Organ Tourism and Cadavers on Display Bill [HL]

Lord Sheikh Excerpts

2nd reading
Friday 16th July 2021 Lords Chamber

[Lord Sheikh (Con) [V]]

My Lords, we must change the United Kingdom’s connection with unethical and unacceptable organ transplantation and harvesting. Successful organ transplants are an outstanding achievement. Such medical procedures, carried out with proper safeguards, save lives. I wholeheartedly support the practice. I am the president of the Conservative Muslim Forum, which has over 1,500 members. We are holding a meeting in September to explain the organ donation system in the country and how organ transplantation harvesting through force and financial coercion and without proper consent being obtained is totally unacceptable. This Bill, from the noble Lord, Lord Hunt, intends to discourage Britain’s involvement in these practices. We must all give it our utmost support.

We appreciate that there are people who are in vulnerable situations and who are targeted or exploited for the value of their human tissue. In certain parts of the world, this practice is more common than in others. United Nations human rights experts are extremely alarmed by reports of organ harvesting in China. A tribunal chaired by Sir Geoffrey Nice QC found that in China, the practice of organ harvesting from prisoners of conscience has gone on for several years. The Uighurs and Falun Gong practitioners have been particularly subjected to these inhumane practices.

I have spoken on this issue in your Lordships’ House previously and I had hoped that it had stopped. The practice of purchasing human organs places a price on somebody’s body or on their value as a human being. This is a violating of humanity, and ethically and morally wrong. Furthermore, this Bill will provide accountability. Patient-identifiable records should be initiated so that we can identify UK citizens travelling for these procedures. The system is shrouded in secrecy. This Bill will introduce suitable and effective regulations to identify the culprits who engage in these practices. Although the United Kingdom’s involvement may be small, this extensive trade is worth millions of dollars. Gangs and traffickers operate all over the world, exploiting people in underdeveloped countries to obtain organs for profit and without any proper aftercare.

I agree with the proposal set out in the Bill that appropriate consent should be made mandatory for cadavers that are imported and displayed in the country. The physical and financial coercion involved in sustaining this practice is inhumane and should be stopped. Through this Bill we can prevent the practice growing and close existing gaps in our legislation.

Covid-19 Update

Lord Sheikh Excerpts

Thursday 4th February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the Government take very seriously their commitments and obligations to those British citizens who live overseas. It is a matter of considerable concern that they be included in the vaccination deployment. However, there are certain practical challenges with this, so we invite those who want the vaccination to return to British shores so that they can be part of the vaccination process, and to ensure that they are registered with their GPs so that they are included in the list. The Prime Minister has made it very clear that we are putting border measures in place that will ensure that we are protected against mutations and variants. Once again, therefore, I invite all those living overseas who want the vaccination to ensure that they have thought-through arrangements in place to return to this country to get their vaccinations.

[Lord Sheikh (Con) [V]]

My Lords, there is evidence of hesitancy to take Covid-19 vaccinations, particularly among some minority communities. I am involved in a national campaign that is actively encouraging everyone to take the vaccine. I raised this point in your Lordships’ House on 13 January, and my noble friend Lord Callanan arranged for us to meet virtually with senior officials from the Vaccine Taskforce. We have had two productive meetings with officials and are moving forward in a satisfactory manner. We received support from Nadhim Zahawi’s office as well as support and participation from a number of other Members from both Houses. Kawsar Zaman, who is a young, bright barrister, is undertaking the bulk of the work on our side. I thank everyone who is rendering this support and assistance, including my noble friend Lord Bethell. I hope that if we all work together, we can achieve the right results in the country. Does my noble friend agree?

[Lord Bethell (Con)]

My Lords, I pay tribute to my noble friend for his work in this matter. I am extremely pleased to hear that the meetings with officials have gone well. I pay tribute to all those parliamentarians in this House and the other place for their spirit of collaboration and for the unity with which those with an ethnic background, in particular, have worked together to champion the message around the vaccine. It is only through example and trusted influencers that we can get our message across. It has been one of the really refreshing and uplifting moments of this awful disease to see the kind of cross-party collaboration that we have in this matter. I am extremely grateful to my noble friend and all his colleagues for the work they are doing in the community to get our message across.

Medicines and Medical Devices Bill

Lord Sheikh Excerpts

Committee stage & Committee: 6th sitting (Hansard) & Committee: 6th sitting (Hansard): House of Lords
Tuesday 17th November 2020 Grand Committee

[Lord Sheikh (Con) [V]]

My Lords, I commend my noble friend Lady Cumberlege on putting forward this important amendment, which has my full support.

I referred to this issue when I spoke at Second Reading. At the outset, I congratulate my noble friend on her thorough and excellent review, including the bravery of its participants. The Cumberlege review was clear that there is an urgent need for action. I welcome this Bill, which aims to put patient safety first.

We need to listen to the review’s recommendations and create an independent patient safety commissioner through the enactment of this amendment. This commissioner would be a trusted voice for patient safety and would ensure that the Primodos, valproate and mesh scandals, or any other previous scandals, are not repeated. As the Cumberlege review shows, the harm caused should have been avoided—and could have been, if patients’ concerns had been properly listened to and acted on.

Furthermore, Sir Cyril Chantler, one of the review’s panel members, rightly said that if such a commissioner had existed before, there would have been no need for this latest inquiry as the Primodos, valproate and mesh scandals would have been dealt with at an early stage, thus preventing the high number of patient incidents that were allowed to occur. Instead, thousands of patients and their families suffered for many years. Many of them were not listened to even though they were right. If this Bill is to succeed in its goal of promoting patient safety, we must accept this amendment.

Patients should not have to fight to be heard. They should not be made to feel that they are in the wrong. Patients and their families need to be consulted, listened to and given a voice. Through this amendment, the patient safety commissioner would be that voice. As is stated in the amendment, the commissioner would

“promote the views and interests of patients”

and would be able to

“receive direct reports from patients and other members of the public”.

