European Union (Withdrawal Agreement) Bill

Baroness Finlay of Llandaff Excerpts

Committee: 1st sitting (Hansard) & Committee stage & Committee: 1st sitting (Hansard): House of Lords
Tuesday 14th January 2020 Lords Chamber

When this agreement was reached between Ministers at Westminster and the Welsh Government, the draft Bill did not contain any provision for Ministers, by regulation, to transfer the functions of the IMA to another body. That is why, now, we need this amendment. It is necessary to include this provision to ensure that there is no danger of UK Ministers circumventing the appointment of members. Over the decades, there could be good reasons for a number of cases falling and for the merging of the IMA’s functions with another tribunal or court. If that is to happen, it is essential that these safeguards are built in. The point of this amendment is to try to ensure that that happens, if not in the Bill then perhaps by a statement from the Minister responding tonight. That would give some assurance that the agreement reached privately in Cardiff underpins the Government’s thinking at this stage in the process of the Bill.

[Baroness Finlay of Llandaff (CB)]

My Lords, the background to this amendment has been well explained by both my friends who have spoken. I would like to stress the importance of this as signalling to the Welsh Government a way forward and a real commitment to make sure that the devolution settlement is respected, now and into the future. Amendment 59 seeks to ensure that if the functions are transferred to another body—I stress “if”—the same obligations should apply as far as is possible in respect of the appointment of a member with a knowledge of Wales.

We now have legislation and regulations in Wales which are interpreted as providing a degree of divergence in some areas; health has already been cited and other areas include education, agriculture and local environment. Therefore, a very real difficulty could arise if the function is transferred to a body that has a mandate only for England, or to a body with governance that does not involve members from Wales who have a working knowledge of Wales and understand the detail of the regulation by which the Welsh Government have overseen services and their organisation and strategy.

If the Minister believes that such an amendment is unduly detailed for inclusion in the Bill, I hope that, at a minimum, he will make a commitment before the House that Ministers intend to act in accordance with the spirit of the provisions on the IMA if functions are at any time transferred to another body.

[Baroness Humphreys (LD)]

My Lords, my contribution to this debate on Amendment 59 will be very brief, because everyone has said what I want to say. I am grateful to the noble and learned Lord, Lord Thomas of Cwmgiedd, for tabling this amendment and giving me the opportunity to add my name to it. I am also grateful for the detailed analysis that he and the noble Lord, Lord Wigley, provided, and for the comments of the noble Baroness.

The independent monitoring authority for citizens' rights will, as noble Lords have outlined, be composed of an independent board of members with experience of matters covered by the citizens’ rights agreements, and—this is important—knowledge of the relevant laws and issues in Scotland, Wales, Northern Ireland, and, I believe, Gibraltar. As the noble Lord, Lord Wigley, pointed out, it is important to note that these qualifications for membership of the IMA are the result of many hours of negotiation between the Government and the devolved Administrations. The qualifications have been taken very seriously. The amendment seeks to ensure that if the functions of the IMA are transferred to another body, the same qualifications for membership of the new body should apply. This seems to be an eminently sensible, simple and straightforward request. I hope that the Minister can commit to it from the Dispatch Box tonight.

--- Later in debate ---

[Lord Keen of Elie]

My Lords, it is of the nature of the IMA’s function that it involves consideration of the views of the devolved Administrations and Gibraltar. It also involves consideration of the interests of those in England. We have to have regard not only to Wales, Northern Ireland and Scotland but, in this context, England and Gibraltar. It would be appropriate to consider all their interests if we were to put forward a proposal for the abolition of the IMA. Indeed, I find it difficult to conceive of a situation in which we could put forward a proposal for the abolition of the IMA at the joint committee without having consulted the devolved Administrations. It strikes me as so improbable that one should not give much weight to it.

[Baroness Finlay of Llandaff]

I hope the Minister will forgive me interrupting. I was wondering whether I would wait until the end of his remarks, but this follows on from the question asked by the noble Lord, Lord Wigley. In the event of the transfer to another body and a view that the IMA could be slimmed down, can the Minister provide assurance that the required consultation of the devolved Administrations would happen—with the devolved Administrations having a say rather than it being tokenistic consulting; I am not asking for a veto—and that there would be no possibility of them then being charged in any way or being requested to provide financial support for having as a member somebody who had particular knowledge of their area, whether it is Wales, Scotland, Gibraltar or Northern Ireland?

Can the Minister explain to me—this is my ignorance —why paragraph 39(1)(b) of Schedule 2 is in italics and the other parts of the Bill are not? Is there some significance to it being in italics?

[Lord Keen of Elie]

My Lords, I am not immediately aware of the significance of the italics, but no doubt someone will pass me a piece of paper in a moment that explains them—or not, as the case may be.

