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Lord Speaker's Corner: Baroness Finlay of Llandaff

24 November 2023 (updated on 24 November 2023)

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Baroness Finlay of Llandaff is a leading doctor, a professor and pioneer in the field of palliative care. 'Always wanting to change the world', Baroness Finlay has often been ahead of the curve in campaigning for change on topics such as smoking, organ donation and protecting young people. Hear about her work in medicine and in the Lords in this episode of Lord Speaker's Corner.

'I think I've learned from all of the campaigns, a simple message gets through, complex messages don't.'

In this episode

'The internet is a great tool for us who feel fit and well to find things. But the trouble is when people are in despair, it can really suck them down a route of despair... And, of course, when life is gone, it's gone... So I was very keen to work with these parents who want desperately to improve things for others.'

In this episode, Baroness Finlay talks about campaigning for change, including on banning smoking in public places, the 'opt out' organ donation scheme and most recently on combatting suicide promotion online.

'Wales means a great deal to me. It has provided me with a fantastic platform. I don't believe I could have done what I have done, particularly in palliative care, if I hadn't had such fantastically supportive colleagues in Wales.'

Baroness Finlay also talks about why she applied to join the House of Lords, her thoughts on assisted dying, what she learned during her time as a GP in Maryhill in Glasgow, and the importance of her work in Wales now.

 

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Lord McFall:

Baroness Finlay of Llandaff. Welcome to the Lord Speaker's Corner podcast. Lovely to have you. You come from a medical family. Your father was a professor of physiology. Were you always expected to go into medicine?

Baroness Finlay:

Well, thank you for inviting me today. I think from the age of three, when I was in hospital for a time and in those days you were separated from your parents, your parents weren't allowed to visit you for more than half an hour a day. And then I got measles in hospital, so then my mother wasn't able to come in at all. I think that's where I got a flavour for hospitals, actually. So I had always wanted to be a doctor. I can't remember wanting to be anything other than a doctor.

Lord McFall:

Well, tell us about your journey in medicine, because you eventually ended up in palliative care. Some would say maybe palliative care is one of the Cinderella specialties in the light that there's cancer, there's heart or whatever, but you go about your business quietly there.

Baroness Finlay:

Well, going back to my childhood, there was lots of illness at home. My brother nearly died in childhood. I was aware both my grandfathers died, my great friends next door, the two houses were almost brought up together. There was illness, TB in the house next door. And then my best friend at school, her brother died suddenly of meningitis when we were in our early teens. And I just thought that it was normal for people to be surrounded by serious illness and near death. And it was almost a surprise later when I went to medical school and met other people that other people didn't come from families like that.

Also, when I was training as a junior doctor, and indeed as a medical student, got worried about the way that patients were viewed as, there's nothing more we can do for you once they had advanced disease, that knowledge of analgesia was poor. And then I worked in a pediatric oncology department for a time. I had done anaesthetics before that. And I suddenly became aware that I knew more about analgesia, pain relief, than the others I was working with. And my consultants there recognised it too.

And then I had some time in intensive care and I just thought when people are really seriously ill, that's when they need good care the most. At that time, Cicely Saunders, she'd just set up St. Christopher's Hospice, was setting up education programmes. I then had gone into general practice, and with another GP, we went on one of her short courses and we said, we've got to do something about the way that dying people are cared for.

And so that was the beginning. And then I was involved later on in setting up a home care charity. And then eventually in palliative medicine becoming recognised as a specialty because when I started out, it wasn't recognised as a specialty. And when I applied for a job to run the hospice in Cardiff, people didn't know even what to call me. They called me a consultant in terminal care. Which was a bit grim for patients. And I had to really argue to have consultant status because I'd come from the GP stable. But you get there slowly.

Lord McFall:

Now, I'm going to ask you about your work in the Lords and your work with palliative care. But maybe for a little interlude, I'll say, you did work as a GP in Maryhill in Glasgow for a time.

