International Health Regulations

Liam Fox Excerpts

Tuesday 14th May 2024 Commons Chamber

[Sir Liam Fox (North Somerset) (Con)]

We all want better co-ordination in the face of any future pandemic risk, but it is also clear that the WHO wants supranational powers. Will my right hon. Friend guarantee that the UK Government will not accept any obligation that requires the UK to legislate to implement any element of the WHO treaty into UK law?

[Andrew Stephenson]

At the moment we do not envisage any proposal that would require changes to domestic law, and it is highly unlikely that any proposals will come forward in that shape or form. I have some sympathy with what my right hon. Friend says: most organisations such as the WHO will always look to expand their remit, and look to gain more power in order to co-ordinate things. But these negotiations are being led by member states and sovereignty is a key part of the negotiating position of the vast majority of the countries involved. It is not just the UK arguing for this; countries around the world are arguing that this needs to be a high-level agreement that helps co-ordination and information-sharing but in no way ties countries’ hands in how we respond domestically to any future pandemic.

Down Syndrome Bill

Liam Fox Excerpts

3rd reading
Friday 4th February 2022 Commons Chamber

[Dr Liam Fox (North Somerset) (Con)]

I beg to move, That the Bill be now read the Third time.

May I begin by thanking Members on both sides of the House for the support that they have given the Bill from the very outset? There are not many things that justify the downsides of being a Member of Parliament, but this is certainly one of the upsides—when we can see what will inevitably be a crisis emerging and do something about it in due time. That is one of the privileges given to us, and I am grateful to Members for their support in taking the Bill forward. They have not only supported it here in the House but advocated for it outside the House, where it has become one of the best-known private Members’ Bills in recent times in terms of public awareness of what is happening. That matters a great deal, because the Bill is not exactly the same as it was when we considered it on Second Reading—a subject that I will come to in a moment.

The most common question that I am asked is, “Why have you been so concerned with this issue?” I explained on Second Reading that when I was growing up, the boy next door to me had Down syndrome. As a GP, I saw a number of those with Down syndrome and their families, and I saw the difficulties that they encountered. We regularly see one of my friends in my constituency, where I live, whose son Freddie has Down syndrome. As Members of Parliament, we have all recognised that having someone in the family with Down syndrome is not just a single problem to be dealt with; it is a conglomeration of problems. Families find themselves fighting on a number of fronts to get the quality of care that, frankly, they already have a right to. For me, that was why we needed a separate Bill.

All Members will have had letters asking why the Bill could not have been wider—why we could not have included more conditions in it. I suppose there are two answers to that. The first is that private Members’ Bills have to be short and concise if we are going to get them through. Let me be very frank: getting a foot on the ladder of legislation in areas such as this is crucial. If we reach for too much in a private Member’s Bill, we can end up with zero. I think we have set the appropriate level of ambition in this Bill.

We also have to recognise the complications that come with an extended Bill when it comes to the view of the Treasury. Many years ago, I was in the place of the Lord Commissioner of Her Majesty’s Treasury, my hon. Friend the Member for Castle Point (Rebecca Harris). It is definitely a case of gamekeeper turned poacher, but you learn a great deal as the gamekeeper for when you have to be the poacher later on when it comes to private Members’ Bills. I put on the record my thanks to her for her help. The role of the Friday Whip is not well understood outside Parliament, but when they are on your side, they can be very powerful allies indeed, and her support is very much appreciated.

We also wanted the Bill to be separate because it is about a definable group in the population. Down syndrome is not something where there is any dubiety about the diagnosis and, as I said, there are complex identifiable needs. For example, we know that those with Down syndrome have a higher level of issues such as congenital heart disease, they have a higher instance of leukaemia, they have myriad ear, nose and throat problems, and the earlier they are dealt with, the better. It is difficult enough for parents to be fighting waiting lists and fighting to be regarded with sufficient urgency; if they are also dealing with the education system and trying to get help for a learning disability, that is an additional problem.

The successes in medical care are the main driver for the Bill. When I was growing up, that boy next door had a life expectancy of 15 years. When I became a doctor in 1983, the life expectancy was about 30. Now, it is about 60. We should all be extremely grateful for that, but, as ever with advances in medical science, it brings its own problems. The problem, if we want to see it as such, is that parents will have this extra worry: “What will happen when I’m not there?” That is why I referred at the very beginning to a perfectly identifiable crisis that is on its way to us. If we actually take measures now, we can prevent individual tragedies. If there is a real justification for Members of Parliament having their own constituencies and dealing with real people, rather than being creatures only of a political party, it is that constituency link, which tells us about problems that need to be addressed and gives us the early warning sign to pass legislation to be able to deal with them. The complexity of the issues is one reason why we need separate legislation and why we had to bring different provisions into the Bill as it comes back for Third Reading from when it left the House after Second Reading.

[Ruth Jones (Newport West) (Lab)]

The right hon. Member is making such a powerful point. He and many other Members have had numerous letters questioning the narrowness of the Bill. Will he reassure us that this is only the beginning and most definitely not the end of the process?

[Dr Fox]

Indeed. I would not even say it is the end of the beginning. It is on the way to being the end of the beginning, but this will be a perpetual battle. So long as medical science is able to make advances in genetics and immunology, this process will continue into the future and we will need to look at it. It is worth pointing out, to answer the hon. Lady’s question more directly, that we considered this in Committee. The Minister for Care and Mental Health, my hon. Friend the Member for Chichester (Gillian Keegan), made it clear that in the guidance that will be issued, which I will come to in a moment, it is entirely possible to deal with the effects of other conditions that may have the same effects as those emanating from Down syndrome. In a way, yes, we are starting the process, and the way in which we change the Bill is absolutely key to that.

