Marriage (Same Sex Couples) Act 2013
Baroness Barker Excerpts(9 years, 9 months ago)
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Baroness Northover
I welcome what the right reverend Prelate has said and his tolerant approach.
Baroness Barker (LD)
Could the Minister tell the House whether there have been any instances of clergymen being asked to conduct same-sex marriages against their convictions?
Baroness Northover
Again, my noble friend will know that built into the Bill was protection for religions that did not want to conduct same-sex marriages, as well as for those within religions that decided that it should be allowed—so we have no evidence of that at all.
Marriage (Same Sex Couples) Act 2013 (Consequential and Contrary Provisions and Scotland) Order 2014
Baroness Barker Excerpts(10 years, 2 months ago)
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Lord Jenkin of Roding (Con)
My Lords, I thank my noble friend on the Front Bench for her very careful explanation of the long and complex orders and regulations before us. She made them extremely clear. When the Conservative Party put in its manifesto for the 2010 election a commitment to legislate for same-sex marriages, I wonder whether those who wrote that paragraph of the manifesto had the remotest conception of what would be involved in the way of changing legislation. The three schedules to the main order that my noble friend described, covering nearly 24 pages of typescript and literally hundreds of amendments to existing legislation and orders, speaks volumes about what had to be done and what has been done very successfully, as far as I can make out, by the department’s advisers and lawyers.
Like the noble Lord, Lord Alli, I rejoice that the first same-sex marriages will be happening sooner than had originally been planned. I have accepted the invitation of the Canon Chancellor of St Paul’s Cathedral, the Reverend Mark Oakley, to a celebration of the first same-sex marriages at the end of this month and I am sure that I am not alone in looking forward to it. That is a remarkable development and I know that many others in the Church will recognise this as a move in the right direction.
I want to raise one specific matter which my noble friend mentioned towards the end of her speech and that is the desire of couples who are in civil partnerships to convert their civil partnerships to marriages as soon as possible. I tabled a Question on this a while ago and the reply from my noble friend Lord Gardiner of Kimble appeared in a list of Written Answers yesterday. Apparently, he was not satisfied with the first draft of the answer that he was given and he told me that it would be a while before we got it but I now have it. However, it raises a number of questions of which I have given my noble friend notice. It says that the Government hope to achieve this by the end of this year. That is nine months away and one has to ask why. It says that these aspects of the Act,
“involve developing and implementing completely new procedures and processes”.—[Official Report, 26/02/14; col. WA261.]
Can the Minister explain to the House what those completely new procedures and processes are? After all, a civil partnership is half way there already. Compared with what has had to be done in these orders to make the rest of the law applicable to same-sex marriages, one would have thought at first sight that it would not have been too difficult to have done this, if not at the same time, at least no more than a few weeks or a month or two afterwards. Why so long? What are these procedures? Will there have to be further orders? Is it going to be necessary for Parliament to approve the orders?
The point has been made to me that some people in civil partnerships are elderly and are anxious that they should convert to marriages with the legal consequences of that as soon as possible. If one dies before that has been done, then the handling of property and so on is different from what it would be if they were married. To be told that they may have to wait nine months or more before this can be done has caused a good deal of dismay and I hope that my noble friend will be able to give a better explanation than my noble friend Lord Gardiner gave at the end of his reply in the Hansard published this morning.
Apart from that I very much echo what the noble Lord, Lord Alli, has said. I think the Government have done a magnificent job on this and I take some pride that in this House, in contrast with the other place, on every single Division a majority of Conservatives supported the Bill. We may be on average 20 to 25 years older than they are at the other end and yet we achieved that. As the noble Lord, Lord Alli, said, that is a considerable tribute to the House of Lords.
Baroness Barker (LD)
My Lords, there is an African proverb which says:
“If you want to go fast, go alone. If you want to go far, go together”.
