HL Deb 14 May 1986 vol 474 cc1169-91

Debate resumed.

Lord Brabazon of Tara

My Lords, it might be for the convenience of the House if I announce that the new revised time for the end of this short debate is now twenty-eight minutes past six.

4.51 p.m.

Baroness Faithfull

My Lords, I seek to elaborate on the last recommendation made by the noble Lord, Lord Winstanley. A few weeks ago at Conservative Central Office I attended the launching of a discussion paper called When Nature Fails—Why Handicap? It was written by Mr. Peter Thurnham, M.P. and his wife. Sarah, who have adopted a handicapped child. They are also founder-members of Progress, a campaigning group which supports controlled research into human reproduction, infertility and congenital handicap.

This booklet recommends that pre-14-day embryos should be given special legal status and that any research should be strictly regulated by licence, such research to be undertaken to prevent hereditary handicap and to help those couples unable to conceive. I agree with this report and I think that it is morally and ethically just, as well as practically beneficial. More than 14,000 babies in England and Wales were voluntarily registered as congenitally malformed within one week of birth in 1984, and 250,000 miscarriages before three months of pregnancy were due to chromosomal abnormalities in the embryo.

There has been set up a voluntary licensing authority, to which the noble Lord, Lord Winstanley, referred, under the chairmanship of Lady Donaldson, funded by the Medical Research Council and the Royal College of Obstetricians and Gynaecologists. On the Floor of the House of Commons, the Prime Minister praised the first year of work of this authority.

I should say that already research work is being carried out by Professor Williamson at St. Mary's Hospital. His special interest, anal the interest of many of us, is in preventing cystic fibrosis. I wonder whether Mr. Enoch Powell, when introducing his Unborn Children (Protection) Bill in the other place, banning pre-embryo research, fully appreciated the disaster it would be both to research and to the one in 10 couples having difficulty in conceiving, and to the one couple in 50 who are at risk of giving birth to a handicapped child.

Therefore, I ask my noble friend the Minister, first, are the Government going to set up a working party composed of experts in order to clarify and define the legal status of a human embryo and to examine the areas in which beneficial research could be encouraged, and to monitor the work of the licensing authority which is already established? Secondly, will Her Majesty's Government either make a substantial contribution to the work of the present voluntary licensing authority or, alternatively, set up a statutory body to do this work? These recommendations were supported by Mr. Brian Rix of MENCAP in a speech which he made in February 1986, in which he said: Legislation, under the recommendations of the Warnock Report, should be introduced to allow research on pre-embryos to prevent handicap". I pass on to the whole realm of prevention of mental handicap and I should like to say that the noble Lord, Lord Allen of Abbeydale, and the noble Lord, Lord Renton, would have spoken on this subject had they been able to be here today. There are 1.25 million people with mental handicap in Britain. That equals 2 per cent. of the whole population and is one in every 45 people.

MENCAP, under the secretary-generalship of Mr. Brian Rix, have made 10 recommendations and perhaps I may bring them to your Lordships' attention. They say: Britain should establish a national policy on prevention of mental handicap, setting out specific targets and guidelines for both national and local action. This should include: 1. Health education should be a part of the core curriculum, with emphasis on using the Health Service for health"— not only for illness. 2. All tobacco products should carry a warning that smoking during pregnancy can damage the unborn child. 3. Efforts must be made to increase both professional and public awareness of the importance of individuals knowing their own family histories. 4. Genetic counselling and screening must be made widely available"— a point made by the noble Lord, Lord Campbell of Croy. 5. Positive discrimination in favour of vulnerable women, who are at risk during pregnancy, for social, economic and health reasons, should be introduced. 6. Good standards of obstetric and neonatal care must no longer be a matter of 'geographical luck' ". I think it is well-known, for instance, that in Oxford, where there is first-class medical help and preventive medicine, there are many more children born healthy as compared with a place such as Liverpool, and that cannot be right. To continue: 7. Screening newborn infants for hypothyroidism should be mandatory. 8. Legislation, under the recommendations of the Warnock Report, should be introduced … 9. A standing committee on prevention should be set up, with the stature of the US President's Committee on Mental Retardation. Its findings should be subject to annual, public reviews". There is not time to elaborate on all these individual recommendations, but I put them to your Lordships' House. I take this opportunity to thank the noble Lord, Lord Henderson, for enabling us to make these recommendations.

4.59 p.m.

Lord Rea

My Lords, we are all indebted to the noble Lord, Lord Henderson, for raising this very important matter and for his explanation of why it is particularly relevant today. It is a vast topic. In fact, just one segment of this topic—the prevention of mental handicap—is being discussed at the Royal Society of Medicine in two weeks' time. That is a two-day conference with 30 papers by acknowledged experts on the subject, and it is only one facet of the whole problem of disability.

Disability can result from almost any serious disease process if people do not reach the ultimate disability, which the noble Lord, Lord Winstanley, mentioned, of perishing. This can occur from before conception until after death, if one considers the damaging effect that bereavement can have. Disability affects all the peoples of the world with different afflictions, according to climate, geography and the stage of economic and social development.

In third world countries severe handicaps are much easier to spot than in our society. Blind or severely disabled people are glaringly obvious, often begging for money from affluent visitors. It is a sad reflection on how poor some countries are that a strategically placed polio victim with useless contorted legs can sometimes collect a great deal more money than the average able bodied citizen, though often the money is taken from him by an organiser in the background. In contrast to the situation in industrial societies such as ours, where new cases of disability are mostly due to congenital disease, accidents or degenerative disease, in third world countries the majority of the disabled are the victims of easily preventable infective disease often made worse by co-existent malnutrition, as was pointed out very succinctly by the noble Lord.

The key to the prevention of most forms of disability lies in the efficient working and availability of appropriate health services to all the people—I emphasise "everybody". This applies at all stages of development. It is reflected in the call of the World Health Organisation for "Health for all by the year 2000", through the provision of primary care. Even more important perhaps than health services are literacy, the provision of clean water and an adequate food supply. I should not like to see one-off campaigns—for example, to eliminate poliomyelitis or measles by immunisation—dissociated from efforts to provide primary care and community development in the developing world. These form the basis of permanent improvement in the health of underprivileged communities in the third world.

In our society, too, good primary care is vital in the prevention of disability, whether this be primary prevention (by immunisation, good ante-natal screening, as has been pointed out, child care and health education), secondary prevention, which spots the early manifestations of disabling disease and prevents or slows its progression, of tertiary prevention, which enables disabled people to make the best use of their lives. Primary care teams of doctors, nurses and others must be aware of what is available in hospitals and special units and make use of new discoveries for their patients, but they are the first port of call—if you like, the eyes and ears of the health service. The Green Paper on primary care recently published by the DHSS makes some useful suggestions with regard to improving preventive services in primary care, although the Royal College of General Practitioners has for some years been making very similar noises. In fact, forward thinking members of all the health professions are acutely aware of the issues about which we are talking this afternoon.

