Health and Care Bill

Lord Alton of Liverpool Excerpts

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

[Baroness Kennedy of The Shaws (Lab)]

I, too, have my name to this amendment and support it, as I have previous amendments to other Bills relating to genocide. Health procurement is a very problematic area that warrants the special attention of Parliament. Not to put too fine a point on it, we will probably all have been wearing slave-made masks, even here. But it is a particular concern if great institutions such as our National Health Service are purchasing them in contravention of the standards we would like to set.

According to the Institute for Government, the UK has spent at least £15 billion on PPE since the onset of the pandemic. To put this into context, the normal annual spend on PPE is around £150 million. Perhaps we should have been putting aside more money for it. Anyway, many PPE contracts use products sourced from China. We do not know how much came from the Uyghur region but one news report alone alleged that we had purchased millions of pounds-worth of PPE from a company strongly suspected of using forced Uighur labour. That is just one report and I suspect we will see more investigations and more coming to light.

Even where the PPE is not manufactured in the Uyghur region, it may contain cotton, plastics and some other constituent parts that were. It has always surprised me that we do not have the import control regime that the United States has had for some time. The USA requires importers to document the source of products, not just the town and city but the particular factory, and to make tracking possible. Indeed, DNA tests can locate the source of the cotton, for example—the very region where it has come from.

What do we mean when we talk about serious risk of genocide? These are not just words. They represent the trigger for state responsibility under the genocide convention, as other speakers have mentioned. The International Court of Justice in 2007, in a judgment of a case involving Bosnia and Serbia, was crystal clear that state responsibility to prevent genocide arises

“at the instant that the State learns of, or should … have learned of … a serious risk”

of genocide. We have taken the words from that judgment. By incorporating those words into regulations, we are providing the Government and Parliament with a mechanism to take action to prevent genocide. This is something they lack in their current policy, which makes all actions dependent on a judgment from an international court—which, as we know, bears the Catch-22 that the very countries getting close to genocide or in the process of committing it do not usually want to play by the international rules of law.

Why should a serious risk of genocide be our procurement threshold? There will always be widespread human rights abuses with attendant supply chain risks for businesses where already there is talk of a possible genocide being in play. This should not represent an obstacle to the United Kingdom because since the Modern Slavey Act—which we passed here proudly as leading the world back in 2015—our aspirations have been to ensure that no business can sell slave-made goods into our market. A serious risk of genocide represents a higher threshold than any modern slavery offence, so the bar is set high here. The ban on procurement that a positive finding of serious risk would attract is proportionate. We need take these steps urgently. It is not, as others have said, just about China, but the amendment would, we hope, have an immediate effect in the Uyghur region.

As many noble Lords will know, last autumn the Uyghur Tribunal sat not very far from here, in Church House, led by a sort of jury of persons and the distinguished international lawyer Sir Geoffrey Nice QC. The tribunal concluded that China was, in fact, committing genocide in the Uyghur region and there was a violation of pre-emptory norms in international law that ought to require government action, by us. We are under a duty to act. If a genocide is in train or in progress, we have a duty to try to prevent it. That is what the convention says.

Although the amendment, rightly, does not identify any single country, I would expect it to have some immediate effect in China. The situation is urgent, and we are having this debate because 800,000 Uighurs are working to produce goods against their will. By some estimates, as many as 300,000 children are separated from their parents, which is really part of a process to take them away from the culture, religion and traditions of their people and to deracinate them. At any one time, up to 1 million are in re-education camps. There has also been shocking evidence of forcible sterilisation of Uighur women and many other heinous crimes. There really is an international legal obligation upon us. This House has expressed its views in previous votes and I hope we will eventually be joined by many noble Lords when this comes at some point to a vote.

We are looking at our supply chains and they are being seriously tainted by human rights abuses. We have taken proud steps, leading the world, in seeking to do something about these supply chains, and here is an opportunity to take it even further.

[Lord Alton of Liverpool (CB)]

My Lords, it is a great pleasure to support the noble Lord, Lord Blencathra, who so ably moved this amendment; to concur with the speeches just made by the noble Baronesses, Lady Kennedy of The Shaws, Lady Harris and Lady Brinton; and to associate myself with friends from across the House in respect of the work they have put in over many months to push to the top of the agenda the issue of honouring our duties under the 1948 convention on the crime of genocide. I have two things I would like to add. The first concerns our international treaty obligations, referred to a moment ago, what we are required to do from the moment we know that a genocide is under way, and how we must never utilise to our benefit slave labour in a state credibly accused of genocide. The second concerns the way in which the lack of transparency in our procurement policies has led to the improper use of public money.

