Secondly, I am concerned about budget support. It inevitably increases the power and influence of the existing Government and bureaucracy in the country that receives it. Where you have a democratic, incorrupt Government and state pursuing rational economic policies, budgetary support is a thoroughly good thing—the Government are part of the solution, not part of the problem. All too often, however, as noble Lords know, that is not the case. We should make it a principle that we will not provide budget support to

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states that are single-party dictatorships. We are supplying budget support to Vietnam, which is a colossal mistake, and we should not be doing that. There are other examples that we should look at carefully. I should like a much more critical view to be taken of the candidates eligible in this world for budgetary support.

Thirdly, if we are to enhance the productivity of our spending on aid and to secure the achievement of the aims that we all hold so dear in spending this money in what is admittedly a very anomalous way—a salient exception to our normal way of doing things—it is essential to have regular audit review meetings with the recipients of the aid under budget support, those who are taking the decisions in the country concerned as to the allocation of funds in the sector that we are supporting.

No decision-takers in any bureaucracy in the world have the time to get involved in detailed discussions of that kind with 10, 12 or 15 separate people. In practice, they can at best manage with three. The three who will be chosen will be the EU, the biggest provider of aid in the world, USAID and the World Bank. If we are to have any influence we need to remain fully committed to the EU programmes and, even when we have national programmes in addition to the EU programme, to concert with our EU partners in having those review meetings. Otherwise, we shall not have the leverage and influence that we need and shall need increasingly as the sums that the British taxpayer expends on this thoroughly worthwhile cause increase.

1.06 pm

Lord Fox (LD) (Maiden Speech): My Lords, time constraints have spared noble Lords from the lengthy maiden speech of my imagination. First, I thank your Lordships for the warm and inclusive welcome that I have been given, which I will work hard to justify. I would highlight my noble friends Lord McNally and Lady Northover who kindly acted as my supporters, alongside Black Rod and Garter King of Arms, and their teams, who helped to make my introduction so enjoyable and smooth. I thank them for that. Finally, I thank the doorkeepers who continue to tolerate my transgressions.

I grew up in an agricultural environment in and around Leominster in Herefordshire. After graduating from Imperial College, London, the majority of my career has been spent working in international engineering and manufacturing, latterly with several UK-based global businesses. It is through the prism of that experience that I hope to engage with your Lordships’ House. I declare my interest as an employee of GKN plc and a shareholder of Smiths Group plc, both of which derive a small proportion of their sales income from developing countries.

Noble Lords will be aware that the lifeblood of engineering and manufacturing is a long-term commitment to investment. In my business experience, project cycles vary from a matter of years to decades. Often, products come on stream well after the people initiating the project have moved on and ever see the results. The projects of today are built on the decisions of the predecessors, which is what we are considering today.

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I know that the international development world often shrinks from business comparison but for development aims to be met and for the aims to be firmly embedded, the principle is very similar. Project commitment needs to be long term. We have heard many speeches that made that point. The noble Baroness, Lady Chalker, eloquently described the need for a long-term approach. This Bill helps to make that long-termism possible. My colleague from another place, Michael Moore MP, is to be congratulated on shepherding the Bill to this stage. My noble friend Lord Purvis of Tweed also should be congratulated on the eloquent way in which he introduced it here.

Clause 5 mandates independent evaluation and reporting. We have heard many speeches setting out its importance, which I endorse. For international development to have a public writ, its work needs to be seen to be effective, as well as being effective. I agree with my noble friend Lord Shipley that auditing is vital. For audits to be possible, we have to be clear about the purpose of each of the projects, and what we are seeking to achieve. We have work to do on that.

As we have heard, well managed engagement helps to create a healthier and more stable world—a world where target communities are increasingly plugged in internationally and where individuals are more able to live life to the full. As the noble Baroness, Lady Royall, set out, raising living standards may one day raise the capacity of individuals to become consumers of UK products—and there is no shame in us wishing for and acknowledging that. Yet we have also heard that the stakes are much higher, and today the signs of those stakes could not be clearer. The evidence of what happens in political and moral vacuums is obvious to millions of people whose lives are being made a misery by those vacuums. Meanwhile, the threat of an international medical pandemic is also clear and obvious to all of us. These are reasons enough for promoting a long-term commitment to engage in development work.

We often hear that Britain punches above her weight. I would question the sporting wisdom of doing that for too long, but I interpret it as an aspiration that the UK should maintain its international significance. I share that aspiration. Inconsistently, many of those who urge us to keep punching are also seeking to slim down the international development budget and to shrink from many elements of internationalism and global co-operation. I suggest that they are seeking to create a Britain with less weight. If successful, this would reduce our significance. On the other hand, a well planned programme of sustained international development adds to our national gravity, communicates our values, internally and externally, and makes us stronger. I support the Bill.

1.12 pm

Baroness Hooper (Con): My Lords, it is a great pleasure to voice the congratulations and welcome of the whole House on the excellent maiden speech of my noble friend Lord Fox. His background and successful career in industry—and in communications in particular —mean that his contributions to our debates will be practical, well informed and persuasive, as was his speech today. We look forward to hearing from him on many occasions in the future.

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I also wish to associate myself with the tribute paid by my noble friend Lord Fowler to the late Lord Brittan, whom, I, too have known as a contemporary since university days.

I support all that has been said concerning the purpose of the Bill and the need to embed the spending target in law to ensure that the commitment that has been made by this Government will be continued into the long-term future, as my noble friend Lady Chalker explained. I am proud that we are one of the few countries to have complied with the target, and I certainly feel the warm glow that was referred to by the noble Baroness, Lady Flather.

Much has already been said about the importance of development assistance, and examples of projects and success stories in many parts of the world have been quoted. I congratulate the noble Lord, Lord Purvis of Tweed, on his lead and on his splendidly comprehensive introduction. I do not need, therefore, to underline the importance of clean water, emergency food assistance, education, access to financial services or the health benefits brought by this funding and the work of NGOs in the field, save only to highlight the example of the fight against malaria. Deaths of young children in Africa have more than halved since 2000. This work must be sustained.

The economic development and the welfare of developing countries are of prime importance in today’s world of interdependence. Ethical and humanitarian considerations apart, it is plain common sense to try to help people and countries to avoid catastrophe and to build themselves up to be economically, as well as politically, independent.

Of course I acknowledge the need for precautions voiced by my noble friend Lord Tugendhat in particular. Of course there must be good, clear and transparent administration of any fund, but the problem of economic refugees taking dangerous means to transport themselves to developed countries has to be averted. If all European Union countries met the 0.7% target, that would make a huge difference to the countries of, for example, sub-Saharan Africa, and prevent some of the tragedies and loss of life resulting from the attempts made by the poorest of people to reach European shores in order to find jobs and security.

I recognise that the part of the world with which I am most involved—Latin America—is outside the overseas development funding criteria. Most countries are now considered to be middle-income or high-income countries. The noble Lord, Lord Cashman, made some important points about this. I assume that it was as a result of the peer review process. I also recognise that some funding to that region may get through on a multilateral basis via the European Union, the IMF and other agencies.

However, there are still pockets of poverty—others have mentioned this—even in the middle-income and high-income countries. There is an issue over the waste and hardship caused when existing country programmes are terminated—or were terminated in the case of Latin American countries—abruptly. Will the Minister tell us whether any direct funding still goes to any Latin American country? Is any thought being given

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to creating a smoother transitional arrangement for projects in countries that are deemed no longer to require official development assistance?

In general, I hope that the United Kingdom will continue to give a lead in this area and work to persuade other countries in the European Union and, indeed, in the Commonwealth—I think of Canada, Australia, New Zealand and India—to reach the targets. My noble friend Lady Williams of Crosby made some very interesting suggestions in this respect which merit further exploration. The passing of this Bill and the arguments and ideas put forward in today’s debate will, I hope, help to ensure this, and I feel confident that it will have a safe and successful passage through your Lordships’ House.

1.18 pm

Lord Judd (Lab): My Lords, I declare an interest as someone who has worked most of my life outside the confines of Westminster in the spheres which we are discussing today. In particular, I should mention that I am a former director of Oxfam and am currently a trustee of Saferworld. I learnt a great deal from that, and I have very many vivid memories. As I listened to the very significant speech by the noble and right reverend Lord, Lord Williams, I recalled once standing in the middle of a refugee camp in the middle of Mozambique’s terrible civil war. It was only possible to reach it by air because the fighting was too serious all round it. People were coming into that camp having walked for days. I remember one family which days previously had seen their child chopped to death and thrown into their house to be burnt with the house. The indelible memory that I brought from that experience was that they were not asking just for blankets or food. Very early in their time in that centre they were asking for spades, watering cans and the implements necessary to grow their own food.

The thing that we should all remember is that we are not talking about us fulfilling our responsibilities to the world, or what we can give to the world; we are talking about participating to the degree that we should be in the privilege of working with people who, in the face of such adversity, show so much courage and so much determination to build their own lives. It really is a privilege for this nation to be able to support such people, and if the Bill is going to help in that respect it deserves the support of us all.

I have been impressed by the quality of the speeches. The speech by the noble Lord, Lord Purvis, introducing the Bill was outstanding—I think that the noble Lord, Lord Purvis, is a good thing in this House. I would also like to say how glad I was to hear the maiden speech by the noble Lord, Lord Fox, which augurs well for his contributions in future. One of the things that has come out of the debate is that we are concerned not just about quantity but about quality and effectiveness. I was glad to hear my noble friend Lady Royall again give a very committed and—as I always find—effective speech, making it absolutely plain that our support on this side of the House for the Bill and all that it talks about is not rhetorical. It is real.

One of the things which I take great joy from is the very serious work that I know has been going on in the leadership and in many other quarters of my own

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party as to how we should approach this in office. I am glad that we are committed, among our priorities, to reduce inequality, to push action to tackle climate change—which is disproportionately affecting the poor of the world—to support the introduction of universal healthcare across the world, to improve working conditions throughout the world, and to crack down on tax evasion and help developing countries build their own tax collection infrastructure. I would add only that education and building human resources are crucial, so that we can have good-quality public administration based on good education and integrity.

