I’ve been a peer now for eight years and contributed to numerous bills and committees and done my best to move causes along behind the scenes when opportunities arose. It is very hard work to achieve small gains and we know from this blog, many folk would prefer we didn’t do it at all! But it’s almost impossible to combine a regular contribution to parliament with any other serious work or writing. After eight years I feel I need to recharge the batteries, get away from politics, forget the loopy arcane inefficiencies of the institution for a while and do something different.  Lord Phillips of Sudbury famously announced his retirement after serving 10 years on the Lib Dem front bench but he couldn’t resist returning Frank Sinatra style when House of Lords reform came up. I know I shall want to return some time soon, perhaps for the next health bill (there’s always another on the way) or the long awaited social care reform bill. So I’m not ‘retiring’, and no doubt colleagues will still see me lurking about the library from time to time.  And perhaps I’ll come in for the debates of the future of the House of Lords, voting for reform but with no expectation that change will happen. The current arrangements suit the Executive very well indeed.

I have enjoyed being a blogger on this site and grateful for the many hundreds of comments that we have attracted. I shall continue to read the blog avidly and undoubtedly I’ll be tempted to comment under a pseudonym. I expect to be back, probably before any of you notice I’m gone. Ci vediamo presto.

But the key question remains. How did we get into a position where the Government introduced a bill which the public had no idea we needed and which they certainly didn’t want? How did a bill which moved policy quite modestly become perceived as a great threat to the very existence of the public’s rightly treasured NHS? And the answer is that no real attempt was made in advance of the Bill to be honest about the real motivation behind the Bill, which is largely about addressing the dire financial situation, improving productivity in secondary care and transferring care into less costly and more appropriate settings. Instead we had the usual PR machine mantra about ‘choice’, ‘patient centred care’ and so on when the public has in fact never been as happy with the NHS as it is now. No wonder the staff of the NHS were puzzled and resistant; no wonder the public thought if doctors didn’t like it then they wouldn’t. The lesson is that Government must be much more open about what problems it is trying to address and tackle head on what it can and cannot do. On this bill they left themselves open to a barrage of misinformation which only the passage of time will reassure the public is wrong.

I bumped into Lord Soley in the Princes’ Chamber outside the chamber after the debate last night. He was his usual friendly self in telling me we supporters were all mad.  Of course he could be right…but I’m sure the resilience of the NHS will prove him wrong even if he is right!

Murphy at sea

Were you wondering where I’d gone? Well I’m back now from Central America and the Caribbean and mightily pleased I missed all that cold weather. I was in some remote spots and got news from Britain only intermittently. But the health bill figured in almost every bulletin. Turmoil, Coalition falling apart, political storms at Westminster, doctors and nurses noisily opposing the reforms and a beleaguered Andrew Lansley on the brink of being sacked. Or so ‘twas said.

So the moment I landed I got out Hansard on line and read through the debates in the Lords that I’d missed. No political storms, no significant challenge, Earl Howe working away negotiating some sensible changes and generously responding to amendments. Of the 6 votes so far, only the minor first amendment was lost by a 4 votes. The rest were won by the Government with a very comfortable majority, which means there were few Lib Dem or Conservative rebels (the maximum number of coalition rebels for any one vote was 4 and that occurred only once) and the crossbenchers largely supported the Coalition. The turn-outs were good.

The week I returned was recess but Earl Howe asked if he could meet me with the bill team that week. He’d been pondering over an amendment that Lord Warner and I had spoken to in Committee and were due to speak to again at Report. We wanted a mechanism to ensure that the Secretary of State could ensure that NHS monies could be transferred to Social Care, or Housing or indeed other organisations if it was in the best interest of patients. There are mechanisms in place at grass roots level but they are rarely, indeed insufficiently used. The bill team came up with the idea of inserting a Secretary of State’s direction to that effect in Schedule 4, which addressed my concerns perfectly, and I was able to table it in time for the debate on Monday. We also had a good discussion about how to achieve a satisfactory process to monitor and intervene in failing hospitals before they get to crisis point. By Wednesday Earl Howe had produced a mechanism which Lord Warner and I felt was an excellent solution.

So in spite of the media hype, in spite of the apparent opposition generated by sackfuls of misinformed briefings and letters, so far the Lords have been listening more carefully to the arguments in the Chamber than the barrage outside. This may not last…we are getting to some controversial bits of the Bill next week  and after all the duty of the Opposition is to oppose.