This way, all concerns will be listened to and properly acted on. The amendment also states that the commissioner will be able to produce

“reports regarding patient safety … with respect to the use of medicines and medical devices.”

This information will be essential in making patients aware of any potential risks or harms so that they can make fully informed decisions about their treatment. I am glad to see that the commissioner would be independent so that the public know that any information is accurate and unbiased.

Our healthcare system is one of our greatest assets. I would like to state my gratitude for all the marvellous work that the NHS has done and continues to do. As we have seen during this pandemic, NHS staff have done sterling work and work effectively as a team. Unfortunately, some key workers have paid the ultimate price and we are for ever grateful to them.

The NHS is a very large organisation that does many great things but it cannot do everything right. Sometimes it is better when activities are undertaken by outside bodies that have specific duties and expertise. This is where a patient safety commissioner will play an important role in overseeing the whole system. Furthermore, as in this amendment, an advisory board will support the commissioner in their work, using its wide range of experience.

Our current complaints system is too complex and there have been issues with reports being misplaced and poor co-ordination between the different departments and actors. As the commissioner would be constantly reviewing patient safety and be completely aware of any potential issues, they would be able to keep the Minister and the Cabinet Office informed, for the benefit of patients. The commissioner will be able to join the dots in our big healthcare system so that nobody gets lost, and will provide a more straightforward direction.

I am also supportive of this amendment because it requires the commissioner to publish an annual business plan. As a businessman, I know how important this is in creating a clear strategy to bring together different stakeholders and respond to current issues. This annual plan, alongside establishing and updating the principle of patient safety, will help guide the whole healthcare system. I am also glad to see that subsection (6) of the proposed new clause means that these principles must

“be drafted in consultation with the public.”

This will make them more accurate, and help build public trust.

Unfortunately, the Primodos, valproate and mesh scandals are not the only cases of a lack of patient safety and we must learn from previous historic mistakes. In 1958, Distaval was licensed in the UK. It was sold as a wonder drug for insomnia, coughs, colds and headaches. It also gave many women relief from morning sickness symptoms, but this drug contained thalidomide and had not been tested on pregnant women.

In November 1961, it was withdrawn from sale and, in May 1962, the Government released an official warning against its use by pregnant women. Thalidomide harmed the development of unborn babies, causing serious life-threatening birth defects, and affected 10,000 babies worldwide, and many more are thought to have died before birth. The drug led to the arms or legs of the babies being very short or incompletely formed, as well as causing deformed eyes, ears and hearts. In the UK, more than 400 adults are still living with these consequences.

In 1968, the UK producer Distillers paid 62 families of thalidomide-affected babies compensation amounting to 40% of assessed damages. A similar amount was paid to a further 367 children in 1973. However, it later became clear that these settlements were not large enough to support those affected in their day-to-day lives. Only in the last 10 or 15 years since the scandal have significant settlements been made and provided by Distillers, now part of Diageo, as well as by the UK Government.

Although there have been many improvements in drug testing since the thalidomide scandal, the delays in dealing with potential risks and proper compensation were totally unacceptable. I comment again that, if there had been a patient safety commissioner, the scale of harm would have been limited, action could have been taken more quickly and compensation may have been paid earlier.

It is imperative that we learn from these historic scandals and the more recent scandals related to Primodos, valproate and mesh. Therefore, we must have a patient safety commissioner. We have to support this amendment, and I welcome its objective to lay reports before Parliament and committees. It is important to take quick and appropriate action against any harmful medicines or medical devices before they become a scandal. It also means that the correct bodies and people can be held to account so that the right improvements can be made.

Independent commissioners have been incredibly valuable in certain areas; for example, the Children’s Commissioner, which was established in 2004. Since the start of the pandemic, 14 different reports and policy briefs have been produced by the Children’s Commissioner. They have provided key information on how children are affected, different vulnerabilities and how the Government—

[The Deputy Chairman of Committees (Lord Russell of Liverpool) (CB)]

My Lords, excuse me. The Grand Committee will adjourn for five minutes because there is a Division. We will reconvene at 6.16 pm.

--- Later in debate ---

[The Deputy Chairman of Committees (Lord Russell of Liverpool) (CB)]

My Lords, the Grand Committee will reconvene again, and I call upon the noble Lord, Lord Sheikh, to finish his contribution.

[Lord Sheikh (Con) [V]]

Thank you. My Lords, I have nearly finished. I conclude by saying that a patient safety commissioner will be a champion to mobilise changes and deliver necessary improvements. This is vital for creating a healthier system that works for everyone because it can listen to everyone. We must ensure that historical or recent scandals are not repeated, and we must therefore accept this amendment.

[Baroness Masham of Ilton (CB) [V]]

My Lords, I would support an independent patient safety commissioner, as its aim would be to

“promote and improve patient safety with respect to the use of medicines and medical devices,”

which is vital. In the past years there have been some tragic cases: patients have been left in long-term pain after operations with medical mesh; pregnant women have taken medicines that have caused disabilities in their children; and people have died due to the wrong dose of morphine or potassium chloride by the wrong button being pressed on the infusion pump.

I hope that, if established, the patient safety commissioner would be able to help patients from the private health sector as well. There have been some unfortunate incidents in plastic surgery, for example.

I would like to ask a few questions, but I do not know whether it is the noble Baroness, Lady Cumberlege, or the Minister who can answer them. The NHS is so huge and has so many different bodies and groups. Many people get confused about who does what. Would the patient safety commissioner co-operate with the Healthcare Safety Investigation Branch and the Citizens’ Partnership, which will work with HSIB on healthcare safety investigations?

