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Lord Freud: My Lords, the noble Baroness is seeking to ensure that the assessment for PIP reflects the social model of disability, which would mean that assessors would not just consider the impact of impairment on an individual, but also the social, practical and environmental barriers they face. On the question raised on the support we have, I should say that we have the Assessment Development Group whose role is to advise on the detail of the new criteria we are developing, so the group is necessarily technical in nature. However, the members of the group have a wide range of experience in working with and supporting disabled people, including two representatives of disabled people and disability organisations. Several of the group members are disabled people. The group includes
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The amendment reflects a commonly held view that the assessment we are developing is a medical assessment. I am pleased to have this opportunity to state that that is not the case. The assessment is not fully based on the medical model, with the impairment or health condition that the individual has or its severity determining the entitlement. Indeed, the type of condition or impairment an individual has is of limited relevance as this assessment focuses on the activities essential to daily living and on outcomes. By looking at holistic activities and participation outcomes, this assessment will better reflect the social model of disability than did previous assessments. I do accept that it is not a full social model assessment; it is not intended to be. However, neither is it a medical model. The reality is that it is somewhere in between. It is perhaps more of a bio-psycho-social model. That is not a term that I have coined; it was coined by Professor Gordon Waddle whose work in the field of health and disability we have discussed in this House before. It recognises that there are biological, psychological and social factors to disability, which we have tried to capture in the assessment.
I should like to take the opportunity to provide more details on why we decided to do the assessment in this way. It does not include some of the additional factors to which the noble Baroness referred and which have been included in the alternative assessment proposals developed by Scope. I should add that we have a shared objective with Scope, which accepts that DLA is in need of reform: the need to overhaul this outdated benefit; assessing people as individuals, not as impairments; and ensuring that support is targeted on those who need it most. Its report contains some interesting proposals, for example, on how to support people through the claims process. We want to explore these further with Scope and others.
However, it is not administratively feasible to assess every aspect of disabled people's lives, every barrier they face or every cost they might incur. Long, intrusive and costly assessments would be required to do so. We therefore need to focus the assessment in a way that enables it to be a summary of the overall level of an individual's need. DLA looks at care and mobility needs to establish this. In this case we have chosen to look at the ability to carry out a series of everyday activities, all of which are essential for participation. We could have looked at other factors, such as those to which the noble Baroness referred. Whatever measure is used, however, it is important to assess need objectively and ensure that there are clear criteria against which to measure it. We must do it consistently for all disabled people, whatever their circumstances and wherever they are in the country.
That is where I think a fully social model assessment is flawed. If we were to consider every social, practical or environmental barrier that individuals face, we could not develop clear criteria against which to assess people, nor could we ensure that there was consistency in how it was applied. Taking into account housing or transport, for example, could lead to very different outcomes for individuals across the country, depending on levels of standards of provision. We believe such an approach to be unfair and at odds with how a national benefit should be paid. Access to personal independence payments should be universal. We do not want effectively to create a form of local needs testing.
I mentioned earlier that considering these wider factors was likely to require longer, more intrusive and more expensive assessments as assessors would need to cover much more ground. They would also be more likely to require more regular reassessments as these external factors could be liable to change more often than the impact of impairments themselves. While we want to review circumstances more frequently in the new benefit, we do not want more assessments than are necessary. Considering that these factors might also lead to an increase in uncertainty around entitlement for individuals and to appeals as people might have very different views about how these external barriers affect them, we are keen to avoid this both for the stress this causes and the cost of handling appeals. Therefore, while I understand the noble Baroness's position, we do not think that including social factors in the assessment is workable. We want it to be simple, objective and consistent. On that basis, I urge the noble Baroness to withdraw her amendment.
Baroness Campbell of Surbiton: I thank the Minister for his comments. I particularly thank all noble Lords who have supported the amendment and teased out some parts of it. The social model sounds so easy but once you start looking into it, it becomes more complex. If the Minister is so confident about this new middle ground called the bio-social-medical model, which I have not heard many disabled people writing songs about recently, why is it not coming up in the guidance or in the Bill? If he is so confident that the social model will be incorporated in the new assessment, why not put it in the Bill alongside the condition? Then the middle ground would be there. It informs and gives intent clearly to all those who are assessing from that legislation.