We are coming to the end of a very long legislative journey. It began in 2002 when my noble friend Lord Lester drafted the first civil partnership legislation, which was withdrawn but was then swiftly taken up and adopted by the then Labour Government, for which they deserve enormous credit. It continued with my right honourable friend in another place, Nick Clegg, in early 2010 stating his position that there should be equal marriage. He was closely and swiftly followed by David Cameron, who deserves enormous credit. My redoubtable colleague, Lynne Featherstone, notwithstanding the fact that this was not in the coalition agreement, announced in 2011 that there would be a consultation on equal marriage and civil partnership. It is as a result of all that work that we have arrived at the situation we are in now.
It was a joyous day on 15 July 2013 when, in the sunshine, we were all serenaded by the London Gay Men’s Chorus outside, as they celebrated with us several weeks and months of very hard work by Members from all parts of your Lordships’ House. We were steered through that process so ably by the noble Baroness, Lady Stowell of Beeston, in a truly remarkable piece of ministerial work. It was a momentous occasion. Since last summer it has been my privilege to meet people all over the UK. I have been a Member of this House since 1999 and I cannot remember so many members of the public going out of their way to express their thanks to this House for doing its job in passing this legislation. They know the true import of what it will mean in their communities.
There has been one very recent discordant note, from the House of Bishops Pastoral Guidance on Same Sex Marriage, issued on 15 February. It was a somewhat dispiriting announcement, and we have to accept that for our colleagues who are members of the Church of England and the Church in Wales, their road to equal treatment will be longer and tougher than they had perhaps expected. I say to the bishops that the default position in the legislation throughout our discussions was that those religions that did not wish to recognise or to celebrate same-sex marriage would not have to do so. At every point that was conceded. Throughout our debates on the subject, those of us who believe the church’s position to be wrong held our peace, and we have still not had that discussion.
However, I hope that the bishops will understand and respect that even in these statutory instruments that same spirit of recognition of their position remains, particularly in the recognition of military chapels and on shared premises. I hope that the individual members of churches who support same-sex marriages can look forward to a point when they can have a dialogue with those members who do not yet formally support them. The noble Lord, Lord Alli is right. The legislation for those of us who have the great luck to live in this country means a tremendous amount. All over the world our friends and colleagues who are gay face the most horrible oppression and intimidation. The church, as with other organisations, has a role to play in making those people’s lives safe.
On 29 March, England and Wales will take one step further to becoming countries that afford dignity and respect to all citizens, including those of us who are gay. I am delighted that Scotland will be coming along fairly swiftly afterwards. I thank all noble Lords and Members of another place who joined the person who today I can call my noble friend Lord Alli, me and the rest of us on what has been a truly wonderful journey.
Lord Collins of Highbury (Lab)
My Lords, I, too, want to associate myself with the remarks of noble Lords this afternoon, particularly those of my noble friend Lord Alli. I, too, congratulate Stonewall on all its hard work across all parties in ensuring that this final act of equality is achieved. In particular, I agree with the remarks of my noble friend Lord Alli about Ben Summerskill, who has done a tremendous job over recent times, and, of course, I welcome Ruth Hunt as the acting director of Stonewall.
This country is now a beacon of equality. I am proud of the record of the previous Government in achieving many changes, not least bringing in an equal age of consent, civil partnerships and the end of discrimination; I am incredibly proud of all those things. I am proud, too, of this Government and of our Prime Minister, who was determined to see this final Act of equality through. Therefore, I want to associate myself with all noble Lords who have spoken today. This country is indeed a beacon of equality but, as noble Lords have said, it brings into sharp focus the difference with those countries where homosexuality is still illegal—indeed, not only illegal but a criminal act punishable, in some cases, by death; some of us have seen the horrific films that have been circulated.
I am also proud of the tremendous cross-party support. Today is one of those rare occasions where I want to break with convention and refer to noble Lords opposite as my noble friends, because they have become friends in this fine battle. Politics is often personal, and I declare an interest in that I have been in a civil partnership since the very first day it was possible. My husband and I were incredibly proud when we were able to do that. We had planned the ceremony for 12 months previously but, ironically, the delays in this House delayed our ability to set the date that we wanted, which was on my birthday. As it happened, my birthday fell on the day when civil partnerships came into force, so we were able to do that. However, my husband has said to me in the strongest possible terms, “Why can’t we get married? It has been in the papers, it has been announced and our families are ringing us up. My niece and nephew spoke to me only last week and asked why we can’t get married”. At one point, my husband suggested—my noble friend Lord Alli knows this—“Let’s get divorced so that we can get married”; I managed to put him off. Some friends of ours who had been in a civil partnership—again, my noble friend Lord Alli knows these people—were so confident and so proud that they proposed to each other on Christmas Day, invited all their friends from New York to come over in March and even booked the hotel. Then they discovered that they would not be able to marry because they were in a civil partnership.
