Health Bill

Debate between Lord Scriven and Baroness Finlay of Llandaff

Committee stage
Monday 9th November 2026 Lords Chamber

[Lord Scriven (LD)]

My Lords, I feel like a mere iron filing after the magnet of wisdom and knowledge from the noble Baroness, Lady Gerada, on primary care and continuity of care, but I will be a little iron filing that does its best. I will speak to Amendment 60, which would insert a new clause after Clause 14, and Amendment 62 to Schedule 1. They are both in my name and I thank the noble Lord, Lord Holmes of Richmond, who is not in his place at the moment, for adding his name to them.

These amendments are about people who the NHS too often fails to see and who, too often, cannot see well for themselves. SeeAbility has campaigned on this for many years and I am particularly grateful to Scott Watkin and Donna O’Brien for their help, research and guidance on these amendments. Research for the Royal National Institute of Blind People and SeeAbility found that adults with a learning disability are 10 times more likely than the general population to be blind or partially sighted. Nearly one in 10 is blind or partially sighted and around six in 10 need glasses. For children with a learning disability, the risk of serious sight problems is 20 times higher.

The conditions are cataracts, glaucoma, diabetic retinopathy and keratoconus. The last of those conditions affects as many as one in 10 people with Down syndrome. According to the Down’s Syndrome Association, if it is not caught early it can take sight for good, yet those at greatest risk are among the least likely to be tested. Around half of adults with a learning disability have not had a sight test in the recommended two years.

When SeeAbility tested children in special schools, more than four in 10 had never had their eyes checked at all. Many people with a learning disability cannot tell us that their sight is failing; instead, it shows up as withdrawal, distress or falls, and too often this is put down to the learning disability itself. This is called “diagnostic overshadowing”: people labelled as challenging when the real problem was that they could not see.

When an adopted pathway was piloted in three London boroughs, over half of those tested had an eye problem that could lead to sight loss, and nearly two-thirds ended up in glasses. Amendment 60 would change Regulation 3 of the Primary Ophthalmic Services Regulations 2008, which lists who gets free NHS sight tests: children, people over 60—probably including many noble Lords—people with diabetes or glaucoma, and people over 40 with a family history of glaucoma. The logic is clinical risk. By that logic, people with a learning disability should be on the list. Today, an adult with a learning disability, however profound, gets a free eye test only by qualifying some other way, often through a means-tested benefit.

So my first question to the Minister is: what is the clinical justification for giving a free eye test to somebody over 40 with a family history of glaucoma but not an adult with a learning disability, who is 10 times more likely to go blind or be partially sighted? The amendment deliberately covers people eligible for the GP learning disability register, not those already on it. The registers undercount, and no one should be denied a test because a practice has not updated its list. It also links to the annual health check, where GPs can prompt for that eye test.

There is also a data problem. NHS sight test claim forms have not recorded disability, so we cannot know how many people with a learning disability get a test. Can the Minister confirm whether that data is now recorded and, if not, how the department can say it is reducing an inequality when it does not measure it? Will it add this field to the data collection?

Amendment 62 deals with assessing need and commissioning services, because a free test is necessary but not enough. The NHS sight test fee is £24.13, and the Association of Optometrists estimates that it covers only about half the cost of a standard test. It pays nothing towards the longer appointments or Easy Read results that many people with a learning disability need. Many are sent to overstretched eye hospital services that are not appropriate to their presenting need. The Easy Eye care pathway, with longer appointments from specially trained optometrists, works, but it is commissioned only in south-east London, parts of the north-west and Durham. Everywhere else, the system is literally blind to the need. Can the Minister say what the plans are to try to ensure that every integrated care board now commissions this type of test? What will the Government do to ensure that it becomes standard across England?

This Bill moves NHS functions, including primary ophthalmic services, to the Secretary of State. This amendment would require the Secretary of State to assess the need and to direct ICBs—I know what I have said previously, but it is still in the Bill—to improve and measure the eye health of people with a learning disability through targeted action. As I said, I am wary of open-ended powers of direction, but I have argued that the Secretary of State should set clear outcomes and hold the system to them. This is exactly the kind of outcome that I would like.

I give the Government credit: the Special Schools Eye Care Service has £12.7 million of recurrent funding to reach up to 165,000 children. However, schools must opt in, rollout is uneven and, at 19, these young people fall off the cliff edge into an adult system not built for them. Will the Minister confirm by what date the service will be available to every ICB in England and what will happen to those young people’s eyecare when they leave school?

