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Lord Morris of Manchester: My Lords, I am grateful to my noble friend Lord Hunt for his reply and for referring so warmly to the importance of the work of chiropodists and podiatrists and the other professions supplementary to medicine.

I am also grateful to my noble friend Lord Lipsey for condemning the practice of making the same speech in one debate after another. Well said. But not every participant in this debate is a serious offender. My speech today, like that of my good and long-standing friend, the noble Lord, Lord Williamson, was my first on this Bill and, like him, I have no intention of competing with the serial offenders in our midst. Naturally, I should like to discuss the Minister's response to my amendments with the Society of Chiropodists and Podiatrists, not least in fairness to my noble friend-- before deciding whether to return to the fray--and thus I reserve my position with regard to the later stages of your Lordships' consideration of the Bill. Meanwhile, I beg leave to withdraw the amendment.

Amendment No. 2, as an amendment to Amendment No. 1, by leave, withdrawn.

Lord Clement-Jones: My Lords, I should like to test the opinion of the House on Amendment No. 1.

6.46 p.m.

On Question, Whether the said amendment (No. 1) shall be agreed to?

Their Lordships divided: Contents, 38; Not-Contents, 88.

Division No. 1


Addington, L.
Avebury, L.
Barker, B. [Teller]
Beaumont of Whitley, L. [Teller]
Bradshaw, L.
Clement-Jones, L.
Dholakia, L.
Ezra, L.
Falkland, V.
Goodhart, L.
Hamwee, B.
Harris of Greenwich, L.
Jacobs, L.
Lester of Herne Hill, L.
Maddock, B.
Mar and Kellie, E.
Methuen, L.
Newby, L.
Northover, B.
Oakeshott of Seagrove Bay, L.
Park of Monmouth, B.
Razzall, L.
Redesdale, L.
Rennard, L
Rix, L.
Rodgers of Quarry Bank, L.
Roper, L.
Russell, E.
Scott of Needham Market, B.
Sharp of Guildford, B.
Shutt of Greetland, L
Thomas of Gresford, L.
Thomson of Monifieth, L.
Tope, L.
Wallace of Saltaire, L.
Walmsley, B.
Watson of Richmond, L.
Williams of Crosby, B.


Acton, L.
Ahmed, L.
Amos, B.
Archer of Sandwell, L.
Ashton of Upholland, B.
Bach, L.
Bassam of Brighton, L.
Berkeley, L.
Brabazon of Tara, L.
Bragg, L.
Brennan, L.
Brooke of Alverthorpe, L.
Brookman, L.
Burlison, L.
Burnham, L.
Carter, L. [Teller]
Chandos, V.
Clarke of Hampstead, L.
Clinton-Davis, L.
Cocks of Hartcliffe, L.
Davies of Coity, L.
Davies of Oldham, L.
Desai, L.
Donoughue, L.
Dubs, L.
Eatwell, L.
Elder, L.
Elis-Thomas, L.
Evans of Parkside, L.
Falconer of Thoroton, L.
Farrington of Ribbleton, B.
Faulkner of Worcester, L.
Filkin, L.
Gale, B.
Gilbert, L.
Gladwin of Clee, L.
Goudie, B.
Graham of Edmonton, L.
Grenfell, L.
Harris of Haringey, L.
Haskel, L.
Hilton of Eggardon, B.
Hollis of Heigham, B.
Howells of St Davids, B.
Howie of Troon, L.
Hoyle, L.
Hughes of Woodside, L.
Hunt of Kings Heath, L.
Irvine of Lairg, L. (Lord Chancellor)
Jay of Paddington, B. (Lord Privy Seal)
Jeger, B.
Jenkins of Putney, L.
King of West Bromwich, L.
Lea of Crondall, L.
Lipsey, L.
Macdonald of Tradeston, L.
McIntosh of Haringey, L. [Teller]
MacKenzie of Culkein, L.
Mallalieu, B.
Merlyn-Rees, L.
Milner of Leeds, L.
Morris of Manchester, L.
Nicol, B.
Plant of Highfield, L.
Ponsonby of Shulbrede, L.
Ramsay of Cartvale, B.
Rendell of Babergh, B.
Richard, L.
Rogers of Riverside, L.
Sainsbury of Turville, L.
Sawyer, L.
Serota, B.
Sewel, L.
Simon, V.
Smith of Leigh, L.
Stewartby, L.
Symons of Vernham Dean, B.
Tomlinson, L.
Thornton, B.
Turnberg, L.
Walker of Doncaster, L.
Warner, L.
Whitaker, B.
Whitty, L.
Williams of Elvel, L.
Williams of Mostyn, L.
Winston, L.
Woolmer of Leeds, L.

Resolved in the negative, and amendment disagreed to accordingly.