I do not want to be churlish because it is fantastic news that the date has been brought forward. It is fantastic that we will see the first same-sex couples getting married so soon. However, I must associate my remarks with those of the noble Lord, Lord Jenkin. Why does it take so long to organise allowing people to convert their civil partnerships into marriage? I am pleased to see the noble Baroness, Lady Stowell, who did such a fantastic job in pushing the Bill through Parliament, here. She knows that I raised at the very first stage the question of when we would be able to have a ceremony to convert our civil partnerships into marriages. She gave me those assurances and I know that the assurances are there. Will the Minister, in her response, please do more than say, “We hope by the end of the year”? Will she set a date as quickly as possible? It does not matter when that date is. We are like other people who get married in that it takes a bit of planning—in my husband’s case, a lot of planning—and we need to book things. So will the Minister please set the date, so that I can set the date?
Female Genital Mutilation
Baroness Barker Excerpts(10 years, 5 months ago)
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Baroness Barker (LD)
My Lords, it is a great honour to follow the noble Baroness, Lady Rendell, who has worked so hard for so many years on this subject. I want to pay tribute to my colleague Lynne Featherstone for having secured the resources within DfID for the £35 million regional programme for Africa and countries where this barbaric practice is prevalent.
I also pay tribute to the Orchid Project, an outstanding charity that works on this subject. It pointed out something extremely important: the prevalent coincidence of FGM and other conditions—such as early marriage and ill health—which damage women. Will the Minister tell us whether DfID, in its programmes abroad, and the MoJ and the Home Office here, will ensure that their programmes on forced marriage go in sync with the programmes on FGM, so that there can be a double benefit?
The Orchid Project pointed out quite rightly that FGM is not a religious practice, it is a cultural practice. However, it said that in attempting to overcome this, it is very important to get religious leaders within communities on one side. Therefore, will the Minister say whether, in the DfID programme, and in the programmes with diaspora communities here, we are targeting religious leaders—and, in particular, men who have influence in forming opinion in communities within which this practice occurs? If we do that, we will be able to support those very brave young women such as Leyla Hussein, who herself was cut at the age of seven in Somalia and who was so eloquent in that amazing documentary, “The Cruel Cut”.
Finally, will the Minister tell us whether, in the DfID programme, there will be a particular concentration on those regions of countries where there has been a significant move towards abandoning the practice? From that, we will learn what it was that enabled people—men and women within those communities—to build resistance to this practice, and this knowledge could then be transferred to places such as Somalia and Sudan and some parts of western Africa where, unfortunately, this practice remains all too prevalent, with all the horror and destruction for individual young women that that entails.
Treatment of Homosexual Men and Women in the Developing World
Baroness Barker Excerpts(11 years, 6 months ago)
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Baroness Barker
I wish to speak briefly in the gap and raise two issues which I think have not been raised in the debate. A number of noble Lords have referred to the fact that in October 2011 the British Government announced conditionality in regard to the overseas aid budget. Will the Minister tell us exactly how the Government intend to monitor that policy and its implementation? The noble Baroness, Lady Nye, well expressed the fear that that policy could create a gap into which right-wing evangelical churches might step to influence poor people in developing countries. I do not think any of us would wish to see that. However, we do wish to see the overseas aid budget being used to advance equality and diversity. If our Government were to monitor this carefully, we could come up with a new model of overseas aid funding for ourselves and other Governments. That would be an important provision.
My second point is a very minor one. Could the Foreign and Commonwealth Office operate a scheme whereby its travel advice states the factual case of each country in relation to the law governing lesbians and gay men? I think that many people know about the awful situation in Uganda, Ghana and perhaps in the Ukraine. However, there are other countries where the situation is perhaps as bad but is not as well known. I would like travellers to be able to use their own independent economic power to not support those countries which are highly discriminatory and to support the ones which are not. We might include in that some of the states of the United States of America which currently appear to be going back to a time of discrimination which we thought had passed.
