indulgence of the House to record that this is my last outing as opposition health spokesperson—although I shall be taking up other Front-Bench duties so your Lordships have not escaped completely. I wish to record a huge thank you to colleagues across the House with whom I have worked over many years; my especial thanks to the small but perfectly-formed Labour health team, my noble friends Lady Wheeler and Lady Merron and indeed the Back-Benchers; and my thanks to the many Ministers whose well-being I may not always have enhanced over the years.

On this Question, the issue is not whether it is a good use of NHS funding to spend £2 billion a year on privately provided mental health beds. It is about whether, given the parity of esteem for mental health recently reinforced in the brand new Health and Care Act, the Government have a plan to invest in reversing the decline of mental health beds and increasing the number of NHS mental health beds available at community level, as the Minister mentioned, where they are needed, and over what period.

[Lord Kamall (Con)]

I begin, if noble Lords will allow me, by paying tribute to the noble Baroness for her doughty and robust opposition, but also for the advice when I was a new Minister suddenly thrown in at the deep end. It was very comforting to have one of the Opposition help me and give advice—I make no comments about the quality of the advice but I was incredibly grateful. I also pay tribute, to requote her words, to the perfectly formed shadow team. I thank them very much for all their holding us to account.

On the issue, when I was looking at the future of mental health, one thing we have to look at its granularity. There are different types of mental health; someone suffering from eating disorders, for example, will have a very different need from someone who is schizophrenic. It is really important that we do not just assume that everyone needs to be in a bed. Where appropriate, we should move people out to the community but make sure that they are supported there, not just kicked out the door and left to fend for themselves. We are looking at a massive programme of investment and at how we can have more targeted interventions for those suffering from different mental health issues.

Health and Care Bill

Baroness Thornton Excerpts

Consideration of Commons amendments
Tuesday 5th April 2022 Lords Chamber

Moved by

[Baroness Thornton]

At end insert “, and do propose Amendments 30B and 108B as amendments to the words so restored to the Bill—

30B: Clause 40, page 48, line 42, at end insert—
“(1A) In section 272(6) of that Act (regulations), omit the “or” at the end of paragraph (b) and after paragraph (c) insert “or
“(d) regulations under paragraph 6A of Schedule 10A,”.”

--- Later in debate ---

[Lord Moylan (Con)]

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

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

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

[Baroness Thornton (Lab)]

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

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

[Lord Kamall (Con)]

I thank all noble Lords who have taken part in this debate and the debates throughout the day. We managed to stick to the point and tried to be as brief as possible. I am afraid I will not be as brief as the noble Baroness, Lady Thornton, but I will try to be briefer than I usually am.

I should just make some acknowledgements, looking at the whole group. First, on learning disabilities and autism, I thank the noble Baroness, Lady Hollins, in her absence, for her constructive engagement with the Government.

On tobacco, I once again urge noble Lords to reject Amendments 85 to 88 and 88B. The independent review is not scheduled for publication until May, when we will of course consider our next steps. I understand that the noble Lord told us to get on with it, but we do not want to pre-empt the independent review. As it is in the process of being drafted, we really want to make sure that we have proper consultation and agreement, both across government and across the UK with the devolved Administrations.

I hope the noble Lord is in no doubt that we are also committed to the tobacco plan and the reduction of smoking. We just do not feel that this is the right amendment, but the noble Lord may feel otherwise. Any changes to tobacco legislation proposed by the Khan review, a plan supported by the Government, will be consulted on. We firmly want to make sure we reach our smoke-free 2030 ambition or get as close to it as feasibly possible.

There is a debate about the polluter pays principle. I am sure the noble Lord, Lord Crisp, will recognise the debate about Pigouvian taxes, taxing negative externalities and who is responsible. Who is the polluter? In the car industry we tax the driver, as they put more petrol in. Should it be the smoker or the industry? There is a debate about this, but I hope these issues will be considered by the Khan review.

I also thank the noble Lord, Lord Sharkey, for his constructive engagement on reciprocal healthcare. I am pleased that we were able to narrow the gap and get to the same place.

I turn now to the telemedicine abortion issue. The Government felt that we should have gone back to pre-pandemic measures, but it was right that there was a free vote. We saw the results of the votes in your Lordships’ House and the other place, and we accept them. The democratic will of both Houses is quite clear. At the same time, we also accept that there were some concerns, as my noble friend Lady Eaton rightly said, about underage women being forced to have abortions and safeguarding. My noble friend Lady Verma also made a point about issues in certain communities; we know that these things go on in certain communities and that there are close relationships.

After the reassurances I gave at the beginning, my noble friend Lady Eaton said she was reassured enough not to push her amendment to a vote. I hope that remains the case and that my noble friend has not been persuaded otherwise. It is important that we consult, treat this sensitively and get the appropriate guidance, but the decision has been made by both Houses and we have to make sure that it works and that we address some of the legitimate concerns that noble Lords have raised in this debate.

Given that, I ask this House to accept the Motions in my name.