Debate on the Address

My Lords, at first sight it might seem as though health featured relatively little in the gracious Speech. I say ““relatively””, as that first sight was deceptive, and the six excellent maiden speeches that we have had today demonstrate the huge concerns that there are for social and health affairs. Those speeches also demonstrated that those noble Lords entering this House bring a degree of expertise that will enrich us. The pace of change in the NHS under the word ““reform”” is indeed very rapid and I am concerned that some of it has not been evaluated for cost efficacy and is now more driven by cost cutting. The recent salary changes across the board have indeed been high, rewarding professionals who often go more than the extra mile to meet the needs of vulnerable patients. But now we face the spectre of medical, nursing and allied professionals being trained for posts that do not exist. We have an outpouring from our universities of students laden with debt who may not have jobs to go to. It seems a sad irony that we are now training people as jobs are being cut. To address one item in the Queen's Speech, I shall comment briefly on the mental health proposals, which we will soon be debating at length. I hope that when we reach that debate the Minister will provide some assurance that the proposals will have a therapeutic benefit. I am concerned that mental health services do not have the resources and capacity to cope with any proposed change in load. We know that our prisons are full and that many who are given a custodial sentence have mental health problems. In many cases, those mental health problems underlie the offending behaviour, because they were not well managed initially. Supervised treatment orders in the community may go some way to help to maintain some of those people in the community, but I hope that the real resource implications of that for health have been fully costed and that it is not being viewed as a cost-saving expedient, because I do not believe that it will be. Like many who will speak on the Bill, I am concerned that the criteria for compulsion are too wide. However, the Bournewood gap needs to be addressed, because some people severely lack capacity and are very vulnerable; they must be detained not arbitrarily, but only in their best interests, to protect them. The gracious Speech also referred to the merger of the Human Fertilisation and Embryology Authority and the Human Tissue Authority. The problem is that the two bodies have quite different functions and remits. I am concerned that there is a subtle subtext here—a real danger that the embryo will be viewed in the same way as tissue removed because it is diseased. The type of decision that the HFEA takes is ethically complex. In his opening speech, we heard from the Minister that Britain has been at the forefront of research and regulatory oversight for such decisions. The authority has indeed developed great expertise in that area—expertise to which the rest of the world refers. The Human Tissue Authority is now developing its own expertise in its area and is relatively new. The debate needs to be held on whether a new joint authority called RATE—I find that a slightly amusing name; how will we rate RATE?—needs to be established and what the benefits and risks of such a merger will be. Will we just create an umbrella organisation with two separate branches that will be disrupted in the process and lose momentum in the development of their individual expertise? It is important to remember that an embryo, with its potential for life, is fundamentally different from tissue that is dead, diseased or discarded. That potential for life leads to very complex and important ethical challenges when we become involved in decisions about it. I know that the gracious Speech has laid out plans for the very vulnerable at the beginning of life, and I am concerned that those may be jeopardised. We must not forget the debate about service provision, which we have not had openly and honestly, and about just what the NHS does and does not do. Need and demand are not the same, although they often overlap. We seem to be increasingly driven by demand, yet we hear horror stories of those in need falling through the net. Nowhere has such a debate been mentioned, but we need to debate how drugs excluded by NICE are funded if a clinician feels that a patient would particularly benefit from them. Perhaps we could learn lessons from some other countries in Europe. I understand that in France there is a system whereby patients can part-pay for some such treatments, so there is a mixed economy of state-funded and personally funded care at the margins of their system for those patients who here would simply be given the decision that the NHS will not fund that treatment. Much of today's debate has addressed the social and health interface, where the most vulnerable in our society fall through the net. I was grateful to the noble Baroness, Lady Greengross, for referring to the need for good palliative care for everyone. Indeed, it is to that end that I have introduced my Bill. I know that the Government are developing a national strategy for palliative care, because the devolved NHS is leading to fewer, not more, hospice services. It is of course completely within the law for a doctor and nurse to prescribe drugs to keep a patient free from distress, whatever the dose of drugs that that patient needs. There are many myths around morphine and similar drugs. There is no evidence that those drugs shorten life when given for the relief of pain and distress. I would like to have that firmly on the record, because there is tremendous fear of morphine and a view that it somehow shortens life when given for pain relief. Patients can and should be able to approach their natural death with care that enhances their dignity and be secure in the knowledge that that care will be provided. Our living and our dying affect all around us. At the moment, we know what to do but, sadly, our NHS is still not delivering it to everyone who is vulnerable.