I should now like to turn to the much discussed question of congenital handicap and its prevention and follow along the lines first mentioned by the noble Lord, Lord Winstanley, and the noble Baroness, Lady Faithfull. I am very sorry, incidentally, that we have not been able to entice the noble Baroness, Lady Warnock, here today, since I feel that her words of wisdom would have been very valuable in this debate.

As noble Lords are aware, owing to the pioneer work of Drs. Edwards and Steptoe it is now possible to collect human ova (or eggs) from a woman's ovary through use of the ingenious instrument the laparoscope. In a suitable culture medium these can be fertilised in vitro—that is, outside the body—by human sperm and then reintroduced into the womb of a woman whose fallopian tubes have become blocked. A proportion of these pre-embryos then implant in the womb and develop normally. Well over 1,000 test-tube babies have been born in many centres throughout the world. Sometimes more ova are collected than are necessary from the infertile woman; sometimes spare, unwanted ova can be collected from women who are undergoing laparoscopic sterilisation because they have completed their families. These are known as donor ova or pre-embryos if they are subsequently fertilised.

The Warnock Committee suggested that these spare ova or pre-embryos could be used for experimental purposes, but only up to 14 days after fertilisation. It is then that the "primitive streak" appears. This is a collection of cells which is the first identifiable sign of the developing human being; in other words, the true embryo. It is also very difficult to culture embryos after this stage. The committee agreed, as the noble Lord and the noble Baroness have pointed out, that any experiments on these embryos must first be licensed by a statutory licensing authority with half of its membership being lay people.

What kind of experiments can be done on pre-embryos? First, there can be experiments to improve existing methods of in vitro fertilisation, to improve a woman's chances of successfully bearing a child. Second (and conversely) experiments can be used to investigate new methods of contraception aimed at the egg or the sperm; and, thirdly, experiments can be devised which are aimed at developing methods of preventing genetic and chromosomal defects, which is what concerns us today. I should like to quote Dr. Ann McLaren, who was a member of the Warnock Committeee. She said: Research could determine whether such defects in a pre-embryo can be diagnosed before implantation. It might also help to elucidate the causes of the chromosomal defects that appear around the time of fertilisation". One per cent. of babies born in Britain suffer from a genetic or chromosomal defect. There are other congenital handicaps due to conditions that occur during pregnancy, but these ones occur at the time of or before fertilisation; that is 7,000 babies each year.

A number of these conditions can be identified from examination of the nucleus of pre-embryonic cells by special methods. Methods of detecting other genetic defects are likely to be developed. It should be possible to develop methods of detecting affected embryos with, for example, Downs' syndrome or fibrocystic disease, which was mentioned by the noble Baroness, so as to be able to replace in the womb only unaffected pre-embryos. These types of experiments are only illustrations of the work that might be done to help to reduce the incidence of handicap. New lines of research would evolve, but all research projects would have to be carefully scrutinised by the licensing authority.

As the noble Baroness, Lady Faithfull, has pointed out, the Royal College of Obstetricians and Gynaecologists and the Medical Research Council have already sponsored a voluntary licensing authority along the lines suggested by the Warnock Committee. That authority has already visited all 26 centres in this country that are involved in in vitro fertilisation; 10 of those centres undertake research. All the research projects that have so far been submitted to that voluntary authority had already been approved by a local hospital or university ethical committee. Most of the experiments were of the first type that I have mentioned, to try to improve the efficiency of in vitro fertilisation itself, and thus improve the treatment of infertility.

Pre-embryo research, far from leading to the birth of human monsters or genetically-engineered clones such as envisaged by Aldous Huxley in Brave New World, should result initially in the reduction of the proportion of handicapped children born to couples known to be at risk, and it might well lead eventually to a reduction in all genetically determined disability.

It is said that the legislation that will arise from the committee of the noble Baroness, Lady Warnock, will be very complex and that is why no government Bill has been introduced. But I join the noble Lord, Lord Winstanley, and the noble Baroness, Lady Faithfull, in asking the Government to think very seriously about introducing such legislation soon.

It is not true to say that complex legislation must wait for a very long time. Complex legislation was introduced very quickly two years ago to abolish the Greater London Council and the metropolitan counties. I hope very much that the Government will find time to introduce that much needed legislation in the next Session. Might it be possible to have even a slice of the cake and not the whole cake; the slice that sets up the statutory licensing body? Such legislation will be very important in averting yet another Private Member's Bill that might attempt to forestall it.

5.12 p.m.

Lord Auckland

My Lords, the House is very much indebted to the noble Lord, Lord Henderson of Brompton, not only for initiating this debate but also for the very cogent way in which he has presented this very important subject, It is a subject of which Parliament should always take account because disablement, despite the progress of medicine, will always be with us—be it congenital, be it at source, or be it already established.

Many noble Lords have personal experience of disability, as can readily be seen. Thirty years ago I certainly could not have made this speech in your Lordships's House, because I had a most terrible stammer. I still have traces of it. During my National Service in the Army my commanding officer gave me a certain amount of help which, together with that of my dear wife and some self-discipline, has made my stammer less noticeable. But mine is a very minor disability compared with some of the disabilities of childhood with which children are afflicted from birth.

I want to say a word or two about research because I believe that research is absolutely fundamental here. The Medical Research Council has done a marvellous job, not only in this sphere but in other medical spheres as well, However, it is worrying to see how depleted is the council of funds currently. If there is ever a body that should be well funded, it is the Medical Research Council. A nation free from disability as far as that is possible, is a healthy nation. Therefore, it is a nation that can be at work, even in times such as these when unemployment is a major problem.

According to the Office of Health Economics, in 1982 the Medical Research Council was given a grant in aid (and I am never quite sure what that means) of £120 million. In 1984–85 that grant was increased by 15 per cent., but as I understand it, and allowing for inflation, there is still a £1.4 million shortfall. I have not given my noble friend the Minister notice of this question, but I wonder whether those figures could be checked and whether the whole question of the grant to the Medical Research Council could be looked into. It seems to me absolutely fundamental to the question now before us that if we are to look into the causes of disability, whether in the United Kingdom or in the third world, research is absolutely vital.