We also want security sector reform, so that security systems in the countries concerned do not alienate people but win their confidence and support so that, together, stability is being built. We also need to put some muscle into our frequent oral commitments to the rule of law and justice across the world, which has been referred to. The rule of law and justice do not come cheaply: if we want to see the rule of law and justice, we have to be prepared to pay for them. That means making sure that the lawyers are there, that the judges are of the necessary integrity—the noble Baroness, Lady Flather, referred to this—and that the facilities for courts to work effectively are there. If not, we just deceive ourselves and frustrate people across the world, and they just see it as a sort of refrain on our part that we must have the rule of law.

The other thing I believe is that we need to strengthen still further the control of the arms trade. This, I think, is crucial, because if I take away one overriding memory of the frustration in my time as director of Oxfam—going back a number of years in my life now—it is that we wanted to get on with sustained, long-term development but, all the time, were being frustrated by conflict. The irresponsible, easy availability of arms across the world is still a disaster.

1.24 pm

Baroness Suttie (LD): My Lords, I, too, congratulate my noble friend Lord Purvis on his truly exemplary speech. I agree with the noble Lord, Lord Judd, that he is indeed a very good thing. I also congratulate my noble friend Lord Fox on his wonderful maiden speech and I look forward very much to working with him in future.

It is a genuine pleasure to speak in a debate in which there has been so much consensus. The journey to this point has been made possible because of the support of all the mainstream parties—the previous Government as well as the current coalition. The NGOs have played an absolutely vital role, as have charities and religious organisations. To have achieved the internationally agreed target of 0.7% is a cause for celebration. As many have also already said, it is a chance for Britain to demonstrate real leadership on the world stage—to fight against poverty, ignorance and disease across our increasingly interconnected world.

However, we cannot be complacent. Our country has a proud history of supporting aid but the case for aid has to be constantly made and refreshed for each new generation, especially at times of economic crisis and global insecurity, when there is a tendency to retreat inwards towards nationalism and insularity.

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We constantly need to restate the case that helping a nation and a people to help themselves, and assisting in the prevention of economic or environmental disasters before they develop into global crises, make sense for all concerned, donor and recipient alike. This is particularly true when it comes to health and disease prevention. In our increasingly globalised world, disease can travel extremely quickly, as we have seen most recently with Ebola but is also the case with less publicised infectious diseases such as TB, particularly multidrug-resistant TB.

Last February, I had the privilege to go in a cross-party delegation to Cambodia with Results UK to look at several projects where British aid has made a significant impact. One particular visit stands out for me: we visited a child vaccination project in a hospital in the outskirts of Phnom Penh, where we saw mothers and grandmothers proudly queuing up with their vaccination passbooks for their children and grandchildren. One grandmother we spoke to said that it was such incredible progress to see several previously fatal infectious diseases—childhood killers—being eradicated from her country.

According to the World Bank, Cambodia has exceeded the millennium development goal poverty target and is now one of the best performers in poverty reduction worldwide. In many ways, Cambodia is a success story for international aid. The country has benefited from assistance from many countries and is now much more self-sufficient. Although the UK bilateral aid programme has now ended, UK funding is still incredibly important through the big global “basket funds” for vaccinations, AIDS, TB and other programmes.

One area where particularly good progress has been made is in the vaccination rate: 10 years ago only 60% of children were being reached by vaccinations in Cambodia; today the coverage has gone up to 95%. The immunisation programme is an example of effective pooling of funds in a global pot. The Global Alliance for Vaccines and Immunization—GAVI—supports the poorest countries with the cost of vaccines. As the economies of the recipient countries improve, they will gradually pay an increasing percentage themselves. The coalition Government are a major supporter of GAVI: DfID has been the largest global contributor during the past five years and I am delighted that this is to be continued for the next five years.

I conclude by restating the case for the Bill. First, it will make aid predictable for recipient countries and so improve the capacity to make intelligent long-term investments. Increasing the predictability of aid will greatly help service providers plan their projects more effectively in both the short and long term. This will allow for effective prioritisation and significantly improve the quality of UK aid. As the noble Lord, Lord McConnell, said so powerfully, the Bill will also help shift the debate from the quantity to the quality of development aid. The focus can therefore shift to the quality of aid investment and how best to get value from it. This should help address a key concern of the public, who ultimately want to see the best value for UK aid.

By passing this Bill, we are a step closer to ensuring that developing countries can reach their full potential and achieve self-reliance in the long term. When Bill Gates

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made his excellent speech to us at the end of last year, he stressed that the ultimate aim of aid had to be the successful transition from recipient status to self-sufficiency. He said that we should aim for a world where nations and individuals are able to chart their own course and attain their own destiny, unburdened by disease or extreme poverty. I believe that this Bill, with strong UK leadership to encourage other nations to follow suit, will help us to achieve this objective.

1.30 pm

Baroness Uddin (Non-Afl): My Lords, I congratulate the noble Lord, Lord Fox, and welcome him to the House. In doing so, perhaps I may take the liberty of expressing my long-standing admiration for the noble Lord, Lord Judd. He, too, has been a very good thing for the House.

I congratulate the noble Lord, Lord Purvis of Tweed, on his impassioned introduction and my noble friend Lady Royall on setting out our historic track record in international development work. I have little to add to the expertise of the noble Lord except to say that I support the Bill becoming law. Legislating will bind the cross-party consensus and set an international benchmark for others to consider.

Whatever the political context of their relationship with the British Government, many developing countries have understood and valued the work of DfID, which has trailblazed in progressing and championing maternal health, reproductive rights, education, clean water, post-conflict reconstruction and increasing women’s economic independence. Of course, that success comes from well established partnerships.

Notwithstanding today’s ever growing uncertainties, British aid has been ever present across the globe, developing with NGOs and Governments alike a vision of a healthy and equitable society. I believe that our persistence has inspired and encouraged other donors. The statistics for success are staggering in many parts of the world. Some excellent examples of DfID’s work are cited in the report produced by the Africa All-Party Parliamentary Group, Democracy Soup. I was able to make a small contribution alongside other notable Members of this House to the evidence-gathering and to several round-table discussions with parliamentarians and experts working in the field in Africa. I also had the privilege of working with DfID alongside the NGO sector post-Cyclone Sidr in Bangladesh, where hundreds of thousands of people lost everything to nature. DfID responded to the humanitarian catastrophe, working alongside Save the Children, Christian Aid, Oxfam, Islamic Relief and Muslim Aid. In both those instances, the respect with which the presence of DfID is held in developing countries was evident.

I draw your Lordships’ attention to two specific aspects of DfID’s work: first, the continued commitment of the British Government to the people of Palestine through DfID, which has exceeded £350 million during the past five years, must be commended. It remains one of the largest donors in support of Gaza—as mothers and children begin their journey towards survival—since the brutal assault by the Israeli forces last summer. Here, DfID alone cannot begin to

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compensate for the loss of livelihood and damage inflicted to infrastructure. I hope that our ongoing financial commitments and expertise will encourage other donors speedily to give attention to this critical situation.

Secondly, I agree with other noble Lords that surely the best work of DfID is its commitment to the advancement of the economic independence of women—I refer in particular to preventing sexual violence across the globe. Such commitment is rooted as an integral part of its value. It has been ongoing over decades, ably picked up and led by the former Foreign Secretary. The Minister will be aware of my long-standing campaign for justice for women in Bangladesh who were raped as a weapon of war in the war of independence. Survivors have since languished over decades, neglected by all parts of society, including their families. However, due to the campaign of the NGOs, the leadership of our Foreign Secretary and the work of some British Bangladeshi women campaigners, the remaining survivors have finally been given national recognition and the status of freedom fighters. This is massively significant, not least for the women survivors, many of whom have endured decades of punishment for crimes that others perpetrated on their bodies and well-being. Will the Minister take this opportunity to congratulate the women campaigners and the Bangladeshi Government on not only being one of the 130 signatories but also issuing directives to provide monthly allowances for all remaining survivors throughout their lives? Does she agree that this is a model of good practice for other countries to follow if we are to begin reparations for those women who survive rape in conflict?

Today’s historic step in legislating our financial commitment has strong roots, emanating from the noble Baronesses, Lady Chalker and Lady Amos, Clare Short and Andrew Mitchell. It is now in the capable hands of Justine Greening. I salute their work and that of the DfID teams across the world in supporting this Bill.

1.35 pm

Baroness Barker (LD): My Lords, to be speaker No. 33 on a day such as this, when we have had the privilege of listening to so many outstanding speeches, is a tough call. It would be invidious to highlight too many individual speeches, but I pay tribute to my noble friend Lord Purvis of Tweed for the way in which he introduced the debate and to my noble friend Lord Fox. Making a maiden speech in a Chamber full of noble Lords as knowledgeable as your Lordships is never easy and I thought he carried that off with great aplomb.

I return to the one speech from today that really went to the heart of our debate: the speech of the noble Lord, Lord Lipsey. It will horrify the noble Lord that, not for the first time, he and I have been thinking upon the same lines. He posed the question, “Why put this target into law?”, and drew the analogy with our domestic commitments to health and social care in spending on the NHS. I had been thinking upon exactly the same lines. He is right in his analogy. If one goes back and looks at the debates held in another place, some of those speeches might seem

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slightly reckless. They were full of the rather populist statement, “Why should we put international aid spending into law? Why not put a percentage into defence spending?”. It is exactly the same argument.

International aid is a very difficult and complex subject to explain domestically. It deals with issues that are largely endemic and have often been considered intractable in countries that are far away, issues which often disproportionately affect those parts of the population most demonised and marginalised. The mechanisms for resolving those issues are really complex. It is a Sun headline-writer’s dream. That is the very reason we should be bold and say we are willing to make this commitment today. We know and understand that the issues with which we are dealing are international issues.

As noble Lords know, I come from a health background. Public health is now an international matter. Tackling HIV and AIDS, malaria and resistance to TB and antibiotics can no longer be done on a country-by-country basis. The noble Lord, Lord Fowler, and I attended a dinner a few weeks ago where a British research scientist, whose work is underpinned by international aid, sat and told us without any hesitation whatever that we will not conquer these diseases unless we do research in those countries abroad. The funding for that research will not come entirely from the private sector. It will come from partnerships between Governments, international funds and the private sector. We have a record in the past 10 to 15 years of driving the efficiency and effectiveness of those bodies in furthering that research—a record of which we should be proud, but for which we get very little recognition.