I wish I had the Minister's faith that society and the assessors will assess from a social model perspective as well as a medical one. I do not have that faith. Most people when they meet me do not ask, "What can I do to make it easy for you to come around to my house for a gin tonight?". They ask me what is wrong with me. I get that nearly every week. Everyone wants to know my medical condition before they invite me to their house. The noble Lord, Lord Wigley, clearly talked about that "light bulb moment" when everything became clear. I believe that by putting a social model definition in the Bill, it will help others to have that light bulb moment. I do not accept that a more social model approach or a social model-informed approach will lead to less objectivity.
The points-based descriptor approach such as the work capability assessment, which it should be noted has been continually subjected to widespread criticism and a high level of appeals overturned in favour of the claimant, has sparked off the need for a four-year review. Professor Harrington says that we must take a more holistic, social model approach to assessment. Using a points-based, tick-boxed descriptors approach will not capture enough information about the barriers and costs faced by disabled people on a daily basis.
The Government also seem to have concerns about inconsistency as an excuse to standardise disabled people's experiences. That is precisely what we are not doing here. My alternative approach recognises the diversity of difficulties faced by disabled people. Difficulties arise from a plethora of barriers, which is why you can have two disabled people with the same condition or impairment but who face different social, practical and environmental barriers as a result of disability. Earlier today, I heard about the disability-related cost assessment of a man called Ali Kashmiri. His costs and needs are entirely different from mine, although we have exactly the same impairment and need for a wheelchair, which again shows a need for a social model approach.
I believe that the Government are working hard to make the assessment process more evenly constructed between a medical and a social model approach. However, there is work to be done and I look forward to discussing further with the Minister the new assessment criteria and to hearing the responses of other disabled people to the criteria. When we look at that, perhaps we will come back to this matter. But, for now, I beg leave to withdraw the amendment.
86ZZZUA: Clause 78, Page 56, line 45, at end insert "including a requirement for the decision maker to collect evidence from the claimant's own health care professionals as a part of the decision making process"
Baroness Grey-Thompson: My Lords, the purpose of the amendment is to ensure that in all cases, as part of the decision-making process to decide eligibility for PIP, evidence is collected by the DWP from the claimant's healthcare professionals. A great deal of evidence suggests that decisions are frequently inaccurate when made on the basis of reports from face-to-face assessments alone, without being informed by evidence from the claimant's healthcare professionals.
There are lessons to be learnt from the current face-to-face assessments. Evidence shows that when face-to-face assessments are carried out for the WCA, inaccurate results frequently occur. Recent figures published by the DWP demonstrate that 29 per cent of claimants who are in the work-related activity group were placed in it only after a reconsideration or appeal, after they had originally been found fit for work on the basis of the WCA. The deciding factor in tribunals overturning decisions is frequently medical evidence from the claimant's doctor or healthcare professional.
A recent small study by Citizens Advice asked claimants to check the accuracy of the report of what they had said during their assessment. It asked claimants to take part in the study before they had been to the assessment to ensure that the claimants were not just taking part because they had had a poor assessment. Thirty-seven claimants took part in the study. Sixteen of the 37 reports were judged to have a very substantial level of inaccuracy. These claimants were not angry because they have been found fit for work. In fact, nine of the 16 had been placed in the work-related group and would not have seen their report if it had not been for the study. Eleven of the 37 reports were judged to have a medium level of inaccuracy and 10 were felt to be an accurate reflection of what happened at the assessment.
The following case is one of the 16 cases judged to be inaccurate enough to affect a decision for ESA-or, if the claimant were found not fit for work, a decision for DLA. The client had a serious mental health condition as a result of a series of traumatic circumstances. He felt that there was little interest in what he said and he reported a number of factual errors. For example, the report stated that the results of an MRI scan and an ECG were normal. The ECG should have been EG and the client had explained that he had not yet had the results. There were also significant omissions and distortions in what the client is recorded as having said, and false assumptions made as a result. There are other examples in this case study.
The medical evidence sent in by the adviser when the client appealed clearly backed the client's view of the assessment, as the decision was changed on reconsideration without the need to go to a tribunal. The DWP and Atos now recognise the value of medical evidence from the claimant's doctors. The value of this evidence as part of the assessment process was acknowledged by Dr Crawford, the clinical director at Atos, in evidence to the Work and Pensions Select Committee on 18 May 2011. HCPs working for Atos also acknowledged this when a sample group were interviewed in a survey by the DWP. The DWP now encourages claimants to send in medical evidence for the WCA.