I should like to put one specific question to my noble friend regarding the marrow bone transplant unit at Westminster Hospital. There are conflicting rumours as to what is to happen to the unit. Perhaps the Government themselves are not too sure. However, I believe that both your Lordships' House and the nation are deeply concerned with the implications of what might happen, because the work done at that unit is essential to preventing the real disabilities of blood cancer and other conditions.

One knows of the problems facing the health service at the present time. That brings to mind the question of ante-natal clinics. Much has been said by the noble Lord, Lord Rea, and others about pre-natal scanning and that kind of screening of pregnant women who can undergo tests to establish whether there is danger of their child being malformed. Those units are essential and it would be a very great shame if there were to be cuts in that field. It is fundamental to those women's peace of mind and also to the number of disabled and handicapped children that there might be, who would require to be looked after.

The noble Lord, Lord Winstanley, made reference to accidents. I am honorary vice-president of the Royal Society for the Prevention of Accidents, and the subject of accidents in the home has always been one of my main interests. The noble Lord is absolutely right. There are about 6,000 fatal accidents in the home every year. Here is the position of disability at source. A man may fall off a ladder at the age of 20. He may previously have been perfectly fit but might then be disabled for life. Accident prevention is largely a question of education. It is essential that schools, from primary schools upwards, should be seized of the need to teach children, particularly with the modern methods of video, of the dangers of climbing frames and so on that they cannot manage, and of drinking strange liquids out of strange bottles, which is the cause of much disability.

This has been a useful debate. It is always much harder to discuss the source of something, what causes disability, than it is to do something once the disablement has taken place. But that is to follow, and I believe that your Lordships' House, and particularly the noble Lord, Lord Henderson of Brompton, has done a very fine service today for Parliament, our nation and and the third world.

5.20 p.m.

Lord Parry

My Lords, in beginning to speak to this Motion I start with a tribute to the lifelong courage of the noble Lord, Lord Auckland, who has demonstrated again the way in which handicap, with care, education and support, can be overcome.

In the hot summer of 1976, during the Recess, I came into this House and passed through the Prince's Chamber to find, to my surprise, a beam crane. The Clerk to the Parliaments, the then Sir Peter Henderson, serving not as Clerk to the Parliaments but as clerk of works, was moving back into position two items of statuary which had been missing from their plinths in the Prince's Chamber for many long years. The statutes of Mercy and of Justice had been held to detract from the majesty of Queen Victoria and had been banished to the cellar until Sir Peter Henderson, historian and Clerk to the Parliaments, had them restored with the help of the committees. I arrived to see one statue in position and the other hanging on the crane. I then heard the remark, which I have cherished ever since, from the then Clerk of the Parliaments. He said, "Parry, you will notice that I have had much more trouble with Justice than I have had with Mercy."

It is a fitting point at which to begin and to tell the House that on Monday of this week, with the Lord Bishop of St. Davids and Mr. David Dell, the newly-elected showman of the year of the Showmans Guild of Great Britain, I spent the entire morning at the Portfield Fair, the May fair, riding the roundabouts and swings with some 50 handicapped children from Pembrokeshire. Two-thirds of those children need not have been there, and some of us need not have been there either if 75 per cent. of the knowledge we have had been applied to them in the period before and immediately after their birth.

The tragedy of our handicapped is that so much handicap is preventable, and the tragedy also is that although we know it we have not yet, despite the great agencies working to secure it under any government, regardless of politics, succeeded in bringing home the message on which the noble Lord, Lord Henderson, is focusing in this debate. It is therefore a privilege to rise with him and bring forward one or two items.

I discovered when I looked at the statistics that in the hot summer year of 1976, perhaps because of the climatic conditions, there were 655,503 births in England, Scotland and Wales in that year. Of those babies, 6,338 were still-born and a great many more were born handicapped because in the period immediately before, during and after their birth they were in some way or other neglected to the point where they became handicapped. The scientists and the doctors in the perinatal clinics in Wales tell me that one of the great tragedies of our time is that here in Britain, in this Western civilised country, in the perinatal period we are handicapping "compost grown", beautiful babies who would otherwise have been perfectly formed. My emphasis, therefore, is on that area where I have shown particular interest: on spasticity and the causes of it. But I am not going to outline those here or dwell upon them because I want to assure this House that certain countries have awoken to the fact that there is self-interest so far as the nation is concerned in giving careful support and care to the handicapped and to the prevention of handicap in the newly-born.

When President Pompidou became President of France that statesman looked at the books, as all governments do when they come into office; and, as all governments are, he was horrified by what he found. He was particularly appalled to find that a very great deal of money was being spent on support for the handicapped—an item in the budget that his country could ill afford and yet to which it was totally committed. He sent first for his statisticians and his economists and said, "What is this figure? How can we cut it down?" They said that it could be done by preventing spasticity, mental handicap, and by preventing injury in the perinatal period. He did not know what the perinatal period was. He sent for his doctors to advise him. They told him that during that period a great deal of damage was done but that it was avoidable to a very large degree.

So President Pompidou set them to work. He told them to produce a system for France which would reduce all the havoc that was being caused. They set about it. The simple product of their investigation was the maternity book which was a presentation to all women who registered in pregnancy. The earlier they registered the better were their chances, so the French Government paid them to register early. It was a simple little payment made in three tranches so that the girls—working-class girls, unemployed girls—during the period of their pregnancy could, through those registrations, be identified as either at risk or as healthy potential mothers. The maternity book became their property and it went with them. If they moved they presented it to the authorities so that their registration could be continued.

The result was dramatic because France, from having had some of the lowest good figures in Europe—conversely, some of the highest bad figures—moved very quickly up to scale of good providers and showed splendid progress in avoiding perinatal damage.

I was given, as were other Members of your Lordships' House, some figures from IMPACT, the international initiative against avoidable disablement. Since we have talked about Britain and about France I wanted to outline that in Africa it is estimated there are over 40 million disabled people in that land and that two-thirds of their disabilities could now be prevented or indeed cured. In Madras, in India, between April and August 1985, 216,000 infants were immunised against poliomyelitis in a city-wide campaign in which the Indian IMPACT foundation collaborated with state and city authorities, and others. They achieved an unprecedented 92 per cent. coverage of those people. It is estimated that that campaign alone saved over 800 of the city's children from paralysis during an epidemic of poliomyelitis.

I shall just mention the fact that France, Africa, India, Latin America and South-East Asia could all give examples of tackling the problem in a way that we would wish to see—with a new urgency. That is not criticism of existing government policy nor does it require defence, because I say it as someone who believes that we care alike for the underprivileged in our society and that we try to plan, whatever view we take of society, the best use of our resources in aid. But we are also much more likely to listen to the articulate. We are much more likely to listen to the organised. The voices of those who are well placed in society, who are well educated and well endowed, can be heard and facilities can be created for them sometimes even at their own expense; but I am not making any reference to that.