We have not yet determined the cost—this also responds to a point made by the noble Lord, Lord Greaves—or budget requirements for the IMA. I therefore cannot comment further on that. The obligation to ensure that it is fully and properly funded lies on the Secretary of State and therefore on the UK Government. What further or future negotiation there might be about cost sharing is a matter beyond the terms of the Bill. I would imagine that if we start with an obligation that lies with the Secretary of State and the UK Government it will not easily be transferred in any form to the devolved Administrations. Perhaps one day we will have a reverse Barnett formula, but we do not have one at present.

In the circumstances I have set out I hope it will be appreciated by the noble Lord, Lord McNicol, that Amendments 58 and 60 are not required in this context. The approach that we take to exercising the powers with regard to the IMA will be proportionate and appropriate and it would therefore not be necessary or appropriate that the procedures in the Public Bodies Act 2011 should apply. The bodies to which that procedure usually applies are those established on the basis of domestic policy. It will be appreciated that this is a rather different body which is the product of an international agreement and therefore it has to comply with the obligations we have entered into at the level of international law and it should not be tied to domestic legislation.

On the noble Baroness’s observations about the italics that appear in the Bill, it may well be that she alighted upon an issue that may arise later in the day, but I am advised very clearly that it is a misprint. Apparently, the entire Bill should have been in italics.

I have sought to reassure noble Lords about the concerns that have been raised and which have motivated these amendments. We have sought to design the IMA to provide robust, effective and fully independent oversight of citizens’ rights and our commitment to citizens’ rights. It is necessary to bear in mind that we are implementing international law obligations that we have incurred by entering into the withdrawal agreement. The clause and the schedule in their present form meet those international obligations and the demand for robust, effective and fully independent oversight of citizens’ rights and obligations. I hope that noble Lords will not press their amendments.

Asylum Seekers: Employment

Baroness Finlay of Llandaff Excerpts

Monday 7th October 2019 Lords Chamber

[Baroness Williams of Trafford]

I agree with what most of what the noble Baroness says. Asylum seekers can do voluntary work, which would certainly improve their mental well-being, but I disagree about the benefit to the economy.

[Baroness Finlay of Llandaff (CB)]

My Lords, can I ask the Minister how many of those waiting in the system are healthcare professionals at any level? While they are waiting, are they being provided with English language skills and tuition to enable them to take the examinations they need in order to work subsequently in their own profession?

[Baroness Williams of Trafford]

I do not have disaggregated figures on what types of skills people claiming asylum possess, but I agree with the noble Baroness that anyone settling in this country should have English language proficiency. It is the best route to economic empowerment.

Global Gender Equality

Baroness Finlay of Llandaff Excerpts

Monday 17th June 2019 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I join other noble Lords in congratulating the Minister on the leadership she has shown, both in her speech opening this debate and in the way that she is taking these issues forward. The theme is rightly on Women Deliver: it is worth reflecting that we have already heard in the debate how women deliver not only children, but their upbringing; they deliver food and water to those who need them; where they receive education they then deliver education in spades; they deliver—and really are the route to—peace; and when older they deliver as grandmothers when a mother is ill or has died.

In March 2018, the Department for International Development published its strategic vision, stating its intention to,

“step up and deliver results for girls and women, pressing DfID and its partners to take action across the board to make gender equality a reality”.

Education and healthcare are of course key priorities in addressing gender inequality, particularly maternal, sexual and reproductive health rights. As has already been pointed out, every year more than 300,000 women die from complications related to pregnancy and childbirth; 99% of these deaths occur in developing countries and more than half in sub-Saharan Africa.

The vast majority of maternal deaths, injuries and illnesses could be prevented but, sadly, not all. Even when high-quality reproductive and maternal health services are in place, things sometimes go wrong. On my way here, in preparation for the debate, I had a communication from UNESCO’s Bioethics Group, of which I am a member, representing my department at Cardiff University. It concerned something that happened last week. Following the death in delivery of a patient, a mob attacked the intensive care unit at a hospital, assaulted the staff with rods, including the female gynaecologist, and left her severely injured. In Darjeeling, violence against medical professionals seems to be reaching new heights, as this recent case of assault shows. The incident took place at the Darjeeling Sadar district hospital on Saturday, when a pregnant woman with a history of cardiac illness, thus already at great risk, was brought there by her family. She collapsed in the ward and was rushed into coronary care but when the doctor conducted a ventouse—that is, a vacuum delivery—in difficult circumstances, sadly the baby was delivered dead. The patient was intubated immediately after delivery, but all resuscitation efforts failed and she died within a few minutes. The news of the patient’s death reached the family and an angry mob rushed in, attacking the staff and vandalising the ICU. I was sent photographs of this poor woman sitting on a bloodstained floor with her head bandaged, having been attacked when she had done all that she could to resuscitate the patient.