Baroness Finlay:

I did.

Lord McFall:

What impression did that make on you?

Baroness Finlay:

I had five years as a GP in Maryhill in Glasgow, and I really saw, if you like, the tough side of life, just how tough it is for some people to live. There was an area that I covered, which was Possilpark. And actually most of those dwellings have been torn down now. A place called Fruin Place, it doesn't exist anymore. It was really poor. I used to have to pay kids to mind the car, if I did a house call, otherwise I'd come and find the wheels were off. I only ever took one prescription to a house because I didn't want to be done over for my drugs or my script pad. And I had patients who when they were in police custody, would ask me to go and see them rather than the police surgeon, because I think they trusted me.

And I looked after three children's homes because no other GP was prepared to look after them. And that was really very sad actually, because I just knew there was something wrong with these children's homes, but I couldn't quite unpick it. And over time, then a few years later, the children themselves set fire to one of the homes, which confirmed my worst fears, I think.

Lord McFall:

And your saying, a phrase which I love, 'without health, a nation cannot thrive.' Was that your experience that led you to such a profound insight?

Baroness Finlay:

It certainly was. I saw the dangers of alcohol. I saw the damage that alcohol does to families. The way that people would fall down a spiral of deprivation ill health, poverty of ambition, poverty of aspiration, a sense of hopelessness, and how that linked to unemployment and lack of success. And actually, if we have a healthy nation, healthy in body and in mind and in attitude, concerned for each other, looking out for each other, then we can all work together and we can thrive.

Lord McFall:

In 2001, you were almost the first to apply to the House of Lords Appointment Committee to come in the House of Lords. Now, it would seem that politics was foreign to you. After immersing yourself all in politics, what made you make that leap, and what was the process like? Was it rigorous?

Baroness Finlay:

It was a funny side of that story, because it was just at the first phase of reform of the House of Lords. I had been often in medicine, been battling against the way things were to improve care for patients, to improve the way we did things, to push the boundaries and generally get things better for our society, if you like. And my husband came home with an advert from the paper, put it on the kitchen table and said, "You're always wanting to change the world. There you are." And I just thought, oh, right. So I looked into it. I had given evidence to a select committee already to Lord Walton Select Committee on Medical Ethics at one point, and been absolutely fascinated and realised that if I was going to improve things, I needed to get onto a bigger stage.

Lord McFall:

In the House of Lords, you're frantically busy on the floor of the House and you're presenting bills, you're presenting quite a number of private bills, which didn't succeed at first. And many occasions you must have thought you were just knocking your head against a brick wall. But somehow I don't think your personality would allow that conclusion.

Baroness Finlay:

I had a very wise mentor over the years and that was Dame Deidre Hine, who was Chief Medical Officer. And one day she said to me, 'Slowly, slowly, catchy monkey.' And actually I'm aware that you put something forwards, people don't want to take it up for various reasons. But once other people come on board with an idea, they refine it, they improve it. So my attempt to ban smoking in public places was pretty naive compared to the eventual legislation that came through. I'm just delighted that it happened. And actually where we get to becomes really important. And it doesn't matter whose name's on it, it's not about taking credit for something, it's about actually what you can do to improve society.

Lord McFall:

But there has to be a public awareness campaign there. Was that your aim there?

Baroness Finlay:

It was very much about working with people. I was very lucky, because in the Welsh assembly government, people like Jane Hutt were particularly supportive of what I was trying to do. We were all working together at the same time, and we were all aware of the dangers of tobacco and how tobacco was taking people's lives early, and leaving children orphaned and so on.

Lord McFall:

And on sunbeds, you pioneered those sunbeds - for under 18s not having access - and also alcohol, minimum pricing, that's still to be implemented in Wales but it's in Scotland. Give us an idea of those campaigns.