On Second Reading, I think it is fair to say, because we can be a little self-critical, that this was a well-meaning Bill that went as far as we could. However, I made it clear that one big issue was missing—the enforcement of rights. It is all very well to make available new provisions and rights in law, but if an individual or parent does not have the ability to enforce those rights, if there are no mechanisms or levels to pull to enable them to get the full benefit of what the legislation supposedly gives them, ultimately we are failing to achieve what we want. We discussed two major issues. I purposely left them out of the Bill on Second Reading because we were not ready. There is nothing worse than poorly-thought-out legislation that we have to come back and amend. It is far better to think the process through, get agreement on both sides of the House and with the Government, and then proceed on the basis of unanimity, as happened in Committee.

The changes were essentially twofold. The first was getting agreement from Ministers that they would issue guidance to local health and education bodies and planning authorities to ensure that healthcare, education and long-term care issues would be properly taken into account. That was a major step forward. Again, it answers the question of how we can broaden the effects of the Bill, even with measures that are not in the Bill. That means looking at other conditions that will face the same problems as created by Down’s syndrome. However, that agreement created its own parliamentary problem for us, because as those who listen to debates in the other place will know, guidance issued by Ministers that is not laid before Parliament creates a potential democratic deficit. That is why I think it was the first major step forward for the Bill in Committee when the Government agreed not simply that the Minister would issue guidance, or that that guidance could apply directly to the various bodies concerned—another important step in itself—but that that guidance would be laid before Parliament.

Up to that point, I had considered whether we needed to put a sunset clause in the Bill, to have it completely reviewed to see whether it worked in practice. The fact that the guidance will be laid before Parliament enables us to look in real time at what is happening, including parliamentary Committees looking at how the guidance actually works. That is a huge step forward. I think it is actually precedent-setting and turns this from a nice Bill into a cutting-edge and meaningful Bill. That is a huge achievement and one thing for which the Bill will be most remembered.

[Craig Williams (Montgomeryshire) (Con)]

I pay huge tribute to my right hon. Friend for bringing forward the Bill and the manner in which he has done so. On the territorial extent of the guidance, as a Welsh Member of Parliament I pay tribute to him, but he will know far better than I, given his length of service in this place, that the Bill’s territorial extent is England only. The Minister has alluded to working with devolved counterparts, but may I ask him to use his passion and experience to urge the devolved Administrations to follow suit?

[Dr Fox]

I thank my hon. Friend for that question. It will not surprise him to hear that, as a committed Unionist, I will come back to that. We need to consider the quality of life of all citizens in the United Kingdom, not just those for whom we are directly legislating today.

I turn to the second element of precedent-setting changes that we made to the Bill in Committee. As we move to the new integrated care structure in the health service, we will have a named individual on the integrated care boards responsible for the application of this legislation, should it receive Royal Assent. That really matters, because those who have Down syndrome, their parents, their families and communities will know who in the new structure is responsible for ensuring that the guidance issued by Ministers is given effect on the ground. I think that even the direct application of ministerial guidance—as it would have had—and parliamentary scrutiny would not have been not quite enough to guarantee the effect of the Bill’s provisions where it really matters.

That is precedent-setting. I doubt very much whether this will be the only occasion on which my hon. Friend the Minister has to consider representations for named individuals to take responsibility, but I take great pride in the Bill being the first, because I think it is a major step change from what we have had. It will give the new integrated care plans the idea of responsibility for their application to named individuals, which gives us a point of pressure in the system that did not otherwise exist.

Finally, I turn to the Bill’s application to one part of the United Kingdom. At the beginning of the legislative process, we had a choice. We could have set out a United Kingdom Bill and challenged the Governments in Scotland, Wales and Northern Ireland for legislative consent orders. We could have said, “We dare you not to have the same provisions.” However, that would have become a debate about devolution, not Down syndrome, and I passionately wanted the Bill to focus on the needs of those with the condition and not become an argument about Government process or our constitutional relationships.

Having said that, I completely take the view that a person with Down syndrome should not have fewer rights in one part of this United Kingdom than in any other. The Bill is making speedy progress through the House. I hope that it will make speedy progress through the other place and that, hopefully, it can get to Royal Assent before World Down Syndrome Day on 21 March, at which point we would be the only country to have legislated for it. That is important for our concept of global Britain, which cannot be just about trade, defence or economies; it must also be about our values, and I can think of no clearer signal to send than to legislate on this point.

I say to those in charge of the legislative programmes in Wales, Scotland and Northern Ireland that it is unthinkable that people with Down syndrome living in those parts of the United Kingdom should have fewer rights, or rights applied at a later date, than those in England, for whom we are legislating today. When it comes to health, it is the duty of all those who run those devolved parts of the United Kingdom to ensure that everybody in the UK, irrespective of where they live, gets the same access at the same time to the changes to which we are giving effect today.

This Bill began with great intentions, and ends now as a landmark Bill. It recognises that, in the provision of services, whether in health, education or long-term care in this country, Parliament will give not only rights, but applicability and enforceability of those rights in our systems. That is a change in the whole way in which we think about such legislation in this House.

I am very proud to have been the mover of this Bill; as the mover of the Bill, I am also very moved by the support that has come from every party in the House of Commons and from the Government. I thank all my colleagues and, with your indulgence, Madam Deputy Speaker, I may be able to thank some others who have been instrumental in the progress of the Bill a little later.

