Lord Wolfson of Tredegar:

Moved by Lord Wolfson of Tredegar

66C: After Clause 72, insert the following new Clause—“Medical evidence of domestic abuseProhibition on charging for the provision of medical evidence of domestic abuse(1) No person may charge a fee or any other remuneration for the preparation or provision of relevant evidence relating to an assessment of an individual carried out by a relevant health professional in England or Wales under a qualifying medical services contract.(2) No person may charge a fee or any other remuneration for the preparation or provision of relevant evidence relating to an individual by a relevant health professional in England or Wales if the services provided by the relevant health professional are wholly or mainly services provided under a qualifying medical services contract.(3) In this section “relevant evidence”, in relation to an individual, means—(a) evidence that the individual is, or is at risk of being, a victim of domestic abuse which is intended to support an application by the individual for civil legal services, or(b) any other evidence that the individual is, or is at risk of being, a victim of domestic abuse which is of a description specified in regulations made by the Secretary of State.(4) In this section “relevant health professional” means—(a) a medical practitioner licensed to practise by the General Medical Council; (b) a health professional registered to practise in the United Kingdom by the Nursing and Midwifery Council;(c) a paramedic registered to practise in the United Kingdom by the Health and Care Professions Council.(5) In this section “qualifying medical services contract” means—(a) in relation to England—(i) a general medical services contract made under section 84(2) of the National Health Service Act 2006;(ii) any contractual arrangements made under section 83(2) of that Act;(iii) an agreement made under section 92 of that Act;(b) in relation to Wales—(i) a general medical services contract made under section 42(2) of the National Health Service (Wales) Act 2006;(ii) any contractual arrangements made under section 41(2)(b) of that Act;(iii) an agreement made under section 50 of that Act.(6) The appropriate national authority may by regulations amend the definition of—(a) “relevant health professional”;(b) “qualifying medical services contract”.(7) In this section—“appropriate national authority” means—(a) in relation to England, the Secretary of State;(b) in relation to Wales, the Welsh Ministers;“assessment” includes a consultation, whether in person or otherwise;“civil legal services” has the meaning given by section 8 of the Legal Aid, Sentencing and Punishment of Offenders Act 2012.(8) Subsections (1) and (2) do not apply in relation to anything done by a relevant health professional before the coming into force of this section.”Member’s explanatory statementThis Amendment would prevent certain health care professionals who either assess a patient under an NHS contract, or provide services wholly or mainly under an NHS contract, from charging victims of domestic abuse for the provision of evidence of their injuries in order to support a claim for civil legal aid.

My Lords, when we debated the Amendment tabled in Committee by the noble Lord, Lord Kennedy of Southwark, which intended to prohibit GPs from charging domestic abuse victims for legal aid evidence letters, I made clear my intention to try to reach a satisfactory conclusion on this matter. I was also clear that the Government wholeheartedly agree that vulnerable patients should not be charged for evidence to support them in accessing legal aid. That remains the Government’s position.

In Committee, I gave an undertaking to give this matter detailed consideration before Report, while, I hope helpfully, pointing out some technical defects with the amendment tabled but ultimately withdrawn by the noble Lord. The current position is that GPs can provide services in addition to NHS contracted services. These are classified as private services for which GPs have discretion to charge the patient for their completion in lieu of their professional time. The provision of letters of evidence to enable access to legal aid is one such private service.

A GP is one of many professionals to whom a vulnerable person can turn for a letter to provide evidence of domestic abuse for access to legal aid. It is up to the discretion of an individual GP practice as to how much any charge for private services should be and, indeed, whether a charge should be levied at all.

As part of the 2020-21 contract agreement, the British Medical Association recommended to all GPs that a charge should not be levied for letters providing this evidence. That was a welcome and important step forward, and a recognition by the BMA that vulnerable patients with limited means should not be expected to pay for such letters. We recognise and commend the vast Majority of GPs who are following this guidance, but we recognise that this is a non-binding recommendation from the BMA, so we now move with this amendment to remedy this gap, having considered the matter carefully since Committee.

Amendment 66C achieves our aim. It will provide that no person may charge for the preparation or provision of evidence demonstrating that a person is, or is at risk of being, a victim of domestic abuse for the purpose of obtaining legal aid. The “relevant health professionals” listed in subsection (4) of the proposed new Clause are those providing services pursuant to any of the general medical services, personal medical services, or alternative provider medical services contracts. A “relevant health professional” who has assessed the patient in the course of providing services under any of those three contracts will be prevented from charging for such a letter.

Importantly, the same amendment also prohibits charging for this letter through any vehicle, the health professional themselves or the practice, be it a company or a partnership. Nobody who seeks evidence from such health professionals demonstrating that they are a victim of domestic abuse, or are at risk thereof, for the purposes of obtaining access to legal aid, may be charged under the government amendment. With the agreement of the Welsh Government, this amendment will extend to England and Wales, subject to a legislative consent Motion which is being debated in the Senedd tomorrow.

