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Debate on the Address

My Lords, perhaps I may start by congratulating the Government. I have had the privilege to be on the End of Life Care Strategy Advisory Board, and as noble Lords know, I introduced a Bill on palliative care in the last Session which completed its passage through this House. The thrust of my Bill was to ensure that each strategic health authority and trust would have to develop a palliative care strategy and report on it to the Secretary of State. So I am delighted that the Government have already called on SHAs to do exactly that, even though the overall national strategy itself will not be published until the summer. I am also delighted that the Minister has already done so much himself to foster such important initiatives. But if the Government do not maintain universal improvements in palliative care as a central theme, I assure the House that I will be seeking support again. What was missing from the gracious Speech? Every year, around 200,000 deaths are reported to coroners, but where is the long-awaited coroners Bill? The Government have dropped it for the second year running. There is a need for a chief coroner, a need for full-time medical examiners, and for powers to conduct more effective investigations to detect unnatural deaths. I seek an assurance that the Government will use this time to work with the Royal College of Pathologists and others who want such a Bill in order to iron out the more contentious aspects so that, when it is eventually brought before Parliament, the long-overdue coroners Bill will have a smooth passage. The gracious Speech made much of the need to harness the workforce. Many want to work part time and thus combine work and family life. The Chief Medical Officer rightly identified the changes in the medical workforce in the chapter entitled ““Opportunity Blocks”” of his 2006 report. In medicine, around two-thirds of graduates are now women, yet the hurdles remain to block careers. Although within medicine and surgery work already undertaken has identified problems and possible solutions across all the different specialties, that intelligence needs to be brought together to change management attitudes and to make ““part time work”” work. It will solve many problems. Doctors are needed at weekends and at all times of the day and night, so why not harness weekend and evening working? The Medical Women's Federation has been calling for each NHS trust to have a bank of registered vetted babysitters who can be called on in an emergency if other childcare arrangements fail, so that the parent can go to work secure in the knowledge that the emergency arrangements are safe. The Government can make much-needed change in work patterns and careers happen fast, so I hope that they will not forget all the lessons Sir John Tooke brought so eloquently to our attention in his report on modernising medical careers. Yet while the working arrangements may keep women in the mainstream of medicine for the benefit of patients, I fear that the proposed changes in regulation of the medical profession may benefit no one. The most damaging proposal is the move from the criminal to the civil burden of proof in cases against doctors. At this juncture, I simply remind your Lordships that the Bristol inquiry concluded: "““The culture of blame is a major barrier to the openness required if sentinel events are to be reported, lessons learned and safety improved. The system of clinical negligence is part of this culture of blame. It should be abolished””." The report on Bristol went on to say: "““For a culture of openness to succeed, those who work in the NHS must be confident that they will be supported by the organisation at all levels. Openness must be valued and rewarded. Otherwise, healthcare professionals will understandably be reluctant to embrace it””." Yet the Government's proposals go towards blame and stigmatisation, which will drive the professionals into defensive practice and encourage cover-up and we will have abandoned the lessons that we so sadly had to learn from Bristol. The Human Fertilisation and Embryology Bill introduced today will be debated soon. I am deeply disappointed that, with all the talk of creating embryos, there are no proposals to deal with the tidal wave of unwanted pregnancies and teenage pregnancies. Why are there no proposals to make oral contraception available over the counter? The safety data support such a move, so why does it not feature here? This is a topic that I will address more fully at Second Reading. Another glaring omission is any action on our poor record on intrapartum deaths, which are often unexplained and no longer fully investigated. Our record is considerably worse than that of North America and Australasia. The Government seem have ignored large tranches of their own Chief Medical Officer's report. His excellent report this year highlighted the appalling shortage of donor organs, yet we see no Bill here on organ donation. Last year, more than 3,000 patients had their lives saved or improved by an organ transplant. Of these, 2,385 received an organ from a deceased donor and, in addition, 2,402 patients had their sight restored through cornea transplant. There are currently 7,474 people waiting for organ transplant: 74 of those are awaiting a heart transplant, while a staggering 6,587 are awaiting a kidney. The average waiting time for a kidney transplant is now two years. We need a new system of organ donation, one which will allow for supply to meet the need or the demand. I urge the Government to look carefully at an ““opt-out””, or presumed consent, system for renal donation after death. Kidney donation has dramatic results; it can transform the recipient's life. Seventy per cent of the public say that they would be willing to donate, but only 20 per cent have registered on the NHS organ donation register to donate their organs after death. But despite 14.1 million people being registered, 459 patients died last year while awaiting their transplant. That is more than one a day, waiting on the list and dying before they get there. Organ shortages lead to poor tissue matches and greater risk of transplant failure, and so it gets worse and worse. Those who are desperate will sometimes turn to the terrible trade of organ trafficking. This trades on poverty and despair, often in the poorest parts of the world. It is tragic, but it will continue if the Government do not grasp the nettle of deceased donors. Finally, I turn to a different type of trafficking referred to in the gracious Speech—that of drugs. Have the Government heeded the debate that we had recently in this House? I simply reiterate the call for an agricultural policy that works with Afghan poppy farmers so that we buy up the raw opium and encourage other crops. Surely we must have a policy that allows us to grow poppies, not terrorists.