The amendment is a logical extension of the debates on the genocide amendment, which, as the noble Lord, Lord Blencathra, said earlier, was passed by three-figure majorities in this House in an attempt to provide a mechanism in the Trade Act 2021 to evaluate when a genocide is or is not taking place. Many promises were made by the Government during that amendment’s many iterations, including the provision of an effective mechanism to determine what constitutes a genocide and to honour our obligations under the 1948 convention. Demonstrably, those promises have not been kept. Worse still, we have established the illusion of a procedure to examine and deal with this most odious and reprehensible of crimes. The fact that we cannot, under that procedure, even look at what is happening in Xinjiang with the Uighurs shows how inadequate it really is.

Can anyone doubt the seriousness of this issue, not least in the light of the pronouncement by the Foreign Secretary, Liz Truss, that a genocide is under way in Xinjiang; or the resolution passed by the House of Commons; or the December judgment just referred to of the Uyghur Tribunal; or the declaration of genocide by United States President Biden; and much more besides? Do we have any excuse, therefore, for not taking action?

The noble Lord, Lord Blencathra, referred to a report by the British Medical Association, which seems particularly pertinent in the context of this Health and Care Bill. It sent a letter on 26 January, which noted

“the shocking reports of human rights abuses, including torture, forced labour, political indoctrination, and reported forced sterilisation. Since then, the situation has developed in the most abhorrent manner and we”—

the BMA—

“issued a joint statement with the Academy of Medical Royal Colleges and other Royal Colleges in December”—

I repeat, December—

“urging the UK Government and international actors to exert pressure on the Chinese Government without delay.”

It goes on to refer to the independent tribunal, saying:

“It found beyond reasonable doubt that the People’s Republic of China … is guilty of genocide. The Tribunal determined that biological genocide is occurring through restriction of births by forced sterilisation and abortion, segregation of sexes within the detention centres, and forced matrimony and procreation between Uyghur women and Han men. Furthermore, mutilation and biological experiments take place in the detention centres.”


If anybody is in any doubt about the enormity of what is taking place, they should read some of the personal testimonies which were given to the Uighur tribunal. I sat through many of its hearings and found the whole process incredibly harrowing. Let us be clear that there will be amendment after amendment to every possible piece of legislation until the promise to hold to account those responsible for these most heinous crimes against humanity are actually honoured. So my first point is that continuing to source goods for the NHS from Xingang is clearly not consistent with the duties laid upon us in the convention on the crime of genocide.

Health and Care Bill

Lord Alton of Liverpool Excerpts

Committee stage
Friday 4th February 2022 Lords Chamber

[Baroness Northover (LD)]

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

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

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

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

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


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

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

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

[Lord Alton of Liverpool (CB)]

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

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

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


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

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

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

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

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

and that

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

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

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


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

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

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

“We believe that the legislation requires reform.”


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

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

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


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

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


People’s Republic of China

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

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

--- Later in debate ---

[Lord Alton of Liverpool (CB)]

I will follow the noble Lord’s point. Even though it may be impossible to collect credible data on people leaving who are not going to say they are going overseas to collect organs, when they return—as the noble Lord, Lord Hunt, pointed out—many of them will receive treatment and care inside the National Health Service as a result of having an organ that has not come from within the United Kingdom. That is data that could surely be collected.

[Earl Howe (Con)]

The noble Lord makes a very good point and, if I may, I will investigate the feasibility of doing that and what systems are in place to capture that kind of data.

I am grateful to the noble Baroness, Lady Finlay, for her Amendment 297H, which covers the retention and use of tissues after coroner post-mortem examinations. I of course share the commitment to promoting education and research. However, I am afraid I do not believe that this amendment represents the right approach to supporting this aim. I appreciate that the noble Baroness emphasised that she was referring to blocks, slides and urine samples; the amendment refers to tissue samples. The advice I have received is that it is important that we remain committed to the principle that consent is fundamental to how we treat the remains of the deceased. I remember the passage of the Human Tissue Act; the noble Lord, Lord Alton, was absolutely right in what he said earlier about that. All of us should have a choice about what happens to our bodies after we die, and if we cannot exercise that choice, those close to us should be able to.

Post-mortems can already be distressing to the families of the deceased. Denying them a say as to what happens to the remains of their loved ones will compound that distress—often unnecessarily, as many of the retained tissues will never be put to use.

There are three other defects, as I see them, in the amendment; I am concerned that it would allow tissues to be stored indefinitely; it would allow for an overly broad interpretation of what constitutes a tissue sample —that is, in fact, my main concern; and it does not address the considerable challenge of how to effectively catalogue, audit or access the large amount of new material that would have to be retained.

