Victims and Prisoners Bill

Baroness Finlay of Llandaff Excerpts

Committee stage
Wednesday 7th February 2024 Lords Chamber

[Lord Thomas of Cwmgiedd (CB)]

My Lords, I will make three brief observations. First, I warmly commend Amendment 115. The law needs to balance very carefully the rights of the defendant and those of the victim. This is an admirable compromise, restricted to professional people, and I hope that it is a good example of the way that Parliament can move the law along to accord with present times.

Secondly, in relation to Amendment 102, consistency is critical. One must remember that the police will have to operate this, and it will be hard work for them as the law is made more and more complicated. Having slight differences between systems makes their life impossible. We need only to look at experience with search warrants and the terrible mess that was made of those to realise why it is essential to have consistency.

The third point relates to Amendment 78. There has been a lot of controversy as to whether victims of rape should have an advocate in court to represent them. As I understand the amendment, it goes nowhere near that; it is merely for advice. It seems to me that an awful lot of the difficulties that occur in rape cases could be solved by the victim having someone who is independent of the prosecution to talk to, because the prosecution cannot go to the extent of the help the victim needs. I am sure that, in the end, this would increase significantly confidence in the criminal justice system. The problem is cost; maybe the Government, with appropriate legislation, should try it in a series of pilots to see how it is best run, rather than rolling out nationwide.

[Baroness Finlay of Llandaff (CB)]

My Lords, I will make a very brief point, following on from that made by my noble and learned friend Lord Thomas of Cwmgiedd.

There is a group of victims who are particularly vulnerable: those with impairments in mental capacity, who may have difficulty in expressing and explaining what has happened to them and are vulnerable to misinterpretation of anything they say—they are in particular need of advocates who understand their needs.

Many years ago, I was asked by Gwent Police to assist them in a prosecution in relation to people with profound mental incapacity who had been abused and raped. It was very difficult to pull the evidence together, and it was a very steep learning curve to see how difficult it is to let the veracity of what they were trying to tell one be heard and come through. I hope the Government will recognise that there is a group in the population who are particularly vulnerable to exploitation and to sexual abuse by the very nature of having learning difficulties and impairments, and of course that also includes young people with autism—we know how vulnerable they are to influence, and to coercion into a situation that they believe.

[Lord Marks of Henley-on-Thames (LD)]

My Lords, in this group, I will speak only to Amendments 78 and 79, in the names of the noble Baronesses, Lady Thornton and Lady Hamwee. They call for free independent legal advocates and free independent legal advice for victims of rape, and I support the principle behind them. I take the point made by the noble and learned Lord, Lord Thomas of Cwmgiedd, that they do not necessarily talk about advocacy in court, although Amendment 78 does talk about free independent legal advocates.

The noble Baroness, Lady Thornton, said that the amendments will not affect our adversarial system; nor will they affect it adversely. However, I hope that they will, if adopted, have an effect by ensuring that the interests and voices of victims are considered and heard throughout the criminal justice system, and—certainly for the purposes of these amendments—more comprehensively in rape cases, and that will be wholly beneficial.

These amendments lie at the heart of what this Bill is all about, which is to bring about a transformation in the way we look after the victims of crime. We have moved, but far too slowly. When I practised in the criminal courts a long time ago now—and this is not intended to be an exercise in reminiscence—as both prosecutor and defender, we were almost encouraged to take pride in the structure of criminal cases as a contest between the state—the Crown—represented by the prosecution’s lawyers, and the defendant, represented by independent barristers and solicitors, generally paid for by the state. The adversarial system was all. The victim, usually called the complainant—or in financial cases, the loser—was universally treated as no more than a witness, liable to be harshly cross-examined almost without restriction, and deserving of no extra consideration on account of the ordeal suffered as a result of the crime.

Levelling-up and Regeneration Bill

Baroness Finlay of Llandaff Excerpts

Committee stage
Wednesday 3rd May 2023 Lords Chamber

[The Earl of Caithness (Con)]

My Lords, my noble friend slightly confused me when she mentioned education, health and affordable housing and then in another sentence said that education, health and affordable housing were the sorts of development which opened the door to other developments coming in. We need to look at that. Can she tell me when we will get all these updates from the Government? Will they be discussed by Parliament? Are we allowed to amend the updates? If the Government come forward with ideas, surely Parliament ought to be able to discuss and amend them.

My noble friend went on to say that it could be more expensive for the local authority in paying hope value, but that does not mean that the scheme is uneconomic. Am I right in thinking that if a local authority thinks that it can get the land by compulsory purchase rather than by negotiation, and for slightly cheaper, it will go for compulsory purchase, rather than negotiation, as a regular way of getting land? These are important issues.

[The Deputy Chairman of Committees (Baroness Finlay of Llandaff) (CB)]

Does the noble Earl wish to withdraw his amendment?

[The Earl of Caithness (Con)]

It is not my amendment; it belongs to the noble Lord, Lord Carrington.

Higher Education (Freedom of Speech) Bill

Baroness Finlay of Llandaff Excerpts

Committee stage
Wednesday 2nd November 2022 Grand Committee

[The Deputy Chairman of Committees (Baroness Finlay of Llandaff) (CB)]

For clarification, it seems that it is once for the Committee stage rather than each time we speak.

[Baroness Chakrabarti (Lab)]

I am grateful to the Deputy Chairman. I hope the Committee will forgive my ignorance; I hope that will help others as well.

I think noble Lords are really on to something here. I have found all the previous contributions compelling. They speak to aspects of my own experience. I have seen the way that funding can either promote or chill free speech, expression and academic inquiry. I understand that there are real challenges in this area. In particular, it is going to be very difficult to compel a corporation in any way to fund research that would be directly contrary to its interests. However, I do not think that we should totally give up on all of this; I do think that my noble friend Lord Sikka and the noble Lord, Lord Moylan, are on to something.

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[Lord Sikka (Lab)]

My Lords, if I may respond to some of the points—

[The Deputy Chairman of Committees (Baroness Finlay of Llandaff) (CB)]

For the convenience of the Committee, the noble Lord, Lord Moylan, has already withdrawn his amendment and no one has objected to that.

Clause 1 agreed.

Health and Care Bill

Baroness Finlay of Llandaff Excerpts

Lords Hansard _ Part 1 & Report stage
Wednesday 16th March 2022 Lords Chamber

Moved by

[Baroness Finlay of Llandaff]

163: After Clause 164, insert the following new Clause—
“Alcohol labelling
(1) The Secretary of State must, no later than one year after this Act is passed—(a) publish a report on alcohol labelling, assessing which elements should be mandatory on labels to improve consumer knowledge, and this should include, but not be limited to—(i) warning about alcohol harms,(ii) calorific and other nutritional information,(b) lay the report before Parliament, and a Minister of the Crown must arrange to make a statement to each House of Parliament setting out any steps which will be taken to implement the findings of the report.”Member’s explanatory statement
This amendment requires the Secretary of State to publish a report on alcohol labelling to improve consumer knowledge.

[Baroness Finlay of Llandaff (CB)]

My Lords, we now come to an amendment on alcohol, and I declare that I chair the Commission on Alcohol Harm. This amendment is designed to get the Government to produce a report on labelling, which is long overdue. Some people in this Chamber have been asking for it for 20 years or so, and nobody can quite understand the delay.

My amendment looks at the feasibility of putting information on labels about the harms and calorie content, and it runs completely in line with the Government’s strategy on trying to do something about obesity across the nation. I know that some people in the alcohol industry have suggested that they would like to put a QR code on, but it seems almost impossible to imagine people going with their mobile phones along a supermarket shelf looking at all these QR codes. If they can put some printing on the QR code, they could put on some printing with proper health information, harms information and calorie information in a way that one can read it in a reasonably sized font.

Alcohol is the leading cause of death and ill-health among 15 to 49 year-olds. It is linked to more than 200 health conditions. Alcohol is highly calorific: two glasses of wine can contain almost the entire daily recommended sugar limit. If you have two glasses of some wines, you will have a calorific intake that is the same as that of a big burger. This is not small numbers of calories.

Currently, the only legal requirements on alcohol labels are alcohol by volume, the volume itself and the common allergens that may be present. This does not match up with other food and drink. Alcohol labels do not list ingredients, calories or other information such as health impacts. There is more information on a bottle of orange juice or a carton of milk than there is on a bottle of wine.

The Government have committed money for the drugs strategy. That is most welcome, but I hope it will not all get diverted into drugs of addiction and that it will actually be used to support alcohol treatment services. We know that, in the last few years, only about one in five dependent drinkers have been able to access treatment services for their alcohol addiction.