15 Mar 2001 : Column 1042

6.56 p.m.

Lord Clement-Jones moved Amendment No. 3:

    Before Clause 1, insert the following new clause--

(1) It shall be the duty of any person or body exercising functions or otherwise providing services under this Act to prevent discrimination against any class of persons receiving services under this Act, including discrimination by reason of age.
(2) It shall be the duty of any relevant authority and any other body exercising functions under this Act to publish an annual statement of the measures they have taken to prevent discrimination against any class of persons receiving services under this Act, including discrimination by reason of age."

The noble Lord said: In moving Amendment No. 3, I shall speak also to Amendment No. 4, which relates to age discrimination. Despite constant urging, this Government's failure to outlaw age discrimination during their term of office is a massive disappointment to all those involved in the care and representation of older people.

15 Mar 2001 : Column 1043

The Secretary of State was quoted in the not too dim and distant past as saying:

    "I will not tolerate anything which smacks of age discrimination in the NHS".

Yet, the fact is that this Government have not done nearly enough to prevent it. They did not agree to an investigation into age discrimination in the NHS which, pre-election, they pledged to do. The national confidential inquiry into perioptic deaths in November 1999 referred to staff shortages and lack of experience leading directly to the deaths of older people. There have been restrictions on heart bypass operations, heart transplants and cardiac rehabilitation for older people. Kidney dialysis and transplants have been refused to patients over the age of 70. There are no public health fitness targets for those over the age of 65 in Our Healthier Nation. We all know of the stories of delays in older people being seen by doctors when admitted to hospital. However, the fact is that two out of three acute beds in the NHS are occupied by people over the age of 75. Therefore, this is a major issue.

We know of the scandals that have taken place. In one case, "Not for resuscitation" was written across a patient's toes. Diamorphine has been administered without medical justification and without consultation with relatives. We have heard of cases of denial of food and drink or food supplements to patients, and the denial of hip operations for older people.

Throughout, the principle seems to have been forgotten that we all have a right to treatment based on clinical need and not age. Age Concern's report on discrimination in the NHS, Turning Your Back on Us, was published in 1999. It put the case very cogently for a duty not to discriminate within the NHS. An Age Concern survey of 1,000 patients at the end of 1999 found that health was, of course, a key concern of older people. However, its survey of GPs found that 77 per cent said that rationing on the basis of age takes place in the NHS.

The most recent report by Age Concern, Speaking Out, which was published in November last year, showed that ill treatment and discrimination against the elderly is still rife. A report published last year by the Association of Community Health Councils on accident and emergency departments demonstrates horrendous discrimination against the elderly. Elderly patients are rushed to hospital but are then sometimes left to die on trolleys. One in five of us is aged 55 or over, and 42 per cent of NHS resources is devoted to the elderly. If we do not get the matter right in relation to the elderly, we are failing horribly.

I know that the National Service Framework for Older People is due to be published shortly. But that, by itself, is not enough. We need to create a positive legal duty and a positive culture of care. It is not only a matter of resources; above all, it is a matter of respect. That should be enshrined in legislation.

We on these Benches argued on previous occasions in relation to both the Care Standards Bill and the Health Bill that there should be such a duty in

15 Mar 2001 : Column 1044

legislation. This Bill presents another opportunity for the Government to accept the need for a clear duty not to discriminate. We shall press hard for that throughout the passage of the Bill. I beg to move.

Earl Howe: We are fully in accord with the spirit of the amendment, as, I believe, are the Government. I cannot express the case any more cogently than the noble Lord, Lord Clement-Jones. I look forward to the Minister's reply.

7 p.m.

Lord Harris of Haringey: I wish to speak to Amendment No. 3, which the noble Lord, Lord Clement-Jones, has introduced. I am not sure what response my noble friend the Minister will give, but there are two possibilities. My noble friend may say that it is unnecessary because it is already enshrined in guidance, or he may say that unfortunately it brings within its ambit all sorts of other things that were not intended by the noble Lord, Lord Clement-Jones.

Discrimination by reason of age is not just about being old. For example, there are a number of thresholds at which point it is assumed that certain treatments will not be available. The standard protocols on breast cancer screening make assumptions about appropriate age ranges for screening to take place. Noble Lords want to adopt the principle that an assessment is done on the basis of an individual's needs and requirements, not on the basis of the standard application of protocols.

The amendment refers to "any class of persons", and I hope that that is not so widely defined as to make it impossible for there to be protocols on treatment. It is important to have clear guidelines on the provision of treatment by the medical profession which are capable of interpretation in the light of individual needs.

While I embrace the spirit of the amendment, I hope that a way can be found to achieve its objectives rather than bringing in all sorts of other factors, which would be unhelpful.

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