All 5 Baroness Smith of Newnham contributions to the Health and Care Act 2022

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Wed 26th Jan 2022
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Wed 9th Feb 2022
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Thu 3rd Mar 2022
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Wed 16th Mar 2022
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Wed 16th Mar 2022
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Lord Carlile of Berriew Portrait Lord Carlile of Berriew (CB)
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The noble Lord is trespassing on the old Social Democratic Party by using words like disingenuous. I will give him an example: some years ago, I chaired a Joint Select Committee of both Houses of Parliament dealing with the draft Mental Health Bill. That particular Bill was never enacted after our year of meetings and the report that we produced, but there was not a single person or NGO—including some that have been mentioned today—that did not believe that it was a parliamentary Bill. A Bill is a Bill is a Bill. In this Parliament we have draft Bills but not half Bills. That is my answer to the noble Lord.

I do not want to take up more time. I finish by saying that I think this is a completely misconceived proposal, both procedurally and, were we to come to it, on the merits.

Baroness Smith of Newnham Portrait Baroness Smith of Newnham (LD)
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My Lords, I shall speak to both amendments but I shall speak first to Amendment 203, which, on the face of it, I am minded to support.

My reason for that—I hope this is not seen as a Second Reading speech—is that two years ago, just before Christmas, my mother contacted me and said she thought she had terminal cancer. She was taken to hospital two weeks before Christmas and died on Boxing Day, not of terminal cancer but of end-of-life COPD. I had no idea that she had end-of-life COPD, although I knew she had COPD. On Christmas morning, I was summoned to the hospital, and a junior doctor asked me what I wanted to do: “Your mother’s been a bit unconscious. What do you want us to do? Do you want us to wake her up? Do you want us to do anything?” That is not really the best conversation to have. The next morning, Boxing Day, I had almost exactly the same telephone call: “Please come to the hospital, your mother is very ill.” I said that I had had the same conversation yesterday. However, on this occasion I was summoned in and met a doctor who spoke to me with compassion. My father and I agreed that my mother should not be resuscitated. I had never had that conversation with her, but, when I went through her things, I discovered that she had completed a form that said: “End-of-life COPD. When in doubt, do not resuscitate.”

So, in many ways the amendment in the name of the noble Baroness, Lady Meacher, is very attractive because it is surely right that, towards the end of their lives, people talk about what is appropriate.

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Baroness Meacher Portrait Baroness Meacher (CB)
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It might help the Committee if I make clear that, as I understand it, all our Fridays are taken up, because people are talking so long on all these Bills that we are having to use Fridays for government business, and also there are lots of Private Members’ Bills with Second Readings to come. So my understanding is that we have done what we can do with my Bill.

Baroness Smith of Newnham Portrait Baroness Smith of Newnham (LD)
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My Lords, perhaps the Minister, in replying, can tell the Committee whether he will talk to the usual channels, especially since I note that the Chief Whip and the Deputy Leader are both in their places, about whether time could be made available for further discussion of the Bill that is extant. Because whatever the merits or demerits of assisted dying, this is not the Bill for such an amendment.

Lord Ashton of Hyde Portrait Lord Ashton of Hyde (Con)
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My Lords, the noble Baroness, Lady Grey-Thompson, has been trying to get in for a while.

Health and Care Bill

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Baroness Cumberlege Portrait Baroness Cumberlege (Con)
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I understand that I have overrun so I will say to my noble friends on the Front Bench that we should value general practice. We should build with the best. We should learn from the best. I know that there are hundreds of general practices; it is up to us to applaud them and cherish them and ensure that we see another era of general practice which is different but which values patients and relationship care.

Baroness Smith of Newnham Portrait Baroness Smith of Newnham (LD)
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My Lords, I support Amendment 297A in the name of the noble Baroness, Lady Hodgson, to which I have added my name. I shall speak briefly, given that that I am only an irregular participant on this Bill. This amendment is particularly important. I come to an understanding of general practice from a very different perspective from the noble Baroness, Lady Cumberlege, as somebody who has only either received the care of a doctor or seen my parents receive or not receive that care.

When I was a young baby, I was extremely ill. I realise in these days where people talk about conspiracy theories about vaccines that this might be something that should not go into Hansard, but I had a reaction to the smallpox vaccine and my mother went to the public telephone box and called the doctor. The family doctor who came was equally concerned and brought a consultant from the local children’s hospital to our home to see me. That would be the sort of gold standard that we could only dream of now. However, it is the sort of care that we need to be looking to in terms of having a family doctor or a doctor in the community who actually knows individuals. As the noble Baroness, Lady Hodgson, said, this is particularly so for the over-65s, when a range of issues might be beginning to affect them.