--- Later in debate ---

[Jo Gideon]

I absolutely agree. The key thing is that APPGs by their very nature are cross-party. On issues such as those we are discussing today with this Bill—this is a cross-party topic—the more that we can find consensus, the better it is for the people we represent.

Looking at schools, the Bill asks for a curriculum tailored more towards children with Down syndrome and for more teachers to be trained to understand how to teach children with the condition and the specific learning profiles of that condition. It is a fact that Down syndrome pupils in mainstream schools achieve on average at two years above the academic level of those in special schools.

Having said that, there are some fabulous special schools, and I want to give a shout-out to Aurora Hanley School in Bucknall in my constituency. There is some wonderful work going on. I also want to mention Stoke and Staffordshire Down syndrome social group, who have posted a lot about this issue. They meet regularly at the Bridge Centre in Birches Head, and they make a difference to about 50 families. It is a massively important contribution that everybody can make.

[Dr Fox]

Is the very point that my hon. Friend makes about the lack of knowledge one of the key reasons why the amendment to the Bill is so important? It will mean there is a named individual on the integrated care board who can act as an advocate, but also spread knowledge to other members of the integrated care process about the condition and the needs and wants of those involved.

[Jo Gideon]

My right hon. Friend makes a hugely important point. The integrated care boards will have a huge amount of responsibility for care across the board, and the understanding of the specific needs of those with Down syndrome requires a named lead. It is essential, because otherwise, sadly, the detail may get lost in the breadth of what the boards have to cover.

--- Later in debate ---

[Dr Fox]

With the leave of the House, may I say what an absolute joy it has been to find this bolthole of consensus in the psychodrama that seems to be British contemporary politics? I thank colleagues for their very kind words today; to get to this level of flattery in the House of Commons, one normally needs to be dead. [Laughter.]

I remind colleagues of the point made by my hon. Friend the Member for North Devon (Selaine Saxby) that this Bill is not about a medical condition, Down syndrome, but about people with Down syndrome, who have a right to dignity and individuality and to make the choices for their own lives that we all take for granted.

I want to thank the many people who have made today possible. I thank the National Down Syndrome Policy Group, and all the other voices in the Down syndrome community, including the carers and families whose input has been invaluable. I thank the officials at the Department of Health and Social Care, who have done outstanding work behind the scenes to bring us to the point that we have reached today. I especially thank the Minister. We have been so lucky to have a Minister in the shape of my hon. Friend the Member for Chichester (Gillian Keegan). Not only is she an outstanding Minister in her own right, but her family background and understanding of the issue have been crucial in helping to provide the necessary momentum within Government. Indeed, I thank the Government as a whole, and in particular the Secretaries of State who signed off the two very important amendments. I am sure that they entirely understood the precedents they were setting, and it was therefore—as they would say in “Yes, Minister”—all the braver of them to do so.

I thank my own staff in the House of Commons, and I thank my constituency assistant Annabel Tall, who began much of this process when she brought her son Freddie to see me at my constituency surgery, shedding light—many colleagues will have had this experience—on the difficulties that parents can have in fighting fire on so many fronts on behalf of those whom they love. I hope that means that in some sense we have gone full circle today.

I thank all colleagues for their support, for their contributions, for the encouragement that they have given, and for their advocacy of this whole process in the House of Commons, in the constituency and in the media. It has been a real example of what we can achieve together—and that includes the all-party parliamentary group on Down syndrome, which provided so much support.

None of us are passengers in our own lives or in the society in which we live, and change is always within our grasp if we choose to seize it, especially those of us who are in the uniquely privileged position of being able to make the laws in our own country. I thank all those who have chosen that path today. The real heroes of this debate, however, are not those in the Chamber or those who make the laws pertaining to Down syndrome, but all those who have fought, struggled, and overcome the challenges that they have faced without our help for far too long.

Question put and agreed to.

Bill accordingly read the Third time and passed.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I am delighted to say that the Ayes have it.

Down Syndrome Bill

Liam Fox Excerpts

Committee stage
Wednesday 26th January 2022 Public Bill Committees

[The Chair]

The selection and grouping of amendments for today’s meeting is available online and in the room. I have selected the three amendments in the name of the Member in charge of the Bill, Dr Liam Fox. The amendments will be considered alongside the existing content of the Bill in a single debate.

Clause 1

Guidance on meeting the needs of persons with Down Syndrome

[Dr Liam Fox (North Somerset) (Con)]

I beg to move amendment 1, in clause 1, page 1, line 10, at end insert—

“(4A) The Secretary of State must lay the guidance before Parliament once it is published.”.

This amendment requires the Secretary of State to lay guidance under clause 1 before Parliament.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 2, in clause 1, page 1, line 12, leave out “(4)” and insert “(4A)”.

This amendment is consequential on Amendment 1.

Clause stand part.

Clause 2 stand part.

That the schedule be the First schedule to the Bill.

Amendment 3, title, line 1, leave out from “syndrome;” to second “and” in line 3.

This amendment brings the long title into line with the content of the Bill.

[Dr Fox]

Those watching our proceedings may be surprised at the brevity of our discussions today. It is worth explaining to them that that is not due to any lack of scrutiny in Committee, but to the fact that the Committee has reached consensus before we have come here. We have worked together across parties to deal with the issues that we thought were important. This is a very good example to those who watch Parliament that when Parliament really wants to get something done and Members believe that they are engaged in a worthwhile task, the work can happen in the most efficient way possible.

I thank colleagues for their work in bringing us to this point. I thank the Minister for her outstanding work. Having once been the Friday Whip in charge of private Members’ Bills, I am an example of gamekeeper turned poacher—although that does bring some advantages, including how to get the best out of the Minister. We have very much benefited from having a Minister with personal experience of a family member with Down syndrome. It is also a very good example of why our system of constituency MPs, with our backgrounds and experience, is a very good one when it comes to appointing people to ministerial office.