Having said that, I believe that under the current consent-based model we can and should do more to encourage the active identification of tissues that could serve an important purpose, and to communicate the significance of retaining this tissue to the deceased’s family when seeking their consent. I understand the force of what the noble Baroness is trying to achieve and there may be different ways of doing that.

While I am grateful to noble Lords for their amendments in this area, I respectfully ask them to withdraw or not press them at this stage.

Health and Care Bill

Lord Alton of Liverpool Excerpts

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

Moved by

[Lord Alton of Liverpool]

108: After Clause 71, insert the following new Clause—
“Health service procurement and supply chains: genocide convention obligations
(1) The Secretary of State must by regulations make provision for the purposes of ensuring that procurement of all goods and services for the purposes of the health service in England is consistent with the United Kingdom's obligations under the Convention on the Prevention and Punishment of the Crime of Genocide.(2) For the purposes of subsection (1), procurement is not consistent if a Minister of the Crown has assessed that there is a serious risk of genocide in the sourcing region.(3) A Minister of the Crown must make an assessment as to whether there is serious risk if the chair of a relevant select committee of either House of Parliament requests one, and must complete such assessment within two months.”

[The Deputy Speaker (Lord Duncan of Springbank) (Con)]

I should note, for the convenience of the House, that the noble Baroness, Lady Brinton, will be taking part in this debate remotely.

[Lord Alton of Liverpool (CB)]

My Lords, as we move to Amendment 108, I should declare my interests as set out in the register: my involvement in a number of all-party parliamentary groups, and the fact that I am patron of the Coalition for Genocide Response. I should also declare my support for the other two amendments in the group, Amendments 162 and 173, which will be spoken to by the noble Lord, Lord Hunt, who has trenchantly and consistently pursued the arguments around forced organ harvesting and the public exhibition of anonymous cadavers from Chinese jails. I have spoken in favour of those amendments previously and will not repeat my arguments today.

Like those two amendments, Amendment 108 is an all-party amendment, which was tabled in Committee by the noble Lord, Lord Blencathra, by the noble Baronesses, Lady Hodgson of Abinger and Lady Kennedy of The Shaws, and by myself, and supported by the noble Baroness, Lady Brinton, who is a sponsor today. It would have been moved by the noble Lord, Lord Blencathra, but he has had to self-isolate in Cumbria with Covid, and we all wish him a speedy return to his place.

Yesterday the noble Lord, Lord Blencathra, was able to attend an online meeting with the noble Earl, Lord Howe, and the noble Lord, Lord Kamall, and he asked me to move the amendment in his place. I thank both Ministers for their constructive engagement, and perhaps I might pursue further with them some of the arguments and issues raised yesterday. During our discussion the department told me that it had found no evidence of child labour, forced labour or unethical behaviour. Indeed, that was a repeat of a statement made to me in a parliamentary reply by the noble Lord, Lord Bethell, when he was a Minister.

--- Later in debate ---

[Earl Howe (Con)]

My Lords, that is a perfectly valid question from the noble Baroness, and I would be happy to take that back to those in the Department of Health and Social Care who have direct responsibility in this area.

[Lord Alton of Liverpool (CB)]

My Lords, I know that this is a complex and long Bill, and that the House will want to move quite quickly to the next business. I will end by simply thanking every noble Lord who has participated in today’s debate, especially the noble Baronesses, Lady Walmsley and Lady Merron, from the opposition Front Benches, and the noble Lords on the Government Benches who have supported the noble Lord, Lord Blencathra, and the noble Baroness, Lady Hodgson, at every stage of the progress of this amendment.

I know that when the noble Earl, Lord Howe, said that he was instinctively drawn to these amendments, and that he found many of these practices abhorrent, he was speaking as he feels. I am grateful to him, not only for the meeting that we had yesterday with the noble Lord, Lord Kamall, but for his promise to look at this further. Among those to whom I would like to introduce him is a Uighur surgeon I have met, who has given evidence here in the House about being forced to remove organs and to kill the patient in the course of that. This is the ethical issue here. If people profit from that in any way whatever, even if inadvertently, we must not be complicit.

A year ago, we were promised that there would be an urgent review of exports to Xinjiang and fines for businesses which failed to comply with the Modern Slavery Act, when parliamentary time allowed. Those things have not happened. The urgent review has just been completed, but it ended up dealing only with military exports and there have been no fines applied one year later. It is never the right Bill or the right time. The noble Lord, Lord Forsyth, and I were told this on the telecommunications Bill, we were told it again on the then Trade Bill. We are told it on every Bill. That is why it is inevitable that we come back with amendments like this until the comprehensive plan, to which the noble Earl referred, actually happens.

