Health and Care Bill

Baroness Walmsley Excerpts

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

[Baroness Fox of Buckley (Non-Afl)]

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

[Baroness Walmsley (LD)]

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

[Lord Naseby (Con)]

I was suggesting that we do carry on because the evidence is there in government data, not in a forecast from the noble Lord, Lord Crisp, or some minor operation that he—

[Baroness Penn (Con)]

I remind noble Lords that only short questions of elucidation are allowed on Report.

[Baroness Walmsley (LD)]

Many thanks. I suggest to the noble Lord, Lord Naseby, that a lot more people will be dead from tobacco if we carry on at this rate. He suggested that, just because this measure was not in the Conservative Party’s manifesto, perhaps we should not carry it forward. Well, the Conservative Party does not have all the best ideas, although I congratulate the Government on the sugary drinks levy, which has been highly successful. We support the polluter pays amendment introduced by the noble Lord, Lord Crisp. I might call it the killer pays amendment because, make no mistake, this is a killer substance.

I happen to live in Wales so I want to raise a matter that has not been mentioned yet. I am glad that the Welsh Government have committed to a smoke-free Wales by 2030. However, although England announced its intention to go smoke-free by 2030 two years before Wales did, Wales has leapt ahead as regards action, which is why I hope that the Minister will either accept Amendment 158 or give adequate assurances. In the Green Paper of July 2019, the Government said:

“Further proposals for moving towards a smoke-free 2030 will be set out at a later date.”


Approaching three years later, still nothing has happened. There are no further proposals and no funding has been announced. In contrast, Wales has published concrete proposals, but many of the interventions require action from the UK Government. Examples include the polluter pays funding mechanism, which could help to fund tobacco control in Wales; raising the age of sale; and putting warnings on cigarettes and pack inserts. I am concerned that, by being so slow, the UK Government are undermining the ability of the devolved Administrations to achieve their smoke-free ambitions. We will support the noble Lord, Lord Crisp, if he chooses to put this amendment to a vote.

[Baroness Merron (Lab)]

My Lords, I am grateful to noble Lords for their contributions to this debate and for putting forward this group of amendments. In introducing Amendment 158 and the consequential amendments, the noble Lord, Lord Crisp, outlined that they would establish a consultation on a polluter pays levy whereby funds are raised by the scheme to pay for the cost of tobacco control measures to deliver a smoke-free 2030. This strikes me as wholly pragmatic; a wide-ranging consultation would undoubtedly help to strike the right balance between all the parties involved.

We know from this debate and many previous debates that tobacco use carries huge health risks, and disproportionately so for the most disadvantaged in society, whose likelihood of smoking is four times higher in the most deprived areas compared to the least deprived. If ever there was a case for levelling up, this is it. My noble friend Lord Faulkner rightly highlighted that we have seen cuts to stop-smoking services, and this group of amendments seeks to redress the situation in a practical way. It is vital that we motivate and support more smokers to quit, while reducing the numbers of children and young people who start to smoke. Greater action is clearly needed now.

The scheme proposed in this group of amendments would provide a well-funded and much-needed boost, and a consultation would allow this proposal to be tested, refined and shaped. I hope that the Minister will accept the opportunity of a consultation but if the will of the House is tested, these Benches will support the amendments.

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[Baroness Bennett of Manor Castle (GP)]

My Lords, I feel I have to respond immediately to that. I intended to speak anyway, having attached my name to an amendment on alcohol advertising in Committee. I would have attached my name to this amendment both in Committee and on Report, had there been space.

The noble Lord, Lord Vinson, talked about freedom of choice. I do not know how many people know that a bottle of wine can contain anywhere between zero and 59 grams of free sugar per bottle. Surely the public do not have the freedom of choice to decide which wine they consume and which level of sugar they consume.

The noble Lord made a point about the difficulty of labelling. Bottles of wine are shipped to many different countries with labels in different languages. We have computers these days which can cope with these things quite simply and easily. It is clearly not beyond the wit of producers to achieve this.