The situation today is so very different. The Minister in answer to an Oral Question a few weeks ago repeatedly said that everyone has the right to see a doctor in person and the doctor must give a clinical reason for refusing to have an in-person consultation. I assure him that this very rarely happens, because ordinary patients cannot simply ring up and speak to the doctor and say, “I need to see you”. They will get to a receptionist who will triage them and decide whether they feel that it is appropriate for this person to see the doctor, or to have a telephone conversation or maybe some other virtual consultation.

There is a real need, particularly for older people, to have the opportunity to know that there is a doctor who understands their medical situation and can join up the dots. Somebody who seems now to have low blood pressure might have that because of the previous set of medication that another doctor has prescribed for them. If somebody rings up and gets a telephone consultation or is sent a prescription without proper assessment, the danger is that the whole picture is lost and individuals’ lives can be blighted because they are not getting the medical care they need.

This is not the fault of any individual practice or of any individual general practitioner. However, we have ended up with a system where that traditional idea of a family doctor who knows their patients has disappeared, and somehow we need to get an element of that back. The other three amendments in this group in many ways fit as part of a suite because, if your GP knows that maybe you have early onset dementia or another sort of dementia and you need different types of therapies, they will know what to recommend.

Furthermore, if your GP knows that you have gone into a care home, visits you and thinks, “That person has lost a stone and a half in weight in the last six weeks”, a GP who knows the individual will be able to respond. Somebody who randomly sees a patient will not. I strongly support the amendment in the name of the noble Baroness, Lady Hodgson, and the other amendments in this group.

Finally, I note that the amendment in the name of the noble Baroness, Lady Hodgson, comes immediately after the amendment in the name of the noble Lord, Lord Forsyth of Drumlean. If anyone were minded to support assisted dying, they should certainly support the following Amendment 297A, because how on earth could any doctor reasonably say that we can sign somebody off when they have no idea who that individual is?

Lord Crisp Portrait Lord Crisp (CB)
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My Lords, I would like to use one example to illustrate the importance of Amendment 291 in the name of my noble friend Lady Greengross, and her call for a dementia care plan. It relates to the second point: that the plan must recognise the different types of dementia and their specific care. It is also true that it needs to recognise the different groups of patients affected by dementia and their needs.

I am thinking from personal experience of people with Down’s syndrome. Noble Lords may know that something like 50% of people with Down’s syndrome who reach the age of 60 also have Alzheimer’s; there is some genetic connection between the two. However, the field of dementia has not really caught up with this yet. This is a developing field. The real importance of the plan that my noble friend advocates is that it constantly develops as knowledge develops about particular groups of patients and how they are affected.

The truth today is that patients such as the person I am thinking of are too often let down by the system, because too few clinicians understand the links between the two diseases and the particular needs of people with Down’s syndrome who also have Alzheimer’s.

Health and Care Bill

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Baroness Finlay of Llandaff Portrait Baroness Finlay of Llandaff (CB)
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My Lords, I support all the amendments in this group, and I shall speak specifically and briefly to Amendments 162 and 173.

These amendments are updates to the Human Tissue Act, which was born out of public outrage following the Alder Hey scandal, when over 100,000 organs, body parts and entire bodies of foetuses and stillborn babies were stored in NHS facilities. The body parts of dead patients, including children, were removed without consent. Today, the Human Tissue Authority’s guiding principles, as set out in its code of practice, are consent, dignity, quality, honesty and openness. These principles should not only reflect how human tissue sourced from within our own nation is treated, we must treat human tissue and organs with the same principles when sourced overseas.

In China, as has been said, there is substantial evidence of Falun Gong practitioners and Uighurs—as well as some evidence of Tibetans and house Christians—being killed on demand for their organs. Blood is taken off them for tissue-typing at the time when they were taken into custody, often with no idea why they were taken into custody at all, other than that they belong to one of those groups. There is no consent, no dignity and no transparency.

On 7 December last year, the British Medical Association released a statement on the abuse of Uighurs in China, expressing

“grave concern regarding the situation in China and the continuing abuse of the Uyghur population of the country as well as other minorities.”

It went on to state:

“We are particularly alarmed by the reports of organ harvesting, forced birth prevention, and the use of genomics data for racial profiling.”


It urged

“the UK government and international actors to exert pressure on the Chinese government to cease its inhumane actions towards the Uyghurs”.

If we do not pass amendments as laid before the House today, we will be complicit with these practices, because we will be looking at them with Nelson’s eye, with all the evidence that we have that they are going on.