In these respects, Amendment 66C will go further than Amendment 71 tabled by the noble Lord, Lord Kennedy. As I observed on a previous occasion, that amendment relies solely on the definition of a general medical services contract in Section 84 of the National Health Service Act 2006, therefore covering only one of those three types of GP contracts, and would not apply to almost 30% of practices. Obviously that was not his intention, but it is an important drafting point.

We have also taken the opportunity to future-proof this prohibition through the two regulation-making powers in proposed new subsections (3)(b) and (6). Proposed new subsection (3)(b) enables the Secretary of State to extend the scope of the prohibition beyond legal aid, should a health professional’s evidence of domestic abuse ever be relevant in other contexts, while proposed new subsection (6) enables the Secretary of State, or the relevant Welsh Ministers, to alter the lists of professionals and contracts caught by the prohibition. Should a change in the delivery of health service necessitate a change in the scope, we can do that with the appropriate regulations.

The remaining government amendments are largely consequential on Amendment 66C. Amendment 89A amends Clause 73 to provide that the Secretary of State can issue guidance about the prohibition. Amendment 103A provides for commencement on the first common commencement date following Royal Assent. Government amendments 95A to 95C, 98A to 98C and 99A to 99C make consequential amendments to Clauses 74, 75 and 76 respectively.

I remember well that in Committee the noble Lord, Lord Kennedy of Southwark, read out an impressive list of occasions when he had raised this matter. He went so far as to list the names of my illustrious predecessors with whom he had engaged, and I know that they worked hard to resolve this matter. On that occasion, I said that I hoped to escape the horrid fate of being added to his list, and I hope that I have achieved that very modest ambition. However, delighted as I am to be the Minister standing today at the Dispatch Box, moving these amendments to bring this very long-running problem to a close—I hope—I am conscious that many other Ministers, present and previous, have worked on this matter, and without their efforts we would not have got to where we are today.

We have listened carefully to the points made by the noble Lord, Lord Kennedy, and other noble Lords, on this important matter. I am pleased that this Government have been able to table these amendments. I look forward to the contributions of other noble Lords, and I beg to move.

My Lords, I am delighted with the amendments tabled by the Minister. I thank him very much; the amendments have my full support. I will at the appropriate time not move my amendments on the Marshalled List.

This campaign has been a long one. I will spend a few minutes setting out how it started, thanking those people who have got us to this day, and paying tribute to those whom I cannot mention. The campaign was started by a domestic abuse survivor in the Wythenshawe area of Manchester, on discovering that their local GP was charging victims of domestic abuse for letters that they needed when applying for legal aid. They thought that this was wrong and decided to change the law. I thank Katy—I am not allowed to give her surname—who first raised the issue with my friend Tom Watson, when he visited Safespots Wythenshawe. He raised the matter in Parliament.

I thank Mike Kane, the local MP who supported the campaign for many years; Laura Hitchen, the local solicitor in Manchester who highlighted how widespread the problem was; Councillor Sarah Judge, who works at Safespots; all the Safespots women who are victims of abuse and who stood up and decided to change the law; Manchester City Council and the other local authorities that gave their support to the campaign; all the police and crime commissioners who gave their support, including my noble friend Lord Bach; Sue Macmillan, my good friend for many years, who got the Mumsnet campaigners on the case; Charles Hymas, the home affairs editor of the Daily Telegraph, for shining a light on the issue at the right time; my good friends Stephanie Peacock MP, for kindly raising the issue in the other place, and Stella Creasy MP, for her valuable advice and support; the noble Baroness, Lady Bertin, who supported me in Committee, along with the noble Baronesses, Lady Bull and Lady Burt of Solihull, the right reverend Prelate the Bishop of London and the noble Baroness, Lady Newlove, who has always been supportive and who encouraged me to carry on; and noble Lords of all parties and on the Cross Benches who have supported me in my numerous questions to a variety of Ministers, whom I thank for their responses to all the amendments to government Bills that I have moved over the years. I have involved officials from at least four government departments.

I also thank Victoria Atkins MP, a Home Office Minister who listened and was a great help in getting out of this position. I am also grateful to our Minister—the noble Lord, Lord Wolfson of Tredegar—who on 8 February, when I raised the issue in the House, listened, bringing these amendments back to the House today. My final thanks go to the noble Baroness, Lady Williams of Trafford. I have tremendous respect for her, and she is also my friend. She listened and understood the points being made and played a key role in us getting to where we are today. I am tremendously grateful to her.

I have always said that this is a good Bill, and it is undoubtedly a better Bill because of the work that we have done in this House. With these amendments being agreed today, we are ending the postcode lottery in which a victim of domestic abuse could be charged by their GP for a letter that they need to gain access to legal aid. With these amendments, that position ends. This is wonderful. I am delighted to have played a small part in achieving this.

My Lords, I thank my dear friend the noble Lord, Lord Kennedy, who has been a wonderful campaigner on this issue. I went back in history a little way because I have the privilege of being the husband of a retired GP. Under the old contract from the pre-Blair period, things were not quite as confusing as they subsequently became. We all know that any GP, when faced with this situation, would do a thorough medical examination. This has never been in doubt. In the period after the Major Government this became less clear; I do not know why, but it did. I thank all the people whom the noble Lord mentioned, and Her Majesty’s Government. It is not easy, particularly at times like this, when everyone is focused on Covid, to make progress on a difficult area. Obviously the Ministers have worked very hard on it, and I pay tribute to the hard work that they have put in.