There are movements highlighting the problem of women delivering healthcare being attacked. In the eight months to the end of last year, 60 women doctors were beaten up in Kashmir. The result, sadly, has been that some women doctors are staying away from labour wards because they are just too frightened to deal with women with complications. There are movements such as “stop violence against doctors” and “doctors are also human”. In all our debates, we must remember that unless we protect women healthcare workers, we really will not be able to provide the services that women need, particularly because they often need them from other women. An interesting recent study from America showed that women providing front-line clinical care carry a much greater burden of the childcare and domestic duties than their partners do, even when they are working full-time or more than their partners are.

Maternal mortality rates are notably high in areas of conflict. In conflict, access to contraception is often one of the first things that women lose. Clinics close, doctors move on, medical supplies diminish and, as we have heard, women often become the victims of gender-based violence. That violence continues long after a peace agreement has been signed. UK development and peace and security strategies must ensure that there is a gender perspective to protect the human rights of women and girls and, as has been said, ensure their participation in conflict prevention and conflict resolution. As has been said, in war zones women and girls are often targeted for rape. Women and their children make up approximately 80% of all refugees, as stated by the State of World Population report. Emergency contraception can be critical, and it is also important for women who are unable to have their partners negotiate condom use.

Women who are affected by conflict often lose their homes and their income. They may be forced into prostitution and other exploitative relationships in order to feed themselves and their families. Despite the role of condoms in preventing sexually transmitted diseases, including HIV, if the partner refuses to use one, women have little power to persuade them. A recent report by Family Planning 2020, FP2020 Catalyzing Collaboration 2017-2018, found that the push to boost the number of women in the poorest countries using safe contraception seems to be slipping. Despite an increase of 46 million in the number of women accessing contraception in the last six years, reaching a total of 317 million, the report said:

“Looking at projected trends, the hill is simply too steep to climb in the two years remaining in this initiative”.


As we have heard, the impact of sexual violence lives on for decades. As the noble Baroness, Lady Goudie, has said, in Vietnam there is a major problem. The Lai Dai Han are the tens of thousands of children of Vietnamese women raped by some of the 320,000 South Korean soldiers deployed to fight alongside the US during the Vietnam War. The story of one woman is quite telling. She was a young nurse, a virgin at the time, who became pregnant and was then ostracised by her family. Her attempted abortion failed and she gave birth to a daughter. Suffering a life of shame, secrecy and prejudice, she was later brutally raped twice more by soldiers, giving birth to another girl and a boy. She has raised her children singlehandedly, but they have all experienced bullying and cruelty from the local community.

Some of those raped or subjected to sexual violence were as young as 12 or 13. There are more than 800 such victims alive and tens of thousands of young adults of mixed Vietnamese-Korean heritage living in the shadows in their own society. Many live in severe poverty, with no access to healthcare and education. Because many are illiterate, they cannot advocate for themselves.

Even in peacetime, affordable contraception can be an elusive goal. I recall an auntie who, in the 1960s, volunteered to provide family planning services when she was living in the West Indies. She said that even though they fitted women with diaphragms, she discovered that the diaphragms were being collected by men after sexual intercourse and held as trophies, so they were becoming single-use contraception only, rather than being for repeated use. It highlighted the problem for these women in avoiding pregnancies when they wanted to do so.

The recent report from the Independent Commission for Aid Impact, the watchdog scrutinising spending, highlighted that between 2011 and 2015,

“DFID did not pursue the strengthening of health systems to provide quality maternal care with the same intensity as it did for family planning, nor did it do enough to address the barriers that the poorest women face in accessing health services”.

Although Britain has been praised as,

“a vocal champion of family planning and safe abortion”,

I ask the Minister why DfID are not doing more to champion safe pregnancy and delivery. We know that,

“severe shortages of beds, trained personnel, equipment and supplies”,

mean that women are dying from “basic obstetric complications”, including obstructed labour, uterine rupture, eclampsia, haemorrhaging to death and dying of infection. This very high maternal mortality cannot be tolerated around the world. We should be making sure that, during birth, every woman is attended by somebody who knows what to do when the biggest emergencies arise.

Sierra Leone has the highest maternal mortality rate: one in 17 women there have a lifetime risk of death associated with childbirth. In the Pujehun district, for example, there is just one ambulance for a population of 340,000. In the fallout following Ebola, healthcare has become more difficult overall, and it is predicted that this mortality rate will rise further. In Sudan, the aid ban is exposing women to risky births; the story of one woman was covered in the Guardian in 2017.

