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Address in Reply to Her Majesty’s Most Gracious Speech

My Lords, I add my sincere congratulations to the noble Lords, Lord Adonis and Lord De Mauley, on their most interesting maiden speeches, and I add my welcome to that of others to the noble Lord, Lord Adonis, in his very important post. I declare interests as a practising palliative care physician and President of ASH in Wales. I shall confine my comments on the Queen’s Speech to health issues relating to alcohol and infection and to those which concern Wales. Before I do so, I must comment on the remarks of the noble Baroness, Lady Jay. I too had the honour to sit on the Assisted Dying for the Terminally Ill Bill committee, but I do not wish to pre-empt the take note debate on the committee’s report. I hope that every noble Lord will read all three volumes of that report carefully before considering altering the law on intentional killing. I expected to be reassured by that committee’s visits and evidence-taking, but I was not. The numbers are not small. One in 38 deaths in Holland is from euthanasia. That proportion rises to one in 32 if one takes into account illegally assisted deaths. That would translate to about 13,000 to 15,000 deaths per annum for our population size. An option in therapy actively to end the patient’s life crosses a Rubicon. But consistent comments have been made in government reports on the shortage of palliative care. This Government promised to increase support to palliative care services in their manifesto. There are inequities in palliative care provision. Despite our knowledge, the skills that are potentially available in this country and the research findings that have transformed pain and symptom control, many patients are unable to access even palliative care, especially out of hours when they are at home. I hope that the noble Lord, Lord Warner, whom I warmly congratulate on his promotion, will go even further than his party’s manifesto to ensure that all patients in the closing months of their lives have everything done to enhance their quality of life, rather than their feeling a burden, abandoned and suffering through lack of care. We know how to do it, yet so many patients still never access the care that they deserve in our society. As the noble Baroness, Lady Hollis, so clearly pointed out to us, much responsibility falls on women to care for dependants in the family at all stages of life, not just early on in childhood. It was heartening to hear that police and local communities will have increased powers to tackle guns, knives and alcohol-related violence. Alcohol-related violence is a huge problem. NHS staff are often on the receiving end in more senses than one. Much of this violence results in injuries, sustained in pubs and clubs from glasses and bottles. Glass injury usually affects the face, causing pain, suffering and long-term deformity, and it predominantly involves young adults. Even the compensation bill to the country, quite apart from the cost of caring and policing, is enormous. The average bill is more than £2,000 per ward. The NHS is a statutory partner in crime and disorder reduction partnerships, yet it cannot make direct representation to licensing authorities under the Licensing Act 2003. I hope that this anomaly will be rectified when we come look at the next piece of legislation. Sadly, alcohol remains a factor also in many road fatalities, particularly at night. It must be considered as part of any strategy to reduce casualties on the road. The Royal Society for the Prevention of Accidents has told me that, in 2002, 560 people were killed by drunk drivers. That is the highest number since 1996. From a total of 19,010 casualties of alcohol-related accidents, 2,500 were seriously injured. As with assaults, those under 30 are more likely to be the driver in drink-drive incidents. Cycling has to become safer too, with proper traffic-free routes and much more driver awareness of cyclists. In 2003, 114 pedal cyclists died on our roads and 2,297 were seriously injured. The toll of accidents and its relationship to alcohol cannot be ignored. What then happens when the sick and injured end up in our NHS hospitals? Much publicity has surrounded dirty hospitals, but perhaps not enough has been said about the state of some of the visitors, who bring in MRSA and other bugs, do not wash their hands and show a flagrant disregard for hygiene. We need to look at hygiene, particularly hand-washing, as a whole public health concern. Staff in hospitals eat and live outside the hospital. They pick up infections such as Norwalk virus at a take-away meal, they come into work and then their symptoms appear. They are taken ill at work, so the community-acquired infection is brought into the hospital. Just to blame the NHS and the trust chief executive is not always appropriate. Surveillance systems document and do not fix the problem yet the sources of infection are actually often not being monitored in the community where the root causes lie. We are breeding out antibiotic resistance by the inappropriate use of antibiotics and unrealistic expectations of medicines. Antibiotics are incredibly valuable and this valuable resource is precious. I fear that in the next major epidemic when we really need our antibiotics there will be too much antibiotic resistance to cope and we will be faced with massive mortality. We must also ensure that the public themselves understand risk. This often cannot be easily quantified. The public need to understand that the unpredictable can happen, however careful staff are in the NHS. It does not always imply negligence. Those negligently harmed, whether in primary or secondary care, must be entitled to compensation, but the current bill for compensation is already huge. In 2003–04, such claims cost the NHS more than £400 million for the hospital sector alone. The NHS Litigation Authority estimates its total liabilities to be nearing £8 billion now. As the NHS is bled by compensation claims, we are not providing adequate care for the most vulnerable in our society—those with chronic advanced disease who are struggling to stay in their own homes and who need care at nights, weekends and bank holidays. I briefly turn my attention to Wales but I do not expect a response from the Minister today—that would be asking too much. A White Paper will be published to extend the powers of the National Assembly for Wales. I hope that there will be consideration of separating the   parliament from the executive, of creating full proportional representation in the Assembly and that the committees will be changed so that they can scrutinise Ministers more effectively. I also propose that serious consideration be given to a Standing Committee of Welsh MPs and Peers, working closely with the Assembly, who could scrutinise legislation concerning Wales and ensure that incompatibilities with England do not emerge. Time on the Floor of both Houses would be saved and requests for legislation could be dealt with rather than remaining restricted to a very small quota coming forward each parliament, which leaves Wales frustrated by being denied the legislation it needs. That brings me to my last point. As noble Lords know, I have being trying to ensure that the Wales Assembly government have the powers they want to prohibit smoking in public places and workplaces in Wales. As we speak the Assembly is debating the report from its own consultative processes. I believe that I have a message waiting for me when I finish speaking to tell me the outcome of that debate. I am sorry that I cannot give it to noble Lords now. Wales is ready to act. Please do not hold up health in Wales while we wait for England to play catch-up, and for England to decide what it wants to do.