The problem for consumers when they start out is that they do not know what they are consuming. They do not realise how calorie-laden the drinks are, and they cannot make informed choices about their health. Nor can they make informed choices about the dangers they pose to others, which includes other people with whom they interact when they are intoxicated as well as the dangers in driving.

Voluntary labelling has failed. We have seen again and again that consumers will not get the information they need on alcohol labels unless it is required in legislation. Seven in 10 people think that the warning should be displayed on alcohol labels as a legal requirement. Even the symbol not to drink in pregnancy is so tiny that it is not getting the message across, and foetal alcohol syndrome featured on the “Today” programme just this morning.

I remind the House that we took forward the Domestic Abuse Act, and one in five people are harmed by other people’s drinking.

As for driving, the road death figures show that problem drinkers are responsible for many of the 2,000 seriously injured or killed each year in alcohol-related crashes. The long-awaited consultation on labelling must also look at lowering the blood alcohol limit to 50 milligrams per 100 millilitres of blood, with its potential to reduce fatal alcohol-related crashes by 11%. There is good evidence that those with blood levels between 50 and 80 milligrams per 100 millilitres are six times more likely to be involved in a fatal accident than people who are alcohol free.

The Government’s intention to consult on including more information on alcohol labels is welcome if it is realised, but we have been waiting almost two years for the announced consultation to be launched. During this time, alcohol harm has increased, and deaths from alcohol reached record highs in 2020. Can the Minister tell us when the consultation’s report will be formulated and when it will appear? We cannot leave this unattended to, with consumers not knowing what they are taking whenever they take a drink. I beg to move.

[Lord Shipley (LD)]

My Lords, in moving this amendment, the noble Baroness, Lady Finlay of Llandaff, has emphasised its importance to improving personal and public health. The amendment requires the Secretary of State to publish a report on alcohol labelling, with the aim of improving consumer knowledge about the contents and potential harms of alcohol products. Surely it is in the interests of consumers for labelling on alcoholic products to meet the standards we have come to expect from food labelling.

The context really matters. As the noble Baroness, Lady Finlay, said, alcohol is the leading risk factor contributing to ill health and death for 15 to 49 year-olds, and it is the fifth leading factor across all age groups. Drinking a bottle of wine is, for example, the equivalent of smoking 10 cigarettes, yet a packet of cigarettes must carry a health warning. Surely consumers should be entitled to know how many units of alcohol, how many calories and how much sugar is in a bottle or can. It is very clear that the alcohol industry’s self-regulation has failed, as the noble Baroness, Lady Finlay, said. Commitments were made a decade ago that labelling would improve in line with Department of Health recommendations, yet that has not happened.

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[Baroness Finlay of Llandaff (CB)]

My Lords, I am very grateful to everyone who has spoken and I note the tone with which “in due course” was uttered, which is really disappointing. Some very important points have been made, particularly about people really having the choice to know what they are taking into their bodies in the name of alcoholic drinks. May I assure the noble Lord, Lord Winston, that I really do not believe that fine wines will be sacrificed on the altar of public health? Very few people drink fine wines; most people drink drinks bottled and labelled in this country—the obesogenic effect is really important.

However, I am a realist and I am aware that the chance of this being thrown out when it goes to the other place means that it would not remain in the Bill. I hope the Government will take the message back to the Secretary of State to empower him to grasp the nettle, provide leadership in public health and, for the first time, proceed to make sure that people know what they are drinking and what the harms are—they might prefer to go out with their family and eat a large burger than have two glasses of wine. Given that, and the reality of the situation we are in, we will hold the Government’s feet to the fire over what “in due course” means; I hope it is a very short course. On that, I beg leave to withdraw the amendment.

Amendment 163 withdrawn.

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I strongly support these two amendments and hope the Minister is at least able to commit to urgent action to improve the experience of pancreatic cancer patients, preferably by accepting both the amendments but, if not, in some other way.

[Baroness Finlay of Llandaff (CB)]

My Lords, I was glad to have been able to put my name to Amendment 166 about PERT. In this Bill, the Government have introduced a milestone in changing the care of people who are facing serious illness at the end of life.

The reality, as we have already heard, is that the majority of patients with pancreatic cancer are diagnosed late, because it comes in the head of the pancreas. The pancreas has two parts—the head and the tail. But, because it can grow without causing much pain in the initial stages, it often goes undetected until it is fairly advanced. That means the outlook is poor. The other thing it does, as it grows, is block off the flow of enzymes into the gut. Without replacement, these patients get a malabsorption syndrome; they can get terrible diarrhoea and muscle wasting, because they are not absorbing the nutrients they need.

This amendment is very important. It could quite easily build on the network that will now be in place to commission specialist palliative care services. The move the Government have made has been welcomed across palliative care in this country and is being seen as a way to dramatically change the care of patients. With data information flows now integrated and networked across the NHS, we will be able to get accurate data on how many patients with pancreatic cancer are getting replacement therapy when they need it. Some people do not need it; some need it later on. This is part of building on the important foundation the Government have laid. It was that which persuaded me to put my name to Amendment 166.

Another point I would like to make is about improving things for the lowest quartile of the population. Incidence of pancreatic cancer is highest in the most deprived areas and it is higher in women than in men. Part of levelling up, to help people to live well for as long as they can, is making sure they get the enzyme replacement they need.

[Baroness Walmsley (LD)]

My Lords, I have in my hands the latest cancer waiting time figures. It is very unfortunate that, despite the hard work of NHS staff, every single metric was worse in January than in December. It therefore seems a great pity that not all patients who have a diagnosis of this dreadful disease of pancreatic cancer can get this medicine, which can improve and even extend their lives.

I well remember a senior, well-loved and well-respected Member of the Labour Benches who died of this dreadful disease. We lost him far too early, because this disease takes people very quickly. Anything at all the Minister can say to encourage us that this effective and approved medicine can be made fully available to everybody who needs it—depending on the conditions, as outlined by the noble Baroness, Lady Finlay—would be helpful.

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[Baroness Finlay of Llandaff (CB)]

My Lords, I feel I have to remind the House that we have had 95 hours of debate in recent years on this topic; and the implication that we have not debated this is a misrepresentation. The noble Lord, Lord Forsyth, has asked us not to talk about assisted dying but then actually did talk about some aspects. We are being asked to test the willingness in both Houses, but I remind the House that the Marris Bill started in the Commons, was debated there and was defeated there by 330 votes to 118. That is where a Bill like this should start.

It is true that, historically, there have been major changes. Those have been in Bills that started in the House of Commons, when the public understood what they were about. The public knew what capital punishment was, and they know what homosexuality is. These Bills started in the elected House, and they then came to this Chamber. That has been our procedure.

I would, though, like to challenge the claim that there is overwhelming support among the public. I think it is questionable. In the poll, when asked a bit more detail, 57% of the public did not understand what assisted dying is; 42% think it is your right to stop treatment, which is already a legal right; and 10% think it is hospice care. Dignity in Dying has said it wants to have the largest record of public support, yet to date it has less than 0.5% of the population of England and Wales signed up to this list. So I do think we have to look at some of the claims being made and think about them.

Whatever noble Lords think about assisted suicide and euthanasia, this amendment would set a dangerous constitutional precedent for any Government. It is surprising that the noble Lord, Lord Forsyth, with his deep respect for parliamentary processes and Governments being able to govern, has taken this approach, because this amendment would set a precedent enabling any Back-Bencher from any pressure group to disrupt a Government’s agenda. Does the noble Lord plan to bring judicial proceedings if his proposal is not tabled in a year? That is the criterion in the text of his amendment. A draft Bill leads to a Bill, assuming and forcing government support, before exploring evidence of the complexities of licensing doctors to provide lethal drugs.

We do indeed already have a Bill before us, and it is awaiting debate. The amendments laid are not vexatious. Based on the extensive evidence from abroad, they expose the problems with the proposals from the noble Baroness, Lady Meacher. Where assisted dying is legal, palliative care has dwindled, legislation has widened, the safeguards have been seen to fail, and non-assisted violent suicide rates rise disproportionately. Post-event reporting, as in her Bill, does not work because it relies on the clinician. I could go on, but I will not.

Yet surprisingly, no request was made for Committee until months after Second Reading, and no one seems to have sought to discuss the amendments that have been widely criticised by those who have spoken today. Some Members openly want the prognosis requirement to be dropped from the Bill to make legal drugs available on request. We have to at least know what the content of the Bill is even before we proceed. An 18 year-old with severe anorexia is already eligible under the Bill that is currently before the House. The answer to harrowing accounts of inadequate care is not to force the Government to draft a Bill that would allow doctors to supply massive overdoses of unevaluated lethal drugs to patients. Good, holistic, palliative care has been made a right in this Bill by this Government, and people should ask for it and insist on it.