In some countries, things are being done well. In some Middle Eastern countries, mosques are serving as more than just centres of faith and are being used for training people in the insertion of IUDs and so on. The WHO has launched a new tool on safe contraception for front-line care providers, which provides guidance on the who and how of delivery, including a checklist to confirm that a woman is not pregnant.

The UNFPA’s aim to achieve three zeros by 2030,

“zero unmet need for contraception; zero preventable maternal deaths; and zero gender-based violence and harmful practices, such as child marriage and female genital mutilation”,

is laudable. We must cling on to that. We must also follow the example already given and provide leadership across the world.

Schools: Free Sanitary Products

Baroness Finlay of Llandaff Excerpts

Tuesday 21st May 2019 Lords Chamber

[Baroness Williams of Trafford]

I have tried to relay that issue; I think that the noble Baroness, Lady Burt, asked her Question in the first place precisely to addresses these issues too. These girls are embarrassed and some of them do not come to school because they cannot access these products.

[Baroness Finlay of Llandaff (CB)]

Will the guidance given to educational establishments on procuring sanitary towels, and possibly tampons, include some guidance about the ecological effect of disposal? Will it make sure that, rather than simply going for the cheapest option, girls also go for the least harmful products in terms of environmental destruction?

[Baroness Williams of Trafford]

I am glad that the noble Baroness has raised that point because one of the concerns that will be addressed in the procurement exercise is to see whether there are organisations which can in fact provide the sustainable products she has talked about on a large scale.

Refugees

Baroness Finlay of Llandaff Excerpts

Wednesday 20th March 2019 Lords Chamber

[Baroness Williams of Trafford]

I can only say “in due course” at the moment, but I am very happy to meet with her and the Red Cross.

[Baroness Finlay of Llandaff (CB)]

Have the Government undertaken discussions with the banks? The problem is that universal credit is paid to banks, but refugees cannot prove residency and therefore need an alternative system to prove that they are refugees when opening a bank account.

[Baroness Williams of Trafford]

I certainly recognise that bank accounts are a difficulty for refugees. Local authorities were doing a pilot in 19 local authority areas, appointing 35 local authority liaison officers. They are there to give just that type of support, because we recognise that that is an issue.

Amesbury Incident

Baroness Finlay of Llandaff Excerpts

Thursday 5th July 2018 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, after the Salisbury attack general practitioners in the area and the emergency department were advised to phone 111 for information. That resulted in delays in clinicians understanding what to do. It is completely understandable that complete secrecy is needed while an investigation goes on for that investigation to be secure and for national security. However, there is also a need to link with somewhere such as the National Poisons Information Service so that clinicians at the front line can receive appropriate targeted clinical information. Has such a system now been put in place following the concerns expressed by GPs last time? Unfortunately, we all feel that there may be further incidents in the future involving acts of terrorism.

Health: Alma-Ata Declaration

Baroness Finlay of Llandaff Excerpts

Monday 22nd January 2018 Lords Chamber

[Lord Bates]

We need to remember that, in Alma-Ata in particular, we are referring to some of the poorest countries in the world. We have the best health service in the world. That is not just my word; that was recognised by the Commonwealth Fund, which produced that statistic saying that we have the best healthcare. It is a tremendous service. In many of the countries that we are dealing with, people have to travel for days or weeks to get any sort of health intervention. We need a priority to ensure that those people are brought into the ambit of the sustainable development goals so that they get the healthcare they need and we save lives as well as being mindful of the important responsibility we have in this country.

[Baroness Finlay of Llandaff (CB)]

Given the excellent public health record that now 91% of the global population has improved water—up from only 76% in 1990—does DfID still recognise that 2.3 billion people do not have access to a decent toilet and that it is important for our own health that the 9 million new cases of tuberculosis worldwide are diagnosed early and managed appropriately? Will DfID undertake to work with those of us in end-of-life care and pain relief to make sure that the 150 countries where there is virtually no access to any pain relief are encouraged to come into line with modern science in pain relief?

[Lord Bates]

I am very happy to do that. Of course, with these waterborne diseases, clean water and sanitation are important. They come under sustainable development goal 6, which we are committed to as well. We are dealing now with the Rohingya situation in Cox’s Bazar—the diphtheria outbreak there is waterborne. There is a massive outbreak of cholera in Yemen. These are important issues, which is why we are drawing on the resources of British taxpayers and ensuring that they are distributed to the people in need.