Formally, as the Leader of the House Lord Strathclyde said in our chamber, “Matters for privilege are not a matter for the Government but a matter for the House of Commons and the Speaker of the House of Commons on advice from his clerks. The position of privilege has of course been jealously guarded by the House of Commons since 1671. It is well precedented and there is nothing unusual, although the second Chamber might always think that the Commons using financial privilege is a little unfair.” Just a year ago the Constitution Committee considered ‘Money Bills and Commons Financial Privilege’ (http://www.publications.parliament.uk/pa/ld201011/ldselect/ldconst/97/97.pdf) and concluded that in any reform of the House these privileges would need to be re-examined.

But of course the Leader’s statement did not fool anyone; the Clerks in the Commons would have been persuaded, and probably quite easily given the financial implications, of the merits of using the Financial Privilege to scupper further delay by the Lords. There was considerable anger in our chamber yesterday afternoon about this decision. Personally I felt the use of the Privilege was unnecessary, the Lords usually agrees to abide by the elected Commons’ decisions after one bout of Ping Pong. But Cameron must have known that the press and public were largely on the Government’s side. Quite what rump of the bill will return to the Lords for discussion is a mystery although apparently something will appear next week.

I shall be abroad for the next two weeks and miss the excitement of the return of the Health Bill. I’ll catch up with it on Day 3 of Report Stage. Lord Owen is plotting rather noisily against almost all the Bill’s provisions and the Minister Earl Howe has tabled a myriad set of new amendments for the Government which take account of our discussions in committee. At least we know that the Government can’t throw out discussions about the Health Bill on the basis of financial privilege since few have financial implications.

The vote on the Child Support Agency charges was fascinating. I was one of the very few Crossbenchers who supported the Government but it was clear before the debate that the Government would lose. Why? Well it was fascinating to watch the way the Lords works. Peers had received  briefings funded by Barnardo’s the children’s charity and other children’s charities. Lord Mackay of Clashfern, a former Lord Chancellor who moved the amendment  on behalf of Barnardo’s, is a respected and well-loved figure and was convinced that charging for those who could not reach an amicable agreement, mostly women trying to get child maintenance money out of a former partner, would be treated unfairly. The lawyers in the House piled in behind him. Peers had worked themselves up into an emotional righteousness against the new disincentives in the Bill to use the Child Support Agency as a matter of course where parents are separating. I confess that before I looked into the detail of the matter I was going to vote with Lord Mackay too. But then I read the independent reports that have consistently said that over 90% of the 300,000 couples with children who separate every year could make their own arrangements  if encouraged to do so but are using the agency unnecessarily, adding to the severe pressure on the Agency, and the huge cost. A small charge would be a disincentive to using the agency for all except those who need it and help the agency tackle the support needs where one party, usually the man, is reluctant to pay. The Government had obviously had discussions with Lord Mackay and recognised his concerns. The Government therefore tabled its own amendments for discretionary waving of charges. But these amendments came up BEFORE Lord Mackay’s and no-one was really listening, so keen were they to get on with the vote.

Lord de Mauley, the assistant minister/ junior whip, was taking this section rather than Lord Freud; this was unfortunate since the ineffably elegant Eton educated Rupert Ponsonby, 7th Baron de Mauley gives the impression that 1000 years of good breeding may not have prepared him to deal with the issue of welfare benefits. This is actually deeply unfair since he has taken a serious interest in this business and is far more clued up and on the ball about the detail than he may be given credit for. And then three former Social Security ministers weighed in against the changes. But there we are…and the one backbenchTory who spoke for the Government, a recently appointed member, barrister Baroness Berridge, said the right things (http://www.publications.parliament.uk/pa/ld201212/ldhansrd/text/120125-0002.htm#12012551000542) but somehow struck an unfortunate tone which does not emerge from reading Hansard. Like a pack of fox hounds peers had scented the quarry…and there was no stopping them.

The Government will think carefully I am sure about its response but I am pretty sure the Commons will reject these amendments.

Lady Meacher

Lord Patel

Lord Norton has referred to the Welfare Reform Bill defeats in the Lords, which I’ve been giving some considerable thought to. I voted with the Government against the amendment by Baroness Meacher to continue ESA for young disabled people who have resources of their own to support them and have not contributed to what is essentially a contributory benefit. The House voted to continue giving benefits to young people even if they inherited a large capital sums or lived in wealthy households. Then I decided not to vote on the other amendments by Lord Patel. I dislike the singly out of cancer as if it is a special case; there are many physically and mentally ill people with chronic distressing conditions requiring long term treatment but that don’t have the shroud-waving potential of cancer. The other matter that people forget is that 90% of people with cancer are past retirement and are not eligible for any of these benefits; older people have to make do as best they can. These small amendments will benefit very few indeed but those few rather unfairly.