The onus should not be placed on claimants to collect this evidence. Claimants are often charged for medical reports. While advertisers are sometimes able to negotiate with a doctor to drop the charge when a claimant goes to a tribunal, doctors who charge will clearly not make this concession in the case of every claim. The charge is often £30 or £35, and sometimes more. Someone living on the basic ESA of £67 a week cannot afford this amount. It must be the responsibility of the DWP to collect the evidence that is needed for
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Lord German: My Lords, I shall speak to Amendment 86ZZZX in my name. I hope that I am pushing at an open door on this matter. The amendment asks for a suitable person to be informed about and to accompany people to their face-to-face or telephone interviews. I note that page 10 of the explanatory notes that we received from DWP on Friday states that while DWP is still developing the second draft of the assessment criteria, it is able to be clear on a few points. One of the bullet points is that individuals will be able to bring another person, such as a family member, friend, carer or advocate, with them to the face-to-face consultation where they would find that helpful.
That is very welcome, but behind a simple bullet point there lies a number of other questions. The most important is whether the person who is accompanying the person being assessed is able to be an active member of the assessment exercise. That is largely because in the WCA assessment exercise, anyone who accompanies the person being assessed is not allowed to take an active part or to communicate. There are some concerns. We are told that the reason is because the assessors say that the accompanying person could give a false impression of the claimant's needs. It is good that it looks likely that an explicit right to bring someone along will be built into the regulations, but we need to be clear. People with some conditions, such as autism, mental illness, deafness or many other forms of disability, have communication problems. People with those conditions might not be able to communicate their needs, particularly given the level of anxiety in an assessment of this sort. For many people, it will be the first time that they have been assessed or had a face-to-face interview-I will come some to other forms of assessment in a moment.
Having someone there to support you is helpful, but the person, whether they are a family member, a carer, an advocate or whoever, must have the ability to intervene to give a clear account of the claimant's situation. In my view, an advocate means someone who can give voice to the feelings of the person being assessed. The worry that I am hoping the Minister can put to one side is that carers might be able to attend the meetings but not be able to speak because they might interfere with the assessment process. In reality, they will give a clearer account of the claimant's issues. There is some history on this matter. People have been present but have been unable to speak for part of the assessment process. I suppose I am asking the Minister to explain the relationship in the communication criteria which are being assessed and whether someone will be able to speak for a person who is being assessed in that area. I do not know quite
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In conclusion, is this meant to be a real open process where the advocate, the friend, the family member or the carer is able to take a full part in that process to ensure that the communication exercise is done in the most appropriate and holistic manner and that the anxiety levels are reduced?
Lord Addington: My Lords, my amendment in this group follows a similar vein but is slightly more specific-unusually for someone who usually prefers a broad brush. It is inspired by the National Autistic Society. Here it is asking for specialist knowledge to be available when somebody is assessed-specifically those in the spectrum that contains autism and Asperger's syndrome.
Why is this a good example? It was put to me at my party conference at a fringe meeting by somebody whose name I have forgotten-and I apologise to them for that-that autism is not only a spectrum but a three-dimensional one where everything interacts differently. It is incredibly difficult for somebody who is not an expert to take part and assess what is going on and work out how these interactions occur and interact with the outside world.
As we are at the stage of probing amendments, I use that as probably the best example but there are very few packages of disability that do not have elements of that. Degenerative and varying conditions are an obvious example where we are asking a hell of a lot of an assessor who is not specifically trained in that area to get it right. This is not a new subject. Anybody who has been around this knows this has happened for a long, long time and it seems to be something that anybody who is on the Treasury Bench has a problem with.
The previous Government did. The issue was raised on numerous occasions and indeed the noble Baroness, Lady Hollis, and I got into a little dance about this at one point. It was a case of her saying, "We are going to give them lots of training", then me saying, "Are you going to give them the ability to go and get a real expert in individual cases?" and her saying, "But we will give them lots of training". The noble Baroness was a very thorough and professional Minister. I think her attitudes might have slightly changed but as she is not here we will wait for another occasion.