AvMA—Action against Medical Accidents—which works for patient safety and justice, would be happy to work with an independent patient safety commissioner. Would that be helpful? Many all-party groups take evidence from patients and experts on safety issues. Would the safety commissioner be interested in collecting the data and promoting what is appropriate? A great deal of time, energy and experience goes into producing these reports.

There are still cover-ups and fears about reporting safety issues. Patients and their supporters need to feel that their voices are heard and will be acted on independently, and that they will stay safe and not be victimised for reporting patient safety matters. I thank the noble Baroness, Lady Cumberlege, for her report and for bringing this subject up the agenda to where it should stay, with the lead of a patient safety commissioner.

Medicines and Medical Devices Bill

Lord Sheikh Excerpts

Committee stage & Committee: 3rd sitting (Hansard) & Committee: 3rd sitting (Hansard): House of Lords
Wednesday 28th October 2020 Grand Committee

[The Deputy Chairman of Committees (Lord Lexden) (Con)]

The noble Baroness, Lady Stroud, who is next on the list, has withdrawn so I call the noble Lord, Lord Sheikh.

[Lord Sheikh (Con) [V]]

My Lords, I fully support Amendment 24. The issue of organ harvesting was raised in the other place and at Second Reading by me and other noble Lords. The ability to use human tissue in medicines and transplants saves many lives and is a great achievement of modern science. However, we need to make sure that the way human tissue is obtained and used is completely ethical. At the moment, we do not have legislation that properly stops organs that have been obtained forcibly or without proper consent from entering the UK. That is completely unacceptable.

We should be greatly concerned about the treatment of Muslim Uighurs and Falun Gong in China. The detention and persecution of these innocent people is a crime against humanity. Millions are suffering in inhumane conditions. They are tortured and a great many have been murdered. Last year, the China Tribunal, chaired by Sir Geoffrey Nice QC, concluded that forced organ harvesting in China had been practised for a substantial time, involving a substantial number of victims. The tribunal also found that Muslim Uighurs were used as an organ bank.

The British Medical Journal found that 99% of studies that looked at organ transplants in China did not report whether the organs used were donated with consent. This is unacceptable and a disturbing violation of human rights. It is also illegal. Furthermore, The Economics of Organ Harvesting in China report found that large profits had been made from organ harvesting.

I appreciate that although the companies, including British ones, may not be directly involved with organ harvesting, they could be part of a wider system that provides devices, drugs, materials and know-how for transplantation. Sir Geoffrey Nice QC also stated that anyone interacting with the People’s Republic of China was interacting with a criminal state. If we do not have proper checks on human tissue entering the UK, we risk being complicit in this crime.

Organ harvesting is not limited to China. There are gangs and traffickers all over the world that exploit vulnerable people to obtain organs without any proper aftercare. This coercion is also illegal and must be stopped. Through this amendment we can prevent this happening and close the gaps in our existing legislation. For instance, the Human Tissue Act 2004 has strict consent and documentation requirements for tissue in the UK, but does not enforce the same standards for imported tissue. Instead, it advises only that the same standards should be applied. Although the human tissue regulations 2007 ensure that there is proper documentation and tracking from donor to recipient, they request details on how consent was obtained and look into whether the donation was voluntary or unpaid or not with consent at all. This means that there is no legislation against importing organs that have been obtained involuntarily and without consent.

We must accept this amendment so we can make better regulations that uphold human rights and values. By including the ability to make provisions about the origin and treatment of human tissue used in developing and manufacturing medicines, this amendment means that we can make regulations if there are any concerns as to whether consent has been given. This amendment would require that informed, unforced and properly documented consent must be given for all tissue entering the United Kingdom. At present we do not have appropriate safeguards against forced organ harvesting or human tissue. Innocent people are tortured and killed while businesses and some Governments have made a profit.

This amendment is an opportunity to take a proper stand against organ harvesting and to have a statutory commitment. Through this amendment we can ensure that all human tissue imports are ethical. During Second Reading, my noble friend Lord Bethell stated that the idea that any British companies profit from these trades is abhorrent. This is an abhorrent practice. We must put a stop to it and therefore we need to pass this amendment. I emphasise that it is our moral duty to do so.

[Baroness Northover (LD) [V]]

I am very pleased to have added my name to Amendment 24. The noble Lord, Lord Hunt of Kings Heath, is to be commended for his determination on this issue. Given his previous service as a Health Minister as well as his career-long engagement at different levels of the NHS, no one can say that he does not have a good grasp of all the implications of his amendments. As he made clear, this amendment gives the power to the Government to take action in this area. It closes a gap between what is expected in terms of the origins and uses of human tissue in the UK and that which may be brought in from overseas.

As we have heard, the Human Bodies exhibitions were able to slip through this gap. It cannot be said that no problem can be envisaged. The noble Lord, Lord Alton, laid out the potentially horrendous origins of those bodies. Like the noble Lord, Lord Hunt, the noble Lord, Lord Alton, has been determined and assiduous in pursuing such cases and he is remarkable in his ability to never pass by on the other side. He made a powerful and passionate contribution here as usual.

Medicines and Medical Devices Bill

Lord Sheikh Excerpts

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Wednesday 2nd September 2020 Lords Chamber

[Lord Sheikh (Con) [V]]

My Lords, I support this Bill as it will enable us to put together and implement the various regulations governing human medicines, veterinary medicines and medical devices. We live in a world that is changing and the medical and veterinary sciences are constantly evolving. The Bill will enable us to innovate and ensure that all medicines and medical devices will be safe to be used by the public when needed. The Bill will enable us to amend the regulations periodically and we will be able to act and react swiftly through secondary legislation and be a world leader in the pharmaceutical industry.

In formulating the regulations, we must ensure complete patient safety. In the regulations, we need to ensure that all the important issues are full covered. I note that Parts 1, 2 and 3 of the Bill stipulate that the appropriate authorities must have regard to the safety, availability and conducting of clinical trials of medicines and medical devices. I fully agree with and support Part 4 of the Bill, as it states that the regulations under Parts 1, 2 and 3 will be subject to the draft affirmative process. The proposed legislation would be required to be fully scrutinised and approved by both Houses.