What does not happen—and it has already been said in this debate—is that sufficient of the resources moves down through society. It was Sir Anthony Eden, a Conservative, who once said that we have not yet succeeded in creating in this country a democracy. All that we have succeeded in doing is to broaden the basis of the oligarchy. At the bottom of the pyramid there are a great many pregnant women in Britain who, because young girls try to hide their pregnancy and because poorer girls try to work longer and will therefore register later, will have babies that are born handicapped.

The core figure is this: if a handicapped child grows up to be a handicapped adult, then between the ages of 16 and 60 he handicaps the economy of the country by £250,000 at least. So the prevention of that handicap would prevent the loss of £250,000 per head. If one adds to that the fact that if that person had lived until the age of 60 as a healthy person, who was at work, paid all his taxes and was able to make the same average contribution as other people, one sees that he too would make a similar contribution to the economy. So one handicapped child saved adds £500,000 to the economy of the country. That makes good sense. It also shows that the country can balance in the swings both Mercy and Justice and put them both back on their plinths.

5.30 p.m.

Baroness Vickers

My Lords, I too am delighted to join in this debate, particularly as we are being introduced to IMPACT, which will be a very valuable organisation in the future. Their present consultant in this country is Sir John Wilson, whose wife is the chairman of the National Rubella Council. I have worked with Sir John Wilson since 1951. When he was 11 years old, he was blinded during a science experiment at school. He was a brilliant pupil who went on to Oxford where he met his wife. The two of them together have sustained a marvellous career over many years, and I should like to wish them luck in the future. I wish that there were more people in the Chamber to listen to this debate. Sir John himself would have liked to be here, but he and his wife are both doing research work in America at the present time.

I shall talk about only two things: first about rubella, which was mentioned earlier by my noble friend. and secondly about blindness. I should like to draw particular attention to rubella because this disease can so easily be overcome. If a woman catches German measles, that is, rubella—which is quite different from ordinary measles—in the first three months of her pregnancy, there is a strong possibility (over 50 per cent. if it occurs during the first month of her pregnancy) of the child being born handicapped. The child can be born deaf, blind, brain damaged, and have congenital heart disease or cerebral palsy. I understand that no developing cell is safe from attack by the virus and very often the foetus is miscarried or the child is still-born. If the mother catches rubella at a later stage of her pregnancy there is a chance of her having a child who is deaf only.

I should also like to say that this disease affects women of all races. It is not confined to European or African women. In 1951 when I was in Northern Rhodesia I came across an epidemic of rubella. The women, who carried their children on their backs, were even more badly affected because they caught the sun in their eyes as well.

In this country there were 120 rubella damaged children born in 1978–79, and there were 1,400 abortions associated with the disease. That is a shocking figure. In 1982–83 I am glad to say that there were fewer abortions associated with rubella—500 in fact. The disease is highly infectious, but it is sometimes very difficult for the victim to realise that she has the disease because its symptoms are quite mild and do not make her feel very ill. There would be no trouble at all, however, if women could be immunised before pregnancy.

The National Rubella Council in this country consists of 11 voluntary organisations which are concerned with the effects of rubella together with the Health Education Council and the Department of Health and Social Security. In 1983 the Minister of Health gave a grant of £1 million for a period of three years, and it is hoped that the number of young people at school who are immunised will go up. I gather that the uptake is about 86 per cent. at the moment. We should aim at 100 per cent. Everybody must work hard for this particular cause so that the blighting of young lives becomes unnecessary. I should now like to mention blindness in overseas countries. Blindness affects about 40 million people in the world today. At least 75 per cent. of them live in developing countries where the prevalence of blindness is 10 to 40 times higher than it is in the developed countries. Four out of five cases of blindness in developing countries could either have been prevented or can now be cured. If the present trend continues, the number of blind people in the world could double in the next 25 years.

The causes of blindness are universal, particularly cataract, glaucoma and trauma. Other major causes of blindness-nutritional blindness, river blindness and trachoma—are found extensively in the developing countries. These causes have almost been eradicated from developed countries as a result of improved standards of living and access to health care.

Over the past 15 years the Royal Commonwealth Society for the Blind medical teams have been restoring sight to nearly 2 million people across Asia, Africa and the Caribbean and have treated the eyes of nearly 20 million people who are threatened with blindness. In India and Bangladesh alone last year the medical teams conducted over a quarter of a million cataract operations. I can still cite a cost of £4 for each operation in an Asian village, for example. Surely this is worth doing, and helping these people.

The organisation that I am at present discussing, the Royal Commonwealth Society for the Blind, works in 38 different countries. There are certain places in Ghana, for example, where there are whole villages whose people are blind through river blindness. There is quite an interesting book telling how very disappointed the people were when visited to hear that the visitors were protecting themselves with mosquito nets. "What is the good of mosquito nets?" they asked, "We do not need them". Yet this was the reason for their blindness. Nonetheless, they were still very cheerful.

I should like to make one final point. In September this year we shall have the big CPA conference held in this country, and there is a book by The Commonwealth Association for Mental Handicap on developmental disabilities. This subject can be brought up during the conference. My noble friend and I are both delegates to this conference, and we hope that there will be a good response and more help will be given to the mentally handicapped in countries overseas. It is an excellent idea for them now to have an association, and I hope that we shall be able to further their interests in the coming weeks.

5.38 p.m.

Baroness Lane-Fox

My Lords, the worthy aim of this Motion is of prime concern to experts and thinkers on health and economics both at home and overseas. The universal value of a healthy person both mentally and physically can be sky high, whereas the cost to any society of the crippled left-overs of accidents, disease or any other condition can be colossal and relentless. Probably it is only those of us who have fallen victim who can calculate fully the individual cost in frustrated purpose and virtual inability to be more than a burden; the cost of support from families and siblings, partners and offspring. Just one victim can handicap a whole family.

It was in the mid-50s that we heard the magic news that Salk vaccine from the USA was to be available to keep people safe from poliomyelitis: that scourge with its ability to maim and kill unsuspecting people could now be wiped out. There was never any deception or attempt to conceal the fact that there existed an infinitesimal degree of risk of vaccine damage; but compared with the risk of catching the virus that was indeed small. Then in every town and in most villages there were ugly, living reminders of the pre-immunisation era. The need to immunise was clear for all to see, and the figures progressed satisfactorily. It was when those horrifying effects began to disappear—when, like the dinosaur, only a few old examples remained preserved—that those immunisation figures were in jeopardy. Worse still, the cruel blow of vaccine damage obviously shattered people's confidence.