On Amendment 173, on the exhibition of whole bodies using a plastinated technique, I suggest that there is no transparency whatever. Any attempt to claim that there has been consent is extremely suspect, because consent is very easily falsified. I went to one of these exhibitions because I thought you ought to go and see what you are criticising. This was not an anatomical, educational experience but a visual display of plastinated bodies in all kinds of different poses. But the one that horrified me the most was a pregnant woman, quite advanced in her pregnancy and with the foetus in her womb, which had been plastinated. I do not believe that that woman would have given consent for plastination. That raised real questions as to why such an advanced foetus was in the womb of a dead woman without something there explaining the nature of her death, the cause of death and the circumstances in which she had decided to consent to such a procedure.

Baroness Smith of Newnham Portrait Baroness Smith of Newnham (LD)
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My Lords, I will speak to Amendment 108, while supporting the other two amendments introduced so powerfully by the noble Lord, Lord Hunt, and my noble friend Lady Northover, and to which the noble Baroness, Lady Finlay, spoke so eloquently.

I am completely in support of those amendments, but I wish to speak briefly to the genocide amendment today. On various occasions during the Covid pandemic questions were asked of the then Health Minister about the procurement of PPE. He was not able to give me a straight answer to say, “We can guarantee that no PPE procured could have had anything to do with slave labour or could have come from Xinjiang.”

The NHS seeks to be world leading. We all support it and want it to be able to deliver for every citizen in this country. But that should not be at the expense of the lives of those in other parts of the world. It is not good enough to say that we have the Modern Slavery Act if that will not lead to a change in practices. It is absolutely essential that our supply chains do not include anything that comes from forced labour.

If one looks at what is going on in Xinjiang, it is possible to barter to get numbers of people, just as it was 200 years ago during the slave trade. That is not acceptable. It may be the case that, as the noble Baroness, Lady Kennedy of The Shaws, pointed out, we will be told, “This is not the right piece of legislation.” If it is not, what will the Government bring forward that will mean that every point of our supply chain—every part of government procurement—ensures that we are not procuring things that have been made using slave labour?

We must not be complicit. This House should support the amendments, and if the Minister is not able to support the amendment, perhaps he could come back with a revised and better version of the amendment that will do what we all seek to achieve.

Lord Moylan Portrait Lord Moylan (Con)
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My Lords, I will speak briefly only to Amendment 108, which I understand the Government are likely to resist when my noble friend the Minister comes to speak. I say simply, very briefly, that to be persuasive, my noble friend has to explain how through administrative measures the National Health Service will achieve the effects of this amendment. He has to explain that in a credible way and that the effects will be rapid and comprehensive. Any idea that this will be kicked into a long review that ambles on and may or may not produce the effects required by at least the first two proposed new subsections of the amendment will lack credibility; I am less concerned about the chairman of the Select Committee part that comes in the third one. I would like my noble friend to know before he speaks that that is what I think we all want to hear.

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Baroness Noakes Portrait Baroness Noakes (Con)
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My Lords, ordinarily I would not support a novel procedure which overrode the precedence of the ways in which we normally do business and in which the Government expect to direct how business is taken in both Houses of Parliament. But I have been increasingly concerned that the Private Member’s Bill processes, both here and in the other place, simply do not work. They do not work for controversial Bills. It is simple to thwart the progress of a controversial Bill both here and in another place—but particularly so in this House through the mechanisms which we have seen used.

This issue is so important: it is clear that there is strong body of opinion within the British public wanting to see this issue addressed in some way. We must find parliamentary time to make a proper decision on it. I accept what the noble Lord, Lord Hunt, says about the unusual nature of a Minister having to lay a draft Bill which is not government business. But sometimes things are so important that we must find practical ways through them. I believe that my noble friend’s amendment is a practical way through a very difficult problem, and I urge all noble Lords on my Benches to ignore the Whip.

Baroness Smith of Newnham Portrait Baroness Smith of Newnham (LD)
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My Lords, in Committee, I asked whether the Minister—I think the noble Lord, Lord Kamall, was responding on that occasion—had thought about giving parliamentary time to the Private Member’s Bill. The proponents of the current amendment are suggesting that this is not about the Government bringing forward a piece of legislation, even though—as the noble and learned Baroness, Lady Butler-Sloss, pointed out—that is exactly what the amendment says. If the intention of the amendment is to request parliamentary time—and we really are looking only at proposed new subsection (2)(b)—could the Minister, in replying, consider whether parliamentary time could be given to the issue without damaging neutrality in any way? The amendment, as drafted, would require the Government to bring forward legislation in favour of assisted dying. An amendment which gives parliamentary time to the issue would be very different.

