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I could not disagree at all with the point made by the noble Baroness about good practice and the comments that have been made here today about communication with the patient and discussion of treatment and medication. Those are the essence of good practice. Good patient care involves understanding the needs and wishes of the patient. We want to ensure that patients’ wishes are fully taken into account, including those expressed in advance. That is the whole purpose of the statutory code. It is there to embrace within it the practice that we want instituted, implemented and developed in the health service.
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The question is: what is the best way to ensure that there is a proper communication of patients' wishes and views? We believe very strongly that it is in the code of practice. It is through the code of practice that we will achieve improved communication with patients and all the other things that the Committee holds dear. That is not an issue just for patients detained under the Mental Health Act, or for mental health services. That is an aspect of good practice in all clinical care—not just through the code of practice. There is also the impact of the National Service Framework, the NICE guidelines and the many programmes that operate through the care services improvement partnership.
Although I agree that records should reflect discussion with patients, there must be scope for some best practice in how that would operate. For instance, in the case of a patient who might repeatedly request a given treatment, even after extensive discussion, would it be right that that would be recorded time, time and time again? Surely, there is a risk that that is too bureaucratic and potentially open to challenge. That is why there must be some room for discretion and why the good practice approach is the best approach to take.
There are two aspects to the substance of the part of the amendment concerning the requirement for second-opinion appointed doctors to record their reasoning or to change the test that they must apply. Members of the Committee have already referred to the fact that it is already well established by case law that SOADs owe a duty to give their reasons to patients. When that patient has capacity and does not consent to treatment, we would expect them to do so in all cases. Good clinical practice would mean that such reasons would be recorded in the patient’s notes and we do not see the need for statutory provision to that effect.
If, however, the amendment is really about a further test that the SOAD must apply—the noble Lord, Lord Patel, referred to that—we do not see the need for the extra test. In a sense, that takes us back to the issue of treatability, appropriate treatment and the therapeutic benefit test. I do not fully understand what is meant by,
Whatever the noble Earl takes it to mean, we believe that it must be subsumed within the test of appropriateness in Clause 6. The amendment focuses on one aspect of a decision, rather than taking a holistic approach, as we have tried to do when drafting the Bill.
In conclusion, I have no doubt about the importance of the second opinion doctor, nor of the need for effective communication with the patient and the practitioner but, in the end, we think that that is best governed by the code of practice.
Earl Howe: The Minister has resisted the amendment and believes that the good practice approach is appropriate. That is not an unexpected reply, although I find it disappointing. He is right to say that listening to patients is automatic in other branches of medicine. Writing down their wishes is
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Amendment, by leave, withdrawn.
Baroness Royall of Blaisdon: This may be an appropriate moment to move that the House be resumed for the Question for Short Debate. In moving the Motion, I suggest that Committee begin again not before 8.30 pm. I also point out that the limit for Back-Bench contributions in the debate has now risen from six to seven minutes, following a reduction in the number of speakers.
Moved accordingly, and, on Question, Motion agreed to.
International Polar Year 2007-08
7.29 pm
Viscount Montgomery of Alamein rose to ask Her Majesty’s Government what benefits are expected from the International Polar Year 2007—08 following the British hosting of the Antarctic Treaty consultative meeting in Edinburgh in June.
The noble Viscount said: My Lords, we turn now to a rather less controversial subject. It is an enormous pleasure to return to a subject in which I have long been interested. Rather suprisingly, last time the Antarctic was discussed at all in this House was 13 years ago, when in 1994 I saw the Antarctic Bill on to the statute book. This was an important measure because it enabled the UK to implement the treaty obligation imposed by the 1991 Environmental Protocol to the original Antarctic Treaty, and to ratify that protocol.
The Bill was originally introduced in the House of Commons by the noble Lord, Lord Jopling, who was at that time in the other place. It is gratifying to see that he is now here. He piloted the Bill successfully there, and to have him participate again tonight is a great pleasure. The other person who participated that time was the noble and learned Lord, Lord Archer of Sandwell, who was vital in dealing with some complex issues raised at that time. I am glad that they are both speaking again. Unfortunately the noble Baroness, Lady Hooper, is not able to speak this evening. Though I see her in her place temporarily, I know she has another important engagement in a few minutes’ time. It is good to see her here and I am sorry she cannot speak.
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Regrettably, I have no right of reply so would like to thank the other speakers new to the cause who have joined this debate. I welcome them aboard and hope that we have another debate on this subject in less than another 13 years. I doubt if I shall be here then, or even alive—but that is another story.
Since all that time ago, the Antarctic—indeed the polar regions both north and south—have become increasingly important both to science and above all to climatology. Antarctica covers approximately one-10th of the Earth’s surface, a continent which doubles in size in winter and has over 75 per cent of the world’s fresh water supply. All this could be vulnerable to global warming with a consequent rise in mean sea level and all that would imply for the whole world. We must always remember that the treaty defines Antarctica as a “continent for peace and science”. We need to take the subject seriously, never more than at present.