The House really needs to send this amendment further. We have had between Committee and now for the Government to help us redraw it, if there are any defects or flaws. I am unaware of what they may be; they have never been pointed out to us. The noble Earl also knows that the Government could say to us, “Bring this back at Third Reading and we will help to draw up such an amendment.” However, I am told that this is not possible either. Therefore, the only way for us to ensure that this amendment can proceed and be perfected is to send it to another place. I am glad to be able to tell the House that a former leader of the Conservative Party, Sir Iain Duncan Smith, has agreed that he will personally promote this amendment if it is passed in your Lordships’ House today and take it further there. He says that he is with us 100%. I would like to seek the opinion of the House.

Health and Care Bill

Lord Alton of Liverpool Excerpts

Lords Hansard - Part 2 & Report stage
Wednesday 16th March 2022 Lords Chamber

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I did not contribute to the debate on this amendment in Committee, but I did sit and listen to the contributions from around the House. What struck me was that in his characteristically sympathetic response, the Minister had not quite understood the purpose of the amendment and the problems it would solve. He stated that the amendment would place the views of parents and guardians above those of clinicians. I do not see that this is the case, especially with the revised amendment that we have before us. Unfortunately, it is a reality that parent-doctor conflict happens. I declare an interest as chief executive of Cerebral Palsy Scotland, and I have seen far too often the views of parents dismissed by clinicians. No matter how qualified parents may be, or what their role in life outside the hospital may be, they are consistently referred to only as “mum” or “dad”. Too often there is an imbalance of power with doctors, and too often parents are labelled as “difficult” or “sharp-elbowed”, as if wanting to do the best for your child is an irritant, and such parents should be grateful for what they get.

By the time a family is faced with palliative care, they will undoubtedly have been through the care of many clinicians: specialist, community, hospital and, potentially, hospice teams. The parents are therefore often the one consistent factor, and they are especially important when the child is too young or too ill, or unable to voice their own views. It is when parents feel they have not been listened to by clinicians that they resort to formal complaints or litigation. It is a last resort, but too often it is the only resort that is open to them. This amendment seeks to address this by giving them space for a formal coming together of all interested parties at an earlier stage, and so preventing costly and lengthy legal disputes. It does not place one party’s views above others; it does not, as outlined in proposed subsection (3), require the provision of resources for any treatment or require a doctor to provide treatment not in the best interests of the child. It simply ensures that there is a clear framework in these tragic, difficult cases to guide what happens next.

This amendment is designed to solve a problem currently faced by families and clinicians at moments of crisis. I urge the Government to consider it, and I will listen carefully to the response of the Minister tonight.

[Lord Alton of Liverpool (CB)]

My Lords, the House will want to move on quickly, so I will not make the speech that I intended to make on this issue, but I would very much like to endorse what the noble Baronesses, Lady Fraser and Lady Stowell, the noble Lord, Lord Balfe, and my noble friend said in their earlier speeches. I know Connie Yates and Chris Gard, who are the parents of Charlie Gard, who died in 2017 of mitochondrial DNA depletion syndrome. Indeed, I have entertained them here in the House, arranged meetings for them and travelled with them. I entirely agree with what my noble friend is trying to do. This will make mediation work; it will create a proper balance and equality of arms. No parents should have to face litigation in these often tragic and troubling circumstances, so this is a good amendment and I hope the Minister will feel he can accept it.

[Lord Sentamu (CB)]

My Lords, I was patron of Martin House in York, which is one of the amazing hospices that care for children and their parents. I was invited by the parents of a nine year-old, who was having a very difficult and trying time, to talk to clinicians, because they did not think that they were being heard. As we talked, it became clear that that was not true: the clinicians were on the side of the parents, but their language was not helpful. We had this amazing conversation, and as a result the needs of the child and the aspirations of both the parents and the clinicians matched, and we were able to get very careful care. What the noble Baroness, Lady Finlay, is trying to do is recognise that in most cases parents have good desires, and clinicians probably know more than they are willing to say but hold back because of the sheer pain and difficulty that they see on the faces of everybody, and another voice can help in these situations.

--- Later in debate ---

[Baroness Eaton (Con)]

My Lords, health and safety have arguably never been more front and centre in our nation’s thinking and approach to healthcare. The Government prioritising healthcare in one of their flagship Bills is therefore expected. I am proud of our Government.

As proud as I am, I feel equally perplexed as to why the amendment tabled by the noble Baroness, Lady Sugg, seeking to override the Government’s decision to end the temporary policy on at-home abortion would garner any serious consideration, given that it would contradict the aims of the Health and Care Bill by placing the health and safety of women and girls at risk. It also distracts from important matters in the Bill, for which the Bill was intended.