Furthermore, I note that under Clause 41, the relevant authority would be asked to approach such persons as the authority considered appropriate. This consultation will be essential. I note that under Chapter 3, the enforcement authority will issue notices in respect of compliance, suspension, safety and information. The right to issue these notices will be essential to consolidate the enforcement regime.

I noted the remedies under Clause 24, which include criminal convictions. Will the Minister say whether it is in order to do so under this Act? I welcome the proposals in Clause 27 and Schedule 1 to apply civil sanctions rather than impose criminal proceedings in relation to offences connected with medical devices.

I will talk briefly about Clause 5, which refers to fees, offences and powers of inspection. Under Clause 5(1)(b), it is stated that the regulations may create a criminal offence

“for failure to comply with a provision made in the regulations”,

which may be punishable by a prison sentence of no more than two years. Will the Minister tell us whether the creation of the criminal offence is in order under the regulations?

I will now discuss the provisions of Clause 35, which relates to the disclosure and sharing of information. My slight concern is the protection of data, particularly relating to the patient. We must ensure that there is complete protection in regard to this. Will the Minister comment on the issue of protection? Will the recommendations in the Cumberlege report be fully implemented, including the appointment of a patient safety commissioner?

Finally, I have three more questions for my noble friend to address. First, under Part 1 of the Bill, will there be provisions to regulate alternative medicines, as some of these can cause serious problems? Secondly, what measures are being taken to prevent the importation of medicines from countries where human organs have been removed for medical testing? Falun Gong and Muslim Uighurs are subjected to these horrible practices in China. I am also concerned about tackling antimicrobial resistance. Can the Minister assure us that this issue will be looked into as a matter of priority?

Covid-19: Masks

Lord Sheikh Excerpts

Thursday 11th June 2020 Lords Chamber

[Lord Sheikh (Con) [V]]

My Lords, it has been announced that from 15 June anyone travelling on public transport must, as a rule, wear a face covering. In addition, all hospital visitors and outpatients will have to wear a face covering and all staff will have to wear surgical masks at all times. The WHO has now revised its guidance relating to the wearing of masks. Will the Minister comment on the recent announcement by the WHO and on whether we should make it compulsory for face coverings to be worn by everyone where social distancing is not possible, as advised by the BMA? As someone who wears a face mask all the time when I go out, I would like us to follow the BMA’s advice. I also feel that the social distancing rule should be reduced from two metres to one metre. Lastly, we need to ensure that face masks sold in the market are of appropriate quality.

National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2020

Lord Sheikh Excerpts

Monday 8th June 2020 Lords Chamber

[Lord Sheikh (Con) [V]]

My Lords, I will talk about the financial aspects of the care home industry, and what needs to be done after the pandemic to ensure its sustainability.

There are more than 420,000 people in care homes; there are more than 22,000 care homes; and the industry generates an annual income of about £15 billion. I pay tribute to the industry, as it has performed well under the circumstances during the pandemic. We need the sector to be stable, as we have an ageing population and some people have health issues. Care homes are of varied sizes. The smaller companies are normally well managed, particularly if there is involvement by the owners. My suggestion to them would be to curtail their borrowings, be cost effective and, importantly, have adequate reserves. In my business, I have always had adequate reserves. My concern is with the larger companies, which are making over £1.5 billion in profits, with considerable amounts going to hedge funds. There may be complex intercompany structures. It is estimated that a high percentage of the care home industry’s £15 billion income is leaked and goes towards the payment of rent, dividends, loans and directors’ fees, not towards front-line care. The situation is opaque and there is reluctance to inject money into the sector, as there may be structural complexities.

Despite the high income generated by the industry, the staff are among the lowest paid workers, with a high turnover. It is hoped that the more money that goes to front-line care the better paid the staff will be. In the last 10 years, Southern Cross and Four Seasons have failed. I worry that there may be other problems post pandemic. The care home sector’s revenue comes from local authorities, the residents and the Government. The weekly amount payable per resident is normally between £600 and £800, and the NHS will pay £183.92 or £253.02 per week for nursing care in eligible cases. As there is a contribution from the state, there needs to be transparency and accountability and we must ensure financial stability. We should, therefore, perhaps consider some form of legislation to achieve this.

Finally, my own business—insurance—is properly controlled and regulated. Would my noble friend the Minister like to comment on the issues I have raised?

Covid-19

Lord Sheikh Excerpts

Thursday 23rd April 2020 Lords Chamber

[Lord Bethell]

I would like to take my noble friend to Skipton House in London’s Elephant and Castle to see the very large room where there is a combination of the diplomatic skills of the FCO, the trade skills of DIT and BEIS, the military skills of the Army and the clinical skills of Health. Seeing all those different skills and abilities work together to deliver the kit that our health workers need is a really impressive sight. That collaboration is the secret to success.

[Lord Sheikh (Con)]

My Lords, my noble friend the Minister referred to the fact that the number of deaths that have occurred as a result of coronavirus stand at 18,738. The BAME community represents about 14% of the UK population, but unfortunately accounts for about 35% of all coronavirus patients in intensive care. The number of people in the BAME community who have contracted coronavirus and died as result is disproportionately high.

My noble friend might perhaps recall that I talked about the burial of Muslims when the Coronavirus Bill was discussed in your Lordships’ House. The Muslim community has got together, and burials are taking place in very difficult circumstances. However, I have been told by leaders of the community that the availability of land for burials should be kept under review and that a system should be provided if the land issue becomes a major problem and burials cannot take place. Secondly, the Government should consider providing additional funds to local authorities, which are dealing with very difficult circumstances. They are stretched to the limit and need additional resources for burials and cremations. Will the Minister comment on those two points?