So one has to ask the question, “ Of all the major changes being introduced and the opposition to them expressed by the disability lobby and other groups representing those in receipt of benefits, why did the House choose these minor issues to revolt on?”  The answer is all to do with mood and general disquiet. The majority of peers agrees with the fundamental changes being introduced in this Bill, they want to see a more rigorous effective system introduced which incentivises work and acts as a deterrent to people remaining on a lifetime of benefits, including those who have had episodes of mental health problems who make up the majority of the huge increase in those on ‘sickness and disability benefits’ over this past decade. As a psychiatrist I have seen the catastrophic effect of the current regime on the lives of patients.

But peers also knows that the implementation of the changes, at a time of rising unemployment, where the system is imperfect and there is as yet insufficient assistance to individual and their families, is going to be difficult and will feel unfair to those who are culturally still stuck in the ‘I’m entitled’ box. It will take a decade at least, a generation probably, for the cultural changes to kick in. And the changes may not work as the Government intended. So with these anxieties about the outcome, the House wants to show its disquiet. That’s what it did….but when ping-pong arrives the House will accept a Commons reversal of these modest changes; they’ve made their protest and that’s enough. So I sat on my hands for two of these three votes, that was my personal small protest.

The Commission finds there is a strong case to provide the choice of assisted dying to people who are suffering at the end of life and likely to die within twelve months, provided that they satisfy the eligibility criteria. People who might not have the mental capacity to make such a choice, who might be clinically depressed or experiencing pressure from friends or relatives, would be protected by a comprehensive set of safeguards.

The Commission also finds that the provision of high quality end of life care must be a priority for Government, independent of the issue of assisted dying. It recommends that in parallel with any change in the law, the Government should also take action to tackle inequalities in end of life care and ensure that good quality end of life care is available to every person approaching the end of their life.

Under the proposed framework, a dying person who met the legal criteria would be able to ask their doctor to prescribe them a dose of medication that would end their life. The person would need to be able to take the medication themselves, as a clear expression of the voluntariness of their choice. Appropriate practical support to take the medication should be provided if it is required by a terminally ill person with physically impairments but this could not take the form of another person administering the medication on their behalf (euthanasia).  The Commission does not propose that any form of euthanasia might be allowed if the law were to be changed.

I want to stress how limited our proposals were, the criteria only includes those who are already quite near death and excludes many groups who might be thought to be suitable. We decided there must be more debate and more time for Society to assess how a limited provision works before going further.

“So fair a fancy few would weave

In these years! Yet, I feel,

If someone said on Christmas Eve,

“Come; see the oxen kneel

“In the lonely barton by yonder coomb

Our childhood used to know,”

I should go with him in the gloom,

Hoping it might be so”

That yearning for simple faith in the midst of a vulgar festival of consumption is surely common enough, even if by Boxing Day reality has set in.

Westminster seems a million miles away and you might think that for two weeks we don’t have to think of amendments, debates, statements or order papers. But we know what’s coming up immediately after recess and I’ve already started to think about the final Report Stages of the Welfare Reform Bill and the Health and Social Care Bills. Time now to review the Committee debates and consider what areas to press on, what to abandon and decide what is likely to be in the long term best interests of us all. This last few months has been harder for me than previous years in the Lords; I’ve espoused unpopular causes because I believed in them as a better thing to do than the alternative. Next year I may need a sabbatical to recharge my depleted batteries.

Transparency and full public accountability appear to be strengthened by public meetings but are often not. Board behaviour is affected by the presence of the public; the level of challenge and scrutiny is diminished and behaviour tends to be more compliant than in private. There are also major anxieties about raising patient safety issues and discussing serious untoward incidents, for fear of producing public alarm. Decisions that should be taken by the board have a tendency to get sorted out in private sub-committee meetings when it would have been better to have full discussion with the main board.

On the other hand public meetings increase public trust and understanding of the issues and there’s no doubt that the quality of reports are improved when they are going into the public domain. Business sensitive and patient confidential matters can be reserved to private parts of a meeting from which the public is excluded. As so often a fudged position is probably the best…the Chair has a responsibility to ensure that dissenting views are expressed to a wider audience and worked through in the public arena but should make sure they know the outcome of a decision long in advance!

Before the Eurozone was established the constituent nations created rules about the way they would behave. There were rules on deficits, borrowing, criteria for joining and so on which were then ignored, treated with contempt by Greece, Italy, Portugal and other countries and tolerated by France and Germany for the sake of the ‘bigger picture’. What confidence do we have that a new accord will be able to take account of the disparities in economic productivity of the constituent countries or be able to impose a sense of political responsibility in the Greeks and other southern European states? I cannot see how a new treaty will change much.

This is not to say that David Cameron’s stance was anything to celebrate; it seems to me that it was inevitable and possibly sad that we could not be part of something that moved us farther forward rather towards a democratic union rather than back. But I cannot see he had any other choice. We are not ready to cede democratic control to leadership outside these islands; mutual trust and understanding are absent.