I thank officials for their work. They have been tireless in trying to bring what were initially some relatively large differences to a position of consensus. I thank colleagues from across the House who are not on the Committee for their support on Second Reading and in campaigns across constituencies to gain support for the Bill.

I thank the public for the widespread support that we have had on the issue. I thank in particular those Down syndrome groups who have gone out of their way to provide support to Members, with anecdotes about personal experience and what they expect from our legislation. It is a pity that there seems to be a small number of people out there who were questioning the measures in the Bill even before they knew what was going to be debated in Committee today. I hope that they will recognise that the intent of the Committee is very clear.

On Second Reading, there was a very clear omission in the Bill. We chose to leave it and deal with it in Committee, rather than inserting a half-baked measure that we would subsequently have to change. The omission was that it was not very well set out how the rights in the Bill could be enforced, for those who wanted to exercise them, and how that could best be redressed. There were two things that I really wanted to see and I am very pleased that the Government have accepted them. I look forward to my hon. Friend the Minister recommitting to those today.

First, if we have new integrated care pathways and integrated care boards, should it not be the responsibility of a named individual to ensure the application of the measures in the Bill, should it become law? In other words, should there not be someone to whom those with Down syndrome or their parents can go, to ensure that the process has been properly applied? Not having that provision would be a serious omission. I look forward to the Minister confirming that there will be a named individual on each board who will be responsible for the application of the measures in the Bill.

--- Later in debate ---

[Sir Robert Goodwill (Scarborough and Whitby) (Con)]

Does my right hon. Friend believe that the Bill creates a precedent for other conditions such as 22q11.2 deletion syndrome, which affects a smaller number of people but manifests in a similar way?

[Dr Fox]

The Minister may say something about that when she makes her remarks, but it is entirely possible that, when guidance is given and there is a named person on the integrated care board, the Bill’s provisions and the measures required to apply it would reasonably be applied to other conditions of that nature.

Again, the fact that the guidance will be laid before Parliament gives us an opportunity in Parliament to deal with the very issues that many Members have reasonably raised. As all colleagues will know, we put Down syndrome as the only condition because of the difficulty of getting a private Member’s Bill through. Getting support requires it to be simple and concise. The fact that the guidance is laid before Parliament enables us to take the legislation forward in a proactive way without too much actually being said in the Bill. That is a good model for how we can take legislation of this nature through in future. I am grateful to my right hon. Friend the Member for Scarborough and Whitby and congratulate him in Committee for the first time on the honour recently—belatedly but very justifiably—bestowed on him.

I go back to the point: the fact that the guidance is laid before Parliament gives us all the chance, on behalf of our constituents, to look at some of these other conditions. If it applies for Down syndrome, why should it not apply in the same way and through the same mechanisms for other conditions? That is an important issue for the Committee to have addressed. With that, I conclude my remarks.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I only want to thank everybody across the parties who worked so hard on the Bill; it has been so heartening to see Parliament come together on something so important. As chair of the all-party parliamentary group on Down syndrome, I have had so many emails from people who are right behind the Bill and think that it will be ground breaking in giving them the recognition that they feel is so important in their lives and for their families.

This is an important piece of legislation, and I thank everybody who has contributed to it. The right hon. Member for North Somerset, who led it, has been exemplary in bringing people together and ensuring that the process is positive.

--- Later in debate ---

[Dr Fox]

As well as the issue of other conditions, employment and employment law were raised a great deal by the public, although we did not address those issues in the Bill because of the complexity that they would bring. Will the guidance given by the Secretary of State include employment issues, so that those issues can be addressed without requiring further legislation?

[Gillian Keegan]

First, I will deal with rare genetic disorders other than Down syndrome. We recognise that people with genetic conditions other than Down syndrome may experience problems similar to those of people with Down syndrome, so we will consider the overlaps and linkages between such conditions and Down syndrome through consultation on the development of the guidance. I will go on to address employment.

I commit that the Secretary of State will ensure through statutory guidance that the integrated care boards will have a named lead for overseeing the implementation of the guidance issued under the Bill. That named lead will ensure that Down syndrome statutory guidance is implemented and considered throughout the commissioning decisions of an integrated care board. That will play an important role in ensuring that there is accountability for improvements at the local level and that the intentions behind the Bill are fully raised across Government.

--- Later in debate ---

[Gillian Keegan]

As one of the Ministers who is a disability champion, I completely agree. It is only when one tries to take a view from the perspective of someone who has some kind of disability that it becomes possible to understand how difficult it is to do many daily things. Whether it is people with physical or learning disabilities, the more that we understand their perspective the more we can accommodate them. That, of course, makes a massive difference for somebody who has more to deal with on a daily basis than perhaps we do. It is important that we all take up the training that we are offered.

I thank my right hon. Friend for tabling amendment 3, which updates the long title of the Bill. I agree with those proposals. As outlined, this guidance only applies to England, as healthcare, education and housing are all devolved matters. I know there is also firm commitment from my counterparts to improve the outcomes for people with Down syndrome in Scotland, Wales and Northern Ireland, including through legislation. I look forward to working collaboratively with the devolved Administrations on this matter.

Regarding the schedule, it is important to have clarity within the Bill about who the relevant authorities are, and what functions the guidance will apply to. The list of authorities and their functions has been drawn from existing legislation, such as the Care Act 2014, the Children and Families Act 2014 and the Housing Act 2004. For that reason, the Government support the schedule.