Health and Social Care Bill: HIV/AIDS Programmes
Baroness Barker Excerpts(12 years, 1 month ago)
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Baroness Northover
As with every other area, this will kept under close review to make sure that things are suitably joined up and that we have high-quality prevention and treatment. As for NICE guidelines, the British HIV Association produced clinical guidelines for HIV treatment in 1999. They were taken forward and are widely accepted by clinicians and commissioners. The association is currently revising its guidelines and we will see what it suggests.
Baroness Barker
My Lords, do the Government still support the work of the UK National Screening Committee and, if so, how will its recommendations be implemented in future?
Baroness Northover
Yes, indeed, the UK National Screening Committee will remain as an independent advisory body and will continue to advise the Government and the NHS on all aspects of screening. The NHS constitution, which was drawn up by the previous Government, commits the Government to providing screening programmes as recommended by the UK National Screening Committee. The NHS Commissioning Board will commission national screening programmes on the Secretary of State’s behalf.
Health and Social Care Bill
Baroness Barker Excerpts(12 years, 5 months ago)
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Baroness Barker
My Lords, I shall speak to Amendment 237A, which is in my name. The justification for this legislation is that it does three things. It enshrines the Government’s stated policy that health services should be built around patients and that all decisions about patients should be taken with them. No decision about me without me: that is the phrase that we have heard. The second justification is that the Bill empowers clinicians and local authorities to commission health services that meet the needs of all groups in the population and reduce health inequalities. The third justification is that the Bill will enable the National Health Service to deal with the pressure on it because of demography and increased longevity among the population by being more efficient and more effective. Those are the justifications for the Bill. It is with that in mind that I go back to a discussion that many noble Lords here this evening had at considerable length during the passage of the Mental Health Act 2007. We were all on different sides of the Chamber then, which is not a point to be missed, I suspect.
The amendment seeks to include in the decision whether someone should be placed under a community treatment order—a compulsory order, as alluded to by the noble Lord, Lord Patel of Bradford—an assessment of whether someone who is suffering from mental illness may yet have capacity to make a decision about their treatment. To put it in lay terms, someone may be ill but still retain sufficient insight into their illness to make decisions about their treatment and in particular about whether they should be subjected to compulsory treatment. It is a similar, although legally slightly different, test of capacity to that in the Mental Capacity Act, with which noble Lords will be familiar.
It is the same provision that occurs in the Mental Health (Care and Treatment) (Scotland) Act 2003. Without going back over the ground that we covered in much greater depth in 2007, when the Scottish authorities prepared their legislation, unlike the Government of the time in England they did not simply go around a lot of different jurisdictions throughout the world where there are variants of community treatment order, pick elements that they liked and put them together. They went through a long and considered process, looking at how to bring their concept of a compulsory community treatment order into being. They did so with a greater degree of protection for people who might end up in effect being subjected to treatment against their will indefinitely. They included this concept of impaired decision-making within the Act.
Why should we revisit this decision? I was about to say that it was made by this House but it was not. This House agreed that we should include the concept of impaired decision-making; it was another place that removed it. The simple answer is statistics. When we debated what was then just a theoretical proposition that there would be community treatment orders, we were repeatedly assured by the then Government that they would be applied to only a very small group of people. Noble Lords will remember that it was envisaged at that time that there would be a few hundred people who were routinely referred to as “revolving door patients”—those patients who were in and out of acute care.
What has happened? In the first year of operation, 4,000 people—not 300—were put on to community treatment orders. There are now 7,000 people on them. I admit that we are still only a few years into the programme, but the number suggests that, first, the law is being much more widely applied than it was ever envisaged that it would be and, secondly, that practitioners are taking a precautionary approach to putting people on to compulsory treatment. In short, I suspect that a number of practitioners decide that the consequences of taking somebody off a community treatment order are potentially so hazardous to those practitioners that they are keeping people on indefinitely. That means that the situation that some of us foresaw whereby people were put on to community treatment orders from which they are unable ever to escape is happening. That seems to me to fly in the face of all the underpinning principles of this Bill.