Children and Families Bill

Baroness Finlay of Llandaff Excerpts

Monday 18th November 2013 Grand Committee

Moved by

[Baroness Finlay of Llandaff]

263: After Clause 88, insert the following new Clause—
“Offence of failing to prevent smoking in a private vehicle when children are present
(1) The Health Act 2006 is amended as follows.
(2) After section 8 insert—
“8A Offence of failing to prevent smoking in a private vehicle when children are present
(1) It is the duty of any person who drives a private vehicle to ensure that that vehicle is smoke-free whenever a child or children under the age of 18 are in such vehicle or part of such vehicle.
(2) A person who fails to comply with the duty in subsection (1) commits an offence.
(3) A person convicted of an offence under this section who has not previously been convicted of such an offence shall have the option of attending a smoke-free driving awareness course in place of paying a fine under subsection (4).
(4) A person who does not wish to attend an awareness course or who has previously been convicted of an offence under this section is liable on summary conviction to a fine of £60.
(5) The Secretary of State may introduce regulations to alter the level of penalty payable under subsection (4).
(6) The Secretary of State shall update all relevant regulations regarding the offence created under subsection (2) within six months of this section coming into force.
(7) The Secretary of State shall introduce regulations within six months of this section coming into force to prescribe the format of the awareness course in subsection (3).”
(3) In section 79(4)(a), for “or 8(7)” substitute “, 8(7), or 8A(5)”.”

[Baroness Finlay of Llandaff (CB)]

My Lords, I will be as brief as I can, and my noble friend—as I must say for the purposes of these amendments—Lord Faulkner of Worcester will speak to Amendments 264, 265 and 266, which are now in this group.

The amendment I have tabled builds on the work of the noble Lord, Lord Ribeiro, who took a Private Member’s Bill through the Lords last summer, and that built on the work of Alex Cunningham MP in 2001, who introduced a 10-minute rule Bill.

This topic of children in cars where people are smoking has been around for some time. The amendment puts the onus of responsibility on the person in charge—that is, the driver of the vehicle. Children who are strapped into a car—as they have to be by law, for their protection—have little or no control over the smoking behaviour of adults in their presence. The British Lung Foundation did a survey of 1,000 children aged eight to 15: 51% had been exposed to cigarette smoke in the car. Of those who had been exposed, 31% reported having asked the people smoking to stop, but 34% were too frightened or embarrassed to ask even though they wanted the person not to smoke.

Smoking in a car is a particular concern because it is a confined space. We all know the hazards of passive smoking. Indeed, we have legislated against it. What we are now doing, however, is leaving children at higher risk than adults were exposed to before. Research has shown that a single cigarette smoked in a moving car with a window half open exposes a child in the centre of the back seat to around two-thirds as much second-hand smoke as in an average smoke-filled pub, in the bad old days when people smoked in pubs. Importantly, however, if someone is smoking in a stationary car with the windows closed, the level increases to 11 times that of a smoky pub.

There is clear evidence that cigarette smoke damages children’s lungs. They have smaller, more fragile lungs; they breathe more quickly and their immune system is less developed. It has been estimated that there are more than 165 new episodes of diseases of all types in children caused by passive smoking, which they are exposed to in such high concentrations primarily in cars, although they may also be exposed at home. This has been estimated to culminate, tragically, in about 40 sudden infant deaths a year, quite apart from about 300,000 primary care consultations and almost 10,000 hospital admissions. It costs us £23 million a year in primary care visits and hospital treatment, particularly asthma treatment. There is a catalogue of case reports about children who have had such severe asthma that they have suffered respiratory arrest. When the parent has stopped smoking in the car—the environment in which the child was exposed—their asthma has improved enough to be controlled. The Department of Health ran a two-month marketing campaign to try to raise awareness but I suggest that the next step has to be legislation.

Children are a protected party in law. Seatbelt-wearing rates increased in the UK from 25% to 91% after legislation was introduced alongside awareness campaigns. Children want this legislation: in the British Lung Foundation survey in 2011, 86% of children aged eight to 15 said they wanted the Government to introduce a law to protect them from cigarette smoke in a car. That is almost nine in 10 children. In another survey, done on Mumsnet, 86% of respondents supported a ban, including 83% of those who were themselves smokers. An ASH-YouGov survey of public opinion showed 78% out of more than 10,000 respondents saying they would support a ban in cars carrying children under 18, even though over 60% of those respondents were themselves smokers.

We are exposing children now to a very high risk of smoke through passive smoking. It is time to address that. I beg to move.

Care Bill [HL]

Baroness Finlay of Llandaff Excerpts

Wednesday 12th June 2013 Lords Chamber

I am not holding a candle for rigid staff to patient ratios on every ward in the country being set at a national level, which is why I am attracted rather more to Robert Francis’s concept of benchmarking. However, I have no doubt that he is right to want to try to safeguard quality by making sure that enough staff are available in clinical areas. We cannot escape from this. Given the financial constraints on the NHS, there has to be some protection when it comes to staff numbers, and the Francis report offers us a rather sensible way through on this. I beg to move.