Lord Carey of Clifton Portrait Lord Carey of Clifton (CB)
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My Lords, I will make a brief intervention. First, I rise to challenge the view that all bishops and religious leaders are against assisted dying. I changed my mind some seven years ago.

Secondly, we are discussing the Health and Care Bill. It so happened that this week I received a letter from two doctors—husband and wife—from Colchester. I will read a part of it because they asked me to intervene on their behalf. Their experience comes from within the National Health Service; they worked in the NHS all their careers. One of them says:

“I visited P a little more than two weeks before he died. Alone with me, he explained that he was beyond misery, from the pain of his condition and from the effects that drugs were having. The time had come, the patient asked, to request something that would allow him to slip away. The look of disbelief and horror as I explained that I could not do this haunts me still.”


The doctor goes on to say:

“The Health Service which has done everything it could to involve the patient in their care and comply with the patient's wishes waits until they are at their most vulnerable and incapacitated, to impose a course diametrically opposed to the wishes of the patient.”

Health and Care Bill

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Lord McCrea of Magherafelt and Cookstown Portrait Lord McCrea of Magherafelt and Cookstown (DUP)
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My Lords, I appreciate the lateness of the hour and, therefore, I want to make just a very few comments.

Without apology, I believe in the sanctity of human life. I believe that it is important to preserve the life of a mother. It is also right to preserve the life of the unborn child. When this measure was originally presented, it was clearly stated that it was an emergency policy introduced because of the unprecedented circumstances of the coronavirus pandemic. The policy was said to be time-limited but many, like me, feared that this was another way of extending abortion on demand. However, many noble Lords accepted that the at-home abortion powers would be exercised only temporarily and be used only for the purpose for which they were granted and in a manner proportionate to the situation. I commend the Government for the actions they took to turn the coronavirus crisis around to the situation we have today. Therefore, continuing the policy is not proportionate, although I did not think it ever was.

At-home abortion endangers the health of the woman and the girl. Consultation revealed that among a number of concerns raised about safety the most common was the risk of women being coerced. I do not think that is an unimportant issue for this House to consider. Therefore, I shall oppose Amendment 183.

Baroness Smith of Newnham Portrait Baroness Smith of Newnham (LD)
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My Lords, I want to intervene briefly, partly because I believe I set a hare running which I perhaps need to explain. I want also to ask the Minister replying to the debate a few questions.

I am told that I am not whipped to vote for this amendment, even though the Liberal Democrat Whip is to support the amendment—those of us who have a conscience reason not to support the amendment do not have to do so. I take that as being not a free vote, which is why I was of the view that, nevertheless, we were being whipped. Make of that what you will. I shall be voting against the amendment, unless the Minister can clarify certain points.

We heard from the noble Baroness, Lady Sugg, in introducing her amendment, and the noble Baroness, Lady Fox, that essentially this amendment changes nothing about the law on abortion. But we have also heard that if that were the case, we would not need this amendment at all. If it changes nothing, why is this amendment here? So it must be changing something. What I am not at all clear about is what protections are actually in place. The 1967 legislation was very tightly drawn. The nature of abortion in 2022 is much more widespread. The provisions are not perhaps quite as Lord Steel would have anticipated.

This is a very detailed amendment. We have heard that it is very simple but it is also very detailed. It explains who women need to see. They are supposed to be seeing people either via video or via telephone. I do not know whether any of your Lordships experienced telemedicine during lockdown, but it is not always very effective. If virtual medicine means a telephone call not on a smartphone, your doctor cannot see you. They have no idea how you are presenting or whether you are vulnerable. There is a real question about what certainty there is. Can the Minister say what security there is about telemedicine?

We also heard that women would still have to go through normal medical tests and so on. Where is this happening? In the amendment, all we hear about is things being virtual. At what point do we know that a woman is nine weeks and six days pregnant when she takes the first tablet? How do we know that she is not actually 22 weeks pregnant and not seen by anybody? How do we know what certainty there is? If this is, for many people, a conscience vote, do noble Lords, in good conscience, believe that telemedicine actually means that women are understood and their needs really recognised? Do they get the care that they would get if they were having consultations in a surgery?

Baroness Brown of Cambridge Portrait Baroness Brown of Cambridge (CB)
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My Lords, at this very late hour, I just rise to say that I hope your Lordships will not confuse individual anecdotes, however moving, with the very extensive scientific evidence base quoted by the noble Baronesses, Lady Sugg and Lady Watkins.