The NHS rightly recognises that people with diabetes need regular eye checks because they are at higher risk. People with a learning disability are at much higher risk and far less able to tell us when something is wrong. These amendments would bring them into line with the clinical risk profile that they face with their eyes. No one should lose their eyesight because the system was not designed with them in mind. I hope the Minister will look favourably at these amendments and I look forward to her response.

[Baroness Finlay of Llandaff (CB)]

My Lords, I thank the noble Baroness, Lady Neville-Rolfe, for having brought this to our attention. As my noble friend Lady Gerada said, continuity of care is incredibly important. A relationship with a clinician is a two-way process. As a patient, you need to have confidence in that clinician and they need to understand the complexity of you as a person. It is very easy to think that this is all about facts that we write down: observations and things that go in patient notes. However, it is important to remember that about 80% of communication is non-verbal. Therefore, the way that you have seen a patient and the way that you observe them later on become absolutely critical.

In my own time when I was a GP, we used to take all our own calls up until midnight and then quite often we were in the pooled rota with other practices. However, that meant that whoever phoned up during the evening was somebody we already knew and understood, and I think we were able to give much more appropriate advice or decide to go straight out to see them than happens now with the 111 screening process.

In my own discipline of specialist palliative care, that continuity is incredibly important. We are looking after patients with very complex needs, often very young people, and conversations with children about the fact that their parent is dying is not something that you can have from one person to another. It has to be the same clinician, whether that is a specialist nurse, the doctor or a specialist social worker, who then follows through. Building up confidence with that family as they face the ultimate disaster is really important, and most of that is non-verbal and interpersonal.

We have seen the advent of Martha’s rule, which has come about because parents have observed that their child was looking and behaving less well, and they were alert even though the staff around had not noticed or picked up on the signs. In a terribly sad way, that is an overwhelming testament to the importance of some continuity, rather than simply looking at observations and exchanging facts.

I can see that perhaps the wording of the amendment could do with a little modification. However, we have raised a very important subject tonight and there is a core principle, and that will mean stripping out some of the bureaucracy that is stopping clinicians from having the continuity that they want to have and that their patients want from them.

The noble Baroness, Lady Neville-Rolfe, spoke about patients getting letters. In fact, it is now standard practice across the NHS in secondary care that a patient will get a letter. Sometimes it is dictated at the time when the patient is still in the room and then they will get the hard copy afterwards. Some clinicians will tape-record the conversation—although not so much now—and allow the patient to listen to it again at home later on, and then see them for questions to be asked. That has come about, but it does not substitute for this core principle of actually being able to have continuity. The one thing that is important is that we do not force patients to be locked into continuity with somebody who they do not feel comfortable with or have confidence in, and who, really, they never want to see again. They need to be able to choose to see somebody different.

Health Bill

Debate between Lord Scriven and Baroness Finlay of Llandaff

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[Lord Scriven (LD)]

My Lords, I just have a very quick practical suggestion to deal with some of the issues the noble Lord, Lord Blencathra, and others raised about staff neutrality, because that is what we are talking about. Would it not be wise, rather than going through a long process, to make it part of the NHS constitution that staff have to be neutral in how they deal with fellow staff and patients with whom they come into contact? I ask the Minister to consider that seriously when she reports back not just today but on Report. It is just a practical suggestion.

[Baroness Finlay of Llandaff (CB)]

I will be very brief in supporting that suggestion from the noble Lord, Lord Scriven. When I was listening to the debate, I was thinking about people who have told me about feeling discriminated against. They often do not declare their racial, religious or whatever view, because they are terrified of being further labelled and discriminated against. The noble Lord, Lord Shinkwin, spoke about the history of this for the Jewish people; there were lists of who was Jewish, particularly in the Netherlands, which were rapidly exploited to round them up with speed and persecute them further. That is a very deep-seated fear in a lot of these people.

The other fear is that, if they disclose that they have been discriminated against, they will be undermined in other forms that make their lives even harder. I can again think of other specific examples that have been brought to my attention. I commend this solution as a way forward.

Terminally Ill Adults (End of Life) Bill

Debate between Lord Scriven and Baroness Finlay of Llandaff

Committee stage
Friday 23rd January 2026 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, this group of amendments is about the process of information giving. The lead amendment, Amendment 39A, is about the person having an understanding.