This amendment is not the way to seek a careful analysis of the complexities of assisted suicide and euthanasia. It creates a constitutional headache for any future Government’s ability to govern. The procedure is to debate a Private Member’s Bill properly in Committee; and that Private Member’s Bill should start in the elected House.

[Baroness Jones of Moulsecoomb (GP)]

My Lords, I hate to disagree with the noble Lords who have spoken against this amendment, almost as much as I loathe supporting the noble Lord, Lord Forsyth, on anything. But, for me, this is a matter of democracy. Public opinion is constantly moving on this, and it becomes more and more supportive as the public understand the issues involved. It is partly the duty of the Government to explain exactly what it is about. Having a proper debate like this is something we should all support.

Personally, I want this on the statute book before I need it. I have five grandchildren, and I try to talk them all into pushing me over a cliff if I were to get too ill. As soon as their mothers told them that it was illegal, they refused me. The idea remains that this is something which many of us want for ourselves, because we fear being incapable. Therefore, I support Amendment 170.

Health and Care Bill

Baroness Finlay of Llandaff Excerpts

Lords Hansard - Part 2 & Report stage
Monday 7th March 2022 Lords Chamber

With those remarks, my opposition to the fluoridation of the water supply remains. I would like to understand further the reasons for which this power to fluoridate the water supply is being transferred away from the local authorities—which, to me, would be a better and more local way of accepting or rejecting this. What consultation has there been with the water companies and from which budget of the Department of Health and Social Care will this come?

[Baroness Finlay of Llandaff (CB)]

My Lords, the hour is late and I shall be brief. The findings of the systematic review of the subject need to be taken into consideration. Screening of over 3,000 papers resulted in careful analysis of 254—quite a large number for a systemic review. Going through this, there are overall benefits. The benefits outweigh any documented harms, and I welcome the clause.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I am also aware of the hour, and offer Green support for the amendment of the noble Baroness, Lady McIntosh. We are talking here about a cost-benefit analysis. Some of the costs on which I would focus, and their impacts, go beyond the narrowly medical impacts of the people who consume the water. The question I raised in Committee was whether people today actually consume tap water, and whether they will continue to do so. I made the point that 90% of people drank tap water in 1978, but that figure had fallen to 73% by 1998. I do not believe that there have been detailed national figures since then.

I thank the noble Lord, Lord Kamall, for writing to me in response to that debate and providing a set of figures which the Government had researched. I will note two of the figures which the Minister cited in that letter. One was a 2010 Ipsos MORI survey in the West Midlands showing that two-thirds of surveyed people supported water fluoridation if it was going to improve dental health. That, of course, shows that a third of people are not supporting it. This is the group about which I am concerned—a group which I have encountered many times and in many parts of the country. I do not agree with all their concerns, but that is a fact.

I noted that the Minister also cited a north-east survey from 2021 where 60% of people backed water fluoridation. As the noble Baroness, Lady McIntosh of Pickering, said, we are talking about people not having a choice about consuming that water, unless they choose to buy bottled water. Anyone going to a supermarket in Sheffield, particularly in its poorer areas, will see people buying bottled water in very large quantities. One of my concerns, and where I hope the cost-benefit analysis would come in, is looking at the sociological issues. The Government should be doing a great deal more to promote the consumption of tap water and to discourage the use of bottled water. However, as the Bill currently stands, it risks pointing us in the opposite direction.

The noble Lord, Lord Storey, talked in Committee about how Liverpool City Council had very successfully engaged in a targeted programme to address the most vulnerable communities and ensure that dental health was improved. It demonstrably was improved.

The Minister said, “Oh well, any local authority can do the same thing.” I point out to him that local authorities’ budgets are enormously overstretched—something we have addressed in the social care elements of the Bill in particular. Would the Government consider perhaps taking the money that might be spent on fluoridation and giving it to local authorities for targeted campaigns to reach the children who need it most?

Living with Covid-19

Baroness Finlay of Llandaff Excerpts

Tuesday 22nd February 2022 Lords Chamber

[Baroness Evans of Bowes Park (Con)]

I agree with the noble Baroness, and that is why we will continue with public health campaigns, as we have seen in the past. We will also be reiterating to the public the safe behaviours we have learnt: the washing of hands; improved hygiene; ventilation; and all those other measures that we can take which do not involve restrictions on people’s lives but which can help ensure we keep Covid at bay—which is what we all want.

[Baroness Finlay of Llandaff (CB)]

My Lords, when people are in hospital and seriously ill, they are often desperate to see their own family and their family are desperate to visit them. However, at the moment, there are very severe restrictions in place. Will free testing be provided to families to facilitate them visiting and to help take a more compassionate view towards those who are often disorientated, frightened and find that they cannot even telephone their own family because they are in a hospital unit where the phone does not work?

[Baroness Evans of Bowes Park (Con)]

As I have said, we will be publishing further guidance and information on the high-risk groups and settings where free testing may be available. However, I cannot make that commitment to the noble Baroness.

Ukraine Update

Baroness Finlay of Llandaff Excerpts

Tuesday 22nd February 2022 Lords Chamber

[The Lord Privy Seal (Baroness Evans of Bowes Park) (Con)]

I thank the noble Lord and noble Baroness for their comments and their support for our standing together with Ukraine and the approach that we are taking.

As both noble Lords rightly said, with his actions in the Donbass region overnight, and the further developments today, President Putin has flagrantly violated Ukrainian sovereignty: he has sent troops in, broken international law, repudiated the Minsk agreement and torn up the understanding from Budapest that Ukraine’s territorial integrity was to be respected. We are working tirelessly to co-ordinate our response with our allies, and will not allow Russia’s violation of its international commitments to go unpunished.

NATO allies remain committed to a dual-track approach to Russia: strong deterrence and defence combined with meaningful dialogue. The noble Baroness asked what other actions we had taken. A small number of marines have already deployed to Poland from the UK, and more will travel next week. These personnel were originally due to deploy on Exercise Cold Response in Norway but have been reassigned to Poland. We are also preparing to reinforce the British-led NATO group in Estonia; that will include deploying RAF Typhoon fighters and Royal Navy warships to protect south-eastern Europe. Further details will be provided as things develop.

We are also working with international partners on options for further economic and defence support for Ukraine, but, as noble Lords will know, we have supported the development of the Ukrainian army. Last month, as I mentioned in the Statement, we sent 2,000 anti-tank missiles to Ukraine alongside a package of training by our troops, and last week we provided more equipment. Over the last eight years, under Operation Orbital, we have trained more than 22,000 members of the Ukrainian armed forces.

Both the noble Lord and the noble Baroness talked about sanctions. The ones announced today are only the first tranche, and are targeted at people and financial institutions who have supported Putin’s violation. We will step up sanctions if Russian aggression continues, and we have been clear that in that regard nothing is off the table.

Our toughened sanctions regime will enable us to sanction oligarchs and companies of strategic importance to the Kremlin: this is the toughest sanctions regime against Russia that the UK has seen. The five Russian banks that the noble Baroness referred to are all active in bankrolling the Russian occupation, and Bank Rossiya in particular is close to the Kremlin. We will also look at sanctioning those Russian parliamentarians who supported the recognition decision taken last night.

The noble Lord rightly mentioned today’s announcement by Chancellor Scholz of Germany, which we very much welcome, that he has instructed his economic ministry to withdraw its earlier security of supply report on Nord Stream 2, with the consequence that it will not be certified for operation. Again, that is something that we have been talking to the German Government about, and we are grateful for and pleased by this morning’s news.

The noble Baroness asked about disinformation, which we take extremely seriously. We are working collaboratively with our allies to build a better understanding of the different techniques that can be used as part of malicious information operations, and our counter-disinformation unit in DCMS brings together monitoring, expert analysis and capabilities across government. We will continue to see what further action we can take in this area.

The noble Baroness also mentioned the ISC’s Russia report. As noble Lords will know, we published our response immediately on its publication. Many of the recommendations are already in train and we will continue to work on further implementation.

The noble Lord asked about the register of beneficial owners. We have set out plans to establish a register of beneficial owners of overseas entities that own UK property, in order to combat money laundering, and we have been clear about our intentions to significantly reform Companies House to strengthen our ability to combat economic crime. We will be taking that forward.