[The Deputy Speaker]

Minister, if you could be very brief, we might be able to fit in the noble and learned Lord, Lord Woolf.

Coronavirus Bill

Lord Sheikh Excerpts

2nd reading & 2nd reading (Hansard - continued) & 2nd reading (Hansard - continued): House of Lords
Tuesday 24th March 2020 Lords Chamber

[Lord Sheikh (Con)]

My Lords, I commend the Government for bringing forward this important piece of legislation. We are indeed facing challenging times. The coronavirus has caused widespread disruption and tragedy. Families have been torn apart and businesses forced to close.

I was in self-isolation but felt that it was important to contribute today as this Bill raises important questions about the treatment of the deceased. The permission granted to local authorities to cremate the deceased caused anxiety within the Jewish and Muslim communities. I therefore broadly welcome the Government’s decision to amend the Bill to provide safeguards against this practice. I pay tribute to members of the Muslim community, who have all worked together on this issue to face the problems in a true spirit of solidarity.

There should be respect for the souls of our dead. Our collective human dignity and preservation should not be compromised and defeated by this pandemic. It is important to emphasise that Islam strictly forbids cremation of the deceased in any circumstances. There are verses in the Holy Koran which state that the body must be buried. We regard what is written in the Holy Koran as the words of God, and we need to abide by them. There is a great deal of disquiet and concern about the provisions of the Bill relating to this subject.

I have had discussions with, and received correspondence from, leaders of mosques, burial grounds and Muslim organisations, and scholars, who all recognise the practical challenges of burials due to the coronavirus pandemic. This has caused deaths in the community to become a major talking point, as a number of Muslims have underlying health issues including heart and lung conditions and diabetes.

Although I welcome the Government’s concession, I fear that it may not go far enough, as there is a chance that cremations could occur in exceptional circumstances. I would therefore be grateful if my noble friend the Minister could inform your Lordships’ House as to whether Her Majesty’s Government will give further guarantees to ensure that cremations do not take place against the will of the deceased’s loved ones in any circumstances. These guarantees are absolutely essential.

The Muslim community is keen to work with local authorities to find solutions to the challenges arising from the coronavirus pandemic. A fatwa has been issued by the Ulama Council of the UK Islamic Mission, which has declared that the practices of Ghusl and Kafan have been suspended in the present climate. Ghusl means washing the body and Kafan means shrouding the body in accordance with Islamic principles. The deceased’s body will therefore be buried as it is received in a body bag. Furthermore, the burial prayers will be performed in a graveyard from a convenient distance at the time of the burial or offered at the grave after the burial has taken place.

Today, I was told that there is a shortage of body bags in mortuaries. That needs to be addressed. Mosques and burial grounds are providing protective clothing to their members who will deal with burials. The number of friends and relatives of the deceased at the funeral is being kept to a minimum. The community also acknowledges that there may be problems regarding burials in the light of a shortage of land and is willing to work with authorities to find solutions. A number of proposals have been made, including: burying bodies one on top of the other; burial in the garden of the deceased person, if this is possible; and burial in mass graves. In relation to the latter, local authorities will need to provide the appropriate land for this to happen. Today, I spoke to the head of a major Muslim charity who is willing to provide support.

The coronavirus pandemic has raised many challenges for our global and local communities. It is vital that we strike a balance between addressing the concerns of our communities and enforcing this important legislation.

--- Later in debate ---

[Lord Bethell]

My Lords, I thank noble Lords enormously for their powerful contributions in this Second Reading debate on this important Bill. It is an incredibly technical Bill; it is nearly 400 pages long. It was drafted on the hoof, at pace and in quick time. Noble Lords have stored up an enormous number of extremely thoughtful and, at times, extremely technical questions; there have been literally hundreds of them in today’s proceedings. I will try my hardest to answer as many of them as I can and I will write to noble Lords where I can, but I emphasise to the Chamber that, given that we will go into recess shortly, my phone remains on for any noble Lords with questions about either the Bill or the ongoing Covid-19 arrangements. I very much want to stay in touch with noble Lords who have questions.

Despite isolation and social distancing, we embraced technological innovation and embarked on a large amount of engagement for the Bill. I thank very much all the parties who engaged on the Bill—the noble Baroness, Lady Thornton, the noble Lord, Lord Newby, the noble and learned Lord, Lord Judge, who is not here, and their various parties and conventions—all of whom engaged in an extremely positive, constructive and important way. The tone adopted was a great example of Parliament coming together. I am very grateful and hope that that will continue during the Bill’s passage.

A number of noble Lords bore testimony to the hard work of NHS staff and those who work in social care. I want to take a moment to say thanks to those who work at Public Health England, without whom we would not be in the good shape that we are in, and who continue to provide incredibly important scientific and supporting work for our healthcare system. I also want to take a moment to say a word of gratitude to every single member of the staff of the House who is here despite the circumstances, as well as to the Bill team, which has literally moved mountains to pull together an incredibly complicated and long Bill in such a short time and done so with great humour and tolerance; huge thanks to them.

I want to use this speech, first, to update the House on a Statement made in another place by the Secretary of State for Health and Social Care earlier today. Ultimately, our goal is clear: we must slow the rate of transmission to protect the NHS. Our instructions are simple: stay at home. People should leave home for one of only four reasons: first, to shop for basic necessities, for example food and medicine, which must be as infrequent as possible; secondly, to exercise once a day, for example a run, walk or cycle alone or with members of the same household; thirdly, for any medical need or to provide care or to help a vulnerable person; fourthly, to travel to and from work but only when it cannot be done from home. Employers should take every possible step to ensure that remote working can happen. These four reasons are exceptions to the rule.