In any process of giving information, there is no point just giving the information: broadcasting it, if you like. You have to check that the person has understood it. Usually, in clinical practice, that is done by asking the patient, “Can you tell me what you have understood from what I have just told you?” That allows the patient to repeat back. Sometimes, you find that they have not understood it at all. Sometimes, you find that they have over-understood and brought in other sources of information, and you can then deal with misinformation that comes in and that might be relevant to them. That process is behind consent. The signing of a consent form is simply verification that the process of handing over and receiving information has happened. It is not the signature that matters, it is the process.

I will deal very briefly with something that came up before lunch—

[Lord Scriven (LD)]

The noble Baroness is absolutely correct that it is the process. In the Bill, there would be two doctors who, after sitting down and discussing with the patient their understanding, have to write an independent report that details the very things that the noble Baroness has noted, which are within the provisions of the Bill, and then goes to the independent commissioner. What is missing in the Bill that would describe the process that the noble Baroness has given that would require extra provision to determine that the two doctors have not just understood that the patient has signed the form but have detailed in the report why they think the patient both has capacity and has given consent?

[Baroness Finlay of Llandaff (CB)]

If I may, I would like to come on to the issue of the information around drugs, because that is key. But I did not want people to think that simply signing the form was adequate.

Withdrawing ventilation, which was raised earlier, is a fundamentally different situation from this. If a patient is on a ventilator, they would have died earlier without that intervention. When they withdraw consent for ventilation to continue, you still have a duty of care towards them. You need to go through all the processes as to what you will do when you withdraw the ventilation and how that will be managed, so the patient understands how long you expect it to take and that they will die without the ventilation. They must understand that they are dying of the disease that they would have died from previously. That is quite different from to the proposal in this Bill about lethal drugs. I will come on to those lethal drugs now.

This has been sold out there to the public as if this is a Hollywood death—as if you take one little tablet and that is the end of it. In evidence to the Select Committee on 22 October, the noble and learned Lord, Lord Falconer, stated that the substance used

“will be safe, efficacious and not cause suffering”.

I would like to know the basis on which he can say that with assurance.

Terminally Ill Adults (End of Life) Bill

Debate between Lord Scriven and Baroness Finlay of Llandaff

Committee stage
Friday 16th January 2026 Lords Chamber

[Lord Scriven (LD)]

The fact that somebody has a terminal diagnosis of six months automatically triggers SR1, so that part of the amendment is superfluous. There are things in amendments that automatically happen but which they would put in the Bill, but they do not need to be put in the Bill by the amendments because they already happen.

[Baroness Finlay of Llandaff (CB)]

My Lords—

[Lord Scriven (LD)]

You cannot intervene on an intervention.

[Baroness Finlay of Llandaff (CB)]

I beg your pardon; I am sorry.

Terminally Ill Adults (End of Life) Bill

Debate between Lord Scriven and Baroness Finlay of Llandaff

Committee stage
Friday 5th December 2025 Lords Chamber

[Lord Scriven (LD)]

The noble Baroness will know that, at present, an 18 to 25 year-old with a terminal diagnosis has the legal capacity to withdraw consent to treatment. Do they go through a different capacity assessment from somebody who is over 25?

[Baroness Finlay of Llandaff (CB)]

I am delighted that the noble Lord has asked me that question, because it reminds me of a patient I had. He was a young man with an advanced testicular tumour and had refused treatment. He was referred to me, and I looked after him for a couple of years, during the time that he became more and more ill with his metastatic disease. He consistently refused treatment. However, when he was moribund, and his parents had come in and were sitting at the bedside, he suddenly asked me, “Is it too late to change my mind and have treatment?” At that point, I was indebted to my local oncologist, who I phoned, and we arranged transfer that day to the Royal Marsden Hospital, which then treated him because that was his wish. My assessment every time I saw him was not to persuade him to have treatment but to allow him to talk about his fears and difficulties. That is the role of specialist palliative care when you are looking after these young people who are very vulnerable. I am simply suggesting that, due to the way the Bill is written, the assessments may not be adequate.

[Lord Scriven (LD)]

I listened to the noble Baroness’s individual case. My question was very specific. Is somebody who is 25 or over given a different mental capacity assessment based on their wish to withdraw treatment from somebody who is 18 to 25? That is the specific question based on what the noble Baroness is now suggesting happens in the Bill.