Last week the Home Secretary announced that she was closing down the tier 1 investor visa route to all applicants with immediate effect. That route has been under constant review and has given rise to security concerns, and we will be making reforms to the innovator route as part of the new points-based immigration system. Closing this route is just the start of a renewed crackdown on fraud and illicit finance. We are soon to publish a fraud action plan, while the forthcoming economic crime Bill will crack down on people abusing our institutions.

Finally, the noble Baroness talked about the Elections Bill, which is having its Second Reading tomorrow. I am sure my noble friend Lord True will listen very carefully to the concerns raised during that debate and we will have discussions as we go forward.

[The Deputy Speaker (Baroness Finlay of Llandaff) (CB)]

My Lords, this is a convenient moment to hear from the noble Lord, Lord Campbell-Savours, who is taking part remotely.

Health and Care Bill

Baroness Finlay of Llandaff Excerpts

Committee stage
Friday 4th February 2022 Lords Chamber

Moved by

[Baroness Finlay of Llandaff]

244: Clause 144, page 123, line 39, at end insert—
“(2) The Secretary of State must, no later than one year after this Act is passed, consult on including alcoholic products in the definition of less healthy products for which advertising will be restricted, and publish a report on the consultation.”Member’s explanatory statement
This amendment would require the Secretary of State to consult on including alcohol in the proposed advertising restrictions for less healthy food and drink and publish a report.

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[Baroness Finlay of Llandaff (CB)]

My Lords, this is a very broad group. As part of the Government’s obesity strategy, Clause 144 and Schedule 17 introduce advertising restrictions on less healthy food and drink, a 9 pm watershed for TV and on-demand services and the prohibition of paid-for advertising online. I declare my interest as chair of the Commission on Alcohol Harm. I will speak only to my amendment, which addresses the problem that currently, the definition of “less healthy food and drink” does not include alcohol beverages as it was drawn from the 2001 Nutrient Profiling Technical Guidance.

The amendment requires the Government to consult on including alcohol in the proposed advertising restrictions, because alcohol is the leading cause of death and ill-health among 15 to 49-year-olds in England. Under the Bill, adverts for sugary soft drinks will be restricted but adverts for alcoholic drinks will not, even though they can be very obesogenic. To quote from the Government’s own obesity strategy, they recognise that

“alcohol is highly calorific … It has been estimated that for those that drink alcohol it accounts for nearly 10% of the calories they consume … each year around 3.4 million adults consume an additional day’s worth of calories each week from alcohol, that is nearly an additional 2 months of food each year.”

The calorie load of 100 millilitres of 40% spirit is 244 calories, compared to just 42 calories in 100 millilitres of coke. A pint of beer has the same calories as a Mars bar and a glass of wine equates to three Jaffa cakes.

Some sweet alcohol products contain more than 100% of the daily recommended sugar intake in a single serving. There is significant evidence that children exposed to alcohol marketing drink more and drink earlier than they otherwise would, and early-age drinking is linked to higher risk drinking and even alcohol dependence in adolescence and early adulthood.

Existing advertising codes are failing. In the past month more than 80% of 11 to 14 year-olds have seen alcohol advertising. Almost 60% of 11 to 17 year-olds had seen alcohol adverts on television and more than 40% saw alcohol adverts on social media platforms. One-fifth had interacted with alcohol marketing online in the past month, despite being underage and therefore not allowed to buy alcohol. These adverts achieve their aim. Children as young as 11 can identify, reference and describe brands and logos of various alcohol companies—which leads them to start drinking more and earlier—making these images most attractive. Ten to 15 year-olds are exposed to more TV alcohol marketing than adults.

Alcohol itself is linked to more than 200 diseases and conditions, including seven cancers, is obesogenic and should be classified as a less healthy product. It should be included in the advertising restriction codes proposed, because the current self-regulatory codes are clearly failing. Children would accept this. The Children’s Parliament investigators and the Young Scot health panel have recommended a TV watershed for alcohol advertising. I beg to move.

[The Deputy Chairman of Committees (Baroness Garden of Frognal) (LD)]

The noble Lord, Lord Howarth of Newport, should be taking part remotely. If the noble Lord is there, would he like to speak? We will continue with the debate and when we can get hold of him, we will bring him in.

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[Lord Lansley (Con)]

My Lords, I am pleased to follow my noble friend Lord Grade. The point he made relates to my own experience in that, when the nutrient profiles in question were introduced in January 2011, I was Secretary of State. They were very much in the context of precisely the programme that I think he is looking for. It was about the reformulation of foods in the manner that had been done in relation to salt and to do the same for sugar and fats and the voluntary removal of transfats, which I think has essentially been accomplished. I have to say to my noble friend and the Committee that we have to be very careful because a lot of progress was made, but much more could have been made on a voluntary basis with the industry.

The nature of the attack made upon the Government and the industry was that, I paraphrase, “You’re working with the industry and, therefore, your activity is undermined by that fact.” It was rejected by many of the organisations that were seeking to achieve a public health objective. That was misplaced, and I am very disappointed that it happened like that. It would be a justifiable approach only if less healthy foods—HFSS foods or, for that matter, alcohol—were in the same position as tobacco. We do not deal with the tobacco industry because there is no safe level of tobacco consumption; we deal with the food and drink industry because there are safe levels of food and drink consumption.

My noble friends are nodding merrily, but I have to warn them that I actually agree with the Government’s proposals, partly because I think they are capable of being implemented in some respects in ways that meet some of the objectives that my noble friends are setting out. They can put practical timetables in place. They can give clear guidance about identifiable products, as distinct from brand sponsorship and the like. I do not like sunset clauses if we do not have to have them—if we have too many of them, as my noble friend Lord Moylan suggested, we would be clogged up with re-legislating all the time—but the Government can, by regulations, significantly change this.

I support the Government partly because they are clearly being attacked for doing too little and attacked for doing too much, so they are probably doing about the right thing. I think they are doing the right thing because we all know—the noble Baroness, Lady Boycott, said it—that obesity, and perhaps especially childhood obesity, is a multifactorial problem, so we must have multifactorial solutions. The one thing I would not accept is the proposition that I have sometimes heard from Governments of all persuasions: something must be done; this is something; therefore, it must be done. We need to implement many responses to this major public health issue—the noble Lord, Lord Stevens, is quite right—and we must tackle it as if it really matters. It is one of those missions that a mission-led Government should be seeking to achieve. It will need a wide range of different responses, of which this is one. All of them should be examined carefully to see whether they are evidence-based and effective.

I have to say that it is very difficult to say what is effective in this context because, for example, although we know that children who consume relatively more less healthy foods have a less healthy diet and are more likely to be obese, if we look at all the correlations, there are quite a lot of children who have a poor diet but it is not necessarily particularly heavy in less healthy foods. There are a lot of children whose poor diet is directly the consequence of their poverty, as my noble friend Lord Bethell said. The idea that we will see direct cause and effect is difficult to accomplish, but that does not mean we should not try. So, for public health reasons, I support what the Government are setting out to do.

I shall make one final point. The lead amendment in this group was tabled by the noble Baroness, Lady Finlay, and we have a later group on alcohol labelling. I have to say to her that I think that, in this context, her amendment is misplaced, first, because I think it derives from the idea that alcohol is like tobacco. For only a small minority of people is it necessary not to drink at all; most people who have a low or moderate alcohol consumption are at low risk. Secondly, she dismissed with a wave of the hand the codes and what has been achieved. I do not think that is fair. I think the alcohol marketing code has made a difference in relation to alcohol. I wish there was an HFSS marketing code that had been similarly effective because, where alcohol is concerned, the Health Survey for England 2019 said that, in 2003, 45% of eight to 15 year-olds had consumed an alcoholic drink and that, by 2019, that had dropped to 15%. These things can move in the right direction. We just need to make them do so. It does not automatically follow—

[Baroness Finlay of Llandaff (CB)]

Will the noble Lord clarify some of his statement about young people? We know that there are specific cultural groups among young people who do not drink at all, which has brought the average down, just as we know that there is a spectrum in poverty and obesity. Does the noble Lord feel that the current guidelines or whatever are working, given that there were 7,000 deaths from alcohol liver disease in 2020 and that there has been a 400% increase in the number of deaths from alcohol liver disease since 1972? If this had been working really well, we would not be seeing these increases. At the moment, we have a catastrophically large number of people dying from alcohol liver disease, which has got much worse during lockdown.

[Lord Lansley (Con)]

The noble Baroness is drawing me into what is a very important debate, but I do not think it is this one in this group. We will come on to it perhaps on Amendment 259 at a later stage. I do not disagree that we have not succeeded where alcohol consumption is concerned, but the nature of the problem has manifested itself more recently, especially in smaller numbers of people consuming alcohol, some not at all, but those who do very often doing so through binge drinking, which is exactly what is giving rise to what we are all most concerned about, which is the significant harm that is resulting for those people. We need to think behaviourally about the nature of the problem in order to find behaviourally what is the nature of the solution.