On the face of it, immunisation figures have kept up remarkably well, though in-touch organisations like the British Polio Fellowship are constantly worried. May I ask my noble friend the Minister whether in her reply she can tell us whether there is further research into the safety of vaccines and the suitability of the recipient's health? Anything to reduce the spectre of damage will boost the immunisation campaign. Action Research for the Crippled Child is always promoting prevention. It is now interested in measuring public reaction to immunisation, and that should lead to further useful progress. To think of the multitude still being paralysed overseas today through polio leaves one with only one light to shed on that dark subject. That is, the drives that are made to increase vaccine take-up by, for instance, Save the Children Fund, boosted by support from enlightened young people who follow Princess Anne's example in promoting immunisation overseas.

While vaccine is a highly scientific and clear-cut method of preventing disability, there is another weapon to which I should like to refer. It is rugged and basic but it is of vital importance and it is too often forgotten. I refer to the teaching of genuine health education within active school life. From their television viewing children have cultivated a superficial sophistication. They understand—they have to—much more about the physique than did earlier generations. After viewing TV programmes about the less fortunate aspects of existence, children are apt to ask, "Could that happen to me?". Positive answers given at school can encourage lasting self-help. It is my belief that by learning about the make-up of their bodies children can make the most of prophylaxis and protection. A message needs to be planted in the conscious and subconscious that damage can be avoided by proper use of the self. There should be an understanding of the variations in human structure and skills, and I support the remarks of my noble friend Lord Auckland.

Elementary anatomy, physiology and psychology need to be made known to pupils. That also applies to kinesiology, which concerns movement patterns and habits in relation to energy and for lifting and handling objects; indeed, all daily movements and activities. Where else but in school can most people get that kind of information? Of course that information is best absorbed after physical activities when the mind and body are relaxed and receptive. Already through the efforts of education authorities, physical education associations and voluntary organisations there are many centres dedicated to sport. There is some dichotomy between sport and attention to physical problems when surely there should be a great connection between the two.

Certainly it is in school that physical disorder can best be spotted. The Chartered Society of Physiotherapy and the Health Education Council are conferring to seek positive methods to promote health and prevent disability. They also seek the co-operation of GPs as essential and a central point in health. There are physical disorders which are best spotted in schools and which are sometimes missed by parents and GPs. They can be equally unaware of a disorder that may grow and change into something which will be of great importance in maturity and old age, such as bad feet, pseudo-rheumatics, back pain and bad postural habits. Unless those conditions receive accurate attention in childhood, adults may suffer pain and severe discomfort later on. To start with, people hate to admit such things; they take pain-killers and probably end up in NHS beds, to everyone's cost.

One result of the tension and pressures of everyday life can land children in avoidable difficulties and threatened situations. Smoking, glue sniffing and drugs all got going in many districts before grown-ups could step in. That must be a pointer to the authorities to provide the full story of how to keep well and to put some of the responsibility on the children themselves. Such a campaign could well be backed up by videos and every other modern aid to assist with interesting and enthusiastic teaching. I hope that the Department of Education and Science will take note of those requests.

The need of this as a subject of teaching has become obvious to many people. Children have never been more interested in self, and that interest should be well targeted now.The climate for such teaching is favourable and I believe the ground for it is fertile. If only the ground is tilled properly, I firmly believe that health education can have a profound effect on the object of the Motion—the Motion of the noble Lord, Lord Henderson, which I beg to support and on which I wholeheartedly congratulate him.

5.47 p.m.

Lord Prys-Davies

My Lords, I too join with noble Lords in thanking the noble Lord, Lord Henderson, for giving us the opportunity to discuss the need to prevent disability or impairment before they occur. I thank him for his stimulating opening address. When we recall that in the United Kingdom—and our problems pale into insignificance compared with the developing world—one in 20 people is suffering from severe disability, it is evident to those of us who believe that the human race should live in happiness and should be free from suffering that prevention of disability must be a basic part of any radical approach to disablement.

The hopeful message that the noble Lord brought to the House is that much can be done to prevent disability. I believe that he was supported in that central message by my noble friend Lord Parry. I may have misinterpreted the noble Lord, Lord Winstanley, but I thought that he was a little more pessimistic about our potential to prevent disability. If I am wrong, I am sorry about that.

Lord Winstanley

The noble Lord is wrong, my Lords.

Lord Prys-Davies

I am wrong, my Lords. Good! It is probably true to say that in a developed country in most situations the responsibility for preventive health care lies with the individual to the extent that he has a real choice in controlling his behaviour.

I agree with the noble Lord, Lord Henderson, that the lower down the heap we are the more difficult it becomes for us to take the right decision. Nevertheless, it is the individual who decides on his diet, within the limit of his means; it is the individual who decides whether he will give up smoking; and it is the individual who decides whether he will drink and drive.

I agree with my noble friend Lord Winstanley that attitudes and lifestyles change slowly, unless of course we are confronted by a drastic problem such as exposure to the risk of radiation, following the nuclear disaster in the Ukraine. We need to give high priority to health education campaigns to promote public awareness of the risks. That is the theme which was developed by the noble Baroness, Lady Lane-Fox, who referred to the need for health education in schools. For the young, the responsibility for preventive health care must of necessity lie elsewhere. It lies with the parents. The message which the noble Lord, Lord Campbell of Croy, who made a very courageous speech, and others brought to the House was that there is a responsibility on parents.

During our century, environmental health services have reduced remarkably the environmental causes of childhood morbidity and disability. Today, infant disability and handicap are in considerable and significant part genetically determined. It is therefore all the more desirable that as few infants as possible should at conception carry a genetic predisposition to physical and mental handicap. We have heard again this afternoon the message that there is a need for accurate genetic counselling, if they want it, for those parents who are at risk of having a disabled child. The advice must be available but the decision whether to take the advice must be for the parents and not for the community or even for the doctors.

As the consequence of disability for an infant is so great and continues throughout his lifetime from the cradle to the grave, we have a moral responsibility to use our knowledge of genetic endowment in the interests of the coming generation. That point was first made this afternoon by my noble friend Lord Longford, who told us of his acquaintance with the horrors of muscular dystrophy. It will not be lost on the Government that that point was reinforced by a number of speakers, including the noble Lords, Lord Winstanley and Lord Rea, and the noble Baroness, Lady Faithfull.