This is why, among other things, the fact that the UK hosted the 29th Antarctic Treaty Consultative Meeting in Edinburgh last year was so important. The deliberations were initiated by the noble Lord, Lord Triesman, and I am glad that he is here and will be able to wind up the debate. The Polar Regions Unit in the Foreign Office is important, and I pay tribute to Dr Mike Richardson, who has just retired after many years’ service there, and who was in office at the time of the 1994 Act. He did sterling work, and it is important that that unit is in no way diminished and not subject to the swathe of cuts which the Foreign Office has been subjected to in recent years. The unit should be expanded not contracted—it is vital.
The meeting was also important as an opportunity to launch the International Polar Year 2007-08, which starts in March. This will be the most significant commitment to polar science since the International Geophysical Year 1957-58, but 50 years on. We are at a crucial stage and in a crucial time. This year will herald an internationally co-ordinated campaign of research to initiate a new era of polar science, particularly in building a comprehensive set of measurements concerned with the changing planetary processes—that is, amongst other matters which sound complicated, climate change.
Britain has played a leading role in Antarctica since the early days, and it is vital that this continues. It would be impossible to discuss Antarctica without mentioning the excellent work over many years of the British Antarctic Survey in Cambridge. Unfortunately we do not have a coherent policy for the Arctic, which is much closer to us and under the same sort of threat. During the International Polar Year, the British Antarctic Survey should be encouraged to extend its coverage to include the Arctic; that is, to produce a bipolar approach. To do this double work it will need additional resources, but a bipolar approach to the two global poles would be a much more coherent policy in the present time of global warming.
Another important development is tourism, which has tripled since 1994. There is now a danger that, with larger and larger ships visiting—as is being planned for the next Antarctic summer—things could go wrong. There is a risk of accidents in these uncertain and frequently uncharted waters. This brings me to the
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I hope the Minister can give the House some reassurance and good news on these several points. It is vital they are considered seriously in the next few years.
7.37 pm
Lord Archer of Sandwell: My Lords, I hope the noble Viscount, Lord Montgomery, will accept my congratulations, both on having secured this debate and on his admirably clear presentation—and not simply because that is conventional on these occasions. His deep concern for the polar environment has been known to us for many years and, as he reminded us, we owe to him and to the noble Lord, Lord Jopling—as he then was not—the Act which enabled this country to ratify the Madrid Convention. Without our ratification, it would not have entered into force.
The Antarctic embodies three concepts which are central to our generation. First is what is being called the “global commons”. Our early ancestors took possession of such limited portions of the world’s surface as they needed for subsistence, just as various species in the animal kingdom fight to protect the limited territory on which their survival depends. Nation states practice no such moderation. They gobble every inch of territory available. Like the enclosure movement in the 18th century, when greedy landlords enclosed more and more of the commons until there was hardly a common left, that is now the pattern of territorial acquisition.
In the 1950s, at the General Assembly of the United Nations, Ambassador Pardo of Malta drew attention to what he called “the common heritage of mankind”. I think he was the first to use that expression. He said that there was little territory left which was not enclosed within national boundaries, but that what was left should be cherished as our common heritage. He named three examples, probably the only ones left: the deep oceans outside the ever-widening territorial margins; outer space; and the polar regions.
By the late 1960s, we were threatened with a Klondike in the Antarctic; one national Government after another claimed territory. The United Nations, which was then addressing the various dangers threatening the oceans, was less vigilant in protecting the polar regions, and the protection of the Antarctic was left to the 12 states most concerned, which concluded a multilateral treaty—the 1959 Antarctic Treaty. The original parties, and those who were later accorded consultative status, were therefore bound in international law by their treaty obligations, while states that have not undertaken the obligations are
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It seems that the parties to the treaty now represent more than 80 per cent of the world’s population, but since the treaty could not lay down a globally binding regime, territorial claims are not renounced but only suspended pending wider consideration. They remain suspended, so it is really an interim measure. The treaty was later supplemented by the Convention for the Conservation of Antarctic Seals and the Convention for the Conservation of Antarctic Marine Living Resources.
The second concept is environmental protection. We may recognise the importance of preserving parts of the globe as our common heritage, but that does not entail a common right to pollute and destroy them. There is now an assault on our family fortune. Human activity far away from the Antarctic is leading to major damage to the ice cap. This is not a matter for a regime simply protecting one continent, but there are activities in the Antarctic itself that can damage or destroy it. The Madrid Protocol—the 1991 protocol on environmental protection, which we owe to the noble Viscount—is in force, but the much more robust Convention on the Regulation of Antarctic Mineral Resource Activities of 1988, which would establish a commission, a secretariat and an arbitration tribunal, is still not in force, and perhaps when the Minister replies he will venture to prophesy its prospects. I hope that the United Kingdom, with its commendable record in these matters, will be in the lead.
The third concept, which deserves a passing thought, is less tangible. The wilderness is now something that we read about in history books. Very little wilderness is left in the world, and if its last traces are lost, posterity will be deprived of something irreplaceable. It is not a scientific concept—indeed, it borders on the mystical—but there are two kinds of people; those who understand that and those who think it is amusing.