The provision allowing at-home abortion made alongside a host of other Covid regulations during an unprecedented global crisis was only ever meant to be temporary alongside almost all other temporary provisions of the Coronavirus Act that the Government are expiring or have already expired. The Prime Minister said that the Covid restrictions

“take a heavy toll on our economy, our society, our mental wellbeing and the life chances of our children”.—[Official Report, Commons, 21/2/22; col. 45.]


The health toll could not, in the specific case of the temporary provision allowing at-home abortion, be more apparent; it is a toll being taken on vulnerable women and girls. As highlighted by a submission to the government consultation on this matter, the lack of in-person consultation increases risks of potentially life-threatening conditions being missed, pills being prescribed beyond the 10-week limit, more women being coerced into a home abortion against their wishes and pills being obtained fraudulently.

These are not unwarranted concerns. Soon after the temporary policy was implemented, story after story emerged of the tragically painful experiences women underwent as a result of this policy. For example, a Telegraph article reported on a nurse whose at-home abortion led to extreme complications needing surgery. Indeed, there have been several cases of women taking these abortion pills outside the legal and safe time limit. For example, in May 2020 police investigated the death of an unborn baby after a woman took pills received by post at 28 weeks pregnant. Such cases are unsurprising given that abortion providers cannot ensure that at-home abortion pills are taken by the intended person in the intended circumstances and time. According to the American College of Obstetricians and Gynecologists, only half of women accurately recall their last menstrual period, again reaffirming that medical confirmation of gestational period is critical.

Given the vast evidence base highlighting how this policy has placed women’s health and safety at risk, an evidence base thoroughly reviewed by the Government in an extensive three-month consultation, I urge the noble Baroness, Lady Sugg, to withdraw her amendment but if she does not, I urge noble Lords to vote against it.

[Lord Alton of Liverpool (CB)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Eaton, and I rather agree with the points that she has just made. But the noble Baroness, Lady Sugg, also knows that I have considerable admiration for her, especially over issues around the stand she took about cuts to our overseas aid programmes; we had the privilege of serving together on the Select Committee of your Lordships’ House that deals with international relations and defence. She will not be surprised to know that I find myself in disagreement with her and I urge your Lordships to think seriously about Amendment 183.

I will give the House two reasons for this, if I may. One is procedural and the other is more substantive. I suppose on the substantive point, I will cite, as the noble Baroness, Lady Eaton, has done, some of the contradictory evidence that we have before us. Your Lordships may not be able to work out whether you believe one side of the argument or the other, and that brings me straight to the point about procedure.

Here we are at almost midnight. This issue has never been debated at any stage in another place in the elected House. Rather like Amendment 170 that we discussed earlier, we have to consider how we resolve sensitive and controversial ethical issues of this kind. There was no consideration of this question in the elected House, and it has come to us without being considered in Committee but at the fag end of Report stage. Surely all of us can agree, wherever we come from on the more substantive point, that this is not the way to go about parliamentary business.

We should bear in mind that since 1967, when the original legislation was passed in another place and then approved here, there have been 10 million abortions, which is around 200,000 every single year. Put another way, there is one abortion every three minutes. You do not have to come from the position that I think noble Lords will be aware that I come from, of believing in the sanctity of every human life, to think that this cannot be right. Indeed, my good friend Lord Steel, who was the mover of the original legislation, has often said that he never intended abortion to be as widespread or repeated as often as it has become.

This all points to the question of procedure. Should there not be a joint committee of both Houses to consider this extraordinarily complex ethical question? Should we not at least have a Select Committee that considers these matters? Should there not be pre-legislative scrutiny before a Bill or an amendment of this kind comes before Parliament? It is passing strange that since 1967, no Select Committee of either House has looked at this legislation, the original Abortion Act 1967. I say to the noble Baroness, Lady Fox, who always makes valuable contributions to your Lordships’ House, that we are changing the law. That is why this amendment is before your Lordships’ House this evening. We would not need the amendment if we were not changing the law.

I also ask those who have rightly emphasised the importance of conscience, and particularly some of my friends and noble friends on the Lib Dem Benches, why this is not a conscience vote. Why is there a Whip on an issue of this kind?

[Noble Lords]

It is!

[Lord Alton of Liverpool (CB)]

I am glad to hear that, because I was sent a document earlier on saying that there would be a Whip and that people should vote “Content” for this amendment.

[Noble Lords]

No.

[Lord Alton of Liverpool (CB)]

If that is so, I am glad to hear it. Noble Lords will know that, for me, this issue led to my leaving the Liberal Democrats when it became a party policy, so I would love to hear clarity on that question as the evening goes by. I passionately believe that this should be a conscience question for every Member but also at every vote. This should never be a party policy; people should be free to make up their own minds on a serious ethical issue—one of such magnitude and order that it should not be dealt with in such a perfunctory manner.