At a time when we know that the resources of the National Health Service are going to be stretched and put under pressure in a way that they never were before, putting people on to treatment orders that they may not need is wrong. We know that lots and lots of people out there are suffering various degrees of mental distress, particularly those for whom their mental distress is not sufficiently serious that they are subject to compulsion, who desperately wish to get themselves into treatment and to see counsellors and therapists but cannot. Why take our already stretched resources and apply them to people who may not need them? I think that is wrong.
Why is this measure included in the Bill? I think it is unlikely that we will have a major revision of mental health legislation for some considerable time. In fact, there is a very good reason why we probably should not do so in that significant changes in mental health legislation happen not quite once in a generation but over a very long period when treatments and therapies have developed. Therefore, as I say, I do not envisage that we will have a major revision of mental health legislation for some years. However, I do not know whether that will be the case as I am not party to the Government’s proposals in that regard.
In the mean time, it appears that we are going to subject thousands of people to treatment that may be wrong—the only people in the country who are subjected to medical treatment against their will. It seems to me that we cannot let that carry on without looking at it in considerable detail. I suspect that the Minister is unlikely to want to go into this area at this stage, but if he cannot accept this amendment can he give a commitment that the issue will be kept under review and that we will return to it at some stage even though another large piece of mental health legislation may not be forthcoming?
Baroness Meacher
I apologise to the Committee and to the Minister for not being present in these debates. However, I cannot resist supporting the noble Baroness, Lady Barker, on this issue, which, as the Minister knows, we debated at length when the Labour Party was in government. I, for one, strongly supported the idea that people leaving hospital should not be put under a community treatment order, most particularly if they are no threat to others, are competent, can give consent and can make rational judgments. Large numbers of people under community treatment orders suffer with depression and the only persons at any risk at any time are themselves. At a time when we so strongly support the principle of autonomy and the right to some control over medical treatment in general, it feels completely inconsistent to throw all those principles away in this one area and say, “No, doctor knows best. Whatever you say and however competent you may be, you have no right to make a decision about the treatment”.
Having said that, I understand Ministers feeling very concerned about having the same principles apply if someone might—if they become unwell again—be a real, serious and major risk to other people. Therefore, my plea to the Minister is that he gives serious consideration at least to those who are no risk to anyone else, because the noble Baroness, Lady Barker, is right to say that while these provisions are on the statute book it is almost impossible for doctors not to impose these community treatment orders or for them then to rescind them because, if something goes wrong, they will be in the most appalling trouble. I will say no more but I wanted to add a strong voice to the comments of the noble Baroness, Lady Barker.
Baroness Barker
I understand entirely my noble friend’s response to my amendment. I am very pleased with that. No doubt I and other noble Lords will spend at least part of 2012 making sure that we hold the Government’s hand to the flame on that review. I wanted to respond to what she said about the amendment in the name of the noble Lord, Lord Patel of Bradford, which I very much support. The first scenario that the Law Society and others were trying to probe in that amendment was one where it was unclear whether or not a patient came under the auspices of a CCG. The second was what would happen if a CCG decided not to commission a particular type of service—for example, some kind of psychological therapy—and it did so independently and not in discussion with the social services authority. I was not clear from the noble Baroness’s answer whether in her discussions with the noble Lord, Lord Patel, she would be covering both those eventualities.
Baroness Northover
My Lords, I am happy to cover both those eventualities in the discussions. Moving on to Clause 51 concerning death certification reforms, this amendment to the Coroners and Justice Act 2009 places responsibility for the appointment of medical examiners and related activities on local authorities in England instead of the PCTs. The Government are committed to implementing the reforms of the process of death certification set out in the Coroners and Justice Act 2009. These are important and long overdue reforms, which will involve a medical examiner providing an independent and proportionate scrutiny of cause of death in all cases not investigated by a coroner. The reforms will improve the quality of information on cause of death, increase transparency for bereaved families, and strengthen local clinical governance and public health surveillance arrangements. As your Lordships will be aware, these reforms form part of the response to the recommendations of the Shipman inquiry and, of course, the noble Baroness played a key role in taking these changes through.