You need expertise to get things right and to try to get away from the number of times assessments are challenged and the results overturned. People may say that 60 per cent of assessments are not being overturned-40 per cent are. Calling in expertise will probably save money in the long term. It will cut down stress. I do not know what benefit that would be to the administration of the system if things were not automatically challenged but calling in the right people at the right time is what we are calling for here. I hope the Minister will be able to give us a positive response because if we carry on as we are at the moment we are simply going to cause more grief and waste money.
Lord Touhig: My Lords, I begin by following the very proper example of the noble Lord, Lord Low, and apologise to the Committee for not participating in its debates until day 13. I have attended a number of sessions and amendments are down in my name and other colleagues' names and have been down for some time but other commitments in the House have prevented me being here. I do not show any disrespect to the hard work this Committee has done because of that.
The noble Baroness, Lady Grey-Thompson, in her Amendment 86ZZZUA makes a very important point. She is seeking to amend Clause 78 entitled, "Ability to carry out daily living activities or mobility activities". It makes commonsense for anyone doing that also to seek to collect evidence from the claimant's own medical healthcare professionals. I hope the Government will certainly see that.
The noble Lord, Lord Addington, very ably put the case for his Amendment 86ZZA which I and others have supported. It expresses concern about people who will carry out assessments having the right and proper qualifications. In making legislation we must learn the lessons of what we have done before and the noble Lord, Lord Addington, referred to it. My party when in government in 2008 introduced the work capability assessment as part of the employment and support allowance. It has been flawed. It has been shown that-the noble Lord just has made this point- 40 per cent of those who appeal against decisions have had their appeal upheld. Clearly there is a problem. It is important to have proper qualified people to carry out assessments. Indeed, Professor Harrington, in his report, recommended that there be mental, intellectual and cognitive champions in each medical assessment centre to support professionals in assessing those with such disabilities. Again, that makes sense.
I shall give two brief anecdotes to the Committee, if I may, from my time in the other place. On one occasion a family came to see me. They had been on holiday and their daughter, a young woman, was staying with an aunt in the same street a couple of houses away. She went home one morning to collect the post only to find a man sitting in a car outside the house. He got out saying that he was Dr So-and-So who had come to assess whether she was still entitled to benefits. The young woman protested; she knew nothing about it. He insisted on coming into the House to carry out an assessment of her, resulting in her benefit being stopped. This young woman was in a wheelchair and had been disabled from birth. The point I am making is that sometimes there is such a casual approach even under the present system to these assessments that I am worried that if we do not have properly qualified people, we will not get proper and fair results in future assessments.
In the other case, a woman came to see me whose benefit had been stopped. I listened to her arguments, read the papers, and so on. I thought this was unjust and took up her case. After about two months I was getting nowhere. I wrote back and forth and eventually asked for all the documents that the assessor completed when the assessment to remove her benefit was done. At the top of the first page on the right-hand side, the assessor had written "Wore a fish badge, probably a Christian". I am not saying that that had any impact
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The purpose of Amendments 86ZA and 86ZB in my name, that of my noble friend Lady Healy of Primrose Hill, my noble colleague and fellow countryman, the noble Lord, Lord Wigley, and the noble Baroness, Lady Gardner of Parkes, are to ensure that claimants are not put through a face-to-face assessment where it is possible to determine the question of a claimant's entitlement to a benefit on the basis of available, medical and social assessment evidence. That approach will not only save a great deal of money but would avoid placing undue stress on claimants with a disability or a significant illness.
I understand that the Government have estimated the cost of implementing the changes to DLA, including the new assessment regime, in the region of about £675 million. They plan to reassess all current recipients of DLA as part of the move to PIP and PIP claimants will also be reassessed regularly. The National Autistic Society has raised specific concerns about the introduction of face-to-face assessments for the new benefit, particularly given the experience of the work capability assessment to which I have already referred. When the educational support allowance was first introduced in 2008 the National Autistic Society followed a group with autism through the work capability assessment process and identified that the medical assessment was a particular barrier to fully assessing need. Many people reported that the Atos doctors undertaking the assessment did not have a full understanding of people with autism. I share the NAS belief that face-to-face assessments are not necessarily an appropriate way to assess the needs of people with autism because of the nature of their condition and associated difficulties that many have with communication.