[Baroness Finlay of Llandaff]

My Lords, this is a very interesting group of amendments. I will initially address the amendment relating to staffing requirements. I declare an interest, having been involved with Gwent Police at the beginning of its Operation Jasmine investigation into nursing homes. It became evident there that the staffing levels in nursing homes—which were owned privately by a GP at the time—fell to such a level that the care was non-existent. What was happening was absolutely appalling. I urge the Government to ask NICE to look at this and come up with some guidance. The biggest problem may well be outside of the hospitals, in the nursing home and care sector. It is not only the staffing levels and the skill mix but about how staff are expected to behave, what they are expected to do and their taking on broader responsibilities for the care of patients. I am not sure whether the wording is right for the Bill itself, but it might be helpful for NICE to come up with some guidance that CQC could use for benchmarking.

It is important that we look at the organisational duty of candour and are cautious so that it cannot simply get focused down and pinned on the individual. The Government have done a great deal of work already, as has the General Medical Council, on the duty of candour of doctors towards patients when something has gone wrong. Sadly, however, the medical defence unions have all found that doctors, by and large—two-thirds of doctors have reported this—are working in what they feel is a blame-and-shame culture in which it becomes increasingly difficult to report errors, and 70% of them report that they do not feel supported when they report errors. However, there is an undoubted need for there to be a duty of candour to patients when something has gone wrong.

One of the clinical difficulties that arise is that in very complex situations, however well a team functions, things sometimes do not go the way you expect them to. It is important to be able to differentiate that situation from one in which somebody has done something wrong, which has resulted in harm to a patient. Therefore, I have a slight worry about whether perverse outcomes might occur that could increase that fear of blame and shame. However, it is important to emphasise that since April this year there is a contractual duty on organisations providing care that advises that doctors should tell patients when something has gone wrong. That has been a major culture shift for many, but patients are, in fact, very receptive to being told when something has gone wrong. I have done it myself with the team, and the other, non-medical members of staff were astonished at how welcoming the patient and their relatives were to being told that something had gone wrong and what we were doing about it. There is also already the ability to impose fines, with the recovery of up to £10,000 from the provider and criminal prosecution for significant or recurrent breaches of the duty of care, and, of course, if an individual professional has failed to be candid about an error, they should be referred for impaired fitness to practice and potential suspension or erasure from the professional register, whether it is a doctor or a nurse.

I will give a quick clinical example of where the situation could get complicated. Take a patient who is prescribed a drug such as methotrexate and is to be monitored regularly by the GP. The GP asks the receptionist to put a flag on the system, but the receptionist forgets to do it. The patient carries on taking the methotrexate, becomes neutropenic—has bone marrow failure—is admitted to hospital and is septic. The patient recovers from that, and in hospital is told exactly what has happened. When the patient leaves hospital, understandably very angry, and goes straight round to the GP, the GP has not yet received the discharge letter and finds it difficult to understand what has happened, and there have been delays in the system so that the discharge letter was delayed in getting to the GP.

That is the kind of catalogue within a whole team of lots of people not quite doing it right, and it becomes very difficult to pin the blame on someone, although undoubtedly an error occurred. That is why I support the duty of candour on an organisation, but we have to be careful that we do not end up creating such a culture of fear and blame that other parts of the organisation get scapegoated and blamed, rather than there being corporate ownership for what has gone on.

One of my other concerns about Amendment 76B is in the first part of the amendment, about being,

“honest, open and truthful in all their dealing with patients and the public”.

I would like to be assured, by those who tabled the amendment, that there is no conflict with the requirement for confidentiality in terms of what you are told by a patient. I could see a clinical situation in which information held by a patient might have made their care more difficult. It might have been disclosed to only one healthcare professional, and the patient may have said that it was not to be disclosed to anybody else. Therefore there are complexities behind this, so that enforcing it in law and imposing sanctions and penalties might become difficult.

