Baroness Blake of Leeds
Main Page: Baroness Blake of Leeds (Labour - Life peer)
Lord Kamall (Con)
I have to be very careful because I am not answering for the Government; I am just trying to reflect that letter. However, the Minister did make it clear that the children’s hospice funding is over the next three years and that it will account for £80 million in total. We all know how Governments work, and I not sure that any Government could give a commitment beyond three or four years or beyond another election. To be fair to the Government, I believe that they have answered the question about how much resource they will be allocating. It is up to noble Lords to decide whether they believe that that is sufficient, but if, whichever side of the debate they are on, they feel that the Government have not answered those questions, it is up to them to come back in future weeks and press the Minister on duty.
Baroness in Waiting/Government Whip (Baroness Blake of Leeds) (Lab)
I thank noble Lords for their thoughtful comments, particularly those on the amendments proposing an assisted dying help service and a minimum timeline for the assisted dying process. I thank the noble Lords, Lord Birt and Lord Mackinlay, and the noble Baroness, Lady Coffey, for their amendments in this group.
I also thank the noble Lord, Lord Kamall, for his helpful comments on the detailed letter that has been sent to noble Lords. I hope that noble Lords can therefore accept that that is in train and that they will refer to the letter. Of course, there will be other opportunities to come back on particular details if required.
The amendments tabled by the noble Lord, Lord Birt, aim to set up a new statutory body entitled the assisted dying help service, which would be part of the National Health Service. From a workability perspective, these amendments would create many new concepts and relationships that would conflict with the current provisions of the Bill. I note that considerable further policy development and legal drafting would be required to create a workable system should noble Lords support these amendments.
Amendments 287A and 287B tabled by the noble Baroness, Lady Coffey, would create a new role for the General Medical Council—GMC—to set the requirements for training, qualifications and experience, and introduce new licensing, for assisted dying. Although the GMC has a function to set standards for doctors and recognise specialisms, it does not set requirements for training and qualifications for specific services, or license doctors to provide them. This would be a significant departure from the way that the GMC operates and would require it to identify a new process to identify the doctors on this register who are licensed to provide this service.
Lord Deben (Con)
My Lords, we have asked the Minister on several occasions to give us the information that I think the Government still need to give us: what is the cost of doing these things? The letter does not meet that. She has just said that there would be difficulties, but we want to know the cost in detail, because it is for the Government to help the Committee to make decisions. Could she please say now, and, if not now, give the undertaking that she will investigate the cost, so we know how to make a decision?
Baroness Blake of Leeds (Lab)
My Lords, I was just about to go on to the whole issue of funding, which many noble Lords have raised throughout this morning’s debate. The Government’s position is absolutely clear on this. Should Parliament pass the Bill, the Government would work to undertake development of the delivery model. Until the parliamentary process is complete, we are making no assumptions as to what the delivery model for an assisted dying service would be or what the role of specific departments in delivering the service would be.
Lord Harper (Con)
My Lords, may I ask the Minister something that I do not think is an operational decision but a decision in principle, as mentioned by the noble Lord, Lord Stevens, and does not require the Government to take a view on whether they support assisted suicide or not? Is it the Government’s view—do they agree with the noble Lord, Lord Stevens—that we would have to change the founding principle underpinning the National Health Service to put this service in the NHS? If they agree with him, is that something the Government support? The Government can remain neutral on the principle of assisted suicide, but I want to know whether they think it should be inside the NHS or not.
Baroness Blake of Leeds (Lab)
My Lords, I am very aware of the repeated requests and comments. I come back again to the point that we have been making throughout the debates on these amendments, and throughout the process: until the parliamentary process is complete, we are making no assumptions as to what the delivery model will be. That is absolutely clear and straightforward, and has been emphasised by other Ministers before me.
Lord Harper (Con)
My Lords, I do not want to unfairly ascribe views to the Minister on behalf of the Government, but, just so I understand this, is she saying that the Labour Government do not have a view at all on whether we should change the founding principles of the National Health Service away from it being one that delivers medical treatment to save lives to one that also helps people to die? Is she really saying that they do not have a view?
Baroness Blake of Leeds (Lab)
I am saying that, at this point, the Government are neutral on the whole area.
Baroness Blake of Leeds (Lab)
I do not think it is extraordinary, but I am sure the noble Lord will keep expressing his point of view.
Lord Deben (Con)
The Government can perfectly well say that they do not have a view on this, but, for Parliament to make a decision, surely they have to tell us whether, if we made this decision, they would have to change the basic principles of the National Health Service. That is the only question that we must ask. The Government must be able to tell us whether, if we make this decision, that is inevitable.
Baroness Blake of Leeds (Lab)
I am sure that the noble Lord and others will find other ways of asking the same question. I refer to my earlier answer.
Baroness Fox of Buckley (Non-Afl)
I honestly believe that noble Lords are asking this question in good faith. I reiterate to the Minister—maybe she can think about this and come back—that we are being asked to make a decision about a huge change in healthcare provision, staffing and money, and the nature of what the NHS is. We are not trying to catch the Government out. We simply want to understand. Nobody could vote for this—even if you supported it, you could not vote for it. Can the Government please tell us, even if not now, what the implications will be if we vote for the Bill?