The clause moves responsibility for the appointment of medical examiners from PCTs to local authorities and makes similar changes to the arrangements for performance managing and funding the medical examiner service. This change is needed because of other provisions in the Bill which will abolish PCTs from April 2013, despite the quote that was made earlier. Establishing the medical examiner service in local authorities should enhance the availability and accessibility of important public health information and intelligence. It will also align the service with other existing local authority responsibilities, including coroner and registration services.
I now turn to the fee payable for death certification, which, clearly, is a very difficult and immensely sensitive issue. Many people, including my noble friend Lady Jolly, have questioned whether there should be a fee at all and whether the state should pay for certification of death. It is the Government’s policy in line with the proposals set out by the previous Government in 2009 that the medical examiner’s independent scrutiny and confirmation of cause of death stated on the certification should not result in an increase in costs. It is also important to remember that the payment of the fee is already the case as regards the 70 per cent of people who are cremated, with this fee forming part of undertakers’ fees.
The current economic situation means hard choices are inevitable and the need to ensure that certification of death is cost neutral is one of those challenges. With regard to how the fee is paid by individuals, I am aware of the problems. Let me make it clear: it is neither the Government’s desire, nor intention, that this fee should be paid upfront. We would like to come to a solution that fully recognises how difficult a time this is for families and we do not want to add to the heavy burden which is felt at such a time.
As such, we have already started discussing with stakeholders and others how to arrive at an appropriate method for payment of fees. We will be consulting fully on this topic and want to hear the full range of views before making a decision. Given the sensitivities, if any Member of the Committee would like to discuss these issues further with me or officials, we would be very happy to take that forward. In due course, I will move that this provision stands part of the Bill.
Health and Social Care Bill
Baroness Barker Excerpts(12 years, 6 months ago)
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Baroness Hollins
My Lords, I shall speak to Amendments 203C and 215A. Although the Bill places a duty on each clinical commissioning group to,
“obtain advice appropriate for enabling it effectively to discharge its functions from persons who (taken together) have a broad range of professional expertise in … the protection or improvement of public health”,
it places no duty on clinical commissioning groups to act at all times with a view to the improvement of public health. Such an omission will render the delivery of public health outcomes significantly less likely, with clinical commissioning groups free to act without regard to the wider public health needs of the populations they serve.
The Government’s intention to leave public health—and therefore public mental health—entirely to local authorities could mean that the opportunity will be lost for clinical commissioning groups, local authorities and national agencies to work in consort to achieve better outcomes. There is a fundamental relationship between mental health and well-being and almost all other aspects of individual and public health. Handing responsibility for public mental health solely to local authorities could have deleterious consequences for achieving good outcomes in public health more generally unless precautions are taken.
The purpose of these two amendments is to try to mitigate the consequences of this decision. They would ensure that clinical commissioning groups are required to act in such a way that they contribute to the improvement of public health—and public mental health—and are required to demonstrate in what ways their actions fulfil such an obligation.
I should also like to add my support to the amendment of the noble Baroness, Lady Tyler. I was unable to participate in the discussion about the previous group— where perhaps the comments I am going to make might have been more relevant—because of a commitment to speak at the same time to an amendment in Grand Committee to the Welfare Reform Bill, due to the rather unfortunate timetabling of that Bill.
The point that is relevant here as well is that public health relies on the relationship between so many different agencies, and I am thinking here particularly about the contribution made by education. The example I want to give is about the health of the next generation, which relies so much on the way in which children are parented. Education and support for future parents seems such a worthwhile investment. I want to give just as an example the work of the charity Teens and Toddlers. It does not work by telling teenagers to change their behaviour, because that does not work; it offers them a holistic and transformative experience which has a much greater effect. It really is a health intervention as well as an educational one. The programme allows teenagers to spend two hours a week for 15 weeks looking after a toddler in a nursery. They also spend time talking through what that experience has taught them. What is so extraordinary is the effect of the programme, which is now available in 12 London boroughs and 13 other areas of the UK. Some 97 per cent of those who graduated from the programme have not become pregnant before the age of 20, and 92 per cent have continued in employment, further education or training. I am sure that the Minister will agree that public health is so much more than the responsibility of only the local authority and the NHS.