I very much look forward to hearing the reply of the noble Baroness the Minister to the questions addressed to the Government by the noble Baroness, Lady Faithfull. We want to know the answer to the question asked by the noble Lord, Lord Campbell of Croy, about how widespread is the availability of genetic counselling facilities.

I found myself in some sympathy with the cautious approach taken by the noble Lord, Lord Winstanley, towards the wholesale adoption of screening facilities, but nevertheless I accept and follow the plea made by the noble Lord, Lord Campbell, the noble Baroness, Lady Lane-Fox, and others who said that it is still necessary for parents to protect their children against preventable diseases by vaccination. After the first year of life, accidents become the major cause of handicap. That point was referred to by the noble Lord, Lord Auckland. It has been said that the home can be highly dangerous for every young child. Dangerous toys lying about the place are a cause of anxiety. Some household products can be highly dangerous in the hands of an infant. Unstrengthened glass doors in the home are highly dangerous, and not only for children.

The noble Lord, Lord Winstanley, reminded the House that for the citizen of working age in developed countries road accidents and accidents in work, many of which could be avoided, are the major cause of serious injury. The cost of road accidents and accidents in work are immense for the individual and his family in terms of pain and suffering. They are also immense for the community in terms of lost output and medical costs. Those points were made by my noble friend Lord Parry.

There have been one or two implied references to the urgent need to reduce dependency upon tobacco and alcohol. The Minister for Health recently described alcohol abuse as a disaster. The debate could have been constructed on the need for action based on the agenda produced by Action on Alcohol Abuse.

In the United Kingdom and the developed countries, in contrast to the developing countries, because medicine has succeeded so well in saving and prolonging life the old constitute the largest single group among whom the incidence of severe handicap is high. I understand that disability of some kind affects 25 per cent. of those over the age of 75. The prevention of disability among the elderly is in a sense, as the noble Lord, Lord Henderson, said, a method of control rather than prevention. We must concentrate on the early detection and treatment of disease with a view to a return to improved health.

The potential effects of improved procedures for the detection and treatment of arthritis and dementia are tremendous. We are immensely grateful to the IMPACT foundation under the leadership of Sir John Wilson for its education campaign spelling out that effective measures for the prevention of disability are now physically possible. I join with the noble Baroness, Lady Vickers, in paying tribute to Sir John and his good work. We are of course indebted to many other organisations which have been working in that area, but the recent IMPACT document Preventing Disability in the United Kingdom amounted, in my view, to a bold attempt to assess the United Kingdom's immediate requirements.

The national seminar held by the IMPACT foundation in February made at least 27 recommendations for the reduction of disability in the United Kingdom. It called for measures to clear the backlog of 20,000 cases of remediable deafness, particularly among children. It called for measures to cut the waiting lists of the 7,000 people who are needlessly blind for the want of a cataract operation. It called for a determined effort to reduce the waiting time for hip replacement operations. Has the department considered the suggestion that patients on the waiting list in one region should be transferred to hospitals in an adjoining region where there is spare capacity?

It should be repeated that the seminar's main conclusion was that the incidence of disability in the United Kingdom could be reduced by at least 20 per cent. by the application, through the National Health Service, of existing technologies and facilities and better management. That is an astounding conclusion.

The seminar's expert analysis and conclusions streamed into the DHSS just over three months ago. Will the Minister tell the House whether they have now reached the Secretary of State? Are they on his desk? Has the department picked a team to consider the recommendations? When does the department propose to be in a position to respond to the regulations? If any of the regulations are rejected, I am sure that the House and the public will want to know how the department responds to the evidence on which the regulations are based. I am without time to dwell on the need for more research, but one obviously supports the need for more research.

I must mention briefly the problems of disability in the third world. One person in 10, not one person in 20, in the under-developed world is affected by severe disability. I do not think that we in the United Kingdom can be concerned exclusively with disability in this country. IMPACT again has drawn our attention to what can be done outside the modern acute hospital of the United Kingdom with simplified technology to intervene massively and effectively to prevent disabilities in the under-developed world in order to restore sight, to restore hearing and to restore movement. The noble Lord, Lord Henderson and my noble friend Lord Parry have underlined some of the startling statistics in the IMPACT document.

In conclusion, I want to support very strongly the appeals made by the noble Lord, Lord Henderson, to the Government on behalf of the under-developed world. I found it rather difficult to believe that any British representative serving on an international committee concerned with the problems of disability would not already have appreciated the quality of the papers produced by IMPACT foundation; but it is conceivable that a British representative may not be aware that IMPACT is in a real sense a British initiative. I therefore agree with the noble Lord, Lord Henderson, that a timely word in the right place at the right time would be helpful. Indeed, the Foreign Office and the DHSS have helped in the past.

The noble Lord, Lord Henderson, then made a plea for a modest contribution of £25,000, and no more, to the IMPACT foundation to help with the expenses incurred by British experts travelling overseas to give voluntary service to the disabled. We urge the Government to give sympathetic consideration to this appeal.

One's final thought at the end of this interesting and stimulating debate is this. The fact that so much can be done to prevent disability which is so widespread and often characterised by pain, distress and frustration makes the fact that it is still tolerated even more scandalous.

6.3 p.m.

Baroness Hooper

My Lords, first I should like to add my congratulations to the noble Lord, Lord Henderson, on choosing this important subject for our debate today. Disability as such and the treatment of disabled people is of course a topic to which this House has rightly given a considerable amount of attention in recent years. However, I believe that we have not previously concentrated in our deliberations on the vital topic of the prevention of disability. As has been said, the reason that we are doing so today is a direct consequence of the valuable initiative by the UK IMPACT foundation in arranging a seminar on the subject last February which had the full support of the Department of Health and Social Security. Like many of your Lordships, I wish also to pay tribute to the foundation and to the vision and energy of the chairman, Sir John Wilson. The seminar was clearly a very useful occasion and the admirably succinct summary of the conclusions, which most of us here today have seen, represents a valuable conspectus of the very wide range of issues involved in the prevention of disability. These are issues which the Government have taken and will continue to take very seriously.

The international repercussions of the IMPACT initiative have been referred to by many of your Lordships. I should like to start therefore by making some brief remarks about those international aspects of the prevention of disability.

The World Health Organisations' global strategy for health enshrined in its action plan to achieve health for all by the year 2000 focuses on primary health care. World health strategy is now therefore increasingly emphasising the importance of prevention of ill-health, removal of health risks and promotion of health. Developing countries in particular can now be expected to do more to prevent disabling conditions arising from, for example, poor perinatal care, malnutrition and infections. A net result should and we hope will be a reduction of new disability among children and infants.