I need to stop, but I shall raise just one point with my noble friend on the Front Bench. I started with nutrient profiling. Nutrient profiling is terribly important. The noble Lord, Lord Clement-Jones, made the point that we do not get to look at that, but what it says is terribly important. As I understand it, we are due for a revision, but we have not yet seen it. There was a 2013 study that looked at our nutrient profiling and compared it to that of the WHO and five European countries. It concluded that, in relation to a large number of processed and packaged foods, under our system 47% would be able to be advertised to children, while under the WHO system it was 32%. There is a significant difference in what one puts into the nutrient profiling. It is not an objective truth, and putting alcohol in it completely misses the point, since it is not constructed around that proposition. I ask my noble friend to tell us a bit more about the nutrient profiling process, the timetable, the evidence and how we are going to put it together to meet the objectives under the Bill.

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[Baroness Penn (Con)]

The date that I have for the commissioning of the work is 2016, which means that we are even further down the road on that piece of work. I am well aware of the time that has passed since then. I will undertake to see if I can provide any update beyond “in due course”, but I do not want to raise noble Lords’ hopes too far on that.

I hope that I have been able to provide noble Lords across the Chamber with assurances as to our plans and, therefore, that noble Lords will feel able not to press their amendments.

[Baroness Finlay of Llandaff (CB)]

My Lords, we are three hours and 49 amendments on and I am sure that everyone in the House will join me in saying that we have enjoyed hearing from the noble Baroness the Minister now that she is back in Committee with us.

It is perhaps a crumb of comfort to those who have been worried about advertising and the outcomes that Norway’s ban since 2013 has shown that other products moved into the space and there was not a total loss of income. Quebec has had the least rise in childhood obesity in Canada since its ban. I will not comment any more on that other than to say that we have all recognised that obesity is a serious problem that needs to be addressed. The Wild West digital space of the platforms needs to be addressed quite urgently and will be more difficult, but I hope that this will not deter the Government from their action to tackle obesity.

For my amendment, I just remind the House that alcohol adverts are tempting young people into early consumption. It is a highly obesogenic and highly addictive substance, which is why my amendment was there. I am disappointed that the Government are not even considering incorporating it in the list of substances, but I beg leave to withdraw my amendment.

Amendment 244 withdrawn.

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Moved by

[Baroness Finlay of Llandaff]

259: Clause 146, page 124, line 42, at end insert—
“(3) The Secretary of State must, no later than one year after this Act is passed—(a) publish a report on alcohol labelling, considering the question of whether to require the following on alcohol product labels—(i) the Chief Medical Officers’ low risk drinking guidelines,(ii) a warning that is intended to inform the public of the danger of alcohol consumption,(iii) a warning that is intended to inform the public of the danger of alcohol consumption when pregnant,(iv) a warning that is intended to inform the public of the direct link between alcohol and cancer, and(v) a full list of ingredients and nutritional information; and(b) lay the report before Parliament.(4) A Minister of the Crown must arrange to make a statement to each House of Parliament setting out in detail any steps which will be taken to implement the findings of the report prepared under subsection (3).”Member’s explanatory statement
This probing amendment requires the Secretary of State to report on the alcohol labelling consultation.

[Baroness Finlay of Llandaff (CB)]

My Lords, these amendments also relate to alcohol. Amendment 259 is about alcohol labelling to prevent harm and Amendment 296 concerns dealing with the harm when someone has become addicted to alcohol. I shall cut what I was going to say dramatically because of the time spent on other amendments earlier today.

Labelling is the way we inform the public of what they are getting. About 70 people die every day from alcohol-related causes in the UK. Alcohol is responsible for 12,000 cancers every year. Covid has compounded this harm, with deaths from alcohol now at the highest rate since records began. There is more information on a carton of orange juice than a bottle of beer. Awareness of the health risks of alcohol is very low. Just one in five people can identify the low-risk drinking guidelines and less than one-quarter know that alcohol can cause breast cancer. Alcohol is linked to the worst pregnancy outcomes and serious lifelong impacts for a baby, yet one in three people are unaware that it is not safe to drink in pregnancy. It has been estimated that 41% of pregnant women consume alcohol.

Alcoholic drinks are also extremely calorific, as we have heard. We have already spoken about the number of calories those who drink take in and I will not go there again, but calories need to be included on the labelling. People have a right to know what they are consuming, but they cannot make informed choices about their drinking. Voluntary inclusion of information on labels has not worked and has been very low: 70% of labels do not include the CMO’s low-risk drinking guidelines, over 70% do not list ingredients and only 7% display nutritional information, including calories. The public want the information. In July 2020, the Government agreed to consult on requiring calories and drinking guidelines to be on alcohol labels, yet here we are all this time later and we are still waiting for the consultation to even be launched.

Amendment 296 refers to treatment services. Alcohol addiction is a complex problem, with many factors driving and perpetuating harmful drinking. People who are trapped by alcohol dependence need help to move towards recovery. The benefits for the health service are reductions in emergency service call-outs and unnecessary hospital admissions, and the benefit for everyone is a reduction in avoidable deaths. These are the outcomes by which the effectiveness of any measure can be assessed.

Many people who require alcohol dependency treatment also have problems with other substance abuse, mental health, domestic abuse and homelessness. It is alarming that, during the pandemic, only 20% of people who need help for problem drinking have been able to access it and there has been a significant and sustained increase in the rate of unplanned admissions for alcohol liver disease. Since 2012, there have been real-term funding cuts in alcohol treatment services, yet every £1 invested in alcohol treatment yields £3 in return; that rises to a return of £26 after 10 years. Only 9% of people with alcohol dependence account for 59% of in-patient alcohol-related admissions. So, a cohort of more than 54,000 people accounts for 365,000 admissions and more than 1.4 million bed days, at an estimated cost of £858 million a year. There are also significant pressures on the treatment workforce because there is a shortage of psychiatry trainees.

I hope that these amendments are self-explanatory, and that the Government will look favourably on doing something about the problem of alcohol harm. I beg to move.

[Lord Scriven (LD)]

My Lords, I rise to support Amendments 259 and 296 in the name of the noble Baroness, Lady Finlay of Llandaff. I speak on behalf of my noble friend Lord Shipley, who, unfortunately, cannot be here today but has added his name to those amendments.

The amendments are on the Marshalled List to push the Government to move faster on something that the public want that has now been shown to be effective, particularly alcohol labelling. A recent YouGov poll showed that 71% of the British public want to know the number of units in an alcoholic drink, 61% want to know the calorific content and 53% want to know the amount of sugar in alcohol. There is clear public support for this, so it is interesting that we have not moved faster.

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[Baroness Finlay of Llandaff (CB)]

I am most grateful to the Minister, and particularly to the noble and right reverend Lord, Lord Sentamu, for pushing on the point of whether the amendment was overprescriptive or adequately prescriptive. Given that, and the rather disappointing remark that the consultation will happen “in due course”, I will withdraw my amendment but am minded to return to something like it on Report if we do not have even a provisional date for when the consultation might start. We seem to have been waiting for it to start for a long time. With that, I beg leave to withdraw the amendment.

Amendment 259 withdrawn.

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[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my interest as an elected member of the BMA ethics committee, which looked at these issues and was involved in producing the statement quoted earlier by the noble Lord, Lord Ribeiro. I strongly support these amendments and cannot see any reason for anyone not to. They set a basic moral standard. As the noble Lords, Lord Hunt, Lord Alton and Lord Ribeiro, and the noble Baroness, Lady Northover, have laid out, the arguments they have given us are in many ways only the tip of the iceberg. There is so much more than could be said.

Our Human Tissue Authority’s guiding principles have a code of practice which has consent, dignity, quality, honesty, and openness as key pillars. These principles should reflect not only how human tissue is sourced from within our own nation but how we treat human tissue and organs from overseas. There is overwhelming evidence now that in China, Falun Gong practitioners and Uighurs, Tibetans and house Christians are being killed on demand for their organs. There is no consent, no dignity and no transparency. Only yesterday I received a letter from a woman whose mother had been a Falun Gong practitioner, and who has been in prison and effectively disappeared. She has no idea where her mother is; she has not heard from her. That is happening all over this population.

I will not repeat the statement that has already been read out, but I just hope that the Government can see that we have a moral obligation to accept these amendments. I hope that they will do so.