Baroness Finlay:

Well, with the sunbeds, I'm married to a dermatologist, so I've become pretty aware of sun damage to the skin. But also we saw young women who got really badly burned using these coin and slot machines. And of course once the skin's destroyed, it doesn't really repair itself to the same extent, they're scarred and so on. So I was really keen that we got that regulated. And then with alcohol, a very good friend of ours at medical school had a very sad background, family history, and he became an alcoholic, and he had the courage to come out and speak about it openly. And he has now died, actually. He died of a malignancy. But I really felt a commitment to Mike Wilks to carry on trying to do what he had been doing, which was really speak openly, destigmatise and help people recognise they need to do something about alcohol.

The Scottish experiment of minimum unit pricing has shown that the people in the lowest decile in society, the ones most at risk, are the ones who actually get the best health benefit when you introduce minimum unit pricing. So you narrow health inequalities by such a measure. And we've also seen, and in Parliament, people have spoken openly about the damage that alcohol has done in their lives, particularly when they were children, perhaps had a parent with an alcohol problem. So I'm not a teetotaler, I'm not an abolitionist. I just think that we need to recognise that there's a difference between social drinking and addiction to alcohol and all of the bad things happen when people lose control because of drink.

And I would like to have no alcohol when you're driving. I'd like the limit to come down to 20, so that if you've got the car keys, you just don't drink anything. Full stop. Simple message. And I think I've learned from all of the campaigns, a simple message gets through, complex messages don't. People don't really understand units of alcohol and so on still. So, and of course my time in Maryhill, I had a lot of patients who had really big alcohol problems and that was a huge influence as well on why I've picked this up as something to deal with.

Lord McFall:

I remember the seatbelt legislation in 1969 with Barbara Castle and it was hugely controversial, but it's everyday life now and people don't go out without putting a seatbelt on.

Baroness Finlay:

Absolutely.

Lord McFall:

So it's the same type of process for-

Baroness Finlay:

It's very much the same. And the law gives messages. It isn't just about punitive. The law gives public health messages. If you say 'you wear a seatbelt', then people just do it and you save lives. And you know the days when we were admitting people had gone through the windscreen, horrendous injuries. Thank goodness we don't see as many, we still see too many. We still see drunk driving, we see drugs and driving, which is a real problem now. But these messages in law aren't just about being punitive, they're about being positive about our care of other people.

Lord McFall:

Good. Assisted dying. You have your concerns. Could you elaborate on that?

Baroness Finlay:

I do have my concerns. I have my concerns based on what I've seen from other countries where they have changed the law. Where actually it becomes too easy for people to view death as a solution. It takes clinicians away. It's been estimated that it's about 60 hours of clinical time to really process a request properly. Well, I would prefer that you spend 60 hours of clinical time improving people's quality of life. And I think it's very easy to clock into a message of despair. And that actually we need to be saying that people's lives are important. We need to help them live as well as possible for as long as possible. And I'm very concerned about saying that you license doctors to provide lethal drugs to patients against any criteria. It would be wonderful if every doctor, every nurse was well motivated. But goodness me, we have seen disasters in this country of people abusing their position to say the least. And of almost clocking into a culture of death, which is dangerous.

And in all the countries that have changed the law, the so-called narrow boundaries gradually get eroded, they get expanded, and you really end up almost with death on demand, which is really worrying. The Canada story is desperately worrying, people with disability being offered lethal drugs but not offered the adaptations that they need, new wheelchair, new ramp to get in the house and so on. And being denied those. But being offered lethal drugs. We hear about veterans who've served their country and have got post-traumatic stress from what they've seen, but instead of being supported and helped through that, they're being offered lethal drugs. That just feels dreadful.

Lord McFall:

And was your expertise in palliative care supportive of your position now?

Baroness Finlay:

Completely. I've had many patients where we've discussed the fact that they were in despair, that they felt that the only thing was for them to die quickly, they'd felt suicidal. And it has been amazing how, when you address the problems, when you address why they feel in despair and what they feel that they really want to do and you get some care in place, those requests just evaporate. I've also learned that you can never predict how long someone will live. I've got one patient still alive now. Many, many years after four of us thought that he'd be dead in three months and he himself was desperate for us to give him lethal drugs because he was in so much despair, but actually we got on top of his problems. And the sad reality is that 11 years after that his wife died and he's brought the children up on his own.