Baroness Barker
My Lords, I want to address briefly the question that Clause 15 should stand part of the Bill raised by the noble Baroness, Lady Thornton, and her colleague on the Front Bench. At this stage I do not intend to go over the points which have already been made so expertly. I simply want to ask a simple question. Clause 15 sets out the functions and the shared duties of local authorities and the Secretary of State to improve public health. What is not clear is which duty falls to the Secretary of State and which to local authorities at any one time. What would be the trigger for an intervention by the Secretary of State? It is quite important that noble Lords should understand this as we go ahead. Would I be right or wrong to assume that it would be exceptional, rather than the norm, for the Secretary of State to intervene? Is that what the department thinks? If it were exceptional, can the Minister set out under what circumstances it is envisaged that the Secretary of State would intervene?
For example, if a local authority unilaterally decided to cut its entire funding of sexual health services, would that be regarded as something which would cause the Secretary of State to intervene? If a local authority came up with a good argument for why it should not fund such services, or there was a major outbreak of an environmental nature, would the Secretary of State intervene under additional powers? I can understand the logic of this in that both the Secretary of State and local authorities need to have powers, and those powers should be shared, but I would welcome further clarification on how these powers will be exercised both jointly and separately.
Baroness Barker
My Lords, I cannot remember which legislation it was, but I know for a fact that I was sitting on the other side of the House and that the Minister was the noble Lord, Lord Hunt of Kings Heath. If I could go back and trawl through Hansard, I would find the reference to the speech in which I started by saying that I feared that one day we would have a piece of primary legislation that consisted solely of regulations and that we were perilously close to it. I point out to the noble Lord, Lord Hunt of Kings Heath, that whatever he may think about this legislation, he has form on this.
Lord Hunt of Kings Heath
There is one very big difference. In the legislation I was bringing forward, we retained the clear accountability of the Secretary of State to Parliament which had clear direction powers over the National Health Service. Therefore, it was much more appropriate that regulations did not have to be affirmative because Parliament could demand the accountability of the Secretary of State. We are moving into a new situation where the Secretary of State is taking a much more hands-off approach, so the argument that the regulations be affirmative is much more persuasive. There is a real degree of difference between then and now.
Baroness Barker
That might have been the case, but I recall that under the Government of which he was a member, a fair amount of Henry VIII powers went through at the same time so, although his basic thesis might be different, I am not sure that Parliament was that much more able to question the intention of the Secretary of State at the point at which primary legislation was being debated in this House.
I want to speak up partly in support of the amendment moved so eloquently by the noble Lord, Lord Hennessey. I would perhaps differ slightly. I think that in this House there is a great deal of very high quality scrutiny of delegated powers and secondary legislation. It is one of the things that this House does extremely well. The additional point in the proposal he has made is to bring to the process of scrutiny of secondary legislation the involvement of people on the Health Select Committee in the House of Commons who, by dint of their membership of that committee, have a detailed and ongoing knowledge of the workings of the National Health Service in its entirety. I understand what he is trying to do, and I have a great deal of sympathy with it. My only reservation about that is that I think the power of the Health Select Committee is that it sets its own agenda and holds the Government to account. I would not like an inadvertent effect of what the noble Lord, Lord Hennessey, is proposing to be to trammel the independence and power of that very important committee to scrutinise what the Government are doing. However having made that criticism, I have a great deal of sympathy with what he is trying to do, but I hesitantly suggest that perhaps this problem is not quite as new as some noble Lords might suggest.
Lord Hunt of Kings Heath
My Lords, perhaps I might just come back to the noble Baroness. Would she agree that this is a point that deserves greater consideration when we come to the mandate itself? At the moment the Government are proposing to simply lay the mandate before Parliament before the start of each financial year. Would she agree that the mandate itself might be subject to more scrutiny by Parliament?