This Bill is hugely significant. It will improve the lives of people with Down syndrome, improve their prospects and improve their families’ lives. I am proud to support it on behalf of the Government as it progresses through Parliament. I thank all the hon. Members for their support. To be in this privileged position, and to be able to use that privilege to make a massive difference to people, is probably what brought most of us here. I thank everybody for their support of the Bill.

[Dr Fox]

One question that was often asked before Second Reading, and continues to be asked, is: “Why Down syndrome?” Many have written to all members of the Committee, I imagine, saying, “Why pick a particular condition? Why not simply have it lumped in with learning difficulties?” The point is that those with Down syndrome and their families know that it is much more than “just” another learning difficulty.

There is the addition of complex health conditions—very complex, in many cases. The changes in demographics, which we discussed on Second Reading—for the first time, many of those with Down syndrome will outlive their parents—bring an element of the importance of care into the equation. Rather than singling out a single grouping, we have shown the increasingly complex needs that a range of different conditions will require, as medical science improves and we have greater life expectancy, which is something we should celebrate, as a society.

The point has been made, as it was on Second Reading, that this Bill is not about a condition, but about people—people who have a particular condition, their families, and the people who care for them. We are talking about individuals who, I believe, have for too long been more vulnerable than they need to be, and were overlooked by a series of pieces of legislation, which did not adequately take into account the combination of needs that they uniquely have.

We all come to this Bill from our personal experiences. As I said in the Chamber, my personal experience is through growing up next door to someone with Down syndrome, from working with people with Down syndrome and, as a doctor, coming into contact with a lot of them. I would like to say a couple of things about what this Bill is not. First, it is not a UK Bill; we purposely took that decision very early on. We could have made it a United Kingdom piece of legislation, and effectively confronted the Welsh, Scottish and Northern Ireland Governments, saying, “You must give us the legislative consent.” That would not have been in the interest of people with Down syndrome. It would have made it a constitutional Bill, with the arguments becoming about constitutional propriety and not about those who are actually involved.

I hope that, with the House of Commons taking this decision, we will see legislation from the devolved parts of the UK giving equal rights to those who live under those devolved systems. It should not matter where someone lives in the United Kingdom; they should have access to the same quality services, the same representation, and the same parliamentary remedies as anybody else. That is why the Bill was designed as it has been.

[Dr Cameron]

I thank the right hon. Gentleman for bringing those issues to the attention of the Committee. The Scottish Government are well aware of the Bill and its merits. They have had discussions and indicated that they will be taking similar types of legislation through their own processes, to see progress made.

[Dr Fox]

I am obviously aware of the discussions that we have had around that. I hope that the devolved Administrations will look at the timetable of the Bill’s passage through Parliament and when it is likely to get Royal Assent, to ensure that there is no time gap between the rights of those with Down syndrome in England and those in other parts of the UK. Those who the devolved Administrations represent should expect no less.

My final thought is that, as with any piece of legislation, this Bill will not be perfect. No Bill is perfect and no Bill requires no further work or changes, but getting the legislation on the statute book is, in itself, a statement of intent. It is a statement of recognition of the needs of those with Down syndrome. We know that private Members’ Bills will generally be limited in scope if they are to get through the House of Commons, but I believe the amendments to the Bill have, as I said earlier, taken it from being a good and well meaning Bill to a landmark Bill: we have signalled not just intent, but how we will give effect to that intent.

All too often we pass legislation in Parliament that sets out great rights and therefore expectations, but we do not set out the mechanisms by which those expectations can be realised. That is the real importance of the amendments. They may look small today and may not be commanding the front pages tomorrow, because they were not accompanied by bottles of wine, but it is important that the Committee understands the importance of what we are about to vote for. We have shown, by setting the guidance in front of Parliament, that there is a link between those who require change and those who can institute the change. That is as it should be, and that is exactly what those we represent have a right to expect.

Amendment 1 agreed to.

Amendment made: 2, in clause 1, page 1, line 12, leave out “(4)” and insert “(4A)”.—(Dr Fox.)

This amendment is consequential on Amendment 1.

Clause 1, as amended, ordered to stand part of the Bill.

Clause 2 ordered to stand part of the Bill.

Schedule agreed to.

Amendment made: 3, title, line 1, leave out from “syndrome;” to second “and” in line 3.—(Dr Fox.)

This amendment brings the long title into line with the content of the Bill.

[Dr Fox]

On a point of order, Ms Elliott. To end our proceedings, I thank you for chairing the Committee, the Clerks for all the work they have done behind the scenes, the Hansard officials, the departmental officials, the Minister and all our own parliamentary teams, who have done a great deal of work. We may be the ones who get the front row seats, but we would not be here without those in our teams, who do all the work on our behalf. I thank all of them on behalf of the Committee for getting us to where we are today.

Bill, as amended, to be reported.

Public Health

Liam Fox Excerpts

Tuesday 14th December 2021 Commons Chamber

[Dr Liam Fox (North Somerset) (Con)]

Let me begin by saying a word about the vaccine programme and issuing a plea to Ministers.

It is important that, with the emergence of omicron, we do not accidentally underplay the success of the vaccine programme to date. We know that vaccines will generate a number of immune responses—the production of neutralising antibodies, the production of marker antibodies, and a T-cell response—and, although with omicron a booster dose is required to bring about the level of neutralising antibodies that we saw following our response of two doses to the delta variant, the whole programme gives both individual and community protection; and we are starting from a very different place from the place where we were with the delta variant.