My Lords, I too address Amendment 71. As the lead bishop for health and social care, and with the support of my friend the right reverend Prelate the Bishop of London—as we have heard, she supported this amendment in Committee—I also thank the Government for listening and for tabling amendments that prohibit charging for medical evidence under these circumstances. I also pay tribute to the noble Lord, Lord Kennedy, for his hard work in raising this matter. I regard the Government’s proposal as an excellent addition to the Bill, which will greatly assist a group of highly vulnerable people in securing the support that they need, and I am glad of this opportunity to express our gratitude to all those involved in bringing this about.

My Lords, I shall intervene briefly on Amendments 66C and 71, which I support. I have been involved as a beneficiary all my professional life with legal aid. Its roots go back to the Labour Governments of 1945 and 1951. When I began practising at the Bar in 1959, it was just about being given new life, and what a blessing it has been to people with limited or no means.

My noble friend Lord Kennedy has put down Amendment 71 which, together with the Government’s amendment, is a clear statement that no appropriate health professional may impose a fee for the purposes of obtaining legal aid by an applicant. Health professionals are paid in accordance with the terms of their contracts. My understanding is that on occasion, such as for medical certificates for insurance and travel purposes, they are entitled to charge extra fees. I am grateful for the Minister’s very careful explanation of what they can do.

There is obviously a loophole that needs to be filled. This is confirmed by the very fact of the result of the Government’s work, on which I congratulate them, in moving Amendment 66C. The need to fill in the loophole is confirmed. The Government seem to have covered all contingencies, and it obviously overtakes the Opposition’s amendment. I also congratulate my noble friend Lord Kennedy on the hard work he and others have done; the result is what we see before us today. It confirms the value of this House as a reforming, confirming and improving Chamber. With those few words, I support the Government’s amendment.

My Lords, the noble and learned Baroness, Lady Butler-Sloss, who is next on the list, has withdrawn from this debate, so I call the noble Baroness, Lady Burt of Solihull.

My Lords, I add my congratulations to the noble Lord, Lord Kennedy, on resolving the injustice of NHS providers charging for evidence of domestic abuse. It is an object lesson in persistence. I hope that the noble and learned Baroness, Lady Butler-Sloss, who I was hoping to follow, will meet the same eventual success with her plans on forced marriage. I am also grateful to the Minister for his amendments to ensure that this is properly and legally installed in law.

In my view, it is a scandal that it ever had to come to this. What hard-hearted group of medical practitioners ever made the decision to charge money for evidence that a woman has been subjected to violence as a qualifying condition for legal aid? I suppose that is what happens when you try to marketise the NHS.

The Minister spoke about the role played by the BMA, but according to the BMA this Amendment should never have been necessary. It says:

“We believe that legal aid agencies should trust the word of victims without needing to consult with a medical professional, who themselves” will rely on what the victim tells them and

“may not be best placed to confirm whether domestic abuse has taken place.”

It recommends that the MoJ should remove altogether the unfair requirement for medical forms in the domestic abuse legal process. It seems to me that this requirement is just placing one more obstacle in front of the victim, perhaps to test to destruction her determination to get justice. Will the Minister say why legal aid agencies are requiring these medical certificates in the first place? Should we not be legislating to remove this requirement, full stop?

My Lords, I begin by taking up the comment of the noble and learned Lord, Lord Morris of Aberavon, who said that this is a loophole that needed to be filled. I respectfully agree, and that is why the Government have tabled the amendments that have the effect that I set out earlier.

It was gratifying to hear the congratulations to the noble Lord, Lord Kennedy of Southwark, from my noble friend Lord Naseby, the right reverend Prelate the Bishop of Carlisle and the noble Baroness, Lady Burt of Solihull. I shall not rise to the challenge in her phrase about marketising the NHS, but I should respond briefly to her point about why any evidence is needed at all. The short answer is that there is limited legal aid spend. We must target it at those who need it most, and we believe that the evidence requirements ensure that the legal aid scheme strikes the best balance between ensuring that victims of domestic abuse can evidence their abuse and access legal aid and ensuring that the risk of fraudulent or unmeritorious claims is as low as possible. To that end, we have significantly extended the accepted forms of evidence. We have removed all time limits and the government amendments seek a clear resolution of the issue of victims being charged to obtain that evidence.

Other than that, it is fair to say that the debate we have just had was something of a tribute band to the noble Lord, Lord Kennedy of Southwark, but on this occasion, tribute is entirely well merited. He has been indefatigable and resolute, and he was very generous, although I associate myself with it, in mentioning my noble friend Lady Williams of Trafford, who has also worked very hard to resolve this matter.

I shall not take up any more of the time of your Lordships’ House. For the reasons I have set out, the Government believe that these amendments will sort out this long-running problem, and I therefore commend them to the House.

Amendment 66C agreed.

My Lords, we now come to Amendment 67. Anyone wishing to press this amendment to a Division must make that clear in debate.