The Labour Government would say that the NHS is the most important, precious jewel in the crown, that nothing should damage it, and that we had to sacrifice an awful lot to save it only recently. I do not then want to vote for a Bill that is going to upturn the nature of the NHS inadvertently because the Government say they are neutral and cannot tell us otherwise. That is a big risk—risking the NHS, so that they do not have to answer. Even if the Minister cannot answer, we have to have that question answered; otherwise, we cannot seriously be asked to vote for the Bill.
Baroness Blake of Leeds (Lab)
I repeat that I am happy to write to noble Lords further on this point. I do not think that Members are going to move away from this point, so I am very happy to do that.
The noble Lord, Lord Gove, asked whether the assisted dying help service could be set up through statutory instrument, and I am happy to write to him to clarify that point. I will write to the noble Baroness, Lady Finlay, on the point of the constitution. That is the most straightforward way to deal with this.
With the undertaking that the Government will write on the points that have not been addressed, I hope noble Lords will understand that, on the areas that I have not raised, we cannot confirm that the amendments are workable. That is the point I must make. With those comments, I hope that the noble Lord will withdraw his amendment.
Lord Falconer of Thoroton (Lab)
I thank everybody who has contributed to this debate, in particular my noble friend Lady Blake, who ended up caught up in the eye of a storm that was not of her own making. I very much sympathise with her. I thank the noble Lord, Lord Kamall, for his mature and helpful interventions.
The amendments from the noble Lord, Lord Birt, would, as he said, effectively do three things. First, they would introduce a new organisation called the assisted dying help service that would be responsible for providing both the judgment and the navigation through the process of assisted dying. Secondly, they would give the assisted dying help service specific power and a timeline that is much shorter and more flexible than the one in the existing Bill. Thirdly, the noble Lord insisted that the commissioner not give guidance, provide leadership, collect information and make assessments as to what is going on. Instead, the commissioner would be solely a regulator, without monitoring and other functions.
As I have indicated, I do not support those amendments. In relation to the key point, the safeguards in the Bill at the moment, as the noble Lord indicated, consist of three doctors, including the preliminary doctor, the panel, the periods of reflection and the doctor who gives the assistance at the end having to be satisfied that all the requirements are still in place and operative. That structure is the one we support, and we stick by it, because we think it provides a safeguard. We are not in favour of changing that.
Separately, in relation to the assisted dying help service, I am strongly in favour of the basic principle outlined by Stephen Kinnock, when he gave evidence to the Lords Committee, and of the points made by the noble Lord, Lord Markham, and my noble friend Lady Blake. The Bill gives the Secretary of State the power to determine how it should be delivered. I accept that Clause 41, which was criticised by the deregulation committee in this House for being too vague, needs more detail. I said that I would come forward with more detail, so let me indicate what sort of detail, because people have indicated that they want that. I particularly isolate the noble Lord, Lord Goodman, whose speech was effective in that respect.
It will name as the possible commissioners ICBs, the National Health Service England—which I appreciate is itself in a terminal condition and will shortly be abolished, but it has to be kept there—or the Secretary of State. Picking up the regulation point, it will specify that the services will have to be regulated by either NHSE or the CQC. It will specifically impose duties that currently reside with the NHS commissioners on the people who can make the commission. It will indicate the principles that the Secretary of State has to provide in doing the commissioning and it will limit the Henry VIII power in Clause 41(6), which is currently very wide and, as the deregulation committee said, needs to be limited. We will make considerable progress on that. I apologise for that not being available at the moment, but there are a number of amendments to be dealt with. I hope that is helpful. That deals with the essence of the points that have been made.
The points made by the noble Lord, Lord Harper, and the noble Baroness, Lady Coffey, were in effect about the problems with the amendment from the noble Lord, Lord Birt. Because I do not support that amendment, it would be otiose and time wasting for me to go through them.
I will deal with two other points: how much it is going to cost and where it is going to come from. There is an impact assessment that, as the noble Lord, Lord Markham, said, suggests that in year 10 the annual cost will be something under £30 million. It is ridiculous to suggest where that money is going to come from in 10 years. The noble Lord, Lord Deben, says that we need to know where the money is going to come from and how much it is going to cost.
The noble Baroness, Lady Grey-Thompson, says that maybe the money will come from somewhere else. The noble Baroness criticises the impact assessment because she says it is based on Oregon, not on greater experience. If the Government take the view that they cannot rely on the impact assessment for the points that she makes—it is not a promoter view; it is a government view—then no doubt the Government will have to make a decision about whether they need a new impact assessment. For my part, the impact assessment looks careful and rigorous. When we make the decision about assisted dying, we know how much it will cost on the basis of the impact assessment. We have to make a decision as a Parliament as to whether, in the light of that cost, we think it should go ahead. It is true to say that it is a very small part—a tiny part—of the total budget for the NHS.