It is very important for us to encourage people, especially young people, to get their second dose. May I make a plea that we stop hearing from Ministers the phrase “two doses don’t work, three doses do”? I think that it is undermining the Government’s own programme. May I also make a plea that we drop this constant reference to the doubling time of the current variant? The fact that the measured doubling has been two days in the very early stages is no measure whatsoever that that is something that we will see in the future. If it doubled every day, the whole population would be affected in nine days. This is not modelling; it is simple extrapolation, which does not contribute to a sensible debate on the subject.

When it comes to the proposals before us today, lawmakers need to look at several elements. Are these measures necessary, are they proportionate, are they enforceable and will they be effective? Let me begin with the 10-day quarantine, which was a bad measure to begin with. It was disproportionate and it was likely to bring about a recurrence of the “pingdemic”, so I am glad that it is being dropped. However, the point made by the right hon. Member for Exeter (Mr Bradshaw) is a key one which must be answered by the Government. If having the red list is pointless and if enforced 10-day quarantine is pointless, why are some people still in enforced 10-day quarantine? It is incumbent on the Government, having abandoned the policy, to let those people go free, otherwise I fear that the Government may face legal action.

[Chris Bryant (Rhondda) (Lab)]

The right hon. Gentleman is making a very important point. Some Welsh rugby players who had covid in South Africa did 10 days’ quarantine there and are halfway through quarantine in England, and they are now being told that they must complete the whole of the quarantine period. When the position is as illogical as that, it brings the whole thing into dispute.

[Dr Fox]

I absolutely agree, and what we do not require is more advice from Ministers on this subject; we require decisions from Ministers on this subject.

I also want to raise the issue of masks. I receive letters, as I imagine all Members do, from people who say, “There is no point in wearing masks because they do not stop transmission.” I assume that those people would not like their surgeons to wear masks during a surgical procedure. This is nonsense: mask wearing is a common-sense thing for us to do if it reduces transmission to some degree. It is a minor inconvenience to the vast majority of people and it is a sensible measure for the Government to introduce, and I therefore support it.

I cannot say the same for the Government’s covid passport. I do not believe it passes the necessity test, and I think the good working of the insurance industry and the availability of civil remedy in the courts are enough to drive the behaviour of venues towards sensible public health policy. We, as a Government, should not be creating criminal offences unnecessarily. I worry about enforcement and penalties in a system that is already overloaded. There is no evidence from Scotland or elsewhere that covid passports actually work. France was mentioned earlier, and there are more than twice as many people in hospital with covid in France than in the United Kingdom.

[Siobhan Baillie (Stroud) (Con)]

Will my right hon. Friend give way?

[Dr Fox]

I have given way once. I am conscious that colleagues want to speak, so I will not give way again.

I assume the lateral flow tests will have to be externally validated, which will add a cost to anyone who wants to go to one of these venues. That will not be the help to the hospitality industry that has been suggested by the Secretary of State and the shadow Secretary of State.

When compulsory vaccination was introduced for care workers, many hon. Members took the view that it was the thin end of the wedge, but we were assured that it would be care workers and no one else. Now it is all NHS workers, with a few exemptions. The ground for compulsory vaccination is that these staff will be working with vulnerable members of the public. Well, so will the police and some retail and post office workers. Where does it stop?

The hon. Member for Blackley and Broughton (Graham Stringer) made the valid point that this is a retrospective change to the terms and conditions of people who already work in the NHS, and it is likely that we will lose staff as a consequence. This is completely unnecessary when more than 91% of NHS staff have already volunteered to be vaccinated. It is disproportionate and illogical, and I do not believe it will be effective. If the logic of the Government’s position on covid passports is that people must be given a choice between being vaccinated and getting a daily lateral flow test, why does that not operate in the health service, too? The lack of logic in many of these measures diminishes support for the Government’s case.

I end on a positive note. Many of these measures are relatively small beer compared with what we can achieve through the booster campaign, so it is essential that the one message we leave the House with tonight is that every one of us has a duty to say to every one of our constituents, “Go out, get immunised and get a booster. That is the best way you can help yourself, your family, your community and wider public health.” If there is to be unanimity in the House at this time of year, that is surely the message that must resonate.

Covid-19 Update

Liam Fox Excerpts

Wednesday 8th December 2021 Commons Chamber

[Sajid Javid]

I will look into whether it can be made even easier for people to access lateral flow tests, but I hope the hon. Lady was reassured when I said that we have plenty of these tests and we will make them as easily available as possible.

[Dr Liam Fox (North Somerset) (Con)]

On the evidence we have seen so far, I think it is difficult to justify these extra measures, but I welcome the sensible shift from isolation to daily tests. In the bigger picture, we cannot allow the permanent threat of overloading the NHS to be a reason for maintaining semi-permanent restrictions on our people. What amount of extra capacity has NHS England looked at? Will the Secretary of State publish that data so we can have a cheaper option than recurrent damage to our economy and to people’s quality of life?

[Sajid Javid]

I am pleased my right hon. Friend welcomes the move from isolation to daily testing. As I said earlier, there is more capacity in the NHS than there was at the start of the pandemic, especially in intensive care, but some of that extra capacity has understandably been taken by the 6,000 or so patients currently in hospital with covid and by the infection prevention and control I mentioned earlier. He is right to say we should be looking for ways to further increase capacity, but I hope he will accept that, whatever that further increase may or may not be—there are plenty of measures in place to try to do that—there will always be a limit.

Covid-19 Update

Liam Fox Excerpts

Monday 6th December 2021 Commons Chamber

[Sajid Javid]

The reason it is not possible to go online to book a third dose is that, often, the GP will need to make a judgment on the particular individual. A lot of cases are different, and often it depends on the reason why that individual is immunosuppressed. It could be for a temporary reason. It could be a long-term issue. It also depends a lot on whether that individual has had any other recent infection. It is a clinical decision. It is right that it is made by a GP, but as soon as that decision is made by the responsible clinician, that person should of course get their third dose as soon as possible.