A number of noble Lords, including the noble and learned Lord, Lord Falconer, asked about the powers to enforce the PM’s instructions regarding essential travel and gatherings. For England and Wales, they will be introduced by regulations under the Public Health (Control of Disease) Act 1984. The Coronavirus Bill will give Scotland and Northern Ireland similar regulation-making powers. As the Prime Minister indicated yesterday, these measures are intended to protect the NHS and our social care service, and to save lives. We have taken the right steps at the right time but the spread of coronavirus across the UK is accelerating more rapidly than was originally forecast. Therefore, it is right that this Bill gives all four UK Governments maximum legislative flexibility to reflect the unpredictable circumstances that we will face.

I was pleased to see widespread support in the Chamber from noble Lords for these measures; the measures will, first, increase the health and social care workface; secondly, they will ease the burden on front-line staff; thirdly, they will contain and slow the spread of coronavirus; fourthly, they will allow us to manage the deceased with respect and dignity; and, finally, they will support people in getting through the crisis. However, I assure all Members of this House that none of these powers is taken lightly. The powers that we take in this Bill are not powers that the Government planned to take, but they are absolutely necessary.

A number of noble Lords spoke about the “on and off” aspect of the powers. I want to reassure the Chamber that the Government will activate them only on the basis of scientific advice. Guided by the experts, we will look at the evidence and continually review the effect of these measures.

Many noble Lords pressed me on whether the necessary powers were in place to curtail the provisions in the Bill. To reiterate, such a power is already in the Bill. Most of the powers in the Bill can be suspended and revived by the Government as the science dictates. On top of this, we amended the Bill last night in the other place to allow us to terminate provisions at the six, 12 and 18-month points.

I hope that noble Lords will agree that the Bill achieves the right balance between the necessary powers alluded to by the noble Lord, Lord Newby, and the noble and learned Lord, Lord Falconer, and the proportionality referred to by the noble Lord, Lord Blunkett, and my noble friend Lord Robathan. I am grateful for the endorsement from my extremely learned friend, the noble and learned Lord, Lord Judge, who notes that the Bill is proportionate in the unparalleled circumstances that we face.

I thank those noble Lords, including the noble Lord, Lord Oates, who raised the issue of the deprivation of liberty safeguards. We recognise that we have to strike a careful balance between the need to protect some of the most vulnerable in our society with preventing the spread of the virus. Therefore, we have decided not to alter deprivation of liberty safeguards in primary legislation. However, we think that we can achieve significant improvement to the process through emergency guidance. That will include making clearer when a deprivation of liberty safeguards authorisation is necessary, and the basis on which an assessment can be made, including, for example, phone or video calling for assessment. We are especially grateful to the noble Baroness, Lady Finlay, and other experts, who have worked with us on this. On that note, I also thank the noble Lord, Lord Anderson, who has given sage advice on a number of highly technical and detailed aspects of the arrangements for lord commissioners. I cannot answer those points from the Dispatch Box right now, but I shall certainly take them home and reply to him in time.

This brings me to the Government’s ongoing work to keep the country running. My noble friends Lord Robathan and Lord Naseby spoke movingly about this, as did the noble Lord, Lord Inglewood, the noble Viscount, Lord Colville, and the noble Baronesses, Lady Ludford and Lady Bennett. They have all raised important points about how we will need to fortify our economy and ensure that it bounces back. As I explained in opening, there is a direct connection between the effectiveness of our healthcare measures and our ability to ensure that people can pay their bills and are not driven back to work. The Chancellor has outlined an unprecedented package of measures to protect millions of people’s jobs and incomes as part of the national effort in response to coronavirus. This Government’s response includes strengthening the safety net for the self-employed, who will benefit from a relaxation of the earnings rules under universal credit and deferring income tax self-assessment payments due in July 2020. We have always said that we will go further where we can, and we are actively considering further steps.

The noble Lords, Lord Adonis, Lord Low, Lord Watson and Lord Blunkett, and the noble Baroness, Lady Blackstone, among others, raised the impact of the pandemic on schools and students. As a father of four children who are being home-schooled at the moment, I feel those questions personally. This Government have confirmed that exams will not go ahead this summer and that we will not publish performance tables. These decisions were not taken lightly. There will instead be a standardised grades process set by the Office of Qualifications and Examinations Regulation which will take into account a range of evidence including, for example, non-exam assessments and mock results. Ofqual is working urgently with the exam boards to set out proposals for how this process will work. I assure noble Lords that they will talk to teachers’ representatives before finalising an approach to ensure that it is as fair to students as possible. Furthermore, the Government will issue a statement shortly on what we will do more broadly to ensure that the teaching workforce is maintained.

I turn next to social care and support for the disabled and carers, which was rightly highlighted by the noble Lord, Lord Low, the noble Baronesses, Lady Blackstone and Lady Grey-Thompson, who spoke incredibly movingly on her own behalf and that of the noble Baroness, Lady Hollins. A number of noble Lords expressed serious concerns about the state of the adult social care market to deal with these profound pressures. I assure noble Lords that these concerns are felt very meaningfully at the Department of Health. My colleague Helen Whately is a tireless champion and an effective administrator, who is bringing both money and expertise to bear on this subject.

I completely accept and take on board the testimonies we heard in the Chamber today. The challenge to social care is profound, and many of the anecdotes told and circumstances alluded to in this House are of paramount concern. The challenges we face are enormous. We know that local authorities and providers will do everything they can to continue to meet all needs. The noble Lord, Lord Scriven, spoke movingly and persuasively about that challenge. But we cannot rule out the possibility that, in the coming period, they will need to take difficult decisions and may need to be able to focus their resources on prioritising accordingly to meet the most urgent needs. The inclusion of the Human Rights Act in these provisions is intended to underscore that, where local authorities need to prioritise care during the coming period, there is an absolute and unavoidable obligation on them to meet everyone’s human rights as an absolute minimum. We are developing guidance on how councils can use these powers in the best possible way. The Secretary of State will have powers to direct councils to comply with this.