Legal Aid, Sentencing and Punishment of Offenders Bill

Baroness Finlay of Llandaff Excerpts

Tuesday 7th February 2012 Lords Chamber

Moved by

[Baroness Finlay of Llandaff]

177A: After Clause 71, insert the following new Clause—
“Alcohol monitoring requirement
(1) After section 212 of the Criminal Justice Act 2003, insert—
“212A Alcohol monitoring requirement
(1) In this Part “alcohol monitoring requirement”, in relation to a relevant order, means a requirement that during a period specified in the order, the offender must—
(a) not consume alcohol,(b) for the purpose of ascertaining whether there is alcohol in the offender’s body, provide samples of such description as may be determined, at such times or in such circumstances as may (subject to the provisions of the order) be determined by the responsible officer or by the person specified as the person to whom the samples are to be provided, and (c) pay such amount of no less than £1 and no more than £5 in respect of the costs of taking and analysing the sample as may be specified in the order.(2) A court may not impose an alcohol monitoring requirement unless—
(a) it is satisfied that—(i) the offender has a propensity to misuse alcohol and the offender expresses willingness to comply with the alcohol monitoring requirement, or(ii) the misuse by the offender of alcohol caused or contributed to the offence in question, and(b) the court has been notified by the Secretary of State that arrangements for implementing the requirement are available in the area proposed to be specified in the order under section 216 (local justice area to be specified in relevant order).(3) A relevant order imposing an alcohol monitoring requirement must provide that the results of any tests carried out on any samples provided by the offender to the monitoring officer in pursuance of the requirement are to be communicated to the responsible officer.
(4) The Secretary of State may from time to time give guidance about the exercise of the function of making determinations as to the provision of samples pursuant to subsection (1)(b).
(5) The Secretary of State may make rules for all or any of the following purposes—
(a) regulating the provision of samples pursuant to an alcohol monitoring requirement, including hours of attendance, interval between samples and the keeping of attendance records;(b) regulating the provision and carrying on of a facility for the testing of samples;(c) determining the maximum and minimum fee that may be specified under subsection (1)(c), and the frequency of such payments;(d) regulating the functions of the monitoring officer; and(e) making such supplemental, incidental, consequential and transitional provision as the Secretary of State considers necessary or expedient.(6) In this section, “monitoring officer” means any person, other than the responsible officer, specified in an alcohol monitoring requirement as the person to whom samples must be provided.”.”

[Baroness Finlay of Llandaff]

My Lords, this set of amendments concerns an alcohol monitoring requirement and is modified from those tabled in Committee on the Police Reform and Social Responsibility Bill. The alcohol monitoring requirement requires an offender to abstain from alcohol and be regularly tested to ensure compliance as part of any community or custodial sentence. It would provide an additional option—a new tool—for the courts.

These amendments would not stop responsible social drinking. They aim to deal with irresponsible, anti-social alcohol abuse and its devastating consequences. When I tabled these amendments previously, the Government’s response was that they would pilot the idea in October, using existing legislation for low-level crimes. October has come and gone. Where is the pilot? Anyway, this is needed for middle and high-level crimes, not just low-level crimes.

I should explain why we need primary legislation to undertake a proper pilot. London wants to do a pilot and will fund that pilot. The proposal has wide support. London Councils, which represents all 32 London boroughs, has written to Ken Clarke supporting the scheme. The chair of London Councils is Mayor Jules Pipe, the Labour elected mayor of Hackney. The scheme’s project board has representatives from Her Majesty’s Courts Service, London Probation, Public Health and the Crown Prosecution Service involved in developing the pilot. Consultation has involved domestic violence victims, Refuge, Women’s Aid, domestic violence offenders, health leads and those with an interest in the night-time economy from transport to addiction support services.

Today, I spoke to Bernard Hogan-Howe, the Metropolitan Police Commissioner, who is “fully supportive” of the proposal. He commented that alcohol is a precursor to crime in about 80 per cent of crimes in London and that after six o’clock at night you can smell the problem in the police cells. Violence against the person offences account for 64 per cent of Metropolitan Police alcohol-flagged offences and criminal damage accounts for some 11 per cent of alcohol- flagged crime. We should remember that only about 10 per cent of offences get flagged as alcohol-related even though, in recent British Crime Surveys, victims believe offenders to be under the influence of alcohol in about half of all violent incidents. The commissioner wants this to be a mandatory scheme. Voluntary schemes do not work because you need to support those who most need it and who are unlikely to recognise that need without compulsion. He wants this measure to act as a driver for better health as youth binge drinking is now a common cause of end-stage alcohol-induced liver failure in those aged under 25. We have a major social and health problem.

The Metropolitan Police view this measure as an additional tool against drink-driving and domestic violence. The proposed alcohol monitoring requirement has the potential to reduce reoffending for alcohol-related crime, particularly drink-driving and domestic violence, and contribute to long-term behavioural change of offenders.

Data in the US, where the scheme has been in place for eight years, show that reoffending rates at three years after alcohol monitoring more than halved when compared with traditional sentences of fines or custody. There in the US, 99 per cent of tests are negative, and two-thirds of those on an alcohol monitoring scheme have perfect compliance throughout the whole period of the scheme.