[Dr Liam Fox (North Somerset) (Con)]

Many of us have constituents who were caught out when South Africa was added to the red list and are now in compulsory hotel quarantine. Given the information that my right hon. Friend gave us today, if someone has had a negative PCR before travel and a negative day 2 PCR, what is the medical rationale for retaining 10-day quarantines? Is it possible to find ways of having safe early release, so we are not using up the capacity that we have unnecessarily?

[Sajid Javid]

The medical rationale is around the incubation period of the virus. Most of the data that we have today is based on previous variants that we have had time to assess. With this particular variant, as my right hon. Friend will know, there has not been enough time so far, but as we learn more, we will change our policies should we need to do so.

Down Syndrome Bill

Liam Fox Excerpts

Friday 26th November 2021 Commons Chamber

[Alex Norris]

I am grateful for that intervention. Members on both sides of the House share a commitment and an ambition to make significant advances in the mental health of the British people. We know that there are barriers for people with the most profound physical health conditions because, traditionally, we have not looked beyond those conditions to evaluate the mental health aspect. I hope that the Bill is a good opportunity to do that.

On housing, we know that with the right support, people with Down’s syndrome can live semi-independently, so we must make sure that the right type of housing, sensitive to need, is available and distributed across the country. Has the Minister made a baseline assessment of where we are and what we might need to do better?

Hon. Members have made important points about education. At the risk of repeating more of what the hon. Member for Carshalton and Wallington said, the points about education, health and care plans were well made and I hope that they were heard. I took from his contribution that they cannot be pro forma exercises; they must be individual exercises that meet individual needs. That is the purpose of having them.

Linked to that, on employment, only 6% of people with a learning disability in this country are in employment. We should aspire to do much better. Work gives purpose, independence and dignity, and is part of the collective investment that we make in each other. Our ambition is for everybody to be in work who can be, irrespective of their challenges. We need a full strategic plan on the active steps that we can take to show employers the benefits of hiring staff with learning disabilities and the support that can be offered to help to facilitate that. It is important to understand that it is a win-win because, as global studies show, workplaces hiring employees who live with Down’s syndrome are happy and productive.

The right hon. Member for North Somerset made the point about redress, which is an important and live conversation in this country. To read across, if I may, to the Cumberlege report and the impact of sodium valproate and Primodos on children who are born having been exposed to them, those families still cannot get redress—in many cases, many decades later—without an expensive, long and hard pursuit in the courts. That system is not working. The report recommended that a redress system be set up to avoid that, which has not happened as the Government have not accepted the recommendation. It should not be happening to them and it should not happen here, so I hope that, through the Bill, we can do better for people living with Down’s syndrome and for others.

[Dr Fox]

There is, of course, a great carrot for the Government in producing a workable redress system, which is that, if it is not fixed in this Chamber, it may be fixed in the other place. One way or another, however, I assure the hon. Gentleman that it will be fixed.

[Alex Norris]

I am very grateful to the right hon. Gentleman for that, although I am not sure that it was a carrot as much as a stick. However, I know that noble Lords will be taking the same interest in the Health and Care Bill, and I absolutely share his confidence in that sense.

To finish, I look forward to seeing this Bill in its next stages, and we want gains to be made in the four areas in the schedule to the Bill. I would make the very important concluding point that, particularly in relation to local authorities, social care is distressed and under-invested in in this country, so if there are new responsibilities, there must be new investment to come with that. We will continue to make such points at future stages. This requires Government commitment, and it is good that we are hearing that today, but also the resources to sit behind it, and I hope we hear that, too.

--- Later in debate ---

[Dr Fox]

I want to say a few words in conclusion. I thank colleagues not only for their support for the Bill but for the warmth of that support, including from my hon. Friend the Minister whose help throughout has been invaluable. It is clear that we have a united voice and a united purpose; now we need to have a united intent to make the aims of the Bill a reality as the process continues forward. This Bill will not be a panacea for a particular problem—no legislation ever is—but it is a key tool. It is a vital first step forward.

However, we still face challenges, as I have mentioned. On the issue of redress, there is no point in having rights unless we can demand they are fulfilled in law. This is also not just a Bill about individuals with Down’s syndrome or families with a member with Down’s syndrome; it is about what we are as a society. We talk a great deal these days about global Britain, but global Britain cannot just be about diplomacy or trade or military prowess; it also has to be about our values.

If we are able to complete the passage of this legislation before we reach World Down Syndrome Day on 21 March next year, we will be the first country to legislate on this problem, making the United Kingdom a beacon for others in the world to follow. That is what global leadership is all about.

We hold power in this place, but we also hold power to empower. People with Down’s syndrome are not supplicants in our society but full citizens who have the same right to demand for themselves quality services in health, education and social care. We have heard today that on their own and through us their voices are increasingly being heard and I urge them to increasingly use their voices. I hope they have understood from both sides of the House and from all parties today that we will be right behind them when they use their voices and exercise the powers that the Bill may bring them.

Question put and agreed to.

Bill accordingly read a Second time; to stand committed to a Public Bill Committee (Standing Order No. 63).