Last Wednesday I was in Nottingham attending the annual meeting of the National Autistic Society. The question of replacing DLA with PIP and the worry about face-to-face assessments were on the minds of a lot of people there. I spoke to people about the problems this would cause for their autistic sons and daughters. If anyone needs to understand what autism is, I would start with four words: autism is for life. It is as simple as that. I repeat, autism is for life. One of the founders of the National Autistic Society, Lorna Wing, said, "When you have seen one person with autism, you have seen one person with autism". That is important to understand because the autism spectrum is such that no two cases are the same.
If there was one message that I would bring to this Committee from the people to whom I spoke in Nottingham, it is simply that they hope that the Government will examine in more detail proposals to amend the assessment process. They want to see a regime that properly takes into account the reality that at the heart of autism lies the difficulty to communicate
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The information provided to noble Lords for today's debate by the National Autistic Society emphases some of those points. The briefing tells us that when one claimant with autism was asked, "Can you travel independently?", he replied that he could. In fact, his support worker had travelled with him every day for the previous six months in order for him to complete a simple bus journey to the local shops. The individual was unable to understand that the real meaning of the question was whether he could independently travel to new places without support. Many people with autism take language literally. This individual felt that he had achieved that. He believed that his answer covered the whole question being put to him, but which he did not fully understand.
This has been my experience of talking to people with autism and their families. Last week, I met two chaps with Asperger's who were not diagnosed until they were 40 years old. When one sees the problems and difficulties that these people have, we must ensure that any assessment is right, proper and fair. Given the complexity of autism and the lack of knowledge of the condition among professionals, it is vital that any decision about the allocation of benefit takes into account any expert assessment of an individual-a point ably made by the noble Lord, Lord Addington.
"Expert reports will be much more comprehensive than any assessment made by a benefits assessor is ever likely to be. In instances, where a detailed report of need, carried out by a specialist is available, we would question the value of a face to face assessment with someone who does not have this expertise",
"The face to face assessment will add unnecessary anxiety to the individual, who has probably ... been subject to numerous assessments and tests. It also makes the process more costly at a time where finances are increasingly",
The Disability Benefits Consortium has rightly argued that people who are severely ill or disabled and suffering from a progressive illness or condition should not be subjected to the stress of a reassessment. The National Autistic Society has taken a similar view and is arguing for a tiered approach to the new assessment process. A paper-based assessment, including self-assessment
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If need has not been sufficiently demonstrated through the process, it would be at this point that a face-to-face assessment could be introduced. Currently, a large majority of DLA decisions are made on the basis of paper evidence. Earlier today, the noble Countess, Lady Mar, made the point that just 1 per cent of these cases are said to have been brought about by fraud. We can be certain that that is not a headline we will see in the newspapers. Surely it is an inefficient use of resources to undertake face-to-face assessments and reassessments of people who have been diagnosed by medical or social care professionals as having a condition that either is unlikely to change significantly or that will certainly, by the nature of the condition, deteriorate over time.
On the positive side, I welcome the Minister's recent indications-I think at Second Reading, but he will correct me if I am wrong-that he felt that in some circumstances the face-to-face assessment might be counterproductive. He noted that a number of Peers had worried about autism and how it would be handled, and stated that where it is,
Amendments 86ZA and 86ZB seek to do just that. They would secure two key objectives that I feel the Minister would be willing to embrace. They would put safeguards in the Bill so that those who have sufficient written evidence to demonstrate their needs do not have to go through a face-to-face assessment unnecessarily. As a result, the Bill would provide that all assessments will take into account expert reports and evidence as a first-tier assessment. This is our chance to ensure a fairer and more reasonable application of the new proposal that the Government are bringing forward. I hope that the Minister will take it on board.
Baroness Howe of Idlicote: My Lords, I will be brief as I have not put my name to any amendments in the group, but there is a definite case for someone who has listened intently to what was said to back the arguments. The noble Lord, Lord Touhig, recalled to my mind a time in the early 1980s when-I usually get this phrase wrong-my noble kinsman held parties at No. 11 Downing Street. I was very involved with the National Autistic Society. The Christmas party, with him as Father Christmas, was held for the benefit of autistic children. In those days, autism covered just one group. Now there is differentiation between different forms of autism, as there is with many other forms of illness.