Another point has been made which has not yet been answered. It has been asked whether we will tie the hands of future Governments. No, we will not, but we will require of a future Government that, if they wish to overturn this legislation, they will have to make their case in a manifesto and come to Parliament to explain it, just as we have been putting forward our case today. I think that that would be no bad thing. As other speakers have alluded to, in times of austerity it is extremely easy to become very narrowly focused and to make very cheap and obvious points. This is a hard sell for an investment which is difficult and may take many years to come to fruition, but it is an investment which matters as much to the generation of people whom I care about in this country—the young people whom I know and meet every day—as it does to those most marginalised people in some of the poorest countries on earth.

What we are doing today is not popular—it is certainly not populist—but it is the wise and right thing to do, and we should do it without delay.

1.41 pm

Lord Collins of Highbury (Lab): My Lords, I, too, congratulate the noble Lord, Lord Purvis, on bringing forward the Bill, and Michael Moore on introducing it in the other place. It is vital that we debate these issues and have a full and frank exchange of opinions. As the noble Baroness, Lady Jenkin, and my noble friends said, it is worth remembering that the provisions of

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the Bill featured in all three party manifestos and in the coalition agreement. All sides of this House passionately support the legislation. I also welcome the noble Lord, Lord Fox, to the House and congratulate him on his excellent maiden speech, which made the points that are at the heart of the matter.

For many here today, the Bill marks a point in a journey that can be traced back through the establishment of the Department for International Development by the incoming Labour government in 1997 and the adoption of the target by the Government back in 1974. It is a long journey, as many noble Lords have pointed out. I congratulate my noble friend Lord Judd on being on that journey all the way. He has been a fantastic advocate for the past 45 years.

As we have heard, the Bill will be a catalyst to action by other countries as, this year, the world agrees the sustainable development goals and how we can end global poverty over the next 15 years. For me, development is about tackling the imbalance of power—politically, economically and socially. Labour’s vision for development tackles that imbalance by expanding freedoms as well as signing cheques, measuring success by the change that we make, not the cash that we put in.

Too often, people say that there is a choice between the interests of rich countries and of those in the developing world, but improving tax fairness benefits both the developed and the developing world. All of us, rich or poor, will be affected by climate change. It might seem that the powerful and the powerless live in different worlds, but it is one planet and we need to change how it is run. Our global contract with the developing countries needs to reflect that.

As many noble Lords have said in this debate, passing the Bill means that the question becomes less about how much we spend and more about how we spend it. As the noble Lord, Lord Shipley, highlighted, it is right to ask whether a larger development budget can be delivered by an ever smaller department. There are real worries that, in a bid to cut costs, the department has kept the bureaucracy but is losing some expertise and, with that, the ability to lead.

Your Lordships’ Economic Affairs Committee questioned the effectiveness of the target, saying that,

“the speed of the planned increase risks reducing the quality, value for money and accountability of the aid programme”,

as we have heard in this debate. I do not see the primary point of DfID as simply distributing aid; rather, it is to help to change the world by redistributing power, as my noble friend Lord Judd said. As the aid budget rises, so must our ability to control it. That is why Labour strongly supports the Independent Commission for Aid Impact. Value for money should mean maximising the impact that we make. When a budget as important as this is ring-fenced, there is a fiscal responsibility and a moral duty to deliver as much change as possible for the money that we invest, and the sort of value for money is crucial.

As my noble friend Lady Kinnock said, aid and development work; development changes and saves lives. Life expectancy is rising while preventable deaths are falling. More children are in school while fewer mothers die in childbirth. Literacy is storming ahead

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while polio is mostly in retreat. This is all in part because of aid and international development efforts across the world.

As, again, we have heard in this debate, development is also in Britain’s best interests. Britain invests in development to prevent extreme poverty, climate change and conflict. Retreating from that responsibility one way or another will still carry a cost, as the noble Lord, Lord Steel, said. The way to eliminate that cost is to tackle it at source. The UK would be immeasurably better off growing and trading with a strong global economy, with a sustainable climate, supportive Governments and secure borders. That is what British development helps to achieve. Tackling the big global issues can save us billions in the future.

I strongly agree with the sentiments of the noble Baroness, Lady Jenkin: I do not believe that this House should impede the progress of the Bill by further amendment. There is an opportunity for us to put this on the statute book, and we should not miss it. This is a very small Bill on just a few sheets of paper. It will save hundreds of thousands of lives of people that we will never meet and whose names we will never know. In years to come, we will look back with a real sense of pride on what we are achieving together today.

1.48 pm

The Parliamentary Under-Secretary of State, Department for International Development (Baroness Northover) (LD): My Lords, on behalf of DfID and the Government, I am delighted to speak in support of the Private Member’s Bill sponsored by my noble friend Lord Purvis. As the noble Lord, Lord McColl, put it, he introduced it with a passionate, comprehensive and evidence-based speech. I pay tribute to my right honourable friend Michael Moore for having the vision, grasp and commitment to introduce and then pilot this vital Bill through the other place. I also pay tribute to all those who have supported the Bill there and here, and for the cross-party agreement here.

I pay tribute to those who have helped to develop the UK’s outstanding record in development, including the right honourable Clare Short and my noble friend Lady Chalker, whose speech showed her long and deep commitment to this area and her understanding of how underpinning economic growth brings the relief of poverty. I thank the noble Lord, Lord Collins, and the noble Baroness, Lady Royall, for pledging the Opposition’s support for the Bill, which is exceedingly welcome.

As other noble Lords have, I pay tribute to the NGOs for doing all that they have to explain, from their own work, why the Bill and the commitment of better-off countries is so important. It is transformational to those in extreme poverty and at the very margins of life around the world. I also pay tribute to DfID staff working in-country—for example, those on rolling shifts in Sierra Leone and those currently locked down in the DRC—and to others from the United Kingdom whose work in humanitarian crises or in longer-term development is so important.

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To hear praise from my noble friend Lady Tonge as she crows, as she put it, particularly warms my heart as we do not always please her. I also note the pride expressed by the noble Baroness, Lady Flather, and she is right.

I am delighted to be part of the United Kingdom Government who have, for the first time, met the 0.7% target of GNI going to support worldwide development. I thank noble Lords for their tributes to that and, from the Government Front Bench, I make it crystal clear that we support the Bill, which will enshrine this commitment in legislation. This was in the coalition agreement and I am delighted that we are so close to ensuring that the legislation is agreed.

Lord Davies of Stamford: Is the Minister going to be able, in the course of her remarks, to respond to my question: why did the Government, who are so evidently in support of this measure, do nothing about it for nearly five years? Even now, it has not been brought forward as a government Bill although the Government appear to be in the process of taking credit for it.

Baroness Northover: I have in my notes an answer to the noble Lord, which was slightly lower down in what I was seeking to address. He said that he was mystified as to why we were dealing with this now. What occurred to me was that I was somewhat mystified that the previous Government had not legislated for this, despite their commitment. What we should welcome—and that is true across this House—is that we have finally ensured that we have met that 0.7% commitment, and that we are now seeking to legislate. That is the important thing and I welcome the cross-party support for it.

The House of Commons has passed the Bill overwhelmingly and handed it to us. It is now our responsibility to help ensure that my noble friend Lord Purvis is able to carry this through and into law. We have heard outstanding and compelling speeches and even those who feel that this is not the right move—

Lord Tugendhat: I take the Minister’s point about the responsibility to carry it forward into law, if that is what the majority want. However, I hope she will agree that this is an amending and revising House, and that there is a duty to seek to amend and improve Bills, regardless of where they are. I think back to the debate we had some months ago on the referendum Bill where many noble Lords opposite, whom I supported, argued that just because such a Bill had a majority in the Commons that was no reason not to try to improve it in the Lords. The same applies on this occasion.

Baroness Northover: I will be coming on to that in a while. Perhaps the noble Lord will be satisfied to wait a little for that.

As I have said, we have heard outstanding and compelling speeches which have recognised that aid is transformational. It is also interesting to note that even those who do not feel that this is the right move are committed in terms of aid, which of course is important. The noble Lord, Lord Lipsey, is an economist and not one to misuse statistics, but he expressed

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more than 90% agreement to what we are doing in terms of aid. I for one will bank that. I knew that we would have a powerful debate on this Bill, that noble Lords would speak from huge experience, and that we would take a far-reaching international perspective.

We know only too well that no man is an island—I might feminise that. As my noble friend Lord Purvis made clear, the first point to make is the moral case, and many noble Lords have made that case. Indeed, it was made with particular power by the right reverend Prelate the Bishop of Derby and—not least through his presence here—the former Archbishop of Canterbury the noble and right reverend Lord, Lord Williams of Oystermouth. I welcome his engagement, and we are pleased to see them involved today. My noble friend Lord Steel quoted strong passages from two global religions as to why we must do this. We heard my noble friend Lord Chidgey’s moving account from Juba, as well as those from the noble Lord, Lord Judd, and others. They all made the moral case exceptionally clear.

As noble Lords also laid out, we recognise our interests and how we are all interlinked. We can see that a weak health system in Sierra Leone, seemingly a distant place, results in an epidemic taking hold on an unprecedented scale. Even in Britain we have felt the effects of that. International development is not an optional extra or an afterthought; it is vital. Investing now to help the poorest can and will prevent some of the terrible situations we see today from happening tomorrow and affecting us. I was especially struck by the powerful speech of the noble Lord, Lord McConnell, about what might have happened had this measure been implemented 40 or 45 years ago. The noble Baroness, Lady Royall, quoted Nelson Mandela saying that:

“Poverty is not an accident”,

while my noble friend Lady Manzoor talked about tackling poverty.

The 2004 report of the UN High-Level Panel on Threats, Challenges and Change, of which our colleague the noble Lord, Lord Hannay, was a leading member, noted the interconnectedness of our world. That was a very important conclusion for the panel to come to. I shall quote from the report:

“Development and security are inextricably linked. A more secure world is only possible if poor countries are given a real chance to develop. Extreme poverty and infectious diseases threaten many people directly, but they also provide a fertile breeding-ground for other threats, including civil conflict. Even people in rich countries will be more secure if their Governments help poor countries to defeat poverty and disease by meeting the Millennium Development Goals”.