The Government often like to talk about being world-leading. I point them to an editorial in the Lancet Gastroenterology & Hepatology titled Shining a light on international alcohol industry lobbying, showing just how powerful this incredibly wealthy industry is in influencing and damaging public health messages around the world. Would the Government not like to be world-leading in standing up against this industry lobbying, in the interests of public health?

[Baroness Walmsley (LD)]

My Lords, at the risk of being boring, I am one of those people who has been asking for this for the last 20 years. I started off asking for the number of units of alcohol in a bottle of wine. Every manufacturer of these alcoholic drinks knows exactly what goes into them. On the issue of labelling products from abroad, there are a lot of foodstuffs that come from abroad and they have to abide by British rules on labelling, so why not wine and spirits? It is time we did this. It is terribly important for public health, and I hope the Minister will say yes.

[Baroness Merron (Lab)]

My Lords, I thank the noble Baroness, Lady Finlay, for bringing forward Amendment 163, and thank other noble Lords for outlining their support for or concerns about it. The amendment refers to publishing a report on alcohol labelling to improve consumer knowledge.

Government data comparing pre-pandemic and post-pandemic figures has shown that sales of alcohol increased by some 25%. This is, as we know, a booming market and consumers need to be equipped with the right information to make informed choices. They have a right to know what is in their drinks and decide what and how much to drink. The consultation promised by the Government, with this in mind, remains something of a consultation in long-overdue waiting.

Currently there is no requirement for alcoholic drinks to include health warnings, drinking guidelines, calorie information or even ingredients. As my noble friend Lord Brooke said, this is very much out of step with any other information on what we consume. There is, as always, a balance to be struck between health improvement measures, consumer information and industry regulation, but this amendment supports a necessary move in the right direction and I hope the Minister will agree to it.

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[Baroness Finlay of Llandaff (CB)]

My Lords, I was glad to have been able to put my name to Amendment 166 about PERT. In this Bill, the Government have introduced a milestone in changing the care of people who are facing serious illness at the end of life.

The reality, as we have already heard, is that the majority of patients with pancreatic cancer are diagnosed late, because it comes in the head of the pancreas. The pancreas has two parts—the head and the tail. But, because it can grow without causing much pain in the initial stages, it often goes undetected until it is fairly advanced. That means the outlook is poor. The other thing it does, as it grows, is block off the flow of enzymes into the gut. Without replacement, these patients get a malabsorption syndrome; they can get terrible diarrhoea and muscle wasting, because they are not absorbing the nutrients they need.

This amendment is very important. It could quite easily build on the network that will now be in place to commission specialist palliative care services. The move the Government have made has been welcomed across palliative care in this country and is being seen as a way to dramatically change the care of patients. With data information flows now integrated and networked across the NHS, we will be able to get accurate data on how many patients with pancreatic cancer are getting replacement therapy when they need it. Some people do not need it; some need it later on. This is part of building on the important foundation the Government have laid. It was that which persuaded me to put my name to Amendment 166.

Another point I would like to make is about improving things for the lowest quartile of the population. Incidence of pancreatic cancer is highest in the most deprived areas and it is higher in women than in men. Part of levelling up, to help people to live well for as long as they can, is making sure they get the enzyme replacement they need.

[Baroness Walmsley (LD)]

My Lords, I have in my hands the latest cancer waiting time figures. It is very unfortunate that, despite the hard work of NHS staff, every single metric was worse in January than in December. It therefore seems a great pity that not all patients who have a diagnosis of this dreadful disease of pancreatic cancer can get this medicine, which can improve and even extend their lives.

I well remember a senior, well-loved and well-respected Member of the Labour Benches who died of this dreadful disease. We lost him far too early, because this disease takes people very quickly. Anything at all the Minister can say to encourage us that this effective and approved medicine can be made fully available to everybody who needs it—depending on the conditions, as outlined by the noble Baroness, Lady Finlay—would be helpful.