We also intend to make changes to the current rules regarding entitlement to carer’s allowance for those who have had to take a break in care, so that they can continue to receive carer’s allowance. During the period of Covid-19, emotional support can also count towards the carer’s allowance care threshold of 35 hours a week.

On protecting the most vulnerable, I want to update the House on shielding, which was introduced yesterday. We are writing to up to 1.5 million of the most vulnerable people in the UK to advise them that they will need to shield themselves from the virus in the coming months. We will provide targeted support for all those who will need it, so that they have the food, supplies and medical care to make it through.

I will say a few words about housing, which was touched on by a number of noble Lords. What we are setting out in this Bill delivers on our commitment to protect tenants during the crisis. These measures will mean that landlords cannot start possession proceedings in court for an initial period of three months, providing tenants with a clearly defined breathing space in which they will not have to leave their home because of a new eviction procedure. This is a proportionate response that mirrors the three-month mortgage relief we are giving to landlords with mortgages. We also have the power to extend both the three-month notice period and the date these powers will end, and we are clear that we will use these powers if necessary. This legislation is one part of our package of support; it should not be seen in isolation. We have sought to ensure that tenants will still have income coming in so that they can continue to pay their rent, and additional legal protections for tenants are being introduced.

However, let us not forget that the cold-weather period is a particularly tough time for those sleeping rough, as was quite rightly highlighted by the noble Lord, Lord Adebowale, and the noble and learned Lord, Lord Falconer. Given the grave situation, they quite rightly asked about the steps that the Government are taking to protect and support those who are most vulnerable and living on the streets. Some £1.6 billion of additional funding will go to local authorities to enable them to respond to Covid-19 pressures across all the services they deliver, including stepping up support for the adult social care workforce and for services helping the most vulnerable, including homeless people.

There is much more that can and will be done. Our work is continuing, our funding is increasing and our determination is unfaltering. I welcome the opportunity to meet Social Enterprise UK, an organisation that I am familiar with, and I will ask my personal office to arrange that.

Many noble Lords have asked about the justice system, including the right reverend Prelate the Bishop of Rochester, the noble and learned Lord, Lord Falconer, and the noble Lords, Lord Hastings, Lord Ramsbotham, Lord Blunkett and Lord Scriven, and rightly so; given the way that people are treated in the justice system, this experience may have a profound effect on helping them to recover. In response to why there is no mention of prisons and probation in the Bill, as the noble Lord, Lord Ramsbotham, asks, the Secretary of State has advised that powers exist that are considered sufficient for the needs in prisons and for the probation service at this time. Any decision on the release of prisoners would need to be made by the Lord Chancellor in agreement with the Prime Minister and would need to balance public protection considerations. Any decision to release individuals would also need to take into consideration the shared pressures faced by probation services.

Regarding the extremely delicate and important question of pregnant women, governors have been provided with guidance issued by the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives on supporting pregnant women, and we will continue to provide updates on this. In addition to this, the prison group director for the women’s estate has issued advice on measures that can be used to enable implementation.

I turn to the remarks of the noble Baroness, Lady Barker, who has made some important and pertinent points about abortion. We completely recognise that continued access to safe abortion services has to be a priority, and in early meetings she bore testimony to the challenge and stresses for women in that situation. That will mean that doctors have to work flexibly to ensure that certification can still take place in a timely way, and not to delay women in any way from receiving treatment. There is no statutory requirement for either doctor to have seen and examined the patient. Assessment can take place via telemedicine or webcam or over the phone; DHSC guidance is clear on this point. We are also clear that the doctors can also rely on information gathered by other members of the multidisciplinary team in reaching their good-faith opinion. For these reasons, we do not consider that changes to certification treatment for abortions should form part of the Bill.

I am sincerely grateful for the important contributions made by my noble friend Lord Sheikh and the noble and learned Lord, Lord Falconer, who asked what steps we have taken to ensure that there are no forced cremations for religious followers. This is a very delicate issue, and stakeholder engagement has been moving and persuasive. I reassure noble Lords that we are engaging with faith communities to make sure that contingency measures are designed with due consideration for different practices around managing the deceased.

[Lord Sheikh]

Is my noble friend able to give me the guarantees that the community is looking for with regard to burial and cremation? They are looking for assurances and guarantees.

[Lord Bethell]

My noble friend Lord Sheikh spoke very movingly. The amendment agreed to in the Commons is, I believe, an extremely important step in the right direction. A huge amount of discretion is given to local councils to make arrangements with the communities that they know best. This is a set of decision-making that is best made at a local level, and for that reason I would prefer to leave it in the hands of the amendment and in the hands of the local councils. However, I want to be clear that faith communities will be involved in the drawing up of statutory guidance that will be issued before any direction affecting burial or cremation is issued. It is of the utmost importance during this difficult time that we continue to respect people of faith and their beliefs.

People across the United Kingdom have already responded heroically to this threat, as we knew they would, and it is clear from the quality of discussion that this House will do the same. I am frustrated that there are several noble Lords whose questions I have not been able to tackle; my noble friend Lord Balfe and the noble Lords, Lord Bates and Lord Watson, and the noble Baroness, Lady Bennett, are on my mind, and there are others who may also wish to stay in touch.

I want to be clear that the Bill is a necessary weapon in the fight against coronavirus. The Bill is a vital tool in our efforts to protect lives and, as this debate has shown, it commands broad support.

Access to Palliative Care and Treatment of Children Bill [HL]

Lord Sheikh Excerpts

2nd reading & 2nd reading (Hansard): House of Lords & 2nd reading (Hansard)
Friday 7th February 2020 Lords Chamber

[Lord Sheikh (Con)]

My Lords, I begin by saying that I support this tremendously important Bill. I commend the noble Baroness, Lady Finlay, on her tireless dedication to the improvement of palliative care across the country and on introducing the Bill in your Lordships’ House. As someone who has supported the hospice movement for many years, I am glad that we are putting palliative care on the agenda and ensuring that it receives the recognition it rightly deserves.