Baroness Barker
My Lords, I do not want to get into that debate, which I think we have not yet come to, but I thank the noble Lord—sorry, I am so tired tonight, I was about to call him “the noble Lord the Minister”; I am going back in time—
Baroness Barker
I thank the noble Lord, Lord Hunt, for drawing attention to a very important point that I think has been missed and in some cases distorted, which is that our debates so far have been about the powers of the Secretary of State and we have ignored a number of other elements that have a direct bearing on that, such as the mandate. That appears to have passed by people like 38 Degrees completely. I thank him for drawing it to our attention but I will resist the temptation to get into the detail of that this evening.
Baroness Wilkins
My Lords, Amendment 92A is tabled in my name and those of the noble Baroness, Lady Hollins, and the noble Lords, Lord Rix and Lord Wigley. It would make explicit the responsibility of the NHS Commissioning Board and clinical commissioning groups to be compliant with the public sector equality duty, as set out in Section 149 of the Equality Act 2010.
Section 149 states that a public authority should,
“take steps to meet the needs of persons who share a relevant protected characteristic that are different from the needs of persons who do not share it”,
as part of the duty on it to advance equality of opportunity. This essentially makes provision for such public authorities to be subject to making reasonable adjustments for individuals who may have specific or different needs as a result of factors such as age, disability and religion or belief. In the context of this amendment, the healthcare bodies concerned and the healthcare professionals who work in them would be required to take the necessary steps so as to offer appropriate care to people with these protected characteristics.
In particular, I am speaking about the provision of reasonable adjustments for disabled people, particularly those with a learning disability. People with a learning disability will often have particularly complex healthcare needs and therefore require specialist interventions in order to have them appropriately met. These interventions are about health professionals adopting a change of attitude towards disabled patients and not making assumptions as to their quality of care which would not be made towards non-disabled patients. For example, the use of hospital passports can help to provide key personal information about an individual’s medical details and, as importantly, details about how they communicate so that health professionals can better understand the patient’s individual needs and communication requirements. Additionally, learning disability liaison nurses can help to provide specialist support and guidance to medical professionals when treating someone with complex needs.
These measures are more often than not achievable, reasonable and proportionate, and help to ensure that health professionals are treating disabled patients with the dignity and respect they are entitled to. Whether this is for planned or non-planned admissions, it is necessary for the NHS to make adequate provision for patients with disabilities. This can be achieved through better disability and learning disability awareness training for all staff so that they can better understand the needs of such individuals who may be in their care.
A 2009 poll conducted by ICM on behalf of Mencap found that a third of healthcare professionals have not been trained in how to make reasonable adjustments for a patient with a learning disability.
At this point, Baroness Northover continued the speech for Baroness Wilkins.
This can lead to poor treatment and can exacerbate existing healthcare inequalities. The same ICM poll indicated that almost half of doctors and a third of nurses said that people with a learning disability receive a poorer standard of healthcare than the rest of the population. The Mencap report Death by Indifference in 2007 also revealed the premature and avoidable deaths, in the NHS, of six patients with a learning disability. Since then, a further 60 families have been in contact with Mencap with similar experiences to this. It is therefore particularly important for the NHS Commissioning Board and clinical commissioning groups to be fully aware as to their responsibilities and obligations under the public sector equality duty.
It is very important that disabled patients and their families can be expected to be treated in the NHS without being the victims of prejudice and discrimination. The amendment tabled in my name and others’ sets out specifically the requirements on these bodies to adhere to the public sector equality duty. They would safeguard disabled patients against malpractice, mistreatment and neglect in the NHS.
Baroness Barker
“(5A) Regulations must also secure procedures for the Board to require clinical commissioning groups not to appoint to the Board or a sub-committee of a clinical commissioning group any person who is an employee or a share-holder of a commissioning support organisation.”
Baroness Barker
My Lords, I spoke to this amendment on Monday. The noble Earl, Lord Howe, replied in the depths of the evening, and at the conclusion of that debate I did not have a chance to say that I believe that this is an extremely important and fundamental matter. It concerns CCGs not being able to appoint shareholders or staff of CSOs to their decision-making committee. I signal my intention to bring this matter back on Report. I hope that it might be possible for the Minister to meet me on that. I would have raised that point the other night, but it was very late.