Quite so, and that underpins the powerful speech of my noble friend Lady Falkner about what other countries should be doing. It is excellent that at least we are taking the lead in this.

One of the most important principles of effective development is to ensure continuity. It is no use moving into a development programme one year and abandoning it the next. Continuity and certainty of programmes over a number of years are essential to securing good development outcomes. That is why we have committed to budgets over four years and why a Bill such as this, which commits us to spending 0.7% of our national

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income, is so important. There is otherwise the risk that the international development budget will fluctuate and fail to provide our partners with certainty when they need to make critical investments in health and education. I can recall, as no doubt can other noble Lords, when Ireland was delighted to make the commitment that it would reach an aid budget of 0.7% by 2007. I remember that that happened after an internal struggle. I also recall, with great disappointment, how quickly it moved away from that—and it is not yet achieved. Neither, prior to 2013, did we in the United Kingdom achieve it.

There is voter pressure in the United Kingdom for other budgets; for example, for the Department of Health, the Department for Education, and the DWP. Their budgets are very large, as my noble friend Lady Barker pointed out, and they are, largely, predictable. That has never been the case for overseas aid. The pressures are very clear as regards that budget, yet we seek to support similar projects: for example, getting girls into and through schools, and establishing and maintaining clinics, as the noble Baroness, Lady Tonge, rightly demanded of us.

I hope that the noble Lord, Lord Tugendhat, recognises that need for predictability. I am sure that he supports our long-term financial commitment to the EU—would it not be easy to push that budget back and forth?—yet we grant to the EU according to our legal obligation, and we are right to do so. The EU can then plan and budget. This is no different. The conflict across borders—

Lord Tugendhat: It is totally different. The problem that I—and I think other members of the committee—have is that while we are fully supportive of aid and made that quite clear, we also made it clear that we are worried, as are others, about the way in which money is spent. We are dealing with multiyear programmes. With such programmes, you will run into a lot of trouble if you have to spend on what is called—since the noble Baroness invokes Europe—the douzième provisoire: that is, if you have to spend one-12th on an annual basis instead of spreading it over the commitment. In the case of the EU, there is a formula by which the member states are assessed, and we pay according to that formula. However, it is not linked to projects. The problem here is that you have a multiyear project and you are saying that a given amount has to be spent each year. The Minister may or may not agree with me, but she is invoking a false parallel.

Baroness Northover: Having been a Minister in the Department for International Development, I know that there is obviously flexibility in the department, because humanitarian conflicts will arise, which you have to put money into, while you also sustain support for various other projects. The noble Lord might read the NAO report; one of the things that struck me when I read it was that every department in government has to budget, and they know more or less what their budgets will be. There may be contingencies, and they may have a contingency fund, but they have to plan. It is not just left to what they may decide to do after six months or so.

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The situation is no different in DfID. I assure the noble Lord that if he reads the NAO report very carefully he will see that it concludes that business was properly stress-tested and assessed. I think I should proceed, because I am now on 14 minutes, and I will come on to some of these other points. I will also be happy to meet the noble Lord after this debate, if that would help, so that we can explore some of those issues.

Noble Lords will be fully aware of the kind of projects that DfID is involved in; during this debate noble Lords have very helpfully outlined a number of these areas. A number of noble Lords emphasised in particular our support for women and girls and how right this is, including my noble friends Lady Hodgson, Lady Jenkin, Lady Manzoor, and the noble Baronesses, Lady Kinnock and Lady Flather. We fully recognise the importance of supporting women and girls and thank noble Lords for supporting us in doing that. In addition, as part of that, the emphasis on maternal health and family planning was mentioned by the noble Lord, Lord Watson, as well as by the noble Baronesses, Lady Tonge and Lady Flather.

Mention was made of women giving birth on a concrete slab. Today is my eldest son’s birthday. This morning I found myself thinking that, had I given birth in a developing country, he would have died and so would I. Noble Lords who think about it will probably recognise that either they or their close family might very well have been in that situation. As has been said, poverty is not an accident. It is not something that certain groups need to suffer from or should suffer from.

Noble Lords have made mention of our commitment of 0.7%, and some have suggested that the increase has not improved the quality of that spend. I assure them that the Development Assistance Committee of the OECD concluded recently in its formal peer review of DfID on the effectiveness of the way in which we have scaled up our spending in recent years, planning carefully to meet the target—and I have seen that this is very much the case—while at the same time increasing the quality of our spend. As noble Lords were speaking, I found myself thinking about the commitment that we have been able to make, for example, on so-called neglected tropical diseases. We hope that they are no longer neglected, so we can combat blindness, which is totally avoidable—something that we were able to do because of the increase in the budget.

In response to the noble Baroness, Lady Tonge, of course there are many lessons to learn from Sierra Leone. This was an unprecedented crisis. We have done a huge amount, as was noted during the debate, to ensure that it did not become a pandemic. She will know the details of our support there.

Baroness Tonge: Could the Minister perhaps expand a little bit on that matter? We would learn a lot if there was a proper inquiry into what happened in Sierra Leone in the years running up to the epidemic.

Baroness Northover: I am really running out of time, and I think that we have another Question down on that matter. We can certainly discuss it, and we will learn a lot of lessons from what has happened.

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Noble Lords are very concerned that what we do is carefully audited. That is where Clause 5 is very important, and the independent evaluation that we put in place in 2010 from ICAI is extremely helpful. Of course, we will keep that under close watch to make sure that aid is effectively spent.

The noble Lords, Lord Lipsey and Lord Tugendhat, mentioned the House of Lords Select Committee on Economic Affairs report of 2012, which the noble Lord, Lord Lipsey, urged noble Lords to read. I also urge them to read the debate in your Lordships’ House on 22 October 2012 on that report and, in particular, the outstanding contribution by another economist, the noble Lord, Lord Stern, professor of economics and government at the LSE. He made an extremely cogent case.

My noble friend Lord Astor asked about the calendar year versus the financial year. We are monitored internationally on the calendar year, not the financial year, and we wish to be consistent with international best practice, which is why we will continue to report in that way.

The noble Lord, Lord Tugendhat, rightly encouraged us to place more investment in developing countries. We recognise the important role that the private sector plays in development, but he will recognise that it is not necessarily targeted at countries that most need it. It is true that that and remittances are playing a very important part, and that kind of investment is clearly key in lifting China and India out of poverty. However, that still leaves many people in poverty, which is why we are involved with so many multilateral organisations. For example, my noble friend Lady Hooper mentioned Latin America and the noble Lord, Lord Cashman, mentioned South Africa. Our involvement with the Global Fund and the World Bank helps to address poverty in those countries. We have to try to ensure that we have a more equitable society globally. Relying on foreign direct investment and remittances does not necessarily achieve that.

My noble friend Lord Astor wondered whether this was just about DfID’s spending. It is not; it is about official development assistance. Most of it is spent by DfID but other departments, such as the Foreign Office, the MoD and the Department of Energy and Climate Change rightly also have ODA budgets. I say to my noble friend Lord Shipley that ODA restraints mean that you cannot spend the money on arms. He is quite right: that would not be an acceptable route to go down. I can write to my noble colleague Lady Tonge about Addis.

I have mentioned the National Audit Office report. I suggest that noble Lords take a very close look at that. As regards those who are concerned about the money that was spent at the end of 2013, I point out that we had the Syrian crisis, with many more displaced people facing a winter in Syria. There was a lot of pressure from your Lordships that we should commit spending to that. We also had Typhoon Haiyan, which cannot be put down to DfID suddenly deciding to do something, and my noble friend Lord Fowler rightly chivvied me endlessly to support the Global Fund, which he and the noble Lord, Lord Chidgey, emphasised the significance of in terms of dealing with AIDS,

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TB and malaria. All departments work to a budget. DfID knew that its budget was increasing and, fortunately, we were able to increase our commitment in some very important areas.

My noble friend Lady Williams rightly emphasised the involvement of young people. As my noble friend Lady Jenkin said, it is fantastic that people involved in the ONE Campaign are present in the Gallery. I pay tribute to my noble friend Lord Fox. I obviously did the right thing in supporting him when he was introduced in the House and look forward to his further contributions.

As noble Lords have said, and as my noble friends Lord Purvis and Lady Suttie emphasised, passing this Bill means that we can move on from the debate on whether we do this to how we do it, and ensuring the quality, predictability and effectiveness of our absolutely vital aid. I hope that noble Lords will give the Bill a Second Reading. Given that this is a simple and effective Bill, which has been carefully scrutinised and amended in the Commons, I hope that it will proceed through all its stages formally and by acclamation. However, if that is not the case, I am sure that noble Lords will engage fully in scrutinising the Bill and, most importantly, making sure that we pass it for all the reasons that they have laid out.

2.12 pm

Lord Purvis of Tweed: My Lords, I am most grateful to all those who have taken part in the debate for their exceptionally well informed, constructive and, at times, moving contributions. I am delighted to receive the support of my noble friend the Minister in this House. The Minister of State, who was present in the House, has offered support in another place. This debate lacked the flowery language that he used in Committee in the Commons. Nevertheless, this is an important debate and I would like briefly to pull together some of the broad areas where I think there has been genuine consensus.

The noble Baroness, Lady Royall of Blaisdon, rightly established the framework for the debate in citing the EU’s designation of 2015 as a year for development, and by recognising that, given that we have reached the target in the United Kingdom, our efforts are now focused on what we do with our partners going forward.

I know it is the practice to reserve the term “noble friend” for those on our own side of the House. However, my noble friend Lord McConnell of Glenscorrodale made a very important remark when he said that this is about not just commitment but also scale because you make a difference by having the scale and the ability. I pay tribute to the work that he did as First Minister of Scotland in bringing this agenda, and particularly support for Malawi, on to the radar of the Scottish Parliament.

I think that most of us—if I may be bold enough to speak for colleagues at this stage—were touched by the contribution of the noble Baroness, Lady Chalker of Wallasey. She reflected on both her frustration and perhaps her regret at having to turn down opportunities because there was no clarity surrounding the future budget. That illustrated more than anything else in this debate why this approach is justified.