Amendment 297H, in my name, is supported by the Royal College of Pathologists. Post-mortem examinations here are subject to careful legislative control and we have the Coroners (Investigations) Regulations 2013, which oversee post-mortems. When a post-mortem happens, it happens without the consent of the next of kin, of course, because there are questions around the cause of death. The coroners’ statistics for England and Wales in 2020 show that 79,400 post-mortem examinations were ordered by coroners. A fifth included histology and a quarter included toxicology samples being taken.

When the coroner’s work is complete, the tissue samples and any fluids taken—the tissue being in the form of blocks and slides—must be destroyed unless specific consent has been provided by someone in a qualifying relationship. However, consent is logistically very difficult to obtain in practice. The McCracken review of the Human Tissue Act in 2013 recommended that:

“Consideration should be given (inter alia) to reducing the scope so that microscope slide and tissue block samples and bodily products such as saliva, urine, and faeces are excluded”.


The Government accepted this recommendation, but the issue has not subsequently progressed.

There are some real difficulties with post-mortems. A post-mortem is effectively a snapshot of the deceased at the point of death. It is only by going back into the clinical records that the pathologist gets some picture of what happened pre-mortem, and many of the other factors. But at the end of the day, it is often subjective in terms of determining the likely cause of death for the report that is then signed off. In Scotland, tissue blocks and slides are deemed to be part of the clinical record and therefore do not have to be destroyed after the procurator fiscal’s investigations are complete. However, no whole organs can be retained in Scotland without explicit consent. In the light of Alder Hey, it is important to stress that point.

Changing to a system that reflects Scottish law could be beneficial because it would provide information about the cause of death if new circumstances came to light months or years after an investigation was complete. Indeed, we have recently had the case of the Farquhar family, where the evidence of long-term poisoning probably came to light many years after the person had died. Crucially, forensic deaths can be masked by natural disease processes and storage of tissues and fluids as part of the medical record would help clarify these at a later date when new information came to light. In a way, that is essential for completion of justice.

In addition, genomics research is rapidly developing, so the family may want to access the tissue later on as disease processes become more clarified. Metabolic storage disorders such as Fabry or Gaucher disease have been examples of this.

The tissue blocks from post-mortems are usually larger than the small pieces of tissue in a biopsy from a living person. That is particularly relevant where you want a piece of the heart or the brain, because a large biopsy from a living person would be impossible. There is also a third use of these tissue blocks and slides, which is as teaching material for autopsy pathologists. There is now a real shortage of teaching material, not only for pathologists who are in training but for ongoing audit of pathology processes.

So this amendment would bring the Human Tissue Act in line with the position in the Human Tissue (Scotland) Act 2006, where tissue samples as blocks and slides, but not—I stress not—organs, automatically become part of the person’s medical record after a post mortem. Explicit consent to keep them does not have to be sought from a grieving family, but it would allow justice in the long term to be pursued if necessary, and it would allow better development of autopsy pathologists.

[Lord Cormack (Con)]

My Lords, I apologise for missing the first minute—but it was only the first minute—of the splendid speech of the noble Lord, Lord Hunt. I am delighted to add my support to his initiative, most splendidly supported by my noble friend Lord Ribeiro. We entered this House on the very same day and it was very good to hear what he had to say. Of course, the noble Baronesses, Lady Northover and Lady Finlay, and the noble Lord, Lord Alton, all have an impeccable record on these matters.

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[Earl Howe (Con)]

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

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

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

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

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

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

[Baroness Finlay of Llandaff (CB)]

Will the Minister undertake that the Government ask the Scottish Government about their experience of retaining tissue blocks and slides? Only tissue blocks and slides—not, I stress, organs—are being retained as part of the clinical record, so that we have some information about problems that have arisen. Also, given that the Government accepted the McCracken review, how do they then intend to implement that acceptance? If you accept the need to have consent, there has to be a process by which consent is obtained. You cannot ask for consent prior to the post-mortem because the post-mortem is a judicial process.

[Earl Howe (Con)]

I noted that the amendment tabled by the noble Baroness is closely modelled on the current law in Scotland. Because of that, it fails to account for the significant differences between how Scotland, and England, Wales and Northern Ireland, regulate the storage and use of human tissue. In England, Wales and Northern Ireland, that storage and use is regulated by the Human Tissue Authority. In Scotland, there is no equivalent body and the amendment is silent as to what impact it would have on the authority, especially given the challenges involved in managing the great quantity of tissue that would be retained.

I am aware that many Scots share my concerns about consent for retaining tissue. A recent petition to the Scottish Government highlighted the anguish faced by a grieving mother on learning that she did not have the choice to have some of her child’s remains returned to her. She was upset at how long it took for those remains even to be located, so although this amendment would apply only to adults the same kind of issues would apply.

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[Baroness Northover (LD)]

My Lords, I have put my name to Amendment 270, which requires the Government to consult on raising the age of sale for tobacco to 21, and which the noble Lord, Lord Faulkner, has just introduced. I also express my support and that of these Benches for all the anti-smoking amendments in this group. My noble friend Lord Rennard will speak on them shortly. Together, these amendments seek to close loopholes, strengthen regulation and provide a mechanism to reinstate vital funding for tobacco control and smoking cessation. Tackling tobacco and the tobacco industry has strong cross-party support, as the noble Earl well knows, having been very much part of that himself over the last 20 years. He will note the number of us speaking to support these amendments, even though only four can sign each one. He will also note the contribution made by his noble friend Lord Young, not only here but in his Private Member’s Bill, and he will no doubt note that there are very few voices—possibly one—who tend to speak against such measures.

I welcome the progress that the Department of Health has made in this area, and that of local government, but other parts of government are not always totally aligned. We found that with pavement licences—the noble Earl will remember this—in the now-termed Department for Levelling Up, even though the new White Paper on levelling up has, rightly, as the noble Lord, Lord Faulkner, pointed out, identified addressing health inequalities as vital, and addressing smoking as part of that. Two cities in the north have the highest smoking rates in the country: Kingston upon Hull, at over 22%, and Blackpool, at over 23%. The average in the south-east is just over 12%.

These amendments are designed to help the Government and the Department of Health take forward their very welcome apparent intention for the country to be smoke free by 2030. The Government say they are committed to delivering a smoke-free country by 2030 but keep putting off what they have themselves declared to be the “bold action”, promised in 2019, needed to deliver what they said was an “extremely challenging” ambition. The tobacco control plan promised in July 2021 has been delayed again. When will it be published? No doubt “in due course”.

Meanwhile, instead of those bold actions, according to a recent leak to the Sunday Times, the Secretary of State “plots vaping revolution”, by providing e-cigarettes on the NHS. I agree that vaping has a role to play in a comprehensive strategy to end smoking. Vaping doubles people’s ability to quit smoking compared with existing nicotine replacement therapy. However, as we know, smoking is highly addictive, and even doubling success means that only a small proportion of smokers who were trying to quit would remain quit at the end of one year. Vaping is not a magic bullet and, although it will increase quitting, it will not prevent youth uptake, as raising the age of sale would, as the noble Lord, Lord Faulkner, has indicated. He set out extremely cogently the evidence for why this measure would be highly effective. I will briefly focus on why it would be proportionate and justified.

The age of 18 is often considered to be the age at which someone acquires all the rights and obligations associated with adulthood. However, this is not the case, and there are several examples of rights or obligations which are acquired earlier or later than the age of 18. Raising the tobacco age of sale to 21 would be consistent with the flexible approach that we apply to other age-restricted activities: those prohibited to under-21s in England include adopting a child, driving a large passenger vehicle, and supervising a learner driver, for example. Thresholds change over time, as demonstrated by the Government’s support for a Private Member’s Bill, which I welcome, to raise the age of marriage from 16 to 18.

It is now accepted that the late teens through to the early 20s—ages approximately 18 to 26—are a distinct period of life: young adulthood, when young people may still need support and protection. It was the period during which I hoped that my sons would develop what I thought of as a judgment gene—a gene that my daughter seemed to have had from at least the age of four, but they noticeably lacked. For care leavers it was excellent, for example, when in recent years social care was extended from 18 to 25. That had long been needed.

As we know, smoking is highly addictive and uniquely harmful, and an addiction which, if not begun by the age of 21, is very unlikely to happen at all. Tobacco is the only legal consumer product which kills when used as intended, causing the death of more than 200 people a day in the UK. This means that a unique response is required to minimise the burden of preventable death and disease that smoking inflicts. The evidence is surely sufficient to proceed with raising the age of sale, therefore this amendment is simply a modest proposal requiring the Government to consult. I commend this proposal and the other amendments in this group.