[Baroness Thornton (Lab)]

My Lords, can I say how much I support this suite of amendments? I congratulate the noble Lord, Lord Moylan, for tabling and speaking to them. This most lethal of killers has been defying science—or we at least have not had enough investment in the science—for many years. This means the survival rate is still not as it should be and as it is for other cancers. Anything that pushes the NHS and research community to tackle this and to set the targets that are needed to do so is very welcome. I look forward to what the Minister has to say.

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[Baroness Grey-Thompson (CB)]

My Lords, I have spoken numerous times about my opposition to assisted suicide for many different reasons. It is not, for me, about the sanctity of life. Not everybody who believes that the law should not be changed has strong faith. However, we are continually being asked to vote through the principle and think about the detail later. The devil is in the detail.

Detailed scrutiny is our role as a revising Chamber. The Commons has so many of its amendments guillotined. However, we have to take an issue such as this, which is about ending people’s lives, very seriously and we have to debate some of the detail. I know that the noble Baroness, Lady Meacher, feels strongly about this and I wish she had pressed much harder and much earlier for a Committee stage for her Bill. In an issue such as this, when we are talking about ending people’s lives, there should be hundreds of amendments, because it has to be debated properly.

I would like to briefly go on the record to thank the hundreds of people who have written in. We are really lucky right now that we live in a democracy and that people are able to freely express their opinions, whether we agree with them or not. Our role in the House of Lords is to deal with those people who write in. Lots of people from both sides have written to me. However, we must also be really careful in our language and not scare people into thinking that assisted suicide is the only option for them.



As a disabled person who sits in this Chamber with a red stripy badge, I have a huge amount of privilege. Many, many thousands—tens of thousands or more—of disabled people do not have privilege in respect of protection. This amendment and what it seeks to do will fundamentally change the political and societal landscape for disabled people. If people have not read it, they should look at the article by the noble Lord, Lord Shinkwin, this weekend about how disabled people are encouraged to think that they would be better off dead than live with an impairment. Even in this Chamber, we hear about things such as incapacity and incontinence and all the things that people fear. I push back on that, and I push back on the view that public opinion is overwhelmingly in support of this. On the Dignity in Dying website, 284,881 people have signed the public petition. On the Commons website, asking for a change in the law, 46,483 people have done so. That is not overwhelming public opinion.

I know the frustration of people who want to change the law. I can feel it; we hear it, and I admire the fact that the noble Lord, Lord Baker, says that we are a democratic Chamber. There are plenty on the outside who would not agree with that in terms of the way that we operate. This, however, is a constitutional matter. For all those arguing in favour of this tonight, I really look forward to them supporting my Private Member’s Bills asking for things such as good education, work, social care and access to trains, which are the things for which disabled people are arguing. This is not it: this is not the right time and not the right place. I do not support this amendment.

[Baroness Walmsley (LD)]

My Lords, I think the mood of the House is that the Front Benches—

[Lord Shinkwin (Con)]

My Lords, may I just be indulged by the House in following the excellent speech by my noble friend Lady Grey-Thompson? Exactly seven weeks ago, not just to the day but to the exact hour, I started to feel very ill. I was barely 36 hours out of the operating theatre after surgery that had gone incredibly well and I knew something was seriously wrong. By midnight I was in agony, my bowels totally blocked by the combined effects of the anaesthesia and the pain relief. By the morning, I was passing blood and my haemoglobin levels had plummeted. That was just seven weeks ago. It was at that point that a decision was made to transfer me by ambulance to St Thomas’ A&E so that I could have an urgent blood transfusion. I lived to tell the tale, but tell it I would much rather not have done. I would much rather forget the whole episode—the unbelievable pain, the helplessness and the acute sense of vulnerability. My family do not know any of this; I have not told them. I am hoping they do not read Hansard.

I share it with your Lordships’ House because I believe that my recent experience is directly relevant to Amendment 170. We have been assured that this is not about the merits of assisted dying, but noble Lords should not underestimate the magnitude of what is at stake in this amendment. This is not the start of some cosy conversation about a harmless, anodyne measure. The end goal is assisted suicide and the means is a Bill proposed in this amendment. If this amendment were passed tonight, I firmly believe that in years to come, we would look back and say that today—16 March 2022—was a pivotal moment.