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My noble friend Lord Chidgey, supported by the noble Baroness, Lady Kinnock, and others, highlighted that many of these areas are difficult because of the circumstances in which we provide this support. They are often in conflict areas and in areas where there is either local corruption or poor governance. That was reinforced most strongly by the noble and right reverend Lord, Lord Williams of Oystermouth, who highlighted that best governance standards are the foundation upon which support can deliver improvements. I agree strongly with the noble Lord, Lord Watson of Invergowrie, and the noble Baroness, Lady Jenkin, in their support for DfID staff. It is worth highlighting that many of them are in East Kilbride. We come down from Scotland each week but a lot of the staff are there. Of course, they are not only in East Kilbride; many, as the Minister said, work in the field.

The noble Lords, Lord Lipsey and Lord Tugendhat, the noble Viscount, Lord Astor, and, to a certain extent, the noble Lord, Lord Davies, highlighted some of the issues that formed a substantive part of the debate. The noble Earl, Lord Sandwich, addressed these points clearly. The noble Lord, Lord Anderson of Swansea, my noble friend Lord Shipley and the noble Baronesses, Lady Flather and Lady Hodgson, all highlighted the fact that significant progress has been made since the EAC report of 2012. There is now much clearer and more consistent reporting and evaluation by DfID, by the Treasury in relation to clarity over budget practice and by the ONS in relation to classifying GNI, with better co-operation between the three.

Michael Moore and I see the Bill not as denying that there are complexities in the budgeting but as an opportunity. If we can resolve these complexities through best practice—we are starting to see that now, as the Minister said and as the National Audit Office has recognised—that will be an opportunity for us to show other major economies with complex budgets how this can be achieved. If we say that we cannot achieve it, what signal will we be sending to those other major G7 economies? We will be saying that it is impossible to do. A stronger signal would be to pass the Bill unamended and to work with DfID, the ONS and others through the aegis of the International Development Committee in another place, informed by ICAI, which is now starting to do globally respected work. I am not simply asking noble Lords to take my word for it as the sponsor of the Bill. The peer review by the OECD looked at all these aspects. It showed areas where it would like to see progress but it also recognised that we have the right model.

I am conscious of the time. Everyone has said what needs to be said. My noble friend Lady Williams highlighted one important area. She asked whether we have developed partnership working, encouraging other countries to become allies, thus adding to the strength of our work.

My noble friend Lord Steel of Aikwood said that there must be something in the Borders air, with Michael Moore and I being associated with this Bill. Perhaps the political air has been infused with his principles and standards over the past 50 years in this area. We are proud to be associated not only with the Bill but with his work.

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I am conscious that I have not mentioned all noble Lords who have taken part in the debate—in particular, my noble friend Lord Fox, who made his maiden speech. We were not spared his imagination, nor his commitment to this area. He highlighted that economic and social development are not mutually exclusive, and that the practices of both can secure great success. I am also grateful for the support of my noble friend Lady Suttie. However, as a relatively new Member and a relative baby in this House, I suspect that the support given by the noble Lord, Lord Judd, and my noble friend Lady Suttie has damned me with faint praise.

I am 40 years old. The target for the 0.7% set by the UN in 1970 was for it to be reached in the year in which I was born. We have now reached it. We should never go back to the debate about whether we will reach it but should now focus our minds on how best we spend our support for those in the world who most need it. I therefore hope that the House will give the Bill a Second Reading.

Bill read a second time and committed to a Committee of the Whole House.

Medical Innovation Bill [HL]

Medical Innovation Bill [HL] Third Reading [Lord Saatchi]

Third Reading

2.20 pm

Clause 1: Responsible innovation

Amendment 1

Moved by Lord Winston

1: Clause 1, page 1, line 10, at end insert “(for the purpose of ensuring that the proposed treatment would command the respect of a representative body of responsible medical opinion, having regard to the needs of patient safety).”

Lord Winston (Lab): My Lords, I shall not detain the House for great length. The amendment in my name and that of the noble Lord, Lord Saatchi, addresses patient safety, an issue which is dear to this Government. One of the concerns expressed again and again throughout the Second Reading and Committee stages of this Bill, and subsequently, has been that some patients might in desperation, for various reasons, seek treatment which is innovative but not properly regulated or properly justified. Particularly in the private sector, patients might be tempted to go into treatments which seem attractive but perhaps are overadvertised as sensible. In the end, they may be more futile than more recognised treatments that may carry known side-effects or perhaps be more frightening. I think that that is the case for cancer in particular.

This amendment is designed to make sure that any treatment given under this Bill would get broad support from responsible medical practitioners. There would be an onus, not only on the person doing the treatment, but on the person responsible for advising that the treatment was reasonable to the operator, the medical practitioner concerned. This would fall within that area.

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Essentially, there would be a legal onus, a responsibility, for that adviser to give advice which was regarded as serious and acceptable to a broad body of medical opinion in that field. That is the essence of this amendment, which we have discussed.

I am delighted that the noble Lord, Lord Saatchi, has agreed to put his name to this amendment. It is helpful. I hope that it will not prevent people participating in trials, particularly in cancer medicine. I also hope that it will make sure that private medicine is carried out responsibly. We all have reservations about this Bill but it covers most of the issues about which we have been concerned. I am concerned about reproductive medicine because I fear that that is now in a burgeoning private area. It worries me still that quite a lot of reproductive medicine done in the private sector is not properly validated and that patients are paying very heavily for it. Beyond that, broadly speaking, this is the amendment that I would like to see on the statute book. I therefore beg to move.

Baroness Gardner of Parkes (Con): My Lords, I am slightly concerned about the wording of the amendment because I would not want it to become a way of dragging things on forever. How do you decide what is,

“a representative body of responsible medical opinion”?

To lay people such as myself, there seem to be heaps of medical bodies and I wonder how that would be determined. I would be interested to be satisfied on those points. The speech of the noble Lord, Lord Winston, was clear that he does not intend the amendment to represent any of those matters, but I would like someone who is more of an expert on the wording of these things to assure me that it would not be only a preventative technique.

Baroness Masham of Ilton (CB): My Lords, having tabled an amendment to the Bill on patient safety, I am happy to support the amendment.

Lord Kakkar (CB): My Lords, I declare my interest as professor of surgery at University College London and as a member of the General Medical Council, although I do not speak for the council in this Chamber.

I thank the noble Lords, Lord Winston and Lord Saatchi, for having tabled this important amendment. It goes to the heart of good medical practice, of course, always to innovate—but always to innovate, first and foremost, with absolute regard to patient safety. The fact that the amendment will now appear in the Bill will provide absolute clarity on what is required to discharge that patient safety responsibility with regard to innovation, as described in the Bill, which is vitally important. I strongly support the amendment. Once again I thank the noble Lord, Lord Winston, for his contributions in the passage of the Bill and, in particular, for tabling this important amendment.

Lord Pannick (CB): My Lords, I, too, welcome the amendment. It will further emphasise that, in order to be lawful, medical innovation must be responsible. The criterion of responsibility has been the essence of

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the law on this subject since the judgment of Mr Justice McNair in the Bolam case in 1957, when he said that a doctor,

“is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art”.

That may provide some reassurance to the noble Baroness, Lady Gardner of Parkes, that the courts will easily understand what is involved in the amendment.

The amendment will reassure many of those concerned about patient safety. The words will further confirm what I understood to be the Minister’s statement in Committee that the Bill is not intended to alter the substance of the Bolam test but to provide a practical means by which innovative doctors can take steps in advance of carrying out the treatment.

Like the noble Lord, Lord Winston, I am less confident than the noble Lord, Lord Saatchi, that this Bill will have much, if any, beneficial effect. I am doubtful that the fear of litigation deters responsible innovation, but I have been reassured by the amendments that the Bill will certainly do no harm. I thank the noble Lord, Lord Saatchi, for the responsible manner in which he has responded to concerns about the Bill by welcoming amendments of this sort. I also thank Mr Daniel Greenberg, a former parliamentary draftsman, now an expert consultant, for the assistance that he has provided to many noble Lords, including myself, on the issues raised.

Lord Dykes (LD): I hope my memory is not at fault when I recall that I have attended all the previous stages of this Bill but deliberately not spoken because I preferred as a lay man to listen to what the medical experts were saying. We have had considerable testimony from them in the previous stages which has helped us make progress. I thank the noble Lord, Lord Saatchi, again. I know it has been done before but it is important to record our thanks for his introduction of this extremely interesting legislation, which will be very useful and important to humanity in the future—although it is difficult at this early stage to tell exactly how it will develop and the noble Lord, Lord Pannick, is right in expressing certain reservations about it.

We all have experience of the sufferings of friends and families in cancer cases and the Bill, not only in a moving way but in a scientifically respectable way, makes progress in widening the ability of medical experts, operating under the strict safeguards that have been agreed in the previous stages, to make sure that people can be helped more than the already marvellous help that doctors give within the existing framework. I am glad to support the amendment.

2.30 pm

Lord Hunt of Kings Heath (Lab): My Lords, I, too, welcome the amendment and thank my noble friend for his efforts. I also thank the noble Lord, Lord Saatchi, for the way in which he has been prepared to listen and to support amendments which we see as improving the Bill. This amendment goes a long way to meeting some of the concerns expressed by medical bodies about what might be described as unintended consequences arising from the Bill.

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I do not agree with the noble Baroness, Lady Gardner, that this amendment could be seen as delaying action. I think it is rather the reverse. Having this provision and the need to act within it would give confidence to doctors. I think the definition of,

“a representative body of respectable medical opinion”,

is a question of you know what it is when you see it. I would have thought that doctors would have no doubts about to which responsible body they should turn.

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con): My Lords, my interpretation of the amendment moved by the noble Lord, Lord Winston, is that it aims to ensure that in obtaining the views of one or more appropriately qualified doctors, a doctor is carrying out a test equivalent to the Bolam test. I recognise that these words are carefully chosen, and I listened closely to what the noble Lord, Lord Winston, said. However, I do not believe that the language of the amendment accurately reflects the requirement of the Bolam test.

To go a bit further, I am concerned that the amendment would create more confusion than clarity for both doctors and the courts. In particular, how would a court determine what is meant by the phrase “command the respect of”? It certainly does not mean agreement. If Noble Lords want an illustration of the difference, I deeply respect the noble Lord, Lord Winston, but, as in this case, I do not always agree with him.

Like my noble friend Lady Gardner, I question what might count as,

“a representative body of responsible medical opinion”.