Covid-19 Update

Liam Fox Excerpts

Friday 26th November 2021 Commons Chamber

[Sajid Javid]

I am pleased to respond to the shadow Minister. His first question was on the six countries we have decided to put on the red list from midday today. We are going primarily by where the new variant has been detected at this point. It has been confirmed in two countries in southern Africa: South Africa and Botswana. We included the four other countries in southern Africa I mentioned earlier as a precaution. The shadow Minister will not be surprised to know that we are keeping this under review and that there are very live discussions going on around whether and when we should add further countries. We will not hesitate to act if we need to do so.

On vaccine donations to developing countries, the shadow Minister is absolutely right about the importance of that. He will know that the UK has, for a country of its size, done far more than any other country in the world, with over 30 million donations already. We are absolutely committed to our 100 million target and will continue to work bilaterally with countries, but also through the COVAX alliance, to get out more vaccines to the developing world.

Testing remains a hugely important part of our response to the pandemic. It is playing an incredibly important role and that will continue for as long as is necessary.

Lastly, vaccinations are of course the primary form of defence in our country. In one sense, we are fortunate with such a high level of vaccination. Over 80% of people over the age of 12 have been double vaccinated and 88% at least are single vaccinated—one of the highest rates in the world—but we need to go further and even faster. It is great news that our booster programme, at over 16 million jabs across the UK, is the most successful in Europe—now, I believe, over 26% of the population over the age of 12—but we want more and more people to come forward as soon as they are eligible. I cannot stress the importance of that enough. Today, as the hon. Gentleman said at the end of his remarks, is a sober reminder that we are still fighting this pandemic and we can all play a part.

[Dr Liam Fox (North Somerset) (Con)]

The viral mutation process of genetic drift depends on the number of times a virus gets to replicate, so the wider the spread geographically and the longer it goes on, the more viral replications will occur and the more chances there will be for mutations—so there is a need to redouble our efforts to vaccinate populations right across the globe. My right hon. Friend mentioned the potential increased transmissibility of the virus, but there is another important element, which is the severity of the illness produced by a variant. What do we know about that so far and the potential, therefore, for an impact on the health service?

[Sajid Javid]

As always, the analysis provided by my right hon. Friend is absolutely correct. On the severity of the new variant, I am afraid we do not know enough yet. From what we can tell from what we might call a desktop analysis, the number of mutations that have been identified—double those for the Delta variant—does indicate that there is a possibility that it might have a different impact on an individual, should they get infected. But as I said earlier, there is a lot we do not know about it and we are working with our international partners to find out more.

Coronavirus Act 2020 (Review of Temporary Provisions) (No. 3)

Liam Fox Excerpts

Tuesday 19th October 2021 Commons Chamber

[Sajid Javid]

The hon. Lady is right to point to the importance of scrutiny. Of course, it is not just the time that we have for debate now or the regular time we have had since this Act has been on the statute book. Scrutiny is also provided in other ways: for example, she will know that Select Committees have looked at the Act, with parliamentarians represented and taking evidence. That is just another way to make sure that the Act is getting the scrutiny that it deserves.

[Dr Liam Fox (North Somerset) (Con)]

No one disputes the success that some of these measures have had but there is a strong resentment—which, I have to say, I share—in many quarters about giving any Government extension to powers that are quite as blank as these are. Have the Government considered any other mechanism for allowing extension for a lesser amount of time or are there alternatives by using the Civil Contingencies Act 2004, which many of us feel should have been used from the outset, rather than presenting this gift-wrapped to the devolved parts of the United Kingdom?

[Sajid Javid]

I understand my right hon. Friend’s concerns and, rightly, many people across the House share those concerns. He will know that when the original Bill was brought to Parliament, the Government said, rightly, that any measures would be kept in place only for as long as necessary and that they would have to be proportionate. Even before coming to the House today with the recommendation to expire seven of the non-devolved provisions in the Act, 13 have already expired. He also pointed to alternative ways that some of these measures, if necessary, could be taken, and that is a very valuable suggestion. For example, I believe that in the Police, Crime, Sentencing and Courts Bill, which is before Parliament now, my colleagues are looking at some of the provisions on courts and keeping the remote working of courts going. So there are possible alternatives and he is right to draw attention to that.

Covid-19 Vaccinations: 12 to 15-year-olds

Liam Fox Excerpts

Monday 13th September 2021 Commons Chamber

[Nadhim Zahawi]

I am grateful for the hon. Gentleman’s question, although I think there is an inherent unfairness in his final few words. The whole House, indeed the nation, would agree that this virus and pandemic have been challenging not just for this country and Government, but for the rest of the world. We have had to learn rapidly about the virus and how it behaves in the human body, and there has been the incredible work of the scientists who developed the vaccine, the NHS and everyone involved in the vaccine roll-out. The interim advice is important and has allowed us to have preparations well under way to deliver the covid booster programme. I am confident that the final advice, depending on the COV-Boost study, will allow us to boost the programme this month, and boost at scale.

[Dr Liam Fox (North Somerset) (Con)]

Who will be responsible for writing to give advice to medical professionals on the risk-benefit analysis of giving a relatively new vaccine to 12-year-olds? Will that be the Chief Medical Officer, or the JCVI? How will the Government ensure timely and well-explained advice to parents, who will be the first point of contact and who may feel anxious about giving advice for which they are not properly qualified?

[Nadhim Zahawi]

My right hon. Friend raises a really important question. Of course, it was the CMOs who led the further work that took place and who made the announcement today. Health is devolved, as he knows, so the chief medical officer for Scotland will take that on in ensuring that the system—whether it is primary care or other parts of the system—understands the advice in full. The school-age vaccination programme is the major element of this particular part of the vaccination programme. It is very well versed in working with parents and teachers, and of course with young people to make sure that they have all the information they need to be able to take it back to their parents, get the consent and get their vaccination on time.