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We are summoned by our sovereign to this place, whether physically in person or remotely, precisely because it is our obligation and responsibility—indeed, our solemn duty—to fast-forward to the worst-case scenario and to pre-empt and prevent that worst-case scenario in law. I fear that the effect of the amendment would be the opposite.

[Baroness Walmsley (LD)]

My Lords, as the noble Baroness, Lady Grey-Thompson, rightly said, the devil is in the detail. That is what Parliament does and it is what the noble Lord, Lord Forsyth, is asking your Lordships to allow Parliament to do.

Like many families across the country, my family has had discussions about the substantive issue of assisted dying. Different views have been expressed and no one has fallen out, but it is not around our dinner table that decisions must be made about an issue as serious as this; that is for Parliament. I trust Parliament, and I do not think it should be—as the noble and learned Lord, Lord Falconer, pointed out—for the Director of Public Prosecutions to make decisions about these issues. Assisted dying is happening and Parliament must decide how or if it should be done.

It has been suggested that this House should not instruct the Secretary of State to do anything. As we have gone through the Bill, we have asked the Secretary of State to do quite a lot of things; in fact, we have voted that the Secretary of State should do a lot of them. What happens to those amendments? They go to the elected House. I have great respect for the noble Lord, Lord Cormack, and I understand how important he feels it is that issues as controversial as this should be decided by the elected Chamber. Well, if we vote for this amendment, those issues will be decided by the elected Chamber. If this novel procedure of a draft Bill being laid before Parliament is used, I trust Parliament; there will be proper debate and I hope that what will come out of it will be a very measured piece of legislation that takes all the concerns into account. The game-changer that my noble friend Lady Finlay has successfully introduced to the Bill will be taken into account by the elected Chamber.

It is very important that people who want to have palliative care to ease their suffering at the end of life actually get it—everyone should get it; there should be no postcode lottery—but even in those situations there may be people who do not want it and instead want to do something else. It is for Parliament, not for my dinner table or anyone else’s around the country, to make that decision and to be given the proper amount of time to come up with something that I hope will reassure those who rightly have fears. They have fears because they do not know what Parliament will decide. If we give Parliament the opportunity, I am quite sure that even a draft Bill, however well drafted, will probably be amended as it goes through the elected House. What will come out at the other end will probably reflect public opinion—genuine public opinion, that is; I am not quoting any polls on either side—as they will have given serious thought to the issue and listened to everyone who wants or does not want this measure on the statute book.

We must give the elected Chamber the opportunity either to accept an amendment that we may pass tonight or to send it back to us, but at least we will have asked them to think again. This House does that very well. We ask another place to think again. I hope we will tonight.

[Baroness Merron (Lab)]

My Lords, I have listened very closely to the many passionate, informed and often personal contributions from noble Lords this evening. This debate has inevitably been about not only parliamentary process and legislative approach but consideration of assisted dying. I thank the noble Lord, Lord Forsyth, for opening the debate on Amendment 170, which proposes, as your Lordships’ House is more than aware, a new clause to bring forward a draft Bill on what the noble Baroness, Lady Campbell of Surbiton, described as a complex and difficult issue.

However, for me, the challenge of this debate is encapsulated in the contributions in the middle of it. The first, from the noble Baroness, Lady Davidson, was that not allowing time for discussion is not a neutral act. This was followed swiftly by my noble friend Lord Hunt taking a different tack, saying that allowing for this amendment is also not a neutral act, and it is that which your Lordships’ House has wrestled with this evening.

It is indeed a matter of profound moral, personal and legislative importance that we find ourselves dealing with in Amendment 170. The noble Lord, Lord Forsyth, will be seeking a Division and these Benches will approach this on free votes. It is a shame that this is not the case on the Government Benches. Your Lordships’ House heard from the noble Lord, Lord Baker, about the importance of principle, whereby matters such as this should be subject to nothing other than a free vote. I certainly share that view. I know that noble Lords will exercise their vote this evening with the greatest of care.