My noble friend Lady Grey-Thompson moved her amendment sensibly and practically. The requirement that the health implications of what the patient was suffering from should be known before any decisions are taken is obvious and essential, quite apart from all the other good reasons why various aspects should be taken into account. The communications skills that are so important in everything have yet again been re-emphasised.
I will say no more, but I hope that the Minister-if he is listening-will say something very positive. I hope that he has listened to and has been as impressed as I have been by the arguments that were made for something rather more positive in the Bill.
Baroness Healy of Primrose Hill: My Lords, I will speak to Amendments 86ZZA, 86ZA and 86ZB in my name. First I will say a few words in support of the amendment of the noble Lord, Lord German. It is vital for adults with autism spectrum conditions to have this right. It is essential that a claimant whose disability impedes communication has an advocate to help them understand the meaning of questions fully and provide accurate answers. The condition also means that many claimants with autism experience high levels of anxiety. A known advocate would be a reassuring presence in an interview.
An autistic adult may have communication problems that are not obvious to the interviewer. That their answers could dictate whether they get the support they need purely on the grounds that they did not adequately understand what was being asked would be very unfair. Judging by the Explanatory Notes to the new draft regulations, which suggest that a claimant can bring another person to a face-to-face assessment, the Government might be sympathetic to the need for such support. However, without clear rights and duties to ensure that advocates are involved, there is no guarantee that such an advocate can attend, translate at and participate in the interview. Therefore claimants must be explicitly informed of their rights, and it cannot be left to the discretion of the assessor.
Amendment 86ZZA, which was tabled by the noble Lord, Lord Addington, and has already been mentioned by my noble friend Lord Touhig, is about the need for adequate training for assessors. I strongly support it. It is important because it is a safeguard against the fear of many parents that their autistic adult children will not be understood and that the wrong decisions will be taken about their needs and their ability to work. Families from the ACT NOW campaign group are very concerned that inadequately trained assessors will not understand the complexities of autism. They also believe that the government target to reduce expenditure on DLA by £1 billion will seriously prejudice individual discretionary decisions.
Although I welcome the Government's acceptance of Professor Harrington's recommendation that there should be mental, intellectual and cognitive champions in each medical assessment, I hope that that will also apply to the assessment of DLA-which possibly may become PIP-and that assessors will have training in autism as well as specific understanding of the limits of their knowledge and will know when to ask for expert advice. It should also be possible for assessors to have access to an expert champion to provide that advice.
The amendment would guarantee the safeguard of properly trained assessors who will have access to the necessary range of medical and psychological expertise. It is about ensuring a standard, regularised system of excellence that will deliver a high-class public service
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Finally, I support the amendments tabled by my noble friend Lord Touhig to allow claimants not to be put through face-to-face assessments where it is possible to determine the claimant's entitlement to benefits on the basis of available medical or social care assessment evidence. Interviews and other similar kinds of encounters may cause people with an autism-spectrum condition severe mental anguish. It is not the nervousness or anxiety that we may experience at the approach of a difficult or unpleasant event, but dread and terror. A person with autism has autism for life, as my noble friend pointed out. It is surely unnecessary to repeat a PIP assessment every few years. For many, it will be needless cruelty. A mother of a 20 year-old man with Asperger's said of his medical assessments, "I think the whole process is completely overwhelming for people with autism".
The amendments seek to ensure that people who have been diagnosed by medical or social care professionals as having a condition that is unlikely to change significantly or that will deteriorate over time are released from the threat of constant assessment which in so many cases adds to their anxiety and so makes their condition more difficult for them and their carers to manage. Many, but not all, DLA claimants with autism typically undergo a number of assessments by expert professionals. Reports from these assessments will be available, as well as detailed information about them from professionals working with them. The National Autistic Society, to which I am grateful for its briefing, has argued strongly that in many cases an additional assessment by DWP is therefore unnecessary.
Lord Wigley: My Lords, I have put my name to these amendments. I support what the noble Baroness, Lady Grey-Thompson, said. As joint patron of Autism Cymru, I identify entirely with the points that have been made by noble Lords. I hope there will be further opportunities to press these matters.
Lord De Mauley: My Lords, I apologise for intervening in the middle of the debate but I am conscious that it is the custom that we do not go beyond 7.45 pm in Grand Committee. I suggest that this is a convenient moment for the Committee to adjourn until 2 pm on Wednesday.
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