It was the noble Lord, Lord Kamall, who said that this

“was always intended to be a temporary measure.”—[Official Report, 10/2/22; col. 1820.]

In February, in announcing its end, the Government gave the results of a public consultation. Some 70% of those who responded said that it should end immediately. The consultation highlighted increasing safeguarding risks and “concerns about coercion”. Reinforcing that point, last weekend, BBC “Newsbeat” reported that 15% of women in a Savanta ComRes survey said that they had experienced pressure to terminate a pregnancy. Some women reported being given substances to cause an abortion without their consent.

I would be very happy to share with the noble Baroness, Lady Sugg, some of the contradictory evidence from GPs and doctors. She cited the RCOG and others, but I point out that, again in that ComRes poll, 86% of GPs surveyed across the UK were concerned about women having a medical abortion past the legal limit of 10 weeks gestation. Concern was highest among female doctors, at 91%. Six in seven GPs were concerned that the policy could see more women being coerced into abortion. Some 86% were concerned that women were at risk of being coerced into an abortion by a family member or partner, and 87% were concerned that women were at risk of unwanted abortion arising from domestic abuse by partners controlling or monitoring their actions. Some 94% agreed that staff at abortion providers need to ensure that they are collecting correct medical and personal information to certify a woman for a home abortion, and that it is important that checks are put in place to ensure that women being certified for abortion meet legal criteria. So, there is contradictory evidence, and surely that should be properly evaluated before we proceed in further liberalising our abortion laws.

A study released in November 2021 suggested that more than 10,000 women had to receive hospital treatment following the use of medical abortion pills in England between April 2020 and September 2021. Previous polling showed that 92% of women in Britain agreed that a woman receiving an abortion should always be seen by a qualified doctor. There are many statements from women that, again, I could provide to the noble Baroness, should she wish to see them.

Health and Care Bill

Lord Alton of Liverpool Excerpts

Consideration of Commons amendments
Tuesday 5th April 2022 Lords Chamber

[Lord Alton of Liverpool (CB)]

My Lords, at earlier stages of this Bill, with my noble friend Lady Finlay, the noble Baroness, Lady Northover, and the noble Lord, Lord Ribeiro, it was a great pleasure to be able to support the noble Lord, Lord Hunt of Kings Heath, in moving his amendments on organ transplantation. It is a crucial issue and I congratulate the Minister on responding so constructively and positively with that amendment. I think that we all wish it a fair wind as it goes on to the statute book.

No one was more relieved than me to see my noble friend—if I may call him that—Lord Blencathra back in his place today, because it fell to me on Report, when he was afflicted by Covid, to move his amendment. It is a pleasure to follow the speech he made earlier and the remarks of the noble Baroness, Lady Brinton, committing her Front Bench—I think the Opposition are of a similar mind—to support this amendment if the noble Lord takes it to a vote. I have only a couple of additional points to make to your Lordships.

One is about the sheer volume of items of personal protective equipment for which China is recorded as the country of origin—I raised this during Oral Questions earlier today. Since Report, the Minister has confirmed that 24.1 billion items have been bought from the People’s Republic of China, where of course the Chinese Communist Party exercises control over all companies. The cost to the British taxpayer has been £10.9 billion.

--- Later in debate ---

[Baroness Sugg (Con)]

My Lords, I rise to speak to Motions N and N1. I fully support the Government’s Motion N; it delivers the same outcome as the cross-party amendment supported by your Lordships’ House and received cross-party support from the other place last week. I am grateful to the Health Secretary and my noble friend the Minister for their engagement on this issue, and to the officials and lawyers in the department for their assistance in drafting.

Motion N makes the provision of access to telemedical early medical abortion permanent. It is supported by the vast majority of medical professionals, vulnerable women’s groups and by women themselves. Following the largest ever abortion study, the service was shown to be safe, effective and compassionate.

I cannot support my noble friend’s Motion N1 for two reasons. First, it was debated in full in the other place, including substantive discussions on whether under-18s should be included. MPs voted in support of this service in its entirety, without requiring any changes. Your Lordships’ House also supported making this service permanent. Both Houses are in agreement, and I do not believe we should reopen an already considered and agreed position.

Secondly, I cannot support it for safeguarding reasons. It is absolutely crucial that we protect young people—I am sure all noble Lords agree on that—which is why the Royal College of Paediatrics and Child Health, the Royal College of Obstetricians and Gynaecologists, the DHSC and abortion providers have already agreed to produce a set of best practice standards on safeguarding and abortion care for young people. I appreciate the Minister reassuring us on this; it is how clinical guidelines should be developed. It is standard professional activity for medical royal colleges and does not warrant any additional legislation.