Death is the only certainty we have in life. However, I believe that life is sacred. We have a duty not to give up on those who are suffering in any way. I therefore feel that we should not debate the ending of lives. This is why I have previously spoken in opposition to the Assisted Dying Bill in your Lordships’ House and in other places. The right to die can easily become a duty to die, but no life is less worth living than another.

Dying is an important stage of life, and, unfortunately, almost everyone will experience the passing away of someone close to them. It is regrettable that dying is made difficult for some people, their families and their carers. I therefore believe that our time should be spent discussing how we can better take care of adults and children or the vulnerable in their final part of life.

I am pleased that the Bill rightly places a duty on clinical services commissioners to ensure that palliative care is accessible to all patients of all ages, all over the country. In the next 10 years, over 5.5 million people in England will die, and around 75% of them will need some form of palliative care. For three-quarters of people, death is not sudden but expected. In the National Survey of Bereaved People, published in 2016, patients’ families recorded that 81% of patients expressed a wish to die at home or in a hospice. Despite this, nearly half of all deaths occur in hospital, while only 23.5% in England take place in the home.

It is important that we focus on recognising people who would benefit from receiving care in the community and move them away from hospital settings. If the increased palliative care needs are not met, acute and A&E services will take the burden. Indeed, around 30% of emergency admissions are for people in their last year of life, which amounts to 11 million bed days, costing the NHS over £2.5 billion. That is projected to double by 2041, and an additional 8,000 hospital beds will be needed. Therefore, we must actively pursue sufficient access to 24-hour general and specialist palliative care services in homes and care homes that provide the same standard of care as hospitals. We should all recognise that we have a duty to provide palliative care in the same way that we do for maternal health, because we are born and therefore we will at some stage die.

Community end-of-life care allows for a holistic approach that emphasises collaboration between the various health providers. Our hospices and the voluntary sector do not have the resources and capacity to provide palliative care for people of all ages who need it. Some hospice services are running on as little as 10% NHS funding, with the rest being raised by charitable means. In some cases, the funding received by voluntary organisations has not risen in 20 years. I note that the Government have pledged £25 million to protect hospices and palliative care services which support around 200,000 people. This cash boost will be distributed by clinical commissioning groups. I would like to see that sum being paid annually—I reinforce the point made by my noble friend Lord Ribeiro and the noble Lord, Lord Hunt.

We need to ensure that the postcode lottery of access to palliative care services must end. Figures from Marie Curie suggest that each year around 150,000 people in the UK do not receive the care and support they need at the end of their life. Furthermore, its fast-track continuing healthcare analysis found that only 22% of clinical commissioning groups were delivering palliative care packages that fell within the guidance timeframe of two days. We must have parity in accessible palliative care across the country and ensure that hospices are treated on the same basis as any service commissioned by clinical commissioning groups.

I am glad that the Bill would entitle hospices providing palliative care services to access pharmaceutical services on the same basis as other services commissioned by clinical commissioning groups. It has been brought to my attention that people are less likely to receive palliative care if they are over 65, have a non-cancer diagnosis, are from a BAME background or are single. I am therefore pleased to note that the Bill provides for general and specialist palliative care services that are consistent with the duty to reduce inequalities. I am also pleased that it contains a requirement for clinical service commissioners to produce end-of-life statistics that include the provision of specialist palliative care and hospice plans to meet the needs of patients.

I find it shocking that Hospice UK identified that in May 2016, 25% of clinical commissioning groups did not have a strategy to address end-of-life care. While preparing for this speech in support of the Bill, I communicated with various hospices, as well as the Rainbow Trust Children’s Charity, which provides emotional and practical support to families where a child has a life-threatening or terminal illness. I have been made aware that the number of children and young people requiring palliative care is rising. This is due in part to advances in medical science which mean that more seriously ill babies are surviving birth and children are living longer with complex conditions. Children’s conditions are also more unpredictable than those of adults.

Another challenge in palliative care for young people relates to the giving up or withdrawal of medical treatment. I am satisfied that the Bill emphasises mediation, with an independent mediator to reduce and resolve any differences that may arise when a child is ill. Mediation is a transparent and holistic process. I worked as a mediator in disputes relating to contracts, so I am a great believer in the mediation process. I stress that a child suffering from a life-limiting illness has an impact on the entire family—parents and siblings. Court cases in this environment can be traumatic for everyone involved and can often be a lengthy process. I emphasise that children are best when they are alive. Furthermore, court cases can lead to high costs for the NHS if a case is not resolved in time.

I feel that this Bill solves many problems, especially concerning the approval of treatment for children. It is significant that it has provision for an independent mediator, as I feel it is important to have an aspect of impartiality in mediation so that a solution can be found.

I end my contribution today by recognising the contribution of Dame Cicely Saunders to palliative care. She was a pioneer of the modern hospice movement, which takes a holistic approach to palliative care, managing physical symptoms and tailoring care to meet the social, emotional and spiritual needs at the end of a person’s life. I met Dame Cicely Saunders and had conversations with her regarding the important role that hospices play in palliative care. In fact, I have a connection with St Christopher’s Hospice, which she founded. She emphasised to me that there is so much more to be done to improve palliative care. I agree with her and I certainly do all I can to support hospice movements in this country.

Palliative care focuses on maximising quality of life, and to me it seems inhumane that specialist and generalist palliative care is not accessible for everyone. So I am grateful to the noble Baroness, Lady Finlay, for providing us with an opportunity to remedy this inequality. I hope that this discussion can be continued by this Bill’s progression, so that palliative care receives the recognition and support it so greatly deserves.