[Baroness Finlay of Llandaff (CB)]

My Lords, it is a great pleasure to follow the noble Baroness, Lady Northover, because I would like to pick up almost where she ended, on raising the age for the sale of tobacco. That measure has been successfully implemented in the United States, where smoking among 18 to 20 year-olds has been reduced by nearly a third as a result, so I support Amendment 270.

On Amendment 271, which affects the sale of nicotine products to children, it is rather horrifying to realise that it is not illegal for free samples of e-cigarettes to be given out to those under 18, even though it is illegal for them to be sold to those under 18. Amendment 271 would cover this. It would also cover the novel nicotine products, such as Japan Tobacco International’s widely advertised nicotine pouches—I do not particularly want to use their name because I do not want to advertise them. Unlike e-cigarettes, the marketing of these products is currently completely unregulated, despite the high levels of nicotine, which is an addictive substance. A quick search on the internet to look at the questions around them reveals that it is admitted that they are highly addictive, that they could affect the development of the brain and that they could result in mood changes in the user as well, possibly making them emotionally volatile. These are loopholes in the law, which can easily be fixed by our Amendment 271.

In Amendment 278, the noble Lord, Lord Rennard, seeks to ban all flavours in smoked tobacco. Again, this is another gaping legislative loophole which has allowed tobacco manufacturers to flout the current flavour ban.

I have led on Amendment 279, which relates to the packaging and labelling of nicotine products such as e-cigarettes. A cursory search online for these reveals that widely available electronic cigarette e-liquids feature cartoon characters in garish, appealing colours, with child-friendly descriptors, including sweet names such as gummy bears. Such branding is clearly unacceptable; it is targeted at the young. It is therefore deeply disappointing to discover that an amendment giving the Government powers by regulation to prohibit child-friendly packaging was voted down by them in the other place. The Minister said then that the Government

“are committed to ensuring that our regulatory framework continues to protect young people and non-smokers from using e-cigarettes.”—[Official Report, Commons, 22/11/21; col. 88.]

The Government can prove their commitment by supporting Amendment 279, which requires the Secretary of State to consult and report to Parliament on e-cigarette packaging, in particular the branding elements designed to be attractive to children.

[Lord Naseby (Con)]

My Lords, I have never smoked and I have no wish to smoke, but I am a marketing man by profession. We have here a legal product, the consumption of which has been steadily falling, particularly in recent years, in every age group throughout the country.

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[Baroness Brinton (LD) [V]]

My Lords, I support the noble Baroness, Lady Cumberlege, in her Amendment 283, which would include financial and non-pecuniary interests of medical practitioners alongside clinical interests and their recognised and accredited specialisms on a register. I particularly thank her for explaining exactly why this is so important for patients. Currently, the GMC does not require them to hold or publish that data, but it is the obvious place for it to be held—and then linked, as she explained, to local employers, contractors and organisations. Anything that reduces the complex maze for a patient or a member of the public trying to find out whether a doctor is being paid for doing some work or using particular devices, and might therefore have an interest, has to be one of the cornerstones of a truly accessible and accountable register of interests. In today’s data-rich society, patients and the wider community want to understand what interests a doctor may have, but which may not be obvious.

A website called whopaysthisdoctor.org at Sunshine UK—so-called, I presume, because sunlight is always the best disinfectant—was set up by number of doctors, including Ben Goldacre. It is a database where doctors who want to be transparent about their interests can declare and register them, and the public can see whether their doctor is listed. The problem, of course, is that those who do not want to make these declarations voluntarily may be those we most want to see. That is why the amendment would make it compulsory.

I thank the GMC for its helpful brief, in which it recognises that the

“current arrangements to register conflicts of interest fall short of delivering adequate transparency and assurance for patients.”

However, the GMC would prefer this register to be maintained just at a local level and

“published by a doctor’s employer, contractor or organisation”.

The noble Baroness, Lady Cumberlege, has already referred to the recommendations in the First Do No Harm review and the Government’s response, in which they said that it was proposed that information would be published locally at an employer level. However, I believe that there is also a golden thread from the obvious place to go, where doctors already have a duty to register other information, and that is the GMC.

Like the noble Baroness, Lady Cumberlege, I am keen to see action on this. Personally, I believe that the registration body is a good place to hold that data and, as she said, we need to start somewhere. But, frankly, we need to see progress on a register of interests. I hope the Minister can give your Lordships’ House some encouraging news on this.

[Baroness Finlay of Llandaff (CB)]

My Lords, I was—it is fair to say—flattered when the noble Baroness, Lady Cumberlege, asked me to co-sign her amendment, because I have admired all the work she has done, and I think her report, First Do No Harm, has had influence way beyond the group of patients she was looking at. Indeed, I was vice-chair of a NICE review, and we referred to it in terms of helping to empower the voice of the patients we had in that review process, which was, first, very important and, secondly, particularly helpful because they were very clear in their thinking, and they worked extremely hard.

I am also grateful to the noble Baroness, Lady Brinton, for referring to the General Medical Council’s briefing, because the GMC agrees that a solution to this needs to be

“Accurate, up-to-date, accessible and presented in a way that is useful for patients, so that they can have confidence in it”.

It also said that it must be “Enforceable”, and the GMC also wants it to be “Multi-professional”. However, I agree that we have to start somewhere. Your Lordships may think that the advantage of a local register is that it is more accessible, but the disadvantage is that doctors move around in different jobs, particularly trainees—but even consultants’ time in one post is now relatively short; it used to be a lifetime appointment.

It is important that, as a doctor, I am prompted to be completely open so that there can be no subliminal influence on my decision-making. The most dangerous influences are the subliminal ones—not the ones where you are completely open about what is going on. There has been a great clamp-down over recent decades on the pharmaceutical industry because of sponsorship and so on, and that has decreased influences on prescribing. But when it comes to using other products in medicine, the same can apply. I think that a register would help the profession itself in making clinical decisions. I do not see this in any way as inhibiting research; on the contrary, it would display who is research active and who is achieving results through their research.

A register would support the development of innovative healthcare and support novel thinking because it would be declared and open. It would also support the move that people should always publish their results, whatever they are.

[Baroness Neuberger (CB)]

My Lords, I support Amendment 283 in the names of the noble Baroness, Lady Cumberlege, and my noble friend Lady Finlay. Like my noble friend Lady Finlay, I want to say how grateful I am and how touched I was that the noble Baroness, Lady Cumberlege, asked me to add my support to this amendment. I also need to beg your Lordships’ indulgence: if we do go beyond 7 pm, which I sincerely hope we will not, it is actually the beginning of the Jewish Sabbath. I should not be here now, and I certainly cannot be here after 7 pm. I will pretend that I am just slipping out briefly, but I am vanishing at 7 pm whatever happens. Your Lordships will be very glad to hear that I am not going to talk until then.

When the noble Baroness, Lady Cumberlege, asked me to support the amendment, I said that I would consult with the medical directors at the two NHS trusts that I chair, the University College London Hospitals Foundation Trust and Whittington Health NHS Trust. I did exactly that, and I have never had emails back so quickly from the medical directors—there are four of them between the two trusts. The amendment was welcomed unreservedly; they really want this to happen. The medical directors had no doubt that this was both an ethical requirement and indeed something to be encouraged in how doctors think about their own practice. That is the point that my noble friend Lady Finlay made. It is something about the subliminal; it makes you start thinking differently and your reactions become different.

One of the medical directors pointed me to Patrick Radden Keefe’s superb book about Purdue in the United States, Empire of Pain, and said that in a way that is exactly the issue here. Some of the people clearly knew that what they were doing was totally wrong, but some did not realise that what they were doing was wrong, because they had not got the subliminal way of judging, because this was accepted practice. That is the really strong argument for this: we need to be able to encourage people to think differently. There are lots of doctors who desperately want it, as the medical directors at my two hospitals have made entirely clear.

I pay huge tribute to the noble Baroness, Lady Cumberlege, for her report First Do No Harm—as well as for the many other things she has done, but in particular for that report. It has changed the way that quite a lot of people think; it is quite hard to achieve that with a report and it is a very remarkable thing to have done. This is a national and international issue. We are concerned here only with the national, but we could—and should—set an international example of good practice.

After the Paterson review and First Do No Harm, this is now urgent. The GMC is obviously the right body to hold such a register, and I say so as a former member of the GMC. I was rather sad to see its somewhat lukewarm reaction in its briefing and I think that it has got this wrong. They are the right people to hold the register and to make it available to patients. The public must be able to access it. The employers, individual doctors, the Medical Royal Colleges and others must all play their part and, of course, other health professions must follow suit.

Let us start here. This needs to happen, and it needs to happen fast.