If Motion N1 is agreed, as a result of the inequitable provision, young women will be more likely to have poorer access to and experience of abortion care. It would mean that young women who are physically unable to make it to a clinic, as a result of a health condition, or who live in a very rural area, have no access to transport or are at risk of violence and abuse, will have no legal way to access abortion services in England and Wales. They would be forced either to access illegal pills online or to continue with their unwanted pregnancies.

I will address a couple of the points that have been raised. I also have anecdotes about how this has helped women and girls, but I do not believe it is helpful to share individual cases—we should listen to the experts on this—but the poor girl in the terrible case raised by my noble friend Lady Eaton was actually seen in a clinic, so my noble friend’s amendment would not have helped. On the point raised by my noble friend Lady Verma, of course we want to avoid sex-selective abortions, but this goes up to only nine weeks and six days, and it is not possible to find out the sex of your baby until after then. That would not be possible in early telemedical abortion.

Children must be protected. I appreciate and agree with my noble friend Lady Eaton’s desire to do this. However, as my noble friend the Minister has set out, this should be done through clinical guidelines and safeguarding best practice. I am pleased there will not be a vote on this, as I could not support it.

[Lord Alton of Liverpool (CB)]

My Lords, I made my substantive points when we debated this on Report, so I will not be tedious in repeating all those arguments about the nature of abortion, why I feel there should be a more thorough consideration of the way the law works in Britain today and why there have been 9 million abortions—one every three minutes. That does not suggest a lack of access to abortion in this country. But I support what the noble Baroness, Lady Eaton, said to us about the lack of safeguards in the amendment that we passed, against the wishes of Health Ministers, during the tail end of the Report stage consideration of the Bill.

If the noble Baroness, Lady Sugg, was right that there had been substantive discussion, I would feel easier about this, but she will agree that there was no discussion of this at Second Reading or in Committee here, and there was no discussion of it in another place. When this was voted on in another place, there was a relatively close majority at the end of a very short debate—215 votes to 188. This demonstrates that this question is not settled.

If one winds back the clock to 1967, only 29 Members of the House of Commons voted against the Abortion Act 1967. That demonstrates that not only is this not settled but there are deep concerns about the way that this public policy has been enacted. That is why I pleaded, on Report, that rather than making policy on the hoof, it would be far better if—despite our differences of opinion, some of them fundamental, on the substantive issue—at some point, there is a review of the legislation, in which we can at least talk to one another, in a civilised way, about the best approach.

That brings me to this amendment, which was introduced with such sensitivity and compassion by the noble Baroness, Lady Eaton, and which deals with safeguarding issues. I will not repeat the quotation that was just given to us by the noble Lord, Lord Morrow, but it comes from a royal college. The royal colleges may be divided about this too—I do not dispute that—but that is exactly the sort of thing that should be laid before a commission of inquiry or a Select Committee of this House to examine the workings of the legislation.

We have heard the quotation about the safeguarding, well-being and physical needs of children from the Royal College of Paediatrics and Child Health, but I was also struck by what a designated doctor for child safeguarding said in a briefing which many of us have been sent by the National Network of Designated Healthcare Professionals for Safeguarding Children. Dr Helen Daley says:

“The considered expert position of the NNDHP is that all children (i.e. those under 18) and looked after individuals under the age of 25, should be seen face-to-face when applying to take both sets of abortion pills at home so as to prevent coercion, child sexual exploitation and abuse, and so that clinical assessments can be made to check the risk of an inadvertent mid- or late-trimester abortion.”


I note what the noble Baroness, Lady Barker, said about specific individual cases. I do not know about the individual cases, other than that one was cited, and one is enough. It struck me, as a parent and someone who has worked with children with special needs, some of whom had significant emotional problems, to think how it would be if, in a home abortion, someone was to abort a late-trimester baby and the children in that household saw what happened. I think that would remain with them for the rest of their lives and it could have a deeply distressing and traumatic effect on them. That is why we should listen to Dr Helen Daley when she says

“We have very real concerns about the harm”


that this amendment to the Bill

“(which would allow girls to take abortion pills at home without a prior face-to-face consultation for any early abortion) will do to children.”

There is one other point, which was not referred to in our early debates. There is evidence about the physical effects on women. For me, this is not a choice between the unborn child and the woman—both lives matter. One in 17 women, or 20 a day, who had taken at least one abortion pill at home in 2020 needed hospital treatment for side-effects. This evidence was provided through a freedom of information request by the previous global director of clinics development at Marie Stopes International. There are significant risks.