The idea of an International Polar Year, which of course goes back to 1882, is a welcome international project for the mutual sharing and co-ordination of research. As a bonus, it helps to capture the intention of the international community and civil society towards the dangers to the polar regions. However, it comes with a price. Tourism is becoming a profitable industry. Tour operators are organising tours in the Antarctic. Tourism is not necessarily a bad thing if it introduces people to the magic of the wilderness, but it calls for regulation. Time precludes a sermon on that subject, but in the very act of calling attention to Antarctica, we could be in danger of destroying it. Our common heritage is as important as our national heritage. I would like my grandchildren to share it.
7.44 pm
The Earl of Selborne: My Lords, I, too, thank the noble Viscount, Lord Montgomery, for giving us this opportunity to consider matters polar. I also pay
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The only claim that I can make—it is a pretty tenuous one—is that when Scott sailed south on the “Discovery” expedition through the Ross Sea, he named a cape Cape Selborne after the then First Lord of the Admiralty, who had helped to get what was a naval expedition, and indeed a scientific expedition, up and running. From time to time, I check at the Royal Geographical Society map room to make sure that no one has changed the name, and I am delighted to say that it is still called Cape Selborne.
This Question refers to the Foreign and Commonwealth Office’s organisation of the consultative meeting in Edinburgh in June, and I pay tribute to what was clearly a very successful meeting, one of several that are helping to prepare us for not one year of an International Polar Year but two years, because it goes on until 2009.
International scientific polar years have been organised on three previous occasions, in the 1880s and the 1930s. In 1957 and 1958, too, there was the highly important International Geophysical Year. If ever one needed an explanation or credibility for organising scientific and explorative programmes on a large international scale, one should consider the success of the 1957-58 programme. That changed our perception of the world. The long disputed theory of continental drift was finally confirmed. Satellites were first launched then—indeed, they discovered the Van Allen radiation belt—and much of the research that was started in 1957-58 continued for many years to come, and still continues. Again, I remind your Lordships that one long-term programme undertaken by the British Antarctic Survey from 1957 onwards led in 1985 to the critical ozone-depletion paper, from which came the Montreal Protocol and much else besides.
The lesson of that is that one- or two-year programmes are highly important in engendering a sense of urgency and focus, but long-term monitoring and the back-up thereafter, such as the sometimes extremely routine number crunching, can be critical. If ever there was a justification for all this, it is that ozone-depletion paper, for which the British Antarctic Survey deserves the credit and from which the international community was able to draw the right conclusions. I do hope that, in the fourth International Polar Year, we remember the importance of basic data collection and the following long-term funding that will be required to consolidate what will certainly be a successful year or two.
Polar research is expensive. It requires ships and aircraft—fixed costs that must be met whatever the budget. When budgets are cut, as clearly they are from time to time, the impact falls not on the fixed costs but on the science budget. I am slightly saddened to see the response of the Minister in another place, Mr Jim Fitzpatrick, to a Written Question in the House of Commons in November, in which he reported that there will be a decline in the
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I noted the plea of the noble Viscount, Lord Montgomery, for what he described as a coherent policy between the Arctic and the Antarctic, and I very much support him on that. We do need a satisfactory balance between Arctic and Antarctic research. It is perfectly reasonable that the United Kingdom should note its interest in mineral extraction, oil extraction, shipping and fishing in the Arctic regions. Fishing is of particular interest when you remember that the conservation of Arctic fish stocks will become ever more pressing as the Arctic ice recedes. Again, both previous speakers mentioned the pressing issue of climate change and the importance of the polar regions.
It follows that it is difficult to predict the consequences on the west Antarctic ice sheet or, in the northern hemisphere, the Greenland ice sheet of further warming and melting, and over what timescale. Albeit on a longish timescale, some models predict potentially devastating long-term effects on coastal communities. We may be talking about hundreds of years or perhaps millennia. Nevertheless, it is highly important that we work further on these predictions. About 25 per cent of the land mass in the northern hemisphere is influenced in one form or another by permafrost. The effect of global warming on permafrost is that methane is removed, which increases the global greenhouse effect. Methane is infinitely more dangerous than carbon dioxide, so we need to look at these issues very carefully.
Even without climate change, the need for another international scientific agenda in the polar regions would be compelling. As we discovered in the previous polar years, we can use the vantage point of the polar regions to study much about our planet. The Earth’s inner core, the Earth’s magnetic field and geospace are correctly in the draft themes for the International Polar Year, simply because of the previous record. But climate change adds further urgency to the need for this International Polar Year, making the case overwhelming. I hope that we ensure that we are able adequately to play our part, not just for the two years but for longer, in the Antarctic and the Arctic polar regions.
7.51 pm
Lord Jopling: My Lords, your Lordships have already been reminded that, following the signing of the Protocol on Environmental Protection to the Antarctic Treaty in 1991, I was invited by the Government, having drawn a satisfactory position in the ballot for Private Members’ Bills, to sponsor a Bill in the other place to allow the United Kingdom to ratify the protocol. Having steered the Bill through another place, I was fortunate to procure the willing and enthusiastic support in your Lordships’ House of my noble friend Lord Montgomery of Alamein. He has a long history of enthusiasm for this area and I
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