Various successful examples of projects carried out in the last decade were quoted by the noble Lord, Lord Henderson, in his opening speech. Because of this increasing emphasis on prevention and the fact underlined by the noble Lord, Lord Winstanley, among others, that health care resources do not meet health care needs, the United Kingdom Government attach great importance to the prevention of disability in the ODA's bilateral aid programme. We approach this through the provision of basic health services to the community, including mother and child health services, immunisation and adequate nutrition.

A major proportion of the £20 million which the UK spends annually on the health sector in developing countries goes towards preventive medicine. This includes the provision of medical personnel and facilities such as clinics and research into the causes and eradication of disabling diseases. It does not, however, include expenditure on water supplies, disaster aid, population activities, main contributions to the international organisations and other related matters which affect health and would bring a total to well over £100 million. I hope that this goes some way to reassuring the noble Lord, Lord Rea.

I can assure noble Lords, and the noble Lord, Lord Henderson, in particular, that British representatives at international organisations already refer to and promote the IMPACT initiative wherever possible. In response to his other question in this area—the request for funds for travelling for voluntary organisations and in particular IMPACT to attend conferences and seminars, funds for this sort of activity are not of course unlimited; but I am sure that the Overseas Development Administration is willing to give consideration to any application and indeed has done so.

We also contribute to a number of multilateral programmes which focus on the prevention of disablement. One of these, the World Health Organisation special programme for research and training in tropical diseases, was launched in 1976 to stimulate action by the international community to control the six major tropical disabling diseases including malaria, leprosy and river blindness. The United Kingdom played a prominent part in setting up the progamme and has been a major donor since it began having contributed a total of almost £3 million. Much of the programme's research is undertaken in the United Kingdom. Other World Health Organisation programmes to which we contribute annually are the expanded programme on immunisation, which aims to immunise all children against six common infectious childhood diseases— diphtheria, whooping cough, tetanus, poliomyelitis, measles and tuberculosis—by 1990; and the action programme on essential drugs and vaccines, which helps developing countries draw up lists of essential drugs and establish local manufacturing and distribution facilities wherever possible.

From the international scene, I turn to the prevention of disability in the United Kingdom. This was the main focus of the IMPACT seminar in February. Let me say first of all that promoting positive health generally through health education and preventive medicine programmes is, and will continue to be, high on the Government's list of priorities. This was made clear in Care in Action, the handbook of the Government's policies and priorities for health and personal social services published in 1981. As we have seen, action to combat disability abroad concentrated on specific, effective measures against, for example, tropical diseases. Similarly, we must be as specific in our actions to combat disability in this country. The position here, however, is very different from that obtaining say, in parts of Africa. Disability here often arises out of our comparatively affluent lifestyle. This was a point made by the noble Lord, Lord Winstanley. We are rightly concerned about heart disease, the effects of smoking, stress, the abuse of alcohol and drug addiction. We need to focus better on particular issues and to think incisively about priorities and deal effectively with the problems that face us in a logical way.

I can perhaps refer at this stage to the question raised by my noble friend Lady Faithfull concerning the MENCAP proposals for strategy on the prevention of mental handicap. These bring together usefully a number of the themes—health education, lifestyle advice and genetic counselling to which I shall be referring later. They apply to many other different kinds of handicap, not just mental handicap. To make people aware of the dangers and risks to health that they can face in everyday life and to ensure that each individual understands as much as possible—the noble Lord, Lord Prys-Davies emphasised that this was ultimately the responsibility of each individual—the Government fund the Health Education Council to enable it to carry out a huge programme of public health education. This year the Government are giving some £10 million to the council. The council's range of activities is extensive. It sees its educational role as encompassing campaigning on healthy life style issues, sponsoring research and training health educators. Its main role is to make widely and easily available authoritative and sensible advice on a wide range of issues linked to good health. These include the effects of smoking, alcohol and drug abuse, family and personal health, and the prevention of coronary heart disease. Education and advice on health are available to all, from mothers-to-be through childhood and adulthood to old age.

Health education is also being taken to the workplace through the Health Education Council and its publication and project entitled Look After Yourself. More and more employers are taking part in this campaign which includes special workplace training courses and covers smoking, diet, exercise and stress management and other ways in which employees can look after their health, the practical effect in many cases being the prevention of injury and accidents. This must be an important step in the right direction.

Health education and, by implication, work on the prevention of ill health start from an early age. I trust that this will reassure my noble friend Lady Lane-Fox. The Health Education Council has a continuing programme of developing materials and providing training to promote an awareness of the importance of health among young people aged from four to 19. The White Paper Better Schools, published in March 1985, made clear that the Government regard health education as an essential curricula element. Health education continues into old age. The council's five-year programme related to health in old age was launched last year. Its aim is to enhance the potential of older people to live independently healthy lives in the community. The programme has set out to improve people's knowledge and understanding of health issues in later life in areas such as dental care, the value of exercise and nutrition. One of the features is an Age Well drive that focuses on ways of promoting health activities for and with older people with the emphasis on participation and self-help.

Sensible eating can, of course, contribute to a healthy life and counter the risk of heart attacks and disability. Much is being done in this respect. It may be of interest to noble Lords to know that, in addition, all National Health Service regions included policies for prevention in their 10-year strategic plans submitted to the Government last year. In turn, regions encourage and help districts carry out health education and monitor progress. Ministers can and do raise with regions questions about their progress in health promotion in the yearly round of ministerial reviews.

In the broad sense measures to avoid disability, therefore, are an inbuilt part of both the Government's and the Health Education Council's objective to improve the nation's health. Preventable accidents were referred to by a number of noble Lords, in particular the noble Lords, Lord Prys-Davies and Lord Winstanley. I should like to focus in particular on accidents to children which are the commonest cause of death of those over one year of age and account for one-sixth of hospital admissions between the ages of one and 15. Responsibility for different types of accidents is widely spread among Government departments co-ordinated by the Child Accident Prevention Trust. The DHSS takes the lead in providing financial support to this organisation and currently has allocated grant aid of about £70,000 a year over three years from 1985 to 1988.

