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.

Teachers and head teachers who strike merely impose an unreasonable burden on children and parents, many of whom will lose a day’s pay to stay home to care for children abandoned by their schools. What sort of solidarity is that? Do they really expect to keep professional respect for that? And that seems to me to be the problem of public sector strikes…it’s always some other poor worker who suffers as a result.

We are about half way through the committee stages of the Health and Social Care Bill; yesterday afternoon and evening we ploughed through the 7^th day of amendments, missing our target as usual by several groups of amendments because so many people want to speak. I spoke in the debate on amendment 103, http://www.publications.parliament.uk/pa/ld201011/ldhansrd/text/111122-0002.htm#11112299000096 about how the Bill might encourage commissioning of more integrated health and social care and had intended to speak in the group 104, the last group after dinner,  about the reconfiguration of hospital services. But by the time Lord Warner introduced the topic my eyelids were closing, my contribution looked superfluous and I decided it was time to go home. Part of the problem is personal…I’m a ‘Farming Today’ person rather than a ‘Book at Bedtime’ type. These evening sessions when one has been working all day seem to me to be largely unnecessary but like many working practices in the house which were devised for the convenience of Edwardian landowners the chances of change are small….it’s tradition, don’t you know?

I have doubts too about the bilateral political debate that colours all our exchanges. Committee debates are set up to enable us to go word by word, line by line through a Bill and challenge each provision. The Bill team of civil servants sits in the box to the left of the Minister ready with notes of reply as to why the Government doesn’t like or want the amendment that has been tabled. The mover of the amendment makes a speech about why such change is necessary and prays in aid his own experience, all his briefings from a wide range of organisations (in the Health and Social Care Bill these are the Kings Fund, The Nuffield Trust, the NHS Confederation and various professional, union, patient and local government groups). Other peers join in the debate after that, quite often making a speech which has only passing relevance to the amendment but proving to the constituency of organisations that make up the lobby that one has been listening! The confrontational style of debate seems ill suited to improving the final Act….the Government holds it ground and resists any amendments at Committee stage and the Opposition chisels away, sometimes voting on amendments of minor significance just to show they can. I was caught out yesterday when Lord Warner called an unpredicted vote on amendment 98 on the content of the mandate that the Secretary of State will give to the NHS National Commissioning Board. I spoke in support of the broad ideas behind the amendment but for me they were a way of probing Government on its intentions, not something to vote on.

And my final grouse this morning is about those peers who save what they are going to say until the Minister has almost finished his reply then pop up and say “Before the Minister sits down…” or even worse simply get to their feet and start talking….and launch into another speech designed to delay proceedings, as if they are too grand to contribute to the debate while the common herd of folk are debating and must reserve their own slot. I have a little list of peers who are doing this regularly in this Bill…Baroness Jay of Paddington, Lord Owen and Lord Davies of Stamford are the guilty parties. Debate content sometimes gets buried in poor manners, a great pity when what they say is often worth listening to. In contrast I admire very much the Opposition style of Lord Hunt of Kings Heath; never pulls his punches but does it in an unfailingly polite incisive way giving credit to speakers on all benches when he agrees with them.

Lord Hunt of Kings Heath