[Baroness Finlay of Llandaff (CB)]

The issue with the Mental Capacity Act is that each assessment must be done individually. It relates to the decision that is to be made, the size of the decision, the time and the personal characteristics. There is no absolute. If we are talking about safety in relation to the Bill and avoiding abuse, I am simply trying to suggest that one way forward may be to ensure that the assessment of young people’s eligibility is particularly thorough. That may mean having different criteria and looking at whether they have pain or suffering.

Human Medicines (Amendments Relating to Hub and Spoke Dispensing etc.) Regulations 2025

Debate between Lord Scriven and Baroness Finlay of Llandaff

Tuesday 17th June 2025 Grand Committee

[Baroness Finlay of Llandaff (CB)]

My Lords, I am most grateful to the Minister for the comprehensive way in which she introduced this instrument, including how it corresponds with all the documentation that we have. I am glad to see that it applies to Wales; we have many small pharmacies with cross-border flow and many roads going across the border, so this SI will make things much easier.

Like the noble Viscount, Lord Stansgate, I have some questions. I hope that at least some of them will be answered; some of them may need time. One of my concerns is about how the finances of this will work, because pharmacies depend on a dispensing fee. Who will get the fee? Will that be down to local negotiation? Will the fee be split?

However, the principle of freeing up time for the pharmacist to undertake more clinical duties is to be welcomed. They are often the first point of call for patients now. They often know the patient. They spot the person who looks less well and can advise them appropriately. They can also advise on drug side-effects, if a person goes into the pharmacist and asks about new symptoms that they might have.

However, I wondered where the liability sits if there is an error. If I understood right, it would sit with the hub if it were in what is dispensed, but there may be a difference in liability for information given to the patient. One hopes this will never happen, but some of those governance issues need to be thought through in detail.

I note that the pharmacists are already taking impressive extended roles in some areas. For example, there is a scheme in Bristol where pharmacists are taking blood for PSA assessment and reaching a population who would not otherwise present for screening for cancers. If we have pharmacists doing more health screening that would certainly free up GP time. Again, pharmacists will need to be remunerated for that.

I was interested to see that the international evidence is a little variable. Germany, Finland, Belgium and Denmark already using a hub-and-spoke dispensing model but the evidence is not overwhelmingly conclusive. In hospitals, where you have a single large building and a large number of prescriptions, automated pharmacy has in many ways revolutionised the administration of medicines.

One of the concerns is the time lag from a dispensed medicine going from the hub out to the spoke. I hope that will be thought through, so that we do not have patients, perhaps with mobility difficulties, having difficulty getting back to collect their prescription, and that those things will be factored into such arrangements.

Another area that I have a slight concern about relates, not surprisingly, to my own area, palliative care. We know that the availability of controlled drugs is poor at times, yet they are often needed urgently. I hope that consideration has been given as to how the dispensing of controlled drugs in particular can be rapid and efficient, especially when the clinical situation has changed and new medications are required at speed for a patient to be able to remain at home, rather than ending up taking an unnecessary or inappropriate voyage to hospital, with possible admission. Those travel systems also come into it.

The last area that I hope this model will tackle is waste, because there are a lot of things that patients are prescribed but never end up taking. Those of us who have been in a house after someone has died will often have been given several supermarket bags—I will not name the supermarket—full of packs of medicines that have been dispensed. They can be extremely expensive but have not been taken. They cannot be taken back in at the moment and cannot be recycled. The schemes that recycled some of the opioids, such as diamorphine, have not continued over the years. This is an enormous financial waste to the NHS, because some of these medicines have been very expensive.

I hope that this model will free up pharmacists and incentivise them to dissuade patients from accepting prescriptions when they are not actually taking those medicines. I could spend hours relating numerous stories of patients who were either not taking their medicines or giving them to somebody else. I have even once been presented with some children trying to sell me grandmother’s pain relief at the foot of the stairs, which helped me understand why I could not get grandmother’s pain under control. There is a real problem of waste in the system. If this instrument will decrease waste without jeopardising pharmacist’ income from prescribing fees, that would be very welcome.

[Lord Scriven (LD)]

My Lords, I thank the Minister for outlining the purpose behind and need for these regulations.

On these Liberal Democrat Benches, we are of course open to innovation and efficiency in our healthcare system. We recognise the potential for modernising practices to streamline operations, to reduce burdens and, ultimately, to try to improve the delivery of medicines to patients. However, for something as sensitive and fundamental as dispensing medicines, the devil, as always, lies in the detail—as the noble Viscount, Lord Stansgate, and the noble Baroness, Lady Finlay of Llandaff, pointed out—so we must scrutinise these proposed changes with the utmost care.