Health and Care Bill

Baroness Finlay of Llandaff Excerpts

Lords Hansard - Part 2 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Lord Bethell (Con)]

My Lords, I support Amendment 266 in the name of the noble Baroness, Lady Merron, and Amendment 293 in the name of my noble friend Lord Lansley for all the reasons that my noble friend just articulated. I will not repeat them as he put them so very well. However, I would say to the Minister that, coming from the innovation space, I can see that the technologies for both cosmetic surgery and non-surgical cosmetic interventions are improving all the time. There is an incredibly rapid pace of change. They are set to continue to get better and better, so the marketplace is getting more sophisticated and their popularity is also exploding. We have been briefed on evidence about the role of social media in promoting non-surgical cosmetic interventions in particular. This is exciting, because it is great that people have access to these interesting products, but also extremely worrying, because not all the surgeries and non-surgical interventions are successful. It is the right time for the Government to intervene, so that we have a register of cosmetic surgical practitioners and a much clearer regulatory regime for non-surgical interventions.

I am pro cosmetic surgery. As a young boy, I had an inherited condition of having very big, sticking-out ears, which my father had and my cousins and aunts have, and it was miserable. I had them pinned back and I am very grateful that that happened. It meant that I could be a much more confident person as I grew up. I am pro cosmetic interventions; if people want to use the benefits of medicine to improve their confidence in the way they look, I applaud that. However, standing next to my noble friend Lady Cumberlege, I am also aware of Bruce Keogh’s extremely good report and the very large number of interventions that have not gone well. I know that the Minister’s instincts are not to intervene unless absolutely required and my suggestion to him is that we have hit that moment. The marketplace is exploding and now is the right time to intervene.

[Baroness Finlay of Llandaff (CB)]

My Lords, as I address Amendment 266, I should declare that I am a vice-president of the Chartered Institute of Environmental Health. I stress that this amendment has been supported by the Beauty Industry Group, which represents 10 industry organisations—two voluntary registers for cosmetic practitioners, the Mental Health Foundation and others.

There are currently significant gaps in our regulatory system. Environmental health and licensing professionals work at a local authority level. They inspect, register and license premises for a very limited set of procedures, such as acupuncture, tattoos and piercing. Even for these procedures, however, there are no nationally set training programmes or qualification requirements for somebody to practise. For the riskier beauty procedures, such as the injectables, there are only voluntary registers of accredited practitioners. They have some approved education and training but that is not mandatory.

That means that there are many unaccredited practitioners on the high street providing services to people directly with no checks. A licensing scheme, as outlined in the amendment, would provide appropriate qualification and competency standards for practitioners wishing to practise, which is key to improving safety. The amendment as drafted is an open power for the Secretary of State, so it is easily amended as new procedures come online and on to the marketplace. The weakness of existing legislation in the area is that it fails to cover many of the newer treatments that are now popular.

When things go wrong, it is the NHS that has to pick up the pieces. Infections, injuries, scarring, burns and allergic reactions from a range of procedures often all end up in the NHS, sometimes with people being hospitalised and disfigured. Injection of fillers—or botulinum toxins—into blood vessels can cause dying back of tissues as well as blindness when administered by people who really are not adequately trained and certainly not registered. That means that there is no recompense for people damaged by these practitioners, who have no medical insurance or qualifications. In addition, there are unauthorised advertisements that breach advertising standards. There are strict laws around prescription-only medicines such as botulinum toxin, but these advertisements seem to bypass those.

Among members of the public who have had cosmetic procedures, alarmingly, three-quarters were given no information about the product, volume, brand or batch number of whatever was being used and just under three-quarters were not asked anything at all about their psychosocial or mental health or any body image issues. It is a vast and complex area and there are gaps in regulations. We need a national framework of standards with qualifications that can be recognised, so that there is a clear badge for members of the public.

To briefly address Amendment 297, I suggest that it is not needed because dermatological surgery and plastic surgery are subsections of medical practice and already registered with the General Medical Council. This gets nearer to credentialling than to requiring a separate qualification. These are doctors. They are highly trained, they have gone through a recognised training programme and they have been often examined as part of their exit from their training in whatever procedure they are undertaking.

I remind the Committee that, in a recent letter from the right honourable Michael Gove, he said that he is considering a licensing scheme. I hope the Government will see that this amendment would allow such a scheme without tying the Government down, and I hope that they will accept it, as well as Amendment 264 from the noble Lord, Lord Hunt, for which I should declare that I am an honorary fellow of the of the Royal College of Physicians of Edinburgh and the Royal College of Emergency Medicine. I think the contents of the amendment would go wider than simply surgical procedures. The Royal College of Emergency Medicine was established as a separate medical college in 2008, but the guidance and regulations were written prior to that, so they are completely out of date for what is now emerging as a major specialty across medicine. That amendment would rectify a lacuna.

Health and Care Bill

Baroness Finlay of Llandaff Excerpts

Lords Hansard - Part 2 & Committee stage
Tuesday 18th January 2022 Lords Chamber

Moved by

[Baroness Finlay of Llandaff]

36A: Schedule 2, page 137, line 23, leave out “one member” and insert “two members”
Member’s explanatory statement
This amendment would strengthen minimum clinical representation on Integrated Care Boards by ensuring there are at least two primary care members.

[Baroness Finlay of Llandaff (CB)]

My Lords, I must declare that I am an elected member of the BMA ethics committee and a past president. The BMA has been particularly concerned about ICB membership. I know we have already debated this, so I expect this group to be quite quick—I am sure the Committee would also hope that.

The Bill sets out a core minimum membership of integrated care boards, but this does not go far enough. We have just discussed not being prescriptive, but there are dangers in that. There is no guarantee of clinical leadership on the board and there is a real danger of undercutting truly representative clinical leadership by failing to retain some of the positive elements of clinical commissioning groups. Clinicians are already demoralised and a failure to give space to their voice and enthusiasm will only worsen this.

ICBs should have clinical representation from primary care and this amendment suggests that there should be two people for this, given the wide area that the boards cover and the very different types of practice within each area. Boards also need a secondary care clinician who is in a front-line, not a management, role and a public health representative. As we have already discussed, without public health representation on the board, there is a real danger that the evidence of health gain and the potential to reduce inequality will not be adequately voiced. The board needs public health input to be able to act as a population health organisation.

Some boards have acknowledged the shortcomings and allocated additional positions for general practice, secondary care and public health within their draft constitutions, but others have not. They appear to be ignoring the voice of the very people who work in front-line healthcare. Unless these voices are heard, along with the voice of public health, there is a real danger that the boards’ decisions will be distant from the reality and that they will become bad decision-makers themselves by losing clinical trust and confidence. I hope that the Government will rethink and ensure that the boards are able to have members who can provide a solely professional view of the whole population for whom the board has responsibility. I know we have already debated much of this, but I want the Government to think again, given the dangers of a further demoralisation in both primary and secondary care. I beg to move.

[Baroness Walmsley (LD)]

My Lords, it is essential that the board have available to it the skill set that you find in people at the clinical front line. I was interested to see that, putting the amendments from the noble Baroness, Lady Finlay, together, we have three people who are not representing one of the big acute hospitals, and one who is. Given the danger referred to by a number of noble Lords that the big acute hospitals will continue to have more influence in an integrated system than perhaps they should, that is a good element of putting the two amendments together.

As I said, it is important that clinical knowledge and experience be available to the board, but I would like to know that there is a balance and that this does not overwhelm other skill sets which all of us want to see represented; that became clear in the discussions we had last week about who should be on the board. With that caveat—the noble Baroness, Lady Finlay, might respond to that if she chooses to withdraw her amendment—I offer qualified support to what she is suggesting.

--- Later in debate ---

[Baroness Finlay of Llandaff (CB)]

I am most grateful to both the noble Baronesses, Lady Walmsley and Lady Thornton, for their comments, which I share. In the previous debate, I argued that we should have people from the allied health professions, and I do not dissent from that. This is not to replace them at all. I also completely recognise the Government’s comments that we need talent and a skills set. Having a balanced board means that you have to have the range of skills. Some people may bring several skills to the table, but they do not automatically bring them because they have a label on their head saying where they come from.

The other difficulty that we will face is that boards need to have contemporaneous experience in an area—and people go out of date remarkably quickly in different areas. The pandemic has shown how some areas have changed enormously in a very short space of time. The representations that I have had from the BMA, at a professional level, have been about how we make sure that the ICBs will be up to date with that contemporaneous input coming through all the time. I am glad to hear that the Minister plans to discuss all of this further. With that, I beg leave to withdraw the amendment.

Amendment 36A withdrawn.