Again, this wording is not in the Bolam test. The Bolam test sets out that a doctor is not negligent if their decision is accepted as proper by a responsible body of medical opinion. Bolam accepts that a doctor is not negligent merely because there is a body that would take a contrary view. Therefore, the courts recognise that there is not necessarily a representative body of medical opinion. The wording of the amendment would be open to interpretation by the courts.

I recognise that the noble Lord’s aim in tabling this amendment is thoroughly worthy and is to ensure the protection of patients. I assure him that the existing provisions in the Bill seek to achieve that same aim. Therefore, the Government do not consider the amendment moved by the noble Lord, Lord Winston, necessary. The Bill’s provisions boil down to one key test: a test of responsibility. Clause 1(2) states:

“It is not negligent for a doctor to depart from the existing range of accepted medical treatments for a condition if the decision to do so is taken responsibly”.

This objective test of responsibility ensures that the decision about whether a doctor has been negligent is based on the same premise as the existing Bolam test: has this doctor acted responsibly? Patient safety is an integral part of this test. Clause 1(3) makes clear that the risks of any innovative treatment must be considered, so if the treatment was likely to compromise patient safety unacceptably, it is highly unlikely that it would be considered a responsible decision when later judged in court. Furthermore, the Bill does not require doctors simply to obtain the views of experts in the field; it requires a doctor to take full account of those views in

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a responsible way. As such, a doctor could not simply listen to, or note, the views of colleagues and then proceed to disregard those with which he or she disagrees. A doctor can fully expect a court to scrutinise closely how they have taken account of those views and consider whether they had acted on the views in a responsible way.

It is that requirement which ensures that the Bill is the nearest equivalent to that of the Bolam test. I fear that the amendment of the noble Lord, Lord Winston, despite its best intentions, would not add to the operative provisions of the Bill but would only risk creating confusion as to the language of the existing Bolam test. It is not just that the Government consider this amendment unnecessary—which we do—but that we also have serious concerns about whether the language of the amendment will create confusion for doctors and, indeed, the courts.

Lord Saatchi (Con): I thank noble Lords who have addressed this amendment. I happily added my name to the amendment of the noble Lord, Lord Winston, because I believe that it provides helpful additional clarity for Peers and those outside the House about the intention and effect of the Bill.

Your Lordships will be aware that on a number of occasions I have tried to stress that the intention and effect of Clauses 1(3)(a) and (b) are not, as my noble friend was just saying, that a doctor can just ignore the views of anyone who disagrees with the proposed treatment or that he or she can choose to consult only those who are known to agree. I agree with my noble friend that Clause 1(3)(a) and (b) contain a legal duty to obtain views and take proper account of them, and that that is a serious and effective threshold. However, I wonder whether I may encourage my noble friend to share with me the observation that a number of noble Lords, including the noble Lords, Lord Winston and Lord Turnberg, were anxious to see this set out more expressly in the Bill in language that at least resembles, if not copies completely, the wording of the Bolam test, as described by the noble Lord, Lord Pannick. I believe that the amendment of the noble Lord, Lord Winston, does that in a manner that will not change the substantive policy of the Bill, as already agreed by your Lordships, but will perhaps give greater clarity about the intention for those Peers and others who want to see this language expressed in the Bill in the closest approximation possible to the existing Bolam test, which is what we are all trying to preserve.

As your Lordships know, the Bill is all about giving greater clarity and certainty to patients and doctors at the point of treatment, and not forcing them to wait for the unpredictable outcome of possible litigation or disciplinary proceedings. I can only welcome any amendment designed to enhance clarity and certainty about the effect of the Bill itself. I am therefore very happy to support it.

Lord Winston: My Lords, as this is probably the last opportunity I will have during the passage of the Bill, I thank the noble Lord, Lord Saatchi, who has behaved with extreme courtesy throughout the debate on this Bill.

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We do not entirely agree, but I think we have come to respect each other’s point of view and we are in total agreement about this issue.

I was surprised that the noble Baroness, Lady Gardner, raised this concern, because a representative body of medical opinion is exactly what courts ask me to give and to be mindful of. I am very grateful to the noble Lord, Lord Pannick, for his quotation, which is of course now on record, because on the number of times that I have been an expert witness in court, that is exactly what my Silk, in taking evidence from me, has required me to recognise—whether I am doing something that is recognised by a responsible body of medical opinion. That is a phrase which is firmly in our minds and was therefore firmly in my mind when I set this amendment down.

I therefore really am disappointed with the response from the noble Earl, Lord Howe, on behalf of the Government. If the Government really want to protect patient safety—I have no doubt about their absolute commitment to that—this would be a very good way of doing that. It seems to me that there is a risk of mavericks operating without that control. This is a very shocking issue. We do have desperate patients seeking all sorts of treatments, sometimes at the end of life but often perhaps because they are infertile— which is hardly at the end of life—and they will go through anything that they think might be of benefit, even though it is not proven. That is innovative treatment and sometimes it is possible that for various reasons that innovative treatment might work; sometimes, purely biology works and random effects happen. The amendment is designed to deal with that issue.

I do not think it would be appropriate to divide the House. I am grateful to see so many of your Lordships here late on a Friday afternoon, which is a great credit to this House and something we should be proud of. I am sure that the noble Lord, Lord Saatchi, is grateful as well. However, I feel that this is something that will need to be teased out. If the Bill now proceeds to another place, I very much hope that some consideration will be given to the patient safety aspect. Of course, it is really in the Government’s interests, particularly at the moment, when we are increasingly concerned, understandably, about our health service, which we all want to see survive and prosper. For the moment, I will withdraw the amendment.

Amendment 1 withdrawn.

Amendment 2

Moved by Lord Hunt of Kings Heath

2: Clause 1, page 1, line 24, at end insert—

“comply with any professional requirements as to registration of the treatment under the provisions of this Act with a scheme for capturing the results of innovative treatment (including positive and negative results and information about small-scale treatments and patients’ experiences),”

Lord Hunt of Kings Heath: My Lords, throughout the passage of the Bill the noble Lord, Lord Saatchi, has been enormously helpful to the House in responding

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to concerns and in his willingness to accept constructive changes to the Bill. I am most grateful to him for adding his name to my amendment.

We had a useful discussion in Committee and on Report about the establishment of a register that could record uses of the Act. This would be immensely helpful to clinicians, regulators and doctors—and, indeed, patients. It would reassure those who have concerns about the implications of the Act. It would enable use of the Act to be tracked. I argue that it would also help spread good practice. It would inform legislators about further changes to the law that might be required in the light of practical uses of the Act.

On Report, I received considerable support around the House. The noble Lord, Lord Kakkar, is here today. He probably will not mind me quoting from what he said—that,

“the register needs to be obligatory, in which all innovation and the outcome of that innovation is properly reported. It would do much to ensure the development of an enhanced culture of innovation, but also, fundamentally, to provide very important protections”.

On Report, the noble Baroness, Lady Jolly, opposed the amendment on four grounds. First, she argued:

“Requiring doctors to record the results of innovative treatments in order to demonstrate that they have not been negligent … would impose requirements … additional to those in the existing law”,


“may risk deterring doctors from innovating”.

Secondly, she argued that my amendment,

“would widen the scope of the Bill to cover all innovation. This Private Member’s Bill is not the right vehicle to make provision that would relate to all innovation”.

Thirdly—and quite remarkably—she said that,

“the act of putting something into legislation does not guarantee that doctors will adhere to it”.

Fourthly, she said that she would support a voluntary register,

“but it should be such that doctors would not dream of not recording on the register”.—[

Official Report

, 12/12/14; cols. 2062-63.]

My response is simply: let us put it beyond doubt by making registration mandatory.

On the question of the amendment going wider than the Bill, I have changed my amendment to make it clear that it relates only to this Bill—or Act, as it will become. On whether having to comply with this provision would dissuade doctors from innovating, I simply do not accept that. I would worry about doctors who were dissuaded because of the need to record an innovation in the register. I would have thought it created the conditions in which doctors would feel more confident in taking innovative action. On the suggestion that doctors will not adhere to the legislation, I simply do not accept that and ask what possible evidence there can be of it.

I do not think it is unreasonable to say that every use of the Act should be captured and available, to check on patient safety from the point of view of regulation but also for the purposes of research. I beg to move.

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2.45 pm

Baroness Masham of Ilton (CB): My Lords, I am very pleased to support this amendment, to which I have added my name. Within the rare disease community, there is significant unmet medical need, and research and innovation are seen as the means through which new therapies for currently untreatable conditions will be developed. For this to make a difference to patients, the barriers to medical research and the adaption and integration of research and innovation into the NHS need to be addressed. Therefore, it is vital to ensure that registries are created to enable the collection and exploitation of real-world patient data and to promote the sharing of research findings and best practice.

The Royal College of Pathologists says that, unfortunately, this Bill, allowing the results of new tests and treatments to go unrecorded, will hinder its work and medical science more widely. Without the mandatory recording of results of such treatments, unexpected adverse outcomes and irresponsible activity will be harder to detect and prevent.

All results of innovative treatments should be centrally recorded, reported and publicly accessible. This must include both positive and negative outcomes and feedback from patients. Without the mandatory recording of results, the public benefits of medical innovation will not be achieved and the advantages to future patients will be lost.

I am pleased that the noble Lord, Lord Saatchi, is supporting this amendment. I hope that the Government will, too. I would like to ask whether patients from both the NHS and the private sector are covered by the Bill. In my view, all patients who wish it should be able to benefit from innovation as long as it is fully explained to them and is felt to be as safe as possible.

There are many splendid trusts which support medical research. I hope that if this Bill becomes an Act they may find it possible to help fund the register.

Lord Kakkar: My Lords, I remind noble Lords of my interests, stated earlier, as professor of surgery at University College and as a member of the GMC, but I do not speak for the council in this Chamber.

I thank the noble Lord, Lord Hunt of Kings Heath, for once again bringing this issue to your Lordships’ House. It is critically important, and probably one of its most vital elements is that there is the opportunity for registration of innovative interventions and therapies.

