Serious Crime Bill [HL] — House of Lords, 2015-03-02
Topic: Health
Narendra Babubhai Patel (Crossbench, Unknown): My Lords, I shall speak to Amendments 5 and 6 in particular. Before I start, let me say that I absolutely agree with the Minister that female genital mutilation—FGM—is a horrible procedure, and it is right to criminalise it, with the severest of penalties for anybody involved. I have seen many adolescent girls and young women whose subsequent health has been affected by female genital mutilation—occasionally resulting in death during childbirth, but much more often in the horrible condition known as obstetric fistula, which I have seen in Africa. I am therefore totally committed to making sure that this horrible procedure is made illegal and removed During the passage of the Bill through the Commons, the Government introduced an amendment to make it a duty for regulated healthcare professionals to notify police of female genital mutilation, and the amendment was accepted there. Like the professional organisations—particularly the regulators of the medical profession, the General Medical Council and the British Medical Association, and some of the colleges, particularly the Royal College of Paediatrics and Child Health—I am concerned about that amendment Our concern is about the proposed duty to report FGM in all known cases in girls and young women under 18. That duty will be a significant step change in the law. I am not aware of any other circumstances in which healthcare professionals are required to refer patients to the police without any regard to the potential impact on the patient. That is what concerns me—the potential impact on the patients, particularly young girls under 18, including 16 to 18 year-olds Doctors are required to make the care of patients their first concern, but of course they have to balance that duty against wider public interest considerations. There are clear circumstances in which they should disclose information to an appropriate agency. For example, it might be necessary to protect a specific person or people, or the public more broadly, from a risk of death or serious harm, or to assist in the investigation or prosecution of a crime. The General Medical Council guidelines in Protecting Children and Young People: The Responsibilities of All Doctors make that absolutely clear The proposed duty, however, allows no scope to consider the best interests of the child or young person. In effect, the duty mandates that the wider public interest in investigating whether or not a crime has been committed would always outweigh the girls’ rights and interests, including those of the individual child or young person. It is difficult to see how that satisfies the proportionality argument or requirement of Article 8 of the European Convention on Human Rights. It also means that doctors will sometimes be obliged—I agree, in rare circumstances—to act against what are considered to be the best interests of the patient. That is in conflict with the primary duty of doctors The Royal College of Paediatrics and Child Health also found that, "there is no credible or conclusive evidence that ... mandatory reporting … better protects children at risk of harm, and its introduction would undermine that cultural approach of risk and responsibility sharing that has been developed in the current system. Mandatory reporting still raises more questions than it provides answers" In response to the Government’s consultation, the professions argued that any duty to report FGM should include a "reasonable excuse" for not reporting if it would be contrary to the best interests of the child or young person to do so. Further consideration needs to be given to the position of young women between the ages of 16 and 18. There is no clear line between childhood and adulthood. While under-18s have a different status in law, at 16 it is presumed that young people have the ability to make a whole range of decisions, including about their own care. Discussions about the treatment and care of a 17 year-old may be indistinguishable from those relating to an adult. Particular risk may arise in the context of maternity care, and here I have a particular concern. A young woman may not present to healthcare services if she fears it will result in a referral to the police. Young women who have undergone female genital mutilation as children will be at increased risk during maternity care and childbirth. They require particular and extra care during labour. That duty would undermine the provision of care that might be given to them There are many positive aspects to the Bill which I absolutely support. It makes a real difference to the lives of children and young women. This particular duty goes counter to that and I wish there was a phrase saying that in some circumstances there might be a need to protect children and young women. If we cannot change this today, I hope that at least there will be a commitment on the Minister’s part to make sure that the guidance will reflect our concern.