He's an absolute inspiration to me of why providing personalised care to people being available nights and weekends when people are in distress is absolutely essential. And I think in healthcare we need to be honest and go back to having seven-day services and have people available at night and weekends and prepare to go out and see people at home, where they are and understand what the problems are they're facing and help them through them. We don't need to license doctors to provide lethal drugs.

Lord McFall:

Have we lost anything in the transition? Say, about 30, 40 years will remember, the doctors in my area and we knew their names off by heart and they were there for their patients the whole time. Has medicine changed quite a bit now?

Baroness Finlay:

Medicine's changed hugely, and it's very easy to look back with rose-tinted spectacles, and there are a lot of bad things that have gone-

Lord McFall:

By the way the doctor I'm talking about was a crabbit man, so don't worry about that.

Baroness Finlay:

Right? So there's good and bad. There's been good and bad all the time. What we need to do is hang onto the good and shed the bad. And I worry that we've lost some of the good as well. That continuity is really important. If I see a patient and I see them a week later and it's the same person who's seeing them, you can spot if they're not quite so well, if they don't look quite so well, if they're just not moving quite so well. If you've never seen them before, all you've got to go on is their notes, and you really don't know whether this is their normal self or whether they're better than they normally are or worse. It only goes on what they say. So there was an interesting study actually done of just observing patients versus monitoring with all the high-tech stuff and looking at patients and listening to them, hearing the tone of their voice, picking up the sweaty hand, the slight tremor, slight wobbliness gives you a really sharp pointer to the fact that there's something you need to look at and improve.

Baroness Finlay:

I think it's really important to remember that you listen not only with your ears, but you do listen with your eyes. You look, you assimilate everything. You listen with your nose, the smell, things are going off.

Lord McFall:

Parkinson's for example.

Baroness Finlay:

Lots of things and then the way that people move. But the most important thing is that you listen from the heart, with your undivided attention and then you assimilate all of those inputs and that gives you a picture of the person. And that's what worries me about some of the remote consultations, is they're fine for transactional stuff, but if you want to pick up the complexities you need to go into people's homes, see them in their own environment where they feel safe, where you can pick up all those cues.

Lord McFall:

You have really gone into the Online Safety Bill very much. And I know that you've worked along with Samaritans and families who have lost close ones with internet engagement.

Baroness Finlay:

The internet is a great tool for us who feel fit and well to find things. But the trouble is when people are in despair, it can really suck them down a route of despair. The algorithms that push out suicidal thoughts, how to kill yourself, that entrap people. And the tragedy for parents when they find that their child, their youngster has gone into this downward spiral and killed themselves, often they had no idea that the child was even engaging in some of these online forums. And, of course, when life is gone, it's gone. And I think people often don't realise the finality of death until that happens.

So I was very keen to work with these parents who want desperately to improve things for others. Of course, recently we've seen about online promotion of suicidal ideation. We've seen the glorification, if you like, of somehow like a commodity of dying and portraying to the public as if somehow if you take your own life then on a sandy beach and there's music playing and all your family around and so on. If you look at the experience from those countries that have changed the law, it's not like that. The time from taking lethal drugs to death, it's sometimes very prolonged.

This is not what people expect, and this isn't how it needs to be either. So in the Online Safety Bill, I was really keen that we make sure that promotion of self-harm, serious self-harm, which leads into suicide isn't a route to hook people in to more and more and more despair and feeling that their only solution is to end life. But that actually that they must have more help. The government have picked up the problem of a serious self-harm and that's in the bill. And I think the person who really needs to be admired, most of all for all the work on the Online Safety Bill is Beeban Kidron, who worked phenomenally for many years and has worked with so many people to really try to make the internet safer.