Clearly, providing transparency and the opportunity for sharing the outcomes of such innovations rapidly and broadly across clinical communities in this country and internationally is of so much importance. It will allow colleagues to understand what has been achieved and not achieved; it will allow those with other ideas to build on knowledge gained from experience to date; and it will ensure that through transparency we have the best opportunity to ensure the greatest patient protection. I am very grateful to the noble Lord, Lord Saatchi, for having considered this issue carefully and having come to the place where he has put his name to the amendment and supports it. I hope that Her Majesty’s Government will be able to consider this issue. The measure enjoys substantial support and will

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be a vital contribution to this long journey with regard to innovation, ensuring that we can do the best for patients as rapidly as possible without undermining the very best practice and the ability to share knowledge, and ultimately ensuring that this Bill enhances patient safety.

Lord Giddens (Lab): My Lords, I strongly support this amendment and hope the Government will take it seriously because we are talking here about not innovation but scientific innovation. Science is a collective enterprise. It depends on the accumulation of evidence. It is crucial that that be recognised formally somewhere in the Bill, with this embodied as part of the advancement of scientific progress more generally.

Baroness Gardner of Parkes: My Lords, I support this amendment. I was surprised that the Government took a line similar to my own on the previous amendment because I was greatly reassured by what noble Lords said on that point. In this case, and right from the start of the passage of the Bill, we have all believed it essential to fully record what happens. The whole aim of this has been not only to give hope to people via an innovative treatment but also to have research that will benefit other people in future. No one has for a minute queried the need for recording the cases and results. I would be amazed and shocked if the Government denied that today.

Lord Ribeiro (Con): My Lords, many noble Lords will remember the disasters that occasioned the introduction of laparoscopic cholecystectomy in the 1990s. Quite a few patients suffered as a result of the innovation of our surgeons playing with a new instrument, new tools and a new operation. At the time, I was secretary of the Association of Surgeons of Great Britain and Ireland. In recognising the problems, we introduced a voluntary register of all surgeons undertaking the procedure and got a very good response. Admittedly, it was not compulsory and not every surgeon introduced their data to it, but the net effect was that when we analysed our data we were able to identify where many of the problems lay. That led to further research and proper control trials in the procedure. We were able to turn to that from an innovation used by a succession of surgeons as and when they felt necessary, without any good evidence on how best to use it. On that basis, and mindful of the benefits that we saw in the 1990s, I would very much support some form of register to ensure that, if an innovation is introduced, we have the information, can go back and refer to it again, learn from the mistakes and improve the outcome.

Lord Winston: My Lords, briefly, I support the amendment of my noble friend Lord Hunt of Kings Heath as well. I was reminded by the noble Lord, Lord Ribeiro, of laparoscopic surgery. Of course, we gynaecologists were doing that 20 years before the noble Lord was and we did not have as many deaths. Having said that, what the surgeons did with laparoscopic surgery and recording those events was really important in bringing down the complication rate and the haemorrhages that occurred. That is a very good

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example and the noble Lord is to be thanked for bringing it to the House. It is exactly what would be covered here.

I would be astonished if the Government seriously opposed this amendment. I was very unconvinced by the noble Baroness, Lady Jolly, in the previous stages of the Bill. She did not seem to take on board exactly what we were trying to say about the need for keeping proper records, which is important in all sorts of ways. If you keep a record and it is done under this Bill then you are effectively legally protected. For that reason if no other that would be important, but in any case we have to build up the knowledge of our experience. We do that automatically in the laboratory. Every single thing we do in the laboratory, whether negative or positive, we record in our laboratory books. If we do not, we are not doing good science or science useful to the public. Here in innovative medicine, we are—whether we like it or not—doing a form of science because we are exploring our knowledge about what a treatment means. That is what science means. I urge the Government to support the amendment. I feel very strongly about this. If the Government were reluctant to support it and my noble friend Lord Hunt were to divide the House, I would certainly join him.

Earl Howe: Perhaps I may deal briefly with the question posed by the noble Baroness, Lady Masham, who asked whether the Bill would apply to patients receiving private treatment. The answer is yes. Any departure from the accepted range of medical treatments for a condition, whether that patient be receiving NHS or private treatment, would be covered under the Bill.

The amendment of the noble Lord, Lord Hunt, would change the test of negligence under the Bill. If accepted—and assuming that the appropriate professional requirements were created—the amendment would require a doctor to comply with any professional requirements as to registration of the treatment; that is, to register the treatment with a scheme for the purposes of taking a responsible decision to depart from the existing range of accepted medical treatments for a condition. In other words, registering details and results of an innovative treatment on a data-capturing scheme would form part of the steps that a doctor has to take under the Bill.

Lord Woolf (CB): I hope the Minister will forgive me for saying that I do not think he is right in saying that the amendment would in any way change the standard. It is only adding a requirement to keep records. That does not change the standard of care which is required. It puts on the doctor an obligation to do something in addition, but I suggest with respect that it does not change the standard.

Earl Howe: I am grateful to the noble and learned Lord. Obviously, I must take account of his expert view, but the fear that I was about to articulate is that if you require a doctor to register the details and results of whatever innovative treatment he or she may have administered on some kind of data-capturing scheme in the way suggested by the noble Lord, Lord Hunt, that would constitute part of the requirement

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for the doctor to demonstrate that he or she has acted responsibly, and thus not negligently. Therefore, if the amendment were accepted, the result could be that a failure to record would be part of the picture when deciding whether a doctor had acted negligently.

If that point is accepted—I expect the noble Lord, Lord Pannick, to take me to task on it—my submission is that that would be a disproportionate requirement.

Lord Pannick: I understand the noble Earl’s concern that if there is an obligation to report the results, that might have an effect on the common law Bolam test, but surely it would not, because of the contents of Clause 2(1), which states:

“Nothing in section 1 … affects any rule of the common law to the effect that a departure from the existing range of accepted medical treatments for a condition is not negligent if supported by a responsible body of medical opinion”.

I therefore understand that under the Bill—the noble Earl can tell me whether I am right or wrong—the doctor has two means of defending himself or herself. One is the Bolam test at common law; the other is to take advantage of the procedures of the Bill. If one of the procedures of the Bill is a duty to report, that does not affect the general Bolam test under Clause 2(1).

Earl Howe: My Lords, I take the point made by the noble Lord, Lord Pannick. My point was not that the amendment would alter the effect of Clause 2(1). It would not have an effect on the common law, but it would create a more burdensome test under the Bill. That is troublesome to me, because to do that would in itself impose requirements which go beyond the current Bolam test of negligence. It would mean that the test of clinical negligence was more burdensome under the Bill than under the common law.

3 pm

Lord Woolf: There are provisions as to machinery and provisions that deal with standards of care. I think that this is a machinery requirement. You could not sue the doctor because he had not reported something. It is something that the law requires but I do not think it is intended that this should be enforced by criminal sanctions. There is certainly no specific provision of that sort.

However, it would exclude the ability to take advantage of Clause 1. You have to do Clause 1 in a way that complies with the Act, and the requirement that is now being inserted says that if you are going to do so, you have to do this. The implication is that if you do not do it, you will not get the benefit of Clause 1. This does not mean that the doctor is going to be liable for negligence just because he has not signed the register. As the noble Lord, Lord Pannick, has made clear and those who have taken part in the debate so far have emphasised, the common-law position remains the same. This is an additional mechanism to allow innovation. I therefore suggest that a machinery provision does not do anything else than act on a requirement that you have to go through if you want to take advantage of the Bill.

Earl Howe: My Lords, I have been in the House long enough to know that when the noble and learned Lord, Lord Woolf, opines on something, it is a matter

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that all noble Lords would do well to listen to, and I am grateful to him. I agree that the amendment does not change the standard of care, we are agreed on that, but our concern is that a court might look at the requirements under the Act—and this is one of the requirements—as part of the picture that it would form as to whether or not the doctor had acted responsibly. It is merely part of the picture.

If we are agreed on that, and I hope that we are, it does not seem sensible to me that we should impose requirements in the Bill additional to those under the existing law, as that could risk deterring doctors from innovating under the Bill. Let us not forget that a doctor does not have to follow the Bill if he or she does not want to; they can simply rely on the Bolam test later on if they are challenged. Do we want to deter doctors in the form of a test or requirement that obliges them to go further than they would otherwise go? If they were deterred by that, it would defeat the whole object of the Bill and result in less benefit to patients, so I worry about that.

The amendment from the noble Lord, Lord Hunt, specifies that the use of a scheme be enforced through professional requirements. We have sought advice from the GMC about whether professional requirements in the form of guidance might be a suitable route to enforce the sharing of learning from innovation. The GMC has been clear that it is very happy to consider anything it can do to be helpful. However, from those initial conversations, it seems that this may not in fact be an effective route. The GMC’s statutory power is to provide advice. Doctors must be prepared to justify their decisions and actions against the standards set out in its guidance.

Serious or persistent failure to follow the guidance would put a doctor’s registration at risk. So on the one hand, were we to go down this route, a doctor who failed only once to use a data registry might not face any consequences; that would be okay for the doctor. However, this would not address noble Lords’ concerns that the results of each and every innovative treatment, whether or not successful, should be recorded. On the other hand, if a doctor persistently failed to use the data registry, this could result in fitness to practise proceedings being brought against him or her for not having recorded information on an online database designed to foster the sharing of learning from innovation. Should a doctor’s fitness to practise be called in question simply on those grounds, that really does not seem a proportionate response.

For the reasons that I have outlined today—namely, the difficulty of relying on professional requirements and the link, which I hope noble Lords will accept, to the test of clinical negligence—the Government would not be able to support this amendment.

Lord Giddens: I am not a medical specialist but I have followed this all the way through. What kind of structure would the Minister envisage being put in place if there is not a formal requirement of this sort? If you do not have some kind of system of dealing with the data produced, the whole thing becomes an erratic exercise and therefore does not contribute to the overall fund of medical knowledge.

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Earl Howe: I would not disagree with the noble Lord at all. I was about to say that on Report, my noble friend Lady Jolly suggested that there should be a registry and made a commitment to that effect. I would like to clarify that the Government are committed to exploring what may be useful in the data registry. The key here is to establish what could be workable and beneficial. The Government have heard a range of views on the topic of a data registry from those who argue, as many of your Lordships do, that this is essential to the Bill to others, including eminent clinicians, who argue that informal methods of sharing learning are more effective and that a compulsory registry would be overly burdensome.