I plead with your Lordships: when we make laws on issues such as this, let us always be respectful of each other’s opinions, attitudes, beliefs and principles, and listen to each other carefully, which we are doing in this House tonight; bluntly, I think we are a very good example to others about how this debate should be conducted. When the noble Baroness, Lady Verma, talks about the risks of, for instance, sex-selection abortions, we must take that seriously, because there have been examples of it and we know to what it can lead; we have seen that in other jurisdictions and countries. When the noble Baroness, Lady Eaton, tells us there could be risks to children over safeguarding, we must take that seriously. I promised to be brief and will now sit down.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I rise very briefly, having contributed quite significantly to the debate on Report. I support the Government’s amendment, which is not a position I find myself in very often. I respectfully disagree with the noble Lord, Lord Alton of Liverpool, who said this was not settled. As the noble Baroness, Lady Sugg—who has been such a leader, working on this issue in the House with great tenacity and determination to defend the well-being of patients—said, it has been settled in both Houses of Parliament and has been debated extensively.

The point the noble Lord, Lord Alton, just made about the sex-selection question was comprehensively answered. The dates do not work; we are talking about early medical abortion and you do not know by that stage. We have to come back to the evidence. We had an unintended experiment as a result of Covid, which showed us that telemedicine not only reduced the rate of abortion complication but increased the level of safeguarding disclosures. It is really important that we think about an equalities issue here. Access to telemedicine is medically preferable and results in more safeguarding disclosures. We do not want to deny that to young women where it is judged that it is medically appropriate.

I note that the National Network of Designated Healthcare Professionals for Safeguarding Children is working with the Royal College of Obstetricians and Gynaecologists to develop standards. It says that this should not be subject to discrimination in the law, as the safeguarding standards and guidelines are adequate. If we think about this as an access issue, this minimises the risks of young people going to provision outside the healthcare system. This is a crucial equalities issue.

Health and Care Bill

Lord Alton of Liverpool Excerpts

Consideration of Commons amendments
Tuesday 26th April 2022 Lords Chamber

[Lord Alton of Liverpool (CB)]

My Lords, it is a great pleasure to welcome government Amendment 48C. To see an amendment committing the National Health Service to the eradication—that word “eradication” is amazing in itself—of slavery and human trafficking in NHS supply chains is as welcome as it is remarkable. This becomes like a mutual admiration society, but I take this chance to thank my noble friend Lord Blencathra and pay tribute to him for the work he has undertaken to secure this amendment; we have become good friends in the course of this amendment and other fights on these issues as the years have gone by.

I also want to reference the work of the Bill team, who my noble friend and I met yesterday along with the Minister. I pay tribute to them for the work that they have done; they have gone an extra mile. I also thank the Minister himself and the noble Earl, for helping us with his advice in earlier stages; it was candid but helpful, and I appreciate that. I thank the Secretary of State, who has been referred to. There is no doubt that this is not just another issue as far as he is concerned; he is deeply committed to it. He does not want to be the Secretary of State presiding over a National Health Service accused of purchasing goods made by slave labour in places such as Xinjiang.

I also pay tribute to the charities and NGOs that have campaigned for this—not least the charity Arise, of which I am a trustee, and its chief executive Luke de Pulford. Serendipitously, it held a reception here attended by some noble Lords who are in the Chamber tonight, including government Ministers, a former Minister and other Members from all sides. The reception included speeches from Sir Iain Duncan Smith, Sarah Champion and Danny Kruger, underlining the bicameral, cross-party and no-party support for this amendment.

The Minister knows that I have two short questions for him about the amendment. One concerns a point raised by my noble friend Lord Blencathra about the timetable for laying the regulations and seeks his assurance that nothing is being done—such as further reviews or consultations—to kick this down the road. I do not believe that that is the case but I would love to hear it from the Dispatch Box. Secondly, the amendment gives power to the Secretary of State to assess the circumstances in which the amendment will be implemented. As the Minister knows, I would like an assurance that the reference to the word “appropriate” in the amendment could never be used to frustrate the decision of Parliament to achieve the central objective of the amendment; that is, to eradicate slavery from the supply chains.

May I also press the Minister on two other related issues? They relate to the purchase of goods from a state that was, after all, described by the Foreign Secretary herself, Elizabeth Truss, as one committing genocide. The Minister knows that the Government continue to use, in his words, commercial sensitivity in answering questions about the loss of UK taxpayers’ money on faulty PPE and addressing legitimate questions involving transparency and accountability. The Minister has confirmed to me—I quote him—that

“the Department’s Anti-Fraud Unit received referrals from varying sources on 37 contracts.”

As recently as 7 April, the Minister told me:

“The Department is committed to transparency and a total of funds recovered may be published in future.”


I wonder whether the Minister can tell us when we will get to a point when publication will be allowed.