We've just had this case of somebody selling a white powder over the internet that seems to be responsible for quite a few suicides in this country. And that is not the answer to our problems.

Lord McFall:

Baroness Kidron, when I interviewed her a few weeks ago in Lord's Speaker's Corner and she gave me her story, which is fantastic. But she did mention that her code of practice that she has established has been adopted in quite a number of countries. The governor of California is going with her to the White House and indicative to me of the House of Lords and the reach of the House of Lords. What can you add to that?

Baroness Finlay:

I think since I've been here in the House of Lords, I've become aware just of the level of expertise, and how actually the public out there are not aware of how much expertise is here. The press, I think, don't portray us terribly well. We don't get much time. The press like a scandal in many ways. And there's been a lot of focus, unfortunately, on some of the way that some of the appointments have come in, which is a distraction really from the terribly important work that we do, because we are refining legislation. Just last night there was a vote about organ harvesting in China, this forced organ harvesting, the persecution of the Uighurs and Falun Gong and these other groups. Terribly important in setting a moral tone, not only for our country, but a message out to the rest of the world. And that's often coming from the House of Lords.

Lord McFall:

In terms of your work, I would think that you're full-time in your palliative care in Cardiff, you're full-time here, you're a deputy speaker, you're fluttering about everywhere and really having penetrative questions and getting on. Has the House of Lords, in any way changed, you personally or changed your approach to medicine and society? What's that mix of politics and expertise done?

Baroness Finlay:

Oh, what an interesting question. I think inevitably, if you asked my family, yes, it's probably changed me. I try to hang on to my values and the most important thing I think I was ever told when I was an angry teenager, writing off to people about various things, but not doing the schoolwork I needed to do. I was too busy being an angry teenager. My father said to me, 'If you really want to change the world, you must get to the top but not lose your principles on the way.' And I hope that I've clung onto my core principles about valuing each person and valuing the people around me with whom I have long longstanding friendships, my family, who I love dearly, and that at the end of the day, I still know where my priorities are.

And many people come and go. People send me nasty letters about things. Well, that's in a way, it's a reflection of their problem, not mine, but I try to respond when I can providing it's not too nasty. And I think possibly out there in society, people don't realise just how much work we do to really try to improve the lot of everybody.

Lord McFall:

Tell me what you and your colleagues in the House of Lords have done that are signature changes. You mentioned the Online Safety Bill with Barnes Kidron. I've mentioned a few to you here. But what ones are dear to your heart?

Baroness Finlay:

Well, obviously all the tobacco control stuff is really dear to my heart. And that was-

Lord McFall:

That was a House of Lords initiative. So without the House of Lords, that would not have progressed.

Baroness Finlay:

No, it would not have progressed. I'm really proud of the fact that we've got palliative care in the Health and Care Act finally as a core service that it has to be provided. Now I'm working with people to try to make sure that the commissioners have the standards that things are rolled out and that things improve. It's taken 20 years to get there, but I think it probably wouldn't have happened if I hadn't been able to get that amendment. And that was the support from around the house to recognise that just because people have a life-limiting illness is no reason to not make sure that they get the best of care everywhere. And we now need to tackle the patchiness of provision. So it's always ongoing work.

We establish one thing, it isn't finished. It's about making sure that it keeps going, that it doesn't drop off the agenda as well. So I think those are probably the things, palliative care and those public health messages that we've already touched on. And if we can stop this view that somehow ending your life is the best thing you can do. And I'm afraid not all families are loving families. We have to be aware of that too. And that we protect people when they're at their most vulnerable.

Lord McFall:

In preparing for a meeting in mental health and the House of Lords, which I convened, I was looking up the history books and actually Enoch Powell was the Minister of Health in the mid 1950s, and he got rid of the asylums and stuff. You remember all that stuff.

Baroness Finlay:

Yeah.