With thanks to the contribution of your Lordships, the Government have started this conversation and are committed to continued engagement with relevant bodies. Any method of learning that should develop from the Bill must surely work for doctors to be of benefit to patients and the wider medical community. That is no simple task. It is crucial that any mechanism to encourage learning should be developed with a sufficiently light touch so that clinicians see it as facilitative of good practice, rather than burdensome and bureaucratic. It is also important to consider the costs of a method of learning and how this can be encouraged in the most cost-effective way. While I do not take issue with the end-point which noble Lords want to reach, I really believe that it is wise for us to remain open to all possibilities, rather than committing in legislation to an approach which may discourage doctors from innovating under the Bill and therefore not be of benefit to patients in the longer term.

This is a beguiling amendment and I understand the motivation behind it but I hope that noble Lords will join me in questioning the wisdom of having such an amendment in the Bill and accept instead our preferred approach: to continue to discuss this issue with relevant parties as the Bill progresses and, should the Bill pass, to engage with the medical community as to the best way to ensure that innovation can be translated into learning.

Baroness Masham of Ilton: Before the Minister sits down, to do research surely one needs data to see what benefits patients because these are new procedures that we are talking about.

Earl Howe: I would just say that the Bill is not to do with research but with innovative treatment, which is rather different. There is no question of the noble Lord, Lord Saatchi, promoting another form of clinical trial so while I accept the principle that the gathering of data is a very good idea, we must be clear that this is not for clinical research.

Baroness Gardner of Parkes: Before the noble Earl sits down, from the outset we have been very clear that this was to be recorded. Everyone has wanted someone reputable to come forward and say that they were going to record it. To see that this will possibly now not happen is just unbelievable because what is the benefit, unless people in the future can benefit from it

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and it is accurately recorded? I am sorry to say that I cannot accept the view that this amendment should not be accepted by the Government.

Lord Woolf: My Lords, before the noble Earl sits down for the last time, I am very conscious of the kind things said by the Minister about my interventions, and I can assure him that I hold his approach to all matters of this sort in equally high esteem, if not higher. He is a lesson to us all in the care with which he approaches these matters.

Just before we leave the subject, I want to draw attention to the words,

“comply with any professional requirements as to registration”.

That is a very important limitation in the amendment because—as I understand it; I did not have anything to do with the drafting—it presupposes that there should be professional requirements. Surely we can rely on the medical profession to put in sensible requirements.

Lord Winston: Before the noble Earl sits down—although I do notice that he has managed to take his seat on the Front Bench—I would argue that of course it is not research; we accept that completely. But it is science within the meaning of the Latin word, which has the notion of knowledge, and of course it is wrong for us to exclude knowledge being dispersed and promulgated. Of course, the Medical Innovation Bill hopes to do this, and that is the point of supporting it. Otherwise, I fear that the Bill when enacted will be almost useless. This has been an issue of great concern and was the cause of correspondence this week from many different medical sources. I hope that the Government will consider that very carefully.

Earl Howe: Of course the Government will consider this carefully. Let me make it clear that I do not want to sound negative about the idea of data gathering. I am the first to recognise that that could be a major advantage of the procedures that my noble friend Lord Saatchi is encouraging within the scope of the Bill. I would not dispute that for a moment. My concern is that to build a further requirement into the test of negligence would be the wrong course to take, because that is how this amendment is framed.

Also, what would be the benefit if we do not engage fully with the medical community to make sure that doctors are able to use any registry that might be created easily and simply? If it does not work for doctors, there will be no benefit—so I think that we need to take longer over this. It is not a case of kicking it into the long grass, but in the time available we have not been able to come up with a precise solution, despite our best endeavours in our discussions with the GMC.

Lord Brown of Eaton-under-Heywood (CB): My Lords, before the Minister finally sits down, does he agree that it would be desirable that any professional requirements of registration should deal not only with innovation,

“under the provisions of this Act”,

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but also with innovation that may well be outside the provisions of this Bill but are covered by Bolam and expressly contemplated in Clause 2(1): namely,

“a departure from the existing range of accepted medical treatments”.

That, too, needs to be recorded and registered because it may point the way ahead. As matters stand, that is not within the compass of the proposed amendment to Clause 1.

Perhaps I may further ask the Minister whether he agrees with me that the real purpose of this Bill is to carry Bolam a stage further. Bolam applies if a proposed innovation is,

“a departure from the existing range of accepted medical treatments”,

and is,

“supported by a responsible body of medical opinion”.

Clause 1 of the Bill, as was made plain by the first proposed amendment, deals with a situation where,

“a departure from the existing range of accepted medical treatments”,

may not actually be supported by, but has the respect of,

“a responsible body of medical opinion”.

In other words, the,

“responsible body of medical opinion”,

may not support it, but, taking that into account and having regard to patient safety, none the less respects it and therefore implicitly allows it to go forward as a responsible treatment. That is outside Bolam but within the compass of the Bill.

3.15 pm

Earl Howe: I will reply very briefly, with apologies to noble Lords for speaking so often. I have been troubled by the fact that if we were to build this amendment into the Bill, it would apply to those innovative treatments covered by my noble friend’s process and not to other innovative treatments. It would seem inherently odd if we did not have a database that captured all innovative treatments—so, again, we need to consider that, and the noble Lord, Lord Hunt, referred to that issue himself.

On the second point made by the noble and learned Lord, my concern is that—going back to the previous amendment we were discussing—there was a mismatch of wording that does not quite conform to the Bolam test. However, I will consider what he said carefully and come back to him, if I may.

Lord Saatchi: My Lords, I am so grateful to all noble Lords who have spoken on this amendment. I will not in any way detain your Lordships by reciting again what has been brilliantly and articulately expressed by other noble Lords. I will say only one thing about this amendment, which is to pay tribute to Oxford University, whose original concept it was—I refer to Professors Alastair Buchan and Stephen Kennedy at Oxford—that a database should be created to record the results, positive and negative, of innovation under the Bill. The reasons were, as expressed by noble Lords today, to advance scientific knowledge, as the noble Lords, Lord Giddens and Lord Winston, said, and to protect patients with full disclosure and full transparency.

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A number of individuals and organisations have told me that any doubts that they had about the utility of the Bill would be removed by the emergence from it of this new and exciting initiative in data collection and sharing. This database will, I hope, be a significant—perhaps enormously significant—development in the field of medical practice. I am confident that my noble friend and the officials in the Department of Health will be able to devise a suitable system, in collaboration with the medical profession and the regulatory bodies, which will achieve what is wanted here.

I will end by saying that I do not remember ever seeing your Lordships’ House in full agreement, on all sides of the House, on one amendment. We have not just had that once, on Report, but have had an exhibition of exactly the same unanimity and strength of feeling again. I very much hope that my noble friend the Minister will not consider voting against the amendment should it be put, but will, as he said, take forward the Government’s commitment to ensure that the register happens and is put in place, and that he will be able to encourage the noble Lord, Lord Hunt, and all the rest of us here that that will happen.

Lord Hunt of Kings Heath: My Lords, it has been a very good debate; I am sorry that it has happened so late in the day. I, too, echo the words of the noble and learned Lord, Lord Woolf, in paying tribute to the noble Earl, who has been extremely helpful during the passage of the Bill. Of course, I am well aware that Sir Bruce Keogh, medical director of the NHS, has himself been extremely helpful in assisting with the drafting of some of the clauses in the Bill.

I will make three or four points. First, the noble Lord, Lord Ribeiro, was very helpful in giving us a practical example of why a register was necessary. The register that he referred to was a voluntary one and was used by most surgeons, but of course not by all. My contention is that, in the specific circumstances of the use of the Bill, we need greater reassurance by having a mandatory register. The noble Lord was concerned in essence that a mandatory register would be a disproportionate requirement, and that in so being it would discourage doctors from using the provisions in the Bill. I disagree with that. All of us have received, at every stage of the Bill, extensive letters from just about all the medical bodies you could think of, all of which have expressed some concerns about the provisions of the Bill. They recognise that the noble Lord has moved a very long way and in a very helpful way, but they remain concerned. My view is that the kind of amendments being proposed today would go a very long way to reassuring those bodies. In the end, the more that those bodies are reassured, the more likely it is that they would provide the advice that would allow their members to consider use of the provisions in this Bill.

We have had a very interesting debate, with contributions from the noble and learned Lords, Lord Woolf and Lord Brown, and the noble Lord, Lord Pannick, on the provisions of the Bill and their relationship to the Bolam test. I make it clear that my amendment refers only to the provisions of this Bill. At Report, my amendment was criticised by the Government because they thought that in its wording it might go wider than

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the Bill, which is why I have rewritten the amendment to make it clear that it provides only for the Bill. It may well be that, as the noble and learned Lord, Lord Brown, suggested, we should discuss the use of a register in relation to all innovation. However, that is not today’s argument. I believe that we are justified in seeking a specific requirement in relation to the use of this Bill because of its special provisions and, in particular, because of concerns raised by many responsible medical bodies.

On the question of the GMC, I agree with the noble Lord, Lord Saatchi, that it is not beyond the bounds of possibility that the Department of Health and the GMC can come to a sensible outcome within the confines of my amendment. In the end, it may well be that, in the circumstances to which my noble friend Lord Winston has referred, whereby rogue doctors use this legislation inappropriately, it should fall to a fitness to practise committee.

In the end, as the Minister said, we need to engage with the medical community. Many of us have been engaged with it for a long time and we have come under great criticism for seeking to help the Bill. Most of the letters that we received from very responsible medical bodies have asked your Lordships’ House to make sure that the Bill does not proceed. We have tried to be as fair to them as to the noble Lord, Lord

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Saatchi, and it is through these kinds of amendments that the Bill can go to the other place considerably enhanced. For that reason, I move the amendment.

Amendment 2 agreed.

3.22 pm


Moved by Lord Saatchi

That the Bill do now pass.

Lord Saatchi: My Lords, I shall not delay the House, as it is late, but I want to express my enormous gratitude to my noble friend the Minister and to his team at the Department of Health, who have been unfailingly courteous and professional in the most admirable way. One hears that this is a scrutinising House and that it is its particular skill to look in detail, line by line, at legislation in a careful way. I do not know of a case in which that has been better demonstrated than in this Bill, and I take my hat off to your Lordships’ House. I beg to move.

Bill passed and sent to the Commons.

House adjourned at 3.23 pm.