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[Baroness Howe of Idlicote]

My Lords, I must admit that when I started to listen to this short and interesting debate, I was somewhat puzzled by it and I certainly did not think that this proposal had much of a part to play. However, the more I listened, the more interested I became. Having heard the very good speeches of my noble friend Lady Finlay and the noble Baroness, Lady Jenkin, setting out the support that exists, and indeed the practical support from the mayor, I am now convinced that this is a possible area for action. However, I have a question. When an assessment of alcohol consumption was made, could a test also be carried out to see whether drugs were involved and, if they were, could drugs also come under the treatment required? We all know that, alas, the consumption of drugs, as with alcohol, is rife. Equally, I totally accept that the amount of alcohol consumed by the young today is huge compared with what young people drank in the past. I am talking about quantities, because one sees how much is drunk by the younger generations. Having heard the noble Baroness, Lady Hayter, I also agree that it might be a good idea to have a sunset clause. Somewhat to my surprise, I am quite attracted to this idea and I shall be very interested to hear what the Government have to say.

[Baroness Finlay of Llandaff]

It may be helpful if I respond briefly to the question about drugs. Drugs can be tested using this model, as has happened in Hawaii. However, this is about alcohol monitoring. The drug problem involves a much smaller number of people and there is not the same level of gratuitous violence as one gets with alcohol. Also, drug-testing usually requires a urine sample, whereas here we are talking about a breathalyser which will pick up alcohol levels. This is exactly why a pilot is important. One can find out the problems that can occur and the pilot could be rolled out further if it was successful. This is about alcohol monitoring, and we are dealing with alcohol because it is the biggest problem that we face. In conjunction with that, of course, there is lots of support on offer to people. The problem is that they do not take it up.

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Although we are very pleased to welcome the principle of these amendments, we ask the noble Baroness to withdraw her amendment and hope to work with her in future to take this forward.

[Baroness Finlay of Llandaff]

I will be grateful if the Minister will tell the Committee under exactly which parts of current legislation these pilots can be conducted. The legal advice that I have had is that it is only low-level offences. I have also been advised that breathalysers cannot be used under current legislation, so it would be helpful if she could specify which legislation they would be used under. Will she tell the Committee whether devices that detect alcohol in sweat are Home Office-approved and, if they are not, when she anticipates that approval will come through so that the pilots can start? Where will these pilots be conducted? When will they start? For how long will they be conducted? Who is funding them? Without that information, it is very difficult to accept at face value what sounds like a great idea, but we have heard it before, last summer, and I am afraid that no action has been seen since then.

I agree that alcohol does not cause domestic violence but I would be grateful if the Minister could tell us why alcohol-fuelled domestic violence is fundamentally different from other forms of domestic violence. Perhaps it is because it is witnessed by children in the family, who will bear those scars for their whole lives; at least if there is a drunken brawl out in the streets at midnight, it is not witnessed by children where their parent is being seriously injured. Therefore, I also ask for an explanation of why the Government have decided to downgrade the importance of domestic violence, which has extremely long-term effects.

[Baroness Northover]

I have to dispute what the noble Baroness says about downgrading the importance of domestic violence—we have not. It is because we recognise that it is a very complex and dangerous form of violence that we are separating it out from the assessment of the practicalities of this scheme in these pilots. It is something that has to be addressed across the board and in a much more complex way than whether or not you breathalyse or tag somebody and decide whether or not they have breached various conditions.

The noble Baroness has made her case extremely clear. We absolutely accept the principles. We are taking this forward in the pilots that I have mentioned. I realise there is another debate coming on. I am very happy to engage with her, as is my noble friend Lord McNally, and give her the answers to all the questions she has raised. I will not detain everybody at this point, and I hope that she will be prepared to work with us to take this further forward. As my noble friend Lord Carlile said, this is a very intractable, long-standing problem, but anything we can do to try to resolve the elements that we can, we should do; that comes overwhelmingly from people in this debate. We are taking forward these pilots—I give her that commitment—and let us discuss the details after the sitting.

[Baroness Finlay of Llandaff]

I am grateful to the Minister for having responded in that way, for offering to meet me and work through all the details. I am also extremely grateful for the support that I have had from all sides of the House, unequivocally. I make it clear that I am not against the tagging process; I am not against anything that deals with this problem effectively. What I am worried about is that if these schemes are not approved this problem will be kicked into touch for yet longer, as the noble Lord, Lord Carlile, said, and we just cannot do that. Like others, I also pay particular tribute to the noble Baroness, Lady Newlove, who has spoken movingly and has committed her life to trying to bring some good out of the tragedy that she personally suffered.

With that, I will not press my amendment tonight, but I look forward to further discussions, and I must warn the Government that if I do not get satisfactory answers I intend to bring this back on Report.

Amendment 177A withdrawn.