Turning to pre-natal care, raised by a number of your Lordships, health education in the widest sense of the word is only part of the story. I must therefore refer to specific medical and other services that have an important role. First, I shall say something about pre-natal care and then something about surveillance and preventive services for children. Vaccination of schoolgirls and women of child-bearing age against rubella is an important element here. I shall say something in more detail about vaccination and immunisation later. It is now possible, in a number of inherited conditions that cause disability, especially in children, to give couples precise advice on the risk of having an affected child. A number of your Lordships, including my noble friend Lord Campbell of Croy and the noble Lord, Lord Winstanley, have referred to screening. Recent advances in clinical genetics can permit informed counselling sometimes before conception or, failing that, early in pregnancy. Already it is possible to counsel those parents at risk of transmitting disorders of haemoglobin. Once a pregnancy has been confirmed some handicapping conditions can be diagnosed pre-natally; for example, neural tube defects or chromosome disorders. A range of tests and procedures is widely available, in addition to specialist genetic advisory centres throughout the country where couples with a family history of a condition can receive expert advice. The techniques to detect various congenital abnormalities and inherited disorders have changed dramatically in recent years. Most notable among the advances are, first, the development of gene markers which permit recognition of the carrier state or of an infected child. These will become increasingly important in the prevention of cystic fibrosis and Duchenne muscular dystrophy, to which the noble Earl, Lord Longford, explicitly referred. I can inform him that support is available in the research field. For example, there is Government support for the grant of £10,000 a year to the Muscular Dystrophy Group towards its welfare services. The second important advance is the use of high resolution ultrasound scanning, and the third the development of the techniques of fetoscopy and of chorion biopsy. With these methods it is now possible to detect a very wide range of conditions in the foetus that could not have been identified as short a time as five years ago.

For a few conditions treatment of the foetus in utero may be possible; in other cases arrangements can be made, where appropriate, for the baby to be delivered in a hospital with the best facilities for care after birth. The ability to predict and identify genetic defects in the pre-natal period has led to increased demand for specialist advice from couples who have a suspected or known family history of inherited disease. Such advice can inform parents of the prenatal diagnostic tests which are available in their particular circumstances and help them to make an informed decision on the basis of the possible outcomes, including treatment at or even before birth.

On this point, the noble Lord, Lord Parry, referred to the French system based on financial incentive. I must say to him that in this country we have preferred not to introduce systems of maternity care which smack of compulsion. But I should remind your Lordships that perinatal mortality figures in the country under our own system are continuing to fall.

We recognise that the likely rapid advance in medical knowledge in this very specialised field as new techniques are developed and refined will lead to an increased demand for advice and screening tests from "at risk" couples. To ensure that this demand is met in an efficient way, the department is currently funding a development project in three centres (two in England and one in Wales) together with a separate evaluation. This initiative is intended to provide a guide for health authorities in reviewing the genetic advisory services they are providing, and in planning future developments.

Screening to detect possible handicap is not limited to the time before birth. Every health authority is responsible for monitoring the health and development of all children living in its area. Preventive and advisory services are provided for pre-school children through a network of clinics and the health visiting service. These child health surveillance programmes aim to monitor the development of children, including their intellectual development. These preventive services also continue after children start school. In the early stages of a child's school career they will focus mainly on the continuing need to monitor vision, hearing and growth. As the children grow older the focus moves on to health education to encourage children to adopt positive attitudes to health and accept responsibilities for their own health.

References have been made to the role of the general practitioner. I would refer your Lordships to the importance which the Government give to this area and the review of family practitioner services and community nursing services which my noble friend Lady Trumpington announced to your Lordships three weeks ago. While we are talking about screening and surveillance perhaps I can report briefly to your Lordships on one or two interesting developments on screening for visual and hearing impairments—two areas on which the IMPACT seminar focused particularly, and to which, in particular, my noble friend Lady Vickers referred.

First, I refer to visual impairment. The commonest cause of adult blindness in this country are senile macular degeneration and diabetic retinopathy. There are encouraging developments in the treatment of these diseases, including the use of lasers. Many patients can be effectively treated if they are diagnosed sufficiently early. The Government are concerned that detection and treatment should be as effective as possible. We are therefore funding a research study to evaluate different methods of screening for diabetic retinopathy. The department's chief medical officer recently asked a group of experts to report on developments in the treatment of senile macular degeneration. We hope that these initiatives will enable us to advise health authorities about the development of these services.

Time is against us, but much was said about vaccination and immunisation. Such programmes have a major part to play in the prevention of disability. Perhaps I can cite, as other noble Lords have, the near total elimination of poliomyelitis—one of the great success stories of public health since the Second World War. In 1955, the year before the first introduction of the poliomyelitis vaccine in the United Kingdom, over 4,000 cases of the disease were notified. In the five years 1978–83, there were only 22 cases in total.

However, in too many cases children are still not being immunised, especially against measles, whooping cough and rubella. This leads in some cases to serious disability. Some progress in improving uptake has certainly been made, but much more still needs to be done if we are to reach the high standards of achievement in many European countries.

I could not leave this subject without pausing to add my support to the comments by my noble friend Lady Vickers and others on the work of the National Rubella Council and its chairman and moving spirit, Lady Wilson. The council is a unique grouping of 11 voluntary bodies, including the Health Education Council and health departments. It has made a major contribution in this area.

I regret that in view of the time I must swiftly pass over one or two points and just refer to the need which was emphasised by a number of noble Lords for more research. In particular, I am aware of the interest of many of your Lordships in the subject of research involving human embryos. My honourable friend the Minister for Health will be meeting representatives from PROGRESS very shortly, and we shall listen very carefully to any suggestions that they put forward. We have fully recognised for some time that the question of research using human embryos has been the cause of deep concern to many people. As my noble friend Lady Trumpington told the House recently, it remains the Government's intention to legislate on the matters covered by the Warnock Report as soon as practicable, but I cannot speculate on the timing of any legislation. Nevertheless, I can reassure noble Lords that their views, and indeed the view of IMPACT, will be taken into account.

We have covered a lot of ground, and I apologise if, because of lack of time, I have not been able to respond to all the specific points raised. However, your Lordships may be sure that we shall follow them up. I should end, however, by once again thanking the noble Lord, Lord Henderson, for providing us with the opportunity for this important and, I think, constructive debate. I hope that I have been able to indicate to your Lordships that the Government are making some progress in the right direction.

Lord Parry

My Lords, without wishing to detain the noble Baroness as she sits down, could she please explain to me how a system that is voluntary and depends on graded payments to encourage "smacks of compulsion", which I think was the phrase that she used?

6.28 p.m.

Lord Henderson of Brompton

My Lords, I think that I have but a minute to reply to the debate. I am sure that the noble Baroness will write to the noble Lord about that matter.

I have to thank with my whole heart everyone who has spoken throughout this debate, on all sides of the House. I must say that it was very nearly a broken-backed debate in view of the two bites taken out of it by Statements. Nonetheless, we are still walking—we are not paraplegic. We have come to the end of this debate with a highly informative and responsive reply by the Minister. With that, I should like to beg leave to withdraw my Motion for Papers.

Motion for Papers, by leave, withdrawn.