Lord McFall:

But he had one phrase there, that he looked forward to the day when mental health and physical health were equal, one. Now given what some would say from the articles in the press, whatever, there's increasing levels of anxiety in society now. Would mental health be another objective for you in the future?

Baroness Finlay:

I was lucky enough to chair the Mental Capacity Forum. I set up the national Mental Capacity Forum, and did it for six years and became really aware of the need for those with learning difficulties. Whether they are long-term or whether they have transient impairments of capacity to be looked after and protected. In a way I have an anxiety about separating out physical and mental as if they're two different things because they're interlinked. People who have got mental health problems often have poor physical health. People with poor physical health have mental health problems. They're integrated. The mind and the body. Our emotions affect the way that we behave and affect our health. We know that people who are depressed, their immune system doesn't work as well. So there are lots of integration and parity of esteem across all the disciplines is really important. And that we recognise the early warning signs and we don't just think, oh, there'll be a drug that will fix this or a drug that'll fix that. Society has to take ownership for the wellbeing of its own population.

Lord McFall:

But from knowing you in here, I know you've got a strong sense of identity, and Wales seems to mean a lot to you.

Baroness Finlay:

Wales means a great deal to me. It has provided me with a fantastic platform. I don't believe I could have done what I have done, particularly in palliative care, if I hadn't had such fantastically supportive colleagues in Wales. When I was appointed as the first consultant in what is now palliative medicine in Wales, I thought, 'well, if I can teach people in Cardiff, if I can change things there, then ripples on the pond, I can change them in Wales. If I can do that, I can do it across the UK.' And of course, the teaching that we set up, then went global and we've educated people around the world to raise the standard of care. And I had open doors from my colleagues across all disciplines really at every level. And it has been a fantastic place to live to bring up my children and to work. And so my gratitude is to Wales.

Lord McFall:

You have your work outside with the palliative care. You work in here. That's unlike the House of Commons where they're full-time MPs and they have their constituents. But what's the benefit of an institution like this, given your lifestyle?

Baroness Finlay:

Well, people who are working outside are always bringing in up-to-date current things from their own experience. I was really struck some time ago now, when the porters in the hospital told me that they'd been watching the evening debate on television. When it was quiet, they'd suddenly become-

Lord McFall:

Well, football or not.

Baroness Finlay:

No. They were suddenly interested in what we were talking about in the Lords. They had a kind of lightbulb moment that we were dealing with things that were really important. And of course, because of being part of society and part of work, we maintain an up-to-date presence that we bring in. I don't think I could have had even a 10th of the insights that I've had if I had been a full-time politician, wherever I've been working. There's something about working directly with people in different areas that you see the complexity of things and the subtle nuances there. So we bring that perspective and that experience, and then we integrate it with all the other things that are going on.

So there was one piece of legislation where I spotted something that nobody else had spotted, and that was that if the biochemistry and bacteriology labs were locked, double locked, treble locked as was being required, because people were frightened of terrorism, that the cardiac arrest team in the hospitals I knew wouldn't be able to get from one side of the hospital to the other. It was just a really simple thing. But actually, if I hadn't worked in these hospitals, I don't think I would've realised it either.

Lord McFall:

I know you never take no for an answer first time. But given your kinetic disposition, what's your next Everest?

Baroness Finlay:

Oh, boy. My next Everest, I think I want to carry on actually with the projects that are going. I do want to see drink-driving go. I want to see palliative care available everywhere 24/7 for those who need it. I think that the disruption at the moment that we're seeing in medicine and the dissatisfaction is very, very sad indeed. And I hope that I remain able to contribute and I hope at my age that my health holds up too. So I guess those are the things. But also that I still stay in touch with my family and treasure them.

Lord McFall:

Good. Well, Baroness Finlay, it's been a pleasure to have this discussion with you. Your profound experience in medicine and your acute sense of politics and all the best for the future. Thank you very much.

Baroness Finlay:

Thank you so much for inviting me. Thank